Taking Drugs While Pregnant

How much weight gain is appropriate during pregnancy depends on your pre-pregnancy body mass index (BMI). For a pre-pregnancy BMI of 18.5 to 25, the ideal weight gain should be somewhere between 25 and 35 pounds. An initial weight gain of 2 to 5 pounds is usually followed by a weekly gain of 1 pound in a normal pregnancy. If you have twins the gain usually falls between 35 and 45 pounds. Women who were overweight at the time of conception usually gain around 15 pounds and those who were underweight gain between 30 to 40 pounds. In case of obesity, your gain should not exceed fifteen pounds.

The most obvious impact of the weight gain can be seen in the form of pains and aches that you will have as your pregnancy progresses. A back ache is the most common complaint, followed by an awkward walk (thanks to your new found tummy). Another complain is of swollen legs, but that has nothing to with weight. It is a result of increased blood flow.

If you’ve had weight problems in the past or are generally finicky about your weight, you might find the gain hard to accept. But there is absolutely no reason to get agitated about the extra weight. In fact it is a sign of a healthy child growing inside you. You just need to pay attention to what you’re eating in terms of nutritional value. Also, you can track your weekly weight gain, and if you have any doubts in mind, you can consult your doctor. Tracking will also help adjust your diet according to the gain in order to get the best for your child. A stop on junk food and a start on some exercise will also help you along the way. Understand that eventually, all those extra pounds will wear off once you’ve delivered your little one. Read the rest of this entry »

Contributing Editor: Marcia L. Buck, Pharm.D.; Editorial Board: Kristi N. Hofer, Pharm.D.; Michelle W. McCarthy, Pharm.D.

Introduction

Supraventricular tachycardia (SVT) is the most common symptomatic arrhythmia of childhood, occurring in 1 in 250 to 1,000 children. In October 1989, adenosine was approved by the Food and Drug Administration (FDA) for the conversion of paroxysmal supraventricular tachycardia (SVT) to sinus rhythm. Even before approval by the FDA, adenosine was studied in the management of infants and children with SVT. Some of the initial studies were conducted at the University of Virginia by John DiMarco and colleagues, who were also involved in its development. Twenty years of accumulated experience have substantiated the efficacy of adenosine and revealed a relatively low incidence of serious adverse effects in patients who undergo treatment. This issue of Pediatric Pharmacotherapy will provide an overview of adenosine and provide recommendations for its use in infants and children with SVT.

Mechanism of Action

Adenosine is an endogenous purine nucleoside present in cells throughout the body. It is formed by breakdown of adenosine triphosphate (ATP) or 5-adenosylhomocysteine. While the multiple roles of endogenous adenosine are still being investigated, it is known to aid in maintaining the balance between oxygen delivery and demand by dilating the coronaries and slowing heart rate. These effects result from binding to adenosine A1 receptors in the sinoatrial (SA) node, the atrioventricular (AV) node, atrial myocytes, and coronaries.

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AMERICAN ACADEMY OF PEDIATRICS. Committee on Child Abuse and Neglect

ABSTRACT. In most cases, when a healthy infant younger than 1 year dies suddenly and unexpectedly, the cause is sudden infant death syndrome (SIDS). SIDS is more common than infanticide. Parents of SIDS victims typically are anxious to provide unlimited information to professionals involved in death investigation or research. They also want and deserve to be approached in a nonaccusatory manner. This statement provides professionals with information and guidelines to avoid distressing or stigmatizing families of SIDS victims while allowing accumulation of appropriate evidence in potential cases of death by infanticide.

Аpproximately 50 years ago, the medical community began a search to understand and prevent sudden infant death syndrome (SIDS). Almost simultaneously, medical professionals were awakened to the realities of child abuse.  Since then, public and professional awareness of SIDS and fatal child abuse during infancy have increased steadily. Recently, well-validated reports of child abuse and infanticide—perpetrated by suffocation and masqueraded as apparent lifethreatening events (ALTE) and/or SIDS—have appeared in the medical literature and in the lay press.  The differentiation between SIDS and fatal child abuse can be a critical diagnostic decision. Additional funding for research into the causes and prevention of SIDS and child abuse is needed.

SIDS: EPIDEMIOLOGY, PRESENTATION, AND RISK FACTORS

SIDS, also called crib or cot death, is the sudden death of an infant under 1 year of age that remains unexplained after thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history.  SIDS is the most common cause of death between 1 and 6 months of age. The incidence of SIDS peaks between 2 and 4 months of age. Approximately 90% of SIDS deaths occur before the age of 6 months.

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Many women feel awkward and even a bit frightened when they see their gynecologist for a routine check up. This level of anxiety can be compounded when there’s a serious medical problem requiring continuing visits. For this reason, women are often selective in who they choose as their gynecologist.

One of the decisions a woman must make in selecting a gynecologist is whether to choose a male or female doctor. When making this decision, it’s important to understand the advantages of choosing a male or female gynecologist. There is no doubt that there are highly competent and caring gynecologists of both sexes, so it will be important to consider the individual and their background over sex. What are the advantages of choosing a female gynecologist over a male gynecologist?

Women doctors tend to spend more time with their patients.

You may have a variety of questions and concerns when you visit your gynecologist. You need a gynecologist who’s willing to take the time to answer your questions. Several studies have shown that, women doctors tend to spend more time with patients when compared to their male counterparts. Again, you’ll want to consider the individual physician since this doesn’t hold true in every case.

Women doctors may have more natural empathy for gynecological problems.

Women physicians have the same reproductive organs that you do and often experience the same problems as their patients. This may give her unique insight and empathy into what you’re experiencing. It can be reassuring to know someone understands what you’re going through.

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If you’ve had a baby recently, congratulations! This can be an exciting time for both you and your baby as you get to know one another. You may also be ready to get back to leading a normal family life and want to take measures to prevent pregnancy. If you’re breastfeeding, what type of contraceptive should you use while nursing? Is it safe to use contraception while breast feeding?

The good news is if you’re breastfeeding, it’s unlikely you’ll become pregnant during the first six weeks after delivery. In fact, pregnancy is unlikely to occur during the first six months of breastfeeding as long as you’re breastfeeding consistently and haven’t had return of your monthly periods. Unfortunately, even though it’s unlikely, it’s not foolproof which is why contraception during breastfeeding is still important.

Most medical experts advise against using birth control pills that contain estrogen during the first six weeks of breastfeeding. This is because the hormones in estrogen containing birth control pills could potentially affect brain development and may alter the flow of milk from the breast. After the first six weeks, it’s generally considered safe to use a birth control pill while nursing, although only progesterone based pills should be used, not pills containing estrogen. These progesterone only pills are sometimes known as “mini-pills” and are considered safe contraception while breastfeeding by most experts, particularly after the first six weeks have passed. This form of contraception is considered to be ninety-eight percent effective.

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You’ve probably heard about an association between the use of oral contraceptives and cancer risk. Some studies conducted several years ago showed a possible weak association between use of the birth control pill and breast cancer. What’s the latest word about the role oral contraceptives play in increasing cancer risk?

It should come as considerable reassurance to women on oral contraceptives that a study carried out in the U.K involving 46,000 women who were followed over a period of thirty-six years showed no increased risk of breast cancer even with longer term use of oral contraceptives for eight years or greater. The results of this study were published in the February 2008 issue of the Journal of Family Practice.

This study showed that short term users of oral contraceptives (less than eight years) actually had a twelve percent lower risk of developing any type of cancer than did non-users. The association between oral contraceptives and cancer showed the greatest risk reduction for cancers of the colon, ovaries, and uterus.

Results were quite different with longer term use birth control pills and cancer risk. According to results of the same study published in the Journal of Family Practice, women who used oral contraceptives for eight years or more had a twenty-two percent greater risk of contracting any type of cancer when compared to non-users. The exceptions were ovarian cancer which showed a risk reduction with longer term use and breast cancer which showed no association between use of the oral contraceptives and cancer risk.

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Your pregnancy weight may have taken nine months to put on, but it seems to be taking much longer than that to take off. While other new moms seem to snap right back to the pre-pregnancy form, you can’t seem to lose much weight. Along with the complete exhaustion of taking care of a baby, your poor body image is not helping your mental and emotional state. To make matters worse, you may have been side-tracked by your realistic weight loss plan by the lure of a fad diet that guaranteed quick results. Whether you have ten or twenty pounds or more to lose, the good news is that you can lose that extra unwanted weight. While it may seem like your motivation and willpower are zapped, you do have what it takes to lose weight. After all, if you can get through the grueling pain of labor and childbirth, you can certainly get your body back in shape!

Get Real! Think back to when you were pregnant and were noticing the different shapes of all the pregnant bellies. Some moms seemed to carry a bowling ball under their shirts while others plumped out nicely in all the right spots. Still others got bigger everywhere. The truth of the matter is that no two bodies are alike. So while you may envy those very few number of moms who can squeeze into their tight jeans a few weeks after childbirth, check your envy at the door. You are not that woman. In fact, most women are not that woman. The vast majority of women have to work very hard at getting their weight back to being even within eye-shot of their pre-pregnancy weight.

And once you lose your baby weight, your body still may not look the same. The fact of the matter is that you may never fit into those old tight-fitting jeans again, even when you reach that  magic number on the scale. So set your expectations accordingly and avoid the disappointment that is bound to ensue. Your body has gone through a tremendous adjustment in order to bring your little miracle into the world, so be content with your baby and the “new” you.

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Maternity leave is the time you take off of work to heal from your labor and delivery, and the time you take to care for your newborn, whether you are the natural mother or whether you adopted a baby. There are two types of maternity leave:

• A maternal disability, or medical leave, is the time that a woman takes off for a vaginal delivery (usually six weeks) or cesarean section (usually eight weeks).
• Family leave is the time spent caring for the baby and is available to the father and adoptive parents. The Family and Medical Leave Act (FMLA) grants everyone equal time of 12 weeks.

Are You Qualified for Maternity Leave?

You may think that after you give birth your company is required to provide you with paid maternity leave for several weeks while you stay at home and adjust to life with your new baby. Unfortunately, a good amount of companies do not offer paid maternity leave, and they are not required to.

Many women also do not qualify for paid maternity leave – depending on the length of employment and the size of their company. In order to qualify for FMLA leave, you must work for the federal or state governement or have been at your current job for at least 12 months and 1,250 hours (about 25 hours a week for 50 weeks). You also must have been employed by a company with a minimum of 50 employees within a 75 mile radius. If this criteria is met, your employer must offer you the twelve weeks unpaid, continue your health insurance, and provide you with the same position (or a position of an equivalent level) when you return.

What if my Company Does Not Offer Maternity Leave?
Most likely, you’ll be able to use a combination of short-term disability, sick time accumulated, vacation time accumulated, personal days, and unpaid family leave during your maternity leave.

If your company does not offer paid or unpaid maternity or family leave, you may have a couple of other options available. According to the Pregnancy Discrimination Act of 1978, if your company has more than 14 employees and held an employee’s job during a different type of medical disability, they must offer you the same position after your leave.

If you live in New York, New Jersey, California, Rhode Island, or Hawaii, you may be eligible for their state-run temporary disability plans. This will cover you during the time you are medically not able to work.

When Should I Begin Researching my Maternity Leave Choices?Experts suggest beginning a dialogue with your employer shortly after the first trimester. You don’t want to wait until you are visibly pregnant, but many complications can arise during the first trimester and the miscarriage rate is highest during that time. Federal guidelines require that you give a minimum of 30 days between requesting leave and taking it, but you’ll want to give your employer more time. When you have the conversation, try to make it positive and discuss your plans for returning after the birth (if you plan to return to work). You can try to negotiate maternity leave and work out a plan that works for the both of you.

How do I Find out More About My State’s Laws?Many states offer additional benefits to the federal FMLA laws. To find out more you can contact your state’s Labor Office.

Exercise is extremely important in promoting health and well-being during your pregnancy. Women who exercise during pregnancy have reduced weight gain, improved moods, improved sleep patterns and most experience a more rapid weight loss after pregnancy!  It also will help you to prepare for the physical stress of your labor and delivery.

There are some guidelines to follow when you choose to exercise during your pregnancy:

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Breastfeeding is best for your baby, and also has added benefits for you.  It’s a great way to bond with your baby, can help your uterus contract to its normal size, and can you help you lose your pregnancy weight.  Unfortunately the first few days and weeks can be uncomfortable and downright painful.  Here are ways to ease your pain.

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