Posts Tagged ‘Nausea & Morning Sickness’

Is Pregnancy a Disability?

Thursday, June 23rd, 2011

Attorney Bernard L. Shapiro

Dr. Suzanne G. Kitchen

A Pregnant Construction Worker

Pregnant women are amazing in their endurance and strength. Without batting an eye, the majority of pregnant women continue to work right up until their due date, despite all the physical and mental changes that are occurring. They manage to juggle the same level of work, maintain a home with all the associated cooking and cleaning tasks, along with responsibility of tending to other children carrying the same fervor and dedication as when they were not pregnant.

In 28 years of obstetrical practice, my admiration and respect for pregnant women is without limits. However, during pregnancy, sometimes some women may experience symptoms, such as nausea, back pain, limited mobility, circulatory problems, or fatigue, which may affect the ability to perform job duties. When this happens, pregnant women often want to explore various options with their employer, such as making modifications to the job duties or work schedule, while others may want to “go out” on disability. Few patients and obstetricians are familiar with employers’ responsibilities and employees’ rights under federal and state employment laws so I thought this week’s blog might be a good place to broaden everyone’s knowledge. In the US, we have over 4 million pregnant women each year. With at least half of them in the workforce, I am sure you will agree that this topic is pertinent and timely.

Is Pregnancy a Disability?

Let’s start by looking at the Americans with Disabilities Act (as amended). The ADA is a civil rights law that protect people with disabilities from being discriminated against, and require the employer to make “reasonable accommodations” to help the person perform the job duties. Pregnancy, generally speaking, is not considered a disability under these laws. That’s because pregnancy (by itself) does not measure up to the definition of disability under these laws. That definition says: a person must have an impairment that substantially limits one or more major life activities.

Is there EVER a time that pregnancy can be considered a disability?

Some women experience complications caused by pregnancy, or have disabilities in addition to the pregnancy, and these women may be considered disabled under these laws. According to the Equal Employment Opportunity Commission (EEOC) “because pregnancy is not the result of a physiological disorder, it is not an impairment. Complications resulting from pregnancy, however, are impairments.”

If a pregnant woman works for an employer with 15 or more employees, and meet the definition of disability, one could initially request a job accommodation under the ADA. For example, pregnant women may need a lifting aid or an ergonomic chair, a modified schedule, performing the job in an alternative fashion (for example, while elevating the feet), and in some cases, even job reassignment. To learn more about job accommodations for women who are pregnant, or who have other types of disabling conditions, contact the Job Accommodation Network (JAN), a service of the US Department of Labor’s Office of Disability Employment Policy, or read JAN’s article here:

If a pregnant woman is not considered disabled, but has pregnancy-related limitations that affect her ability to work, how should the employer meet her needs?

The Pregnancy Discrimination Act (PDA) is an amendment to the Civil Rights Act of 1964. This civil rights law can apply to pregnant women who have typical limitations associated with pregnancy, such as varicose veins or back pain, and are not protected by the ADA. They still may need some job modifications in order to perform the duties safely and comfortably. The PDA requires an employer with 15 or more employees to treat women with pregnancy-related conditions the same as other employees with other types of temporary conditions (such as a broken bone). According to the EEOC, if an employee is temporarily unable to perform her job because of her pregnancy, the employer must treat her similarly as any other temporarily disabled employee. For example, according to the EEOC, if the employer allows temporarily disabled employees to modify tasks, perform alternative assignments, or take disability leave or leave without pay, the employer also must allow an employee who is temporarily disabled because of pregnancy to do the same. To learn more about the PDA, click here.

If a pregnant woman is forced to leave her job because of pregnancy and/or disability, does she have any measure of job protection?

The Family and Medical Leave Act (FMLA) is a federal law that applies to employers with 50 or more employees. The employee must have worked for 1 year, or 1,250 hours within that year. This law provides 12 weeks of job-protected leave, generally unpaid. So, for pregnant women whose pregnancy-related conditions are severe enough to warrant no longer working during the pregnancy—for example, hypertension or heart disease, FMLA can cover their absence from work, with job security. While many women would like to use all 12 weeks of FMLA post-delivery, sometimes it is necessary to begin using it prior.

Are there monetary or compensation benefits to help pregnant women who cannot work?

Yes, in most states there are plans, and each one is different. Five states have mandated short term disability coverage that can be used for pregnancy: CA, HI, NJ, NY, and RI. Most states will allow a pregnant woman to apply for unemployment benefits, though not every state will award payments. Contact each state’s Department of Labor to inquire about benefits for which you may be eligible: http://www.dol.gov/whd/america2.htm

Some pregnant women may work for employers that provide short-term disability plans through a private insurance plan. Sometimes this benefit is provided, though most of the time it is an opt-in program for which the employee pays a premium. If an employee has a short-term disability policy available, the employee should enquire with Personnel or Human Resources about using it to cover a leave of absence during pregnancy. Most often, such benefits can be used for any short-term condition, pregnancy included.

On occasion, a pregnant woman who is also disabled can apply for Social Security Disability Insurance (SSDI). Eligibility for that program is governed by Social Security Administration (SSA). SSA’s website http://www.ssa.gov can help people determine if and when they should file a claim for benefits. The legal description of ”disability“ varies in private insurance claims, various State programs and the Federal Social Security program. A knowledgeable attorney, working with the physician, knows the descriptions of disability under the various programs and the effects of the medical conditions. They are in the best possible position to assess and advise as to potential qualification for disability benefits.

What should a pregnant woman do if she feels she is being discriminated against in the workforce?

Pregnant women might experience discrimination in the workplace because of pregnancy or disabling condition. They have the ability to file complaints with the EEOC under the ADA or the PDA by calling 1-800-669-4000. Pregnant women who are denied leave under the FMLA can file complaints with the DOL by calling 1-866-487-9243. Statute of limitations for timely filing applies for such complaints.

Conclusion

Though pregnancy is rarely considered a disability, accommodations can sometimes be obtained by using the ADA, but more likely, job modifications can be obtained by using the PDA, and leave obtained by using the FMLA. Helping a pregnant woman obtain adjustments in the workplace that allow her to continue working is ideal, but not possible for everyone. Thus, when necessary, the obstetrician can help a pregnant woman become eligible for disability benefits by writing adequate documentation about her condition. Patients must let the obstetrician know all the signs and symptoms necessary to document the case so it can be provided to the employer and help secure job accommodations or eligibility for special benefits, such as short term disability. Also, it should be stated that pregnancy is not a guarantee of a secure position regardless of how you perform your job, in all instances. If a pregnant woman cannot perform her job properly, even with modifications, an employer has the right to terminate her position despite the fact that she is pregnant.

Thanks to my co-authors:

I want to thank Bernard L. Shapiro, an attorney in private practice in Stamford, Connecticut who specializes in the field of Social Security and other disability claims. He is Chairman of the Disability Law Committee of the Connecticut Bar Association and speaks at continuing education programs for physicians, clinicians and attorneys.

- Contact Bernard L. Shapiro at bls@ssdssilaw.com or visit his website at ssdssilaw.com

I also want to thank Dr. Suzanne Gosden Kitchen, a Senior Consultant for the Job Accommodation Network (JAN), a service of the U.S. Department of Labor’s Office of Disability and Employment Policy. Dr. Kitchen teaches at West Virginia University, preparing American and International students to become leaders in contemporary human resource fields. Dr. Kitchen designs disability awareness activities to educate the public, and enjoys finding new ways to promote disability etiquette in society.

- Contact Dr. Suzanne Gosden Kitchen at Suzanne.Gosden@mail.wvu.edu

Be sure to visit our fine line of natural products for pregnant women.

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The Sly Masquerader: Thyroid Disease During Pregnancy

Wednesday, June 30th, 2010

A 26 year old, newly-pregnant woman sits on the exam table in her obstetrician’s office. She is excited about her pregnancy and does not want to complain about her nausea, vomiting, weight loss, anxiety, difficulty sleeping, and fatigue. The obstetrician can tell just by looking at her that she seems to be suffering the normal symptoms of pregnancy and is not overly worried. After all, nausea and vomiting occur in 50–80% of all pregnant women, especially between the 5th and 13th week. The doctor reassures the patient that this is normal, and encourages her to hydrate and rest. Sometimes the physician will suggest a medication, or a supplement, to reduce the symptoms of nausea and vomiting.

Is it possible that this woman is experiencing something more severe than the normal, early pregnancy symptoms?

One of the great masqueraders for pregnant women is thyroid disease. Many of the symptoms that women experience in the early stages of pregnancy are the exact symptoms that occur with thyroid problems. Women will commonly experience fatigue, weight gain, constipation, insomnia, and lethargy. Health care providers will often reassure patients that this is normal and these symptoms are due to the hormonal and physiological changes that one expects with the early stages of a healthy pregnancy. However, one must be on the alert that these same symptoms could be representative of a much more serious underlying problem; one that could have major, negative ramifications on the pregnancy and the newborn infant. Left undiagnosed and untreated, hypothyroidism (low thyroid hormone) could result in serious, high-risk conditions during the pregnancy. Prematurity, preeclampsia, placental separation (abruption), and/or serious consequences in the child such as congenital cretinism (mental retardation, deafness, muteness).

This weeks blog will focus only on hy-PER-thyroidism (when you have too much thyroid hormone.)

Next week we will review hyp-O-thyroidism. (when you have too little thyroid hormone) and its effects on pregnancy.

Who should get screened for thyroid disease in pregnancy?

The current American College of Obstetrics and Gynecology guidelines state that thyroid functions should be checked only in women with a personal history of thyroid disease or symptoms of thyroid disease. It is NOT universally recommended to test all pregnant women even though there are cases of women who have disease that do not have symptoms (subclinical cases).

How does maternal thyroid hormone effect the fetus?

The fetal brain is completely dependent on maternal thyroid hormone until about 12 weeks gestation. At that time, the fetus is able to manufacture its own thyroid hormone in conjunction with the maternal hormone that crosses the placenta. Diminished levels of thyroid hormone in the mother impair fetal brain development. Elevated levels can also cross the placenta and cause excessive production in the fetus. (Graves disease.)

What is hyperthyroidism?

The thyroid is an endocrine gland located in the neck that controls metabolism. It receives a message (TSH) from an area in the brain called the pituitary which releases thyroid hormone (T4).

When the gland produces more hormone than it is supposed to, hyperthyroidism is diagnosed (elevated thyroid hormone T4 and low TSH.) This can occur in about .2% of all pregnancies. The most common form of the disease is Graves disease where certain antibodies are made by the body that stimulate thyroid hormone production. Other causes can be multinodular goiter, subacute thyroiditis, an extra thyroid source of hormone production (certain tumors of the ovary or pituitary), thyroid adenoma.

What are the symptoms of hyperthyroidism?

  • nervousness
  • tremors
  • tachycardia
  • frequent stool
  • excessive sweating
  • heat intolerance
  • weight loss
  • goiter
  • insomnia
  • palpitations
  • hypertension
  • eye changes-lagging of the eyelid and retraction of the eye lid

What are the risks to the mother and the fetus if hyperthyroidism is left untreated?

If left untreated, hyperthyroid can cause:

  • preterm delivery
  • severe preeclampsia
  • heart failure
  • fetal loss
  • low birth weight infants
  • stillbirth
  • fetal hyperthyroidism

How do you treat hyperthyroidism in the mother?

A classification of drugs called thioamides are used to treat hyperthyroidism.

  • PTU
  • methimazole

These drugs prevent the manufacture of the thyroid hormone by preventing a needed substrate iodine from attaching to the thyroid molecule and it also blocks the the manufacture of of another active form of the hormone T3.

These drugs do cross the placenta and can effect the fetal thyroid, although it is generally transient. Generally, these drugs are safe to use in pregnancy but rare side effects of the drug can include fever, sore throat, hepatitis, rash, nausea, loss of taste and smell, loss of appetite and a very serious and rare side effect called agranulocytosis (less than 1%) which is an abnormal condition of the blood characterized by a severe reduction of white blood cells (fever, prostration and bleeding ulcers of rectum, mouth, and vagina.)

Infants must be observed carefully after birth with mothers on antithyroid medication since newborns have been known to have neonatal hypothyroidism and goiter in mothers who have been treated. Babies are ultrasounded during pregnancy looking for fetal goiter and growth problems which can present problems at delivery due to the hyperextension of the neck.

It is generally considered safe to breast feed on these medications.

Other drugs used to treat hyperthyroidism are beta-blockers (propranolol) which act to reduce the rapid heart rate that can occur. Side effects from this drug can include growth retardation in the fetus, fetal bradycardia (slowed heart rate) and hypoglycemia in the infant (low blood sugar).

Radioactive iodine is never used in pregnancy since it can ablate the fetal thyroid. A patient was treated with radioactive iodine prior to becoming pregnant, should avoid becoming pregnant for at least 4 months. If all medications fail, or allergy to the medications exist, thyroidectomy, or surgical excision of the thyroid is recommended.

What is subclinical hyperthyroidism?

In about 1.7% of women there are asymptomatic women with normal thyroid hormone but a low TSH. This condition generally has been found to have no effect on the pregnancy since it is the maternal T4 level that is critical for fetal brain development, regardless of what the TSH level is. However, these women should be observed for osteoporosis, cardiovascular morbidity and progression to overt disease or thyroid failure in the future.

What is thyroid storm?

Thyroid storm is an acute obstetrical emergency that occurs in about 10% of women with hyperthyroidism. Symptoms include a change in mental status, seizures, nausea, diarrhea, and cardiac arrythmias. Patients are placed in the intensive care unit for constant monitoring and observation since there is a high risk of maternal heart failure. Thyroid storm can be precipitated by an acute surgical emergency, infection, diabetes. anesthesia, and noncompliance with thyroid medications. In addition to the usual treatment of hyperthyroidism as described above, steroids are commonly given.

Can thyroid disease present itself right after delivery?

About 6 to 9% of women with no history of thyroid disease can present with disease after delivery, generally within the first year postpartum. This is common in women that have previously known thyroid antibodies that are not activated until after the delivery, or women with a strong family history of diabetes or other autoimmune disorders. Most women have transient hyperthyroidism which then converts to hypothyroidism requiring treatment. About 77% of women will completely recover but 30% will continue with thyroid disease permanently. Many women that recover will develop this disorder again with subsequent pregnancies.

Summary:

Because of the close similarity of symptoms that occur with a normal early pregnancy, be sure to ask your health care providers if you should be screened for thyroid disease. Discovery and correction of this condition can have beneficial ramifications to ensure a happy, healthy mother and baby. As stated in many previous blogs, pregnancy can be the crystal ball of future medical conditions and by being vigilant, pregnancy can help a woman avoid diseases and conditions from surfacing later in life.

If it’s actually Morning Sickness you have, Beauté de Maman Nausea Supplement can help! With Ginger, Vitamin B6, Vitamin D and Lime, morning sickness will be a thing of the past… Try it now!

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Vitamin D Deficiency and Pregnancy

Tuesday, July 28th, 2009

What is Vitamin D?

Vitamin D is a fat-soluble vitamin that plays a central role in calcium and phosphorous metabolism, which is critical for bone formation and maintenance.

Why is Vitamin D important?

morning-sickness-supplement
(more…)

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