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Asthma and pregnancy

If you have asthma,it's hard to predict whether your asthma symptoms will be any different in pregnancy.Some women's symptoms will improve, others may not see any change and some will find they get worse.

Most asthma medications are safe to take in pregnancy and if your asthma is well controlled there is little or no risk to your baby. It is important to discuss any changing asthma symptoms and medications with your GP.

There are things you can do to help manage your condition during pregnancy, such as:

  • using a preventer inhaler (steroids) when you get a cough or cold – speak to a doctor about using preventer inhalers in pregnancy
  • avoiding smoking – ask to be referred for smoking cessation support
  • avoiding things that trigger allergic reactions for you – for example, pet fur
  • controlling hay fever with antihistamines – talk to a doctor or pharmacist about which antihistamines are safe to take in pregnancy
  • avoiding hayfever triggers, such as mowing the lawn
  • continuing to exercise and eat a healthy diet
  • ensure you have flu vaccine

Click the link below or more information on managing your asthma during pregnancy.

https://www.asthma.org.uk/advice/manage-your-asthma/pregnancy/

Congenital heart disease

Even if you are normally fit and well, pregnancy requires your heart to work harder. If you were born with a heart abnormality that affects how well your heart works, there is a potential for problems to arise.

WHAT SHOULD YOU DO BEFORE YOU GET PREGNANT?

Ideally, you should talk to your GP or specialist cardiac doctor if you’re planning on getting pregnant since it may be helpful to optimise your health or adjust medication before trying.

WHAT WILL HAPPEN WHEN YOU GET PREGNANT?

If you have a congenital heart defect, your midwife will refer you to an obstetrician. You will also have a cardiologist involved in planning your care. You are usually advised to deliver in a maternity hospital, rather than birth centre.

If you have had previous heart surgery, you may require close follow up during your pregnancy. For women living in Wessex (Dorset, Hampshire & IOW) with more complicated problems, a regional service is provided in the form of a clinic organised jointly by cardiologists and obstetricians, at the Princess Anne Hospital in Southampton. Your obstetrician, cardiologist or GP can refer you there.Even if you are normally fit and well, pregnancy requires your heart to work harder. If you were born with a heart abnormality that affects how well your heart works, there is a potential for problems to arise.

WILL MY BABY BE OK?

Congenital heart disease can affect your baby in a number of ways. Babies may be smaller if the mother's heart does not pump as efficiently as it should and delivers less oxygen and nutrients to the placenta and developing baby. In addition, your baby has an increased risk of having congenital heart disease. Your obstetrician may arrange for you to have additional ultrasound scans and you will be seen regularly by your midwife.

For more information either look on the NHS choices website

https://www.nhs.uk/conditions/pregnancy-and-baby/congenital-heart-disease-pregnant/ or click here .




Diabetes prior to pregnancy

Most women with diabetes will have healthy babies. However, you are more at risk of certain complications developing during your pregnancy if your diabetes is poorly managed.

WHAT CAN YOU DO BEFORE YOU GET PREGNANT?

The good news is that by planning ahead and getting support from your GP and diabetes team, you can really reduce the risks involved. Which also means that you’re more likely to enjoy a healthy pregnancy and give birth to a healthy baby.

  • Your doctor or nurse will prescribe you a high-dose folic acid (5mg) to take as soon as you decide you want to get pregnant. You should be taking folic acid 5mgs each day at least 12 weeks before you conceive as this also reduces the risks to your baby. You’ll then need to keep taking this until you’re 12 weeks pregnant.

WHAT ARE THE RISKS?

Pregnancy can make some diabetes complications worse, such as eye and kidney problems. So it’s really important to have eye screening and tests for your kidneys before you stop using contraception. Eye problems due to diabetes (diabetic retinopathy) can be treated if caught early, so screening is important.

Your diabetes team can arrange this, and they’ll talk to you about the results. In some cases, you may be referred to a specialist team for extra support.

Click hereto see the checklist for a healthy pregnancy

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy

Epilepsy in pregnancy

Epilepsy is a relatively common condition. Most women who have epilepsy remain free of seizures throughout pregnancy and they have straightforward pregnancies and healthy babies. It is important to continue taking your medication because having frequent seizures during pregnancy can be harmful for you and your baby. Therefore, planning your pregnancy and having extra care during your pregnancy can reduce the risks to you and your baby.

WHAT IS THE RISK TO MY BABY?

With any pregnancy there is a small chance that your baby may not develop normally in the womb. The risk of this happening may be slightly higher with anti-epileptic drugs. The risk of harm to your baby is higher with sodium valproate than others. The most common problems for your baby linked to these medications include spina bifida, facial cleft or heart abnormalities. If you are planning a pregnancy it is important to discuss this with your GP or epilepsy specialist. This is because they may wish to change your medications or dose for use in pregnancy.

HOW WILL BEING PREGNANT AFFECT MY EPILEPSY?
It's difficult to predict how pregnancy will affect epilepsy. For some women their epilepsy is unaffected, while others may see an improvement in their condition. However, as pregnancy can cause physical and emotional stress, as well as increased tiredness, your seizures may become more frequent and severe.If this happens to you, let your doctor, midwife or epilepsy specialist know.

WHAT DO I NEED TO DO?
If you're taking medication to control your epilepsy, you will need to take 5 milligrams (5mg) of folic acid once a day as soon as you start trying for a baby. This is to reduce the risk of developmental problems with your baby. This will need to be prescribed for you, usually by your GP, as it is a higher dose than normal.

A specific epilepsy in pregnancy tool kit has been designed to provide a summary of your epilepsy, treatment, management and recommendations. Please download, print,complete and store in the front of your maternity hand held notes.

http://www.womenwithepilepsy.co.uk/pregnancy-toolkit/

The link below includes more information on what to expect during pregnancy, labour and postnatal period.

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-epilepsy-in-pregnancy.pdf

Overweight

Bring overweight or obese during pregnancy can put you at an increased risk of complications. If you are overweight, the best way to protect your health and your baby's well being is to lose weight before you become pregnant. By reaching a healthy weight, you increase your chances of conceiving naturally and reduce your risk of the problems associated with being overweight in pregnancy.

It is important to have a healthy balanced diet and moderate exercise throughout pregnancy. This will help you maintain your weight rather gaining too much. Please read the information in the staying healthy in pregnancy and weight gain section.

Many areas offer free weight management support services before, during and after pregnancy. Please ask your midwife for details in your local area.

Screening you for diabetes


The likelihood of you developing diabetes in pregnancy (gestational diabetes) increases with your BMI. Your midwife will arrange a screening test for diabetes for when you are 26 weeks.


Monitoring your blood pressure


Women who have a high BMI are at a higher risk of developing high blood pressure. If you develop high blood pressure in pregnancy, you may also develop a more serious condition called pre-eclampsia,which can affect the health of you and your baby. Your midwife will be assessing your health including your blood pressure at each antenatal visit.


Your risk of blood clots


Pregnant women are ten times more likely to develop blood clots (venous thrombosis) than women who are the same age and not pregnant. You are even more likely to develop blood clots if your BMI is above 30 at your booking appointment. You are therefore encouraged to stay well hydrated and active during pregnancy and will be advised to wear support stockings, if you are admitted to hospital.

Your midwife will assess your individual risk of developing blood clots. Women who are most at risk of developing blood clots may be prescribed additional preventative medication.


Your BMI and your baby


All women are offered two scans in their pregnancy. These scans check your baby’s major organs and physical characteristics. If you have a high BMI, especially with body fat around your abdomen (tummy), the ultrasound image will not be as clear. This limits your sonographer’s ability to assess your baby’s growth and development.

It is also more difficult to estimate growth or determine your baby’s position using abdominal palpation. A further scan to assess your baby’s growth or position may be necessary later in your pregnancy. Your midwife will discuss this with you.

Studies suggest that having a high BMI is associated with an increased risk of stillbirth. If your BMI is above 35 your risk of stillbirth is twice as high as the general pregnant population (8.6 per 1000 births compared to 3.9 per 1000 births). The risk of stillbirth increases with increasing BMI and the reason for this is largely unknown. It is important to become familiar with your baby’s daily pattern of movements and contact the Maternity Unit if you have any concerns or your baby’s movements are reduced.


Labour and Birth


While many women with a high BMI have straightforward births, the likelihood of complications is increased. These complications include:

  • induction of labour
  • a longer labour
  • a caesarean section
  • difficulties in hearing the baby’s heartbeat
  • larger babies and difficulties delivering the baby’s shoulders
  • heavy bleeding after the baby is born
  • problems having epidurals and drips inserted
  • less chance of having a successful vaginal birth after a previous caesarean section

Please discuss place of birth with your midwife.


Epidural and anaesthetics:


Anaesthetic procedures such as an epidural and general anaesthetic become more difficult with a high BMI, you maybe referred to see an Anaesthetist ante natally to discuss this and other pain relief option for you.


Your health after your baby is born

Feeding your baby


Breastfeeding has many benefits for you and your baby. It can also help you with weight loss. Find out as much as you can about breastfeeding before you have your baby. You will feel more confident when you start breastfeeding your baby if you have prepared beforehand. Your preparations may include:


  • reading the tips for successful breastfeeding in the ‘Off to the Best Start’ booklet which is available to download from the Unicef website: www.unicef.org.uk/babyfriendly


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