Screening for diabetes. At your first prenatal visit, and again between the tional diabetes may result. It can be controlled …
SUNY DOWNSTATE MEDICAL CENTER AT BROOKLYN
Having Healthy BABIES
A revolution has taken place in the way weve come to view pregnancy and birth In the bad old days, women who did not need to work outside the home were expected to stay hidden from public view Thankfully, we now live in more enlightened times For many women, pregnancy is an empowering, lifeaffirming experience But that doesnt mean that it is a walk in the park When it comes to having a healthy baby, you can never prepare too soon Early and continuous prenatal care is vitally important to keep you healthy and to detect and treat any condition that might threaten you or your unborn child No matter which health provider you choose– family practitioner, obstetrician, nurse practitioner, or midwife–be sure to schedule a visit at the first sign of pregnancy Your provider probably will want to see you once a month during the first two trimesters and more often as you approach the delivery date Its a good idea to know what to expect at these visits so that you can make wise and informed decisions time she also will test your urine, since pregnant women are at greater risk for bladder and kidney infections If you have not
had a Pap test recently, you should have one now, not only to screen for cervical cancer but to detect sexually transmitted diseases and other infections that might harm the baby HIV testing, while optional, is a wise move because effective drugs are now available that can prevent the virus from being passed from mother to child
S P R I N G 2 0 01
In This Issue
Having Healthy Babies
Learn why early prenatal care and good nutrition are so important
Skin Care during Pregnancy
Finding relief for your worst problems
Facts about Breastfeeding
Real answers to some common myths
Winning Control over Epilepsy
New treatment options make it possible to improve seizure control and quality of life
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Other diagnostic tests
Screening for diabetes
What to expect
At each visit, your health provider will perform certain routine procedures, such as recording your weight and blood pressure, listening to the babys heartbeat, and measuring your belly to check on the growth of the uterus womb She will do a blood work-up to identify your blood type, measure your iron level to prevent anemia, and test for syphilis, hepatitis B, and immunity to rubella German measles
From time to
At your first prenatal visit, and again between the 24th and 28th week of pregnancy, your doctor may want to give you a glucose test to check for gestational diabetes, a form of diabetes that occurs during pregnancy This illness affects only 2 to 5 percent of mothers-to-be but is nevertheless the most common complication of pregnancy Normally the pancreas, the organ that produces insulin, makes enough to deliver glucose, a major source of energy, from the bloodstream to the muscles and other tissues of the body Midway through pregnancy, however, the growing placenta which joins the unborn baby to the uterus produces hormones that partly prevent the insulin from working properly Most women begin to produce additional insulin to combat this resistance, but if not, gestational diabetes may result It can be controlled through diet, exercise, or medication and usually disappears after the baby is born
It is now possible to tell before birth if a baby has a genetic inherited disorder such as Downs syndrome or a neural tube defect Because the risk of this happening increases with the mothers age, you may be advised to have certain tests if you are 35 or older Amniocentesis,
the test that is performed most often, involves inserting a thin needle through the mothers abdomen to the uterus and drawing out some of the amniotic fluid surrounding the baby The doctor or a trained professional uses sonography, also known as ultrasound, to create an image of the baby and see exactly where to place the needle so that the baby is out of harms way Ultrasound exams are performed throughout pregnancy Early on ultrasound is used to pinpoint the age, location, and number of babies growing inside Later it is used to produce a picture of the babys anatomy and the location of the placenta to make sure that all is going well
Be a partner in your health care
To prepare for the many exciting changes you are about to experience, learn as much as you can by reading and asking others Be alert to anything that might spell trouble, such as blurred vision, abdominal pains, leg cramps, unusual swelling in the face, headaches or other unusual symptoms Chances are you will have a perfectly normal pregnancy and delivery, so relax and enjoy this special period in your life s
The Importance of Good Nutrition
Eating for two? Now you need to be doubly careful about what you eat, drink,
and put into your body, because fetal growth and development begin early in pregnancy Its important to maintain a healthful diet right from the start Ideally, the time to start evaluating your diet and lifestyle is before you become pregnant During pregnancy your body will need about 300 extra calories a day, so you can expect to gain between 25 and 35 pounds If you know that you are already tipping the scales, why not seek the advice of a good nutritionist to help you bring your weight under control Are you a smoker? As you already know from the US Surgeon Generals warning on every cigarette pack, smoking can put your baby at risk for preterm delivery, low birth weight, and respiratory problems in early childhood Many women who tried to kick the habit once before and failed discover that pregnancy is a powerful motivator Try cutting down on your caffeine intake from coffee, tea, and soda, and avoid alcohol altogether Each year some 12,000 babies are born in this country with fetal alcohol syndrome, a condition that can cause mental retardation and facial abnormalities Since alcohol travels quickly to the bloodstream, whatever you drink your baby is forced to drink No one knows how
much alcohol is safe or how much may be dangerous, but why take the chance? bearing age to consume 400 micrograms daily Most multivitamins contain this amount, and orange juice, green leafy vegetables, beans, and enriched grains are good natural sources of this important nutrient
Skin Care during Pregnancy
As if my heartburn and swollen feet werent bad enough, now Ive got teenage skin, Alysha laments Like many mothers-tobe, she considers itchy rashes, acne, and other bothersome skin conditions as discomforts of pregnancy she just has to live with But shes wrong; in many cases, treatments are available While no one knows why some women have skin problems and others dont, doctors suspect that hormonal changes or a weakened immune system are to blame for many of these common complaints of pregnancy: Acne, eczema, and psoriasis– If you had any of these skin conditions before you became pregnant, you may be pleasantly surprised Eczema sometimes improves during pregnancy; however, rosacea, an acne-type rash on the face, tends to get worse because of increased blood flow Be sure to discuss treatment options with your physician, because the medications you used before may not be safe
during pregnancy Itchy rash — Small red bumps and hives, known as puerperal urticaria of pregnancy, often appear in the third trimester and then disappear after the baby is born Topical ointments, such as calamine lotion, and oatmeal baths can offer soothing relief Ultraviolet light is sometimes effective If youre really uncomfortable, ask your doctor if she can prescribe a safe antihistimine to use during pregnancy Mask of pregnancy — An increase in skin pigmentation caused by hormonal changes can produce brown patches or mottling on the forehead, nose, and cheeks Known as melasma or chloasma, these marks appear in the second or third trimester and affect roughly 70 percent of pregnant women, especially those with darker complexions Since exposure to the sun can make it worse, be sure to wear a protective sunscreen whenever you go outdoors Varicose veins — The added weight youre carrying along with increased blood flow may cause the veins in your legs to swell and protrude and smaller spider veins to appear on your face and chest Try not to stand or sit for long periods of time Elevate your legs whenever possible and avoid tight clothes that can constrict blood circulation Some
varicose veins disappear after delivery, but not always Ask your doctor if he recommends support stockings or other treatment options
Are you getting enough iron?
Iron helps build the red blood cells that carry oxygen throughout the body During the second trimester of pregnancy, when blood volume increases 50 percent, these red blood cells may become diluted Not getting enough iron can cause anemia low blood count Studies have shown that severe anemia may increase the risk of premature delivery For this reason, it is important to have a blood test early in pregnancy and again at 24 to 28 weeks Green leafy vegetables are a good natural source of iron; however, your health provider may prescribe iron supplements to make sure that youre getting enough If you experience constipation when taking these supplements, drink extra fluids, add fiber to your diet, and exercise
Bone up on calcium
Preventing birth defects
Getting enough of certain nutrients prior to conception may help reduce the risk of birth defects Folic acid, for example, can prevent neural tube defects The neural tube forms the brain and spinal cord In roughly one out of every 1,000 births, it does not close properly
This can result in spina bifida, a malformation of the spinal cord, or anencephaly, a fatal defect of the brain Studies have shown that an adequate supply of folic acid can reduce these risks by 70 percent This B vitamin is essential for cell division, growth and healing Since neural tube development happens in the very early stages of pregnancy, it is important to begin getting enough folic acid well before conception takes place To publicize the importance of folic acid in preventing birth defects, a national coalition of health organizations led by the March of Dimes has launched a major campaign urging women of child-
Pregnant and nursing women need 40 percent more calcium in their diets, roughly 1,200 to 1,500 mg a day During pregnancy this added calcium will be used to build healthy bones for the baby You can achieve this goal by drinking three cups of milk, or by eating more dairy products and other calcium-rich foods If you are lactose intolerant, meaning you cant digest milk, your health provider may recommend a calcium supplement Besides being good for the baby, calcium can make you less achy and irritable, and a glass of milk at bedtime will help you get a good nights
sleep
Benefits of daily exercise
If you are accustomed to exercising, there is no reason why you should stop during pregnancy Walking, swimming, riding a stationary bike, or joining an aerobic exercise class for expectant mothers can help you keep your weight in check and tone your muscles for labor But be sure to check with your health provider before you begin any exercise regimen, especially if you are not used to working out s
Newborn HIV Screening Program
If a healthcare provider approaches you while you are in labor to ask if you would like to be tested for HIV, do not be offended New York State now requires all hospital maternity staff to offer HIV screening to expectant mothers who have not previously been tested You can decline the offer, but be aware that if you are not tested, the law requires that your newborn will be Critics of the new law, which went into effect in August 1999, object that it is an invasion of privacy However, its broad purpose is to prevent the spread of HIV–the virus that causes AIDS– through universal testing and counseling during pregnancy More women need to know that if they are HIV-positive, they can infect their baby in several ways:
during pregnancy, delivery, or breast-feeding Now that an effective treatment is available to prevent the transmission of the virus from mother to child, HIV screening is more important than ever There is usually a 25 percent chance that an infected mother will pass the virus to her baby But if she takes zidovudine AZT during labor or her newborn receives it soon after birth, the babys risk is reduced by two-thirds A note of caution: women who began treatment for HIV before becoming pregnant should discuss the pros and cons of continuing or changing medications with their doctor If you are pregnant, or even thinking about it, dont delay being tested for HIV Its a simple procedure that can be done along with your other prenatal blood work Remember that early screening is best, for your babys sake and your own peace of mind
Some children are offered cigarettes and alcohol when they are very little Public service message from the New York City Council
CHILD HEALTH PLUS
During a recent visit to the Downstate campus, New York State Health Commissioner Antonia C Novello commented, We are fortunate to live in a state where every child has access to health care New York leads the nation
in enrolling needy children in health plans, and University Hospital of Brooklyn leads the state in Child Health Plus enrollments Child Health Plus is a state-subsidized program for children whose parents cannot afford insurance but are not eligible for Medicaid The plan covers routine physical exams and immunizations, emergency care, x-rays and lab tests, medicine, surgery, dental care, vision, speech and hearing services The cost of premiums is determined by household income and may be free for poor families To find out more about New York State health programs for children, call 1-800-698-4KIDS
For a referral to a Downstate physician, please call toll free 1 - 888 - 270 - SUNY
Winning Control over Epilepsy
Mary G is 32 and has had epilepsy since the age of 15, yet she leads a completely normal life Her daily medication prevents her from having seizures and does not produce any side effects Nancy M began having seizures three years ago, when she turned 50 At first they were hard to control, but now, thanks to new medication, she hasnt had a seizure in six months However, the medication makes her sleepy and unable to concentrate I fall asleep at work and forget to do important
things, she says I worry that I might lose my job, but I dont want the seizures to come back Anne B, 29, was diagnosed with epilepsy when she was seven Since then she has tried more than six different medications but still has one or two seizures every month She cannot hold a job or drive, and constantly worries that she may injure herself while having a seizure All three women have epilepsy, but the ways it affects their lives are very different ficult, and only you can determine if your seizure control is right
Treatment options
Fortunately, there are many effective treatments for epilepsy There are nearly two dozen different medications approved for the treatment of seizures In recent years new anticonvulsant medications have been introduced that produce fewer side affects and improve seizure control for some patients Since certain medications work best for different types of seizures, your doctor will choose your first medication based on the type of epilepsy you have For patients who continue to have seizures or who cannot tolerate the side effects of their medication, other therapies are available, including: Ketogenic diet–This high-fat, low-carbohydrate, no-sugar diet
must be monitored closely b 
y a doctor and nutritionist Vagus nerve stimulation VNS–A small, implanted device, similar to a pacemaker, delivers an electrical impulse to the vagus nerve in the neck Surgery to remove that small part of the brain that is causing seizures
Dr Susan Herman keeps careful watch over a young patient who is being monitored at University Hospital of Brooklyns Epilepsy Center
mining muscle mass, bone strength, and behavior They can affect certain brain cells, especially in the temporal lobes, where many seizures begin Estrogen excites these brain cells, making seizures more likely to occur Progesterone can inhibit or prevent seizures Because estrogen levels are highest at the time of ovulation and the onset of menstruation, this may trigger an epileptic seizure in some women The use of contraceptives containing progesterone can help block such seizures Ask your doctor if this is right for you
What is epilepsy?
Epilepsy is a chronic neurological nerve disorder that produces seizures Caused by abnormal excitability in all or part of the brain, such seizures are usually brief and unpredictable, without any immediate cause such as fever, an infection of the
brain, or a blow to the head Generalized seizures involve the entire brain and cause a loss or change of consciousness During a grand mal tonic-clonic seizure, the person falls down unconscious and her body stiffens and jerks A petit mal or absence seizure produces a momentary loss of consciousness without these convulsions Partial or focal seizures, on the other hand, begin in one part of the brain They sometimes cause auras, unusual warning sensations such as a sound, smell, or funny feeling in the stomach Other symptoms include staring, chewing, lip smacking, shaking or stiffening of some part of the body, wandering, or confusion A partial seizure may remain in one part of the brain or spread to the rest of the brain Even though most seizures are over in seconds or a few minutes, they may be followed by sleep or confusion that lasts for hours People with epilepsy often ask, How many seizures are too many? Should I change my medication? Balancing seizures and side effects can be dif-
Because of these recent advances, most people with epilepsy can achieve complete seizure control with minimal or no side effects Unfortunately, many patients live with uncontrolled seizures or
disabling side effects because they dont know about the new options, says Dr Susan Herman, assistant professor of neurology and clinical director of the University Hospital of Brooklyn Epilepsy Center She advises them to seek a physician who is willing to work with them to improve seizure control and quality of life
Planning ahead for pregnancy
Some women believe that they cannot have children because they have epilepsy This is absolutely not true Although there is a greater risk for complications, such as increased seizures during pregnancy or having a child with birth defects, most women with epilepsy–more than 90 percent–have completely healthy babies All women should take folic acid to reduce the risk of certain birth defects However, it may be necessary to take higher doses of folic acid if you are epileptic, since anticonvulsant medications can decrease the level of folate No one antiepileptic medication has been proven to be safer than others for use during pregnancy The best medication is the one that controls your seizures at the lowest possible dose with the fewest side effects All women with epilepsy should discuss these issues with their doctor before they plan a
pregnancy, says Dr Herman Careful planning for pregnancy can help ensure a healthy baby s
Epilepsy and reproductive health
Some women tend to have seizures at certain times of their menstrual cycle The exact cause of this condition, known as catamenial epilepsy, is not well understood, but researchers believe it has to do with the actions of estrogen and progesterone These female sex hormones not only control reproduction but also play an important role in deter-
MIDWIVES DELIVER HEALTHY BABIES
In our grandmothers day, babies often were delivered at home or in a maternity hospital with the help of a trusted midwife Even today, midwives deliver the majority of babies in Britain, Europe, and many other parts of the world Yet in the United States, only one in 20 births is attended by a midwife This is surprising in view of recent studies that show midwives deliver healthy babies using fewer interventions Researchers at the University of Washington reported that women with low-risk pregnancies who used midwives were less likely to have induced labor or need anesthesia and had fewer Caesarians and episiotomies Another study by scientists at the Centers for Disease Control and
Prevention found that infant mortality was 19 percent lower, and the risk of death during the first 28 days of life was 33 percent lower, following midwife-attended births Infant birthweight–a major predictor of infant mortality–also tended to be higher for babies delivered by midwives
Although physicians in this study attended a greater proportion of deliveries involving medical complications, certified nurse midwives attended proportionately more women who are considered at higher risk for poor outcomes: African- American women, teenagers, unmarried mothers, and women with less than a high school education Lily Hsia, CNM, head the Midwifery Education Program at SUNY Downstate, believes that the differences reported in these studies, may reflect different educational approaches The medical model focuses on deviations from the healthy norm and the interventions that are necessary when medical conditions or obstetric emergencies complicate pregnancy and birth Midwifery education centers on wellness and prevention By emphasizing that pregnancy, labor, and birth are normal physiologic processes, midwives encourage women to become active participants in their own health care plan,
she says Midwives spend time counseling and sharing health information with their patients, and giving lots of emotional support They are also skilled troubleshooters, quick to consult with a physician when medical complications appear
Nurse midwife Aleida Llanes-Oberstein offers encouraging words to a mother-to-be during her labor
For these reasons, perhaps, the number of births attended by midwives in this country is on the rise, nearly doubling in the last decade, from 37 percent in 1989 to 7 percent in 1997 In New York, it has steadily risen, with the greatest use in the Bronx, Brooklyn, and Manhattan At University Hospital of Brooklyn, midwives have been serving the community for more than 30 years For information call Downstate Midwifery Practice at 718-270-1885
For information about University Hospital of Brooklyn and its services, please call 718-270-4762
Breast-feeding Is Good For You and Your Baby
If youre a mother-to-be and plan to go back to work or school after your baby is born, you may be wondering if breast-feeding is right for you: Will it tie me down? Is it worth doing for only a short time? Breast-feeding is probably the single best thing you can do for your
newborn, says Julie L Johnson, MD, womens health fellow in the Department of Family Practice at SUNY Downstate If you are unable to breast-feed for a full year, consider using a breast pump That way your baby can get most of the benefits of breast-feeding while youre away from home Breast milk contains antibodies that protect your baby against infection and disease This is particularly important in the weeks before your babys first vaccinations And because mothers milk is the perfect food, breast-fed babies are not prone to ear infections or diarrhea and have fewer allergies Breast-feeding is also good for you It causes the uterus to contract, making your tummy appear flatter, and burns up 500 calories a day, helping you to lose extra pounds naturally Though breast-fed babies must be nursed more often because they digest the milk so quickly and easily, the extra time together helps many new mothers feel closer to their babies Knowing that they are giving their baby something that no one else can makes them feel special Although women who are HIV-positive should not nurse their infants, most common illnesses such as colds and flu are not passed to the baby through the breast milk If
you are healthy and would like to breast-feed, dont let anyone discourage you Here are real answers to some common myths: Your breasts are too small to produce enough milk Milk comes from glandular tissue that develops during pregnancy It has nothing to do with the size of your breasts Breast-feeding will make your breasts sag Sagging breasts are hereditary If it runs in your family, it will happen whether you breast-feed or not You have to drink lots of milk to breast-feed Cows milk is not needed to produce human breast milk, but it is an excellent source of calcium While nursing, youll need 1,000 milligrams of calcium a day, which you can get by drinking three glasses of milk or by eating calcium-rich foods such as yogurt, sardines, and collard greens You wont know if your baby is getting enough milk If your baby nurses eight to twelve times a day, has at least six wet diapers and three dirty diapers after the third day of life, and is gaining one pound or more every month, you have nothing to worry about Need more information? For more information call Jemma Hanson, RN, who leads the Breast Feeding Support Group at University Hospital of Brooklyn, 718-270-2116
and
Q: What is
the best sleeping position for my Q: What is the best sleeping position for my baby? My sister says that putting an infant to sleep on his stomach may lead to crib death Is this true?
Sudden Infant Death Syndrome SIDS is the diagnosis given for the unexplained death of an infant before the age of one Because SIDS occurs most often while a baby is sleeping, it is often called crib death For reasons that are not well understood, male infants are more often stricken by SIDS than females, and African American and Native American babies are more susceptible than others Its frightening to think that this could happen to your baby, but fortunately there is something you can do to reduce the risk Doctors recommend putting babies to sleep on their backs because sleeping on their stomachs may prevent some babies from receiving enough oxygen, especially if they have a respiratory infection Parents may fear that placing their infant on his back will increase the risk of choking on spit up food or liquid Yet in England, New Zealand, Australia, and Norway, where for years doctors have been urging parents to place their infants on their backs for sleep, the number of SIDS cases has dramatically
declined–in some countries by as much as 50 percent An important rule of thumb before deciding to follow this or any other advice is to discuss it with your healthcare provider If your baby has a special medical condition, your provider will recommend which sleeping position is best Here are some general guidelines you can safely follow to ensure that your baby gets a healthy rest: Provide a mattress or other bedding surface that is comfortable but firm Dont place your baby on fluffy blankets, pillows, or other soft materials for sleep Provide a smoke-free environment for your baby Infants who are exposed to tobacco smoke tend to have more respiratory ailments that can increase the risk of SIDS Call your healthcare provider at the first sign of a respiratory infection or other illness Sleep well, knowing that you are giving your baby the best care possible
Stephen Ajl, MD
Department of Pediatrics
Brooklyn Womens Health is published by the Office of Institutional Advancement, SUNY Downstate Medical Center, Box 2, 450 Clarkson Avenue, Brooklyn, NY 11203 Editor-in-Chief : Judith LaRosa, RN, PhD, Professor of Preventive Medicine and Community Health Lily Hsia, CNM, MS Sheila
Johnson, MS Judith LaRosa, PhD Suzanne Mirra, MD Susan Schwartz-Giblin, PhD Miriam Vincent, MD
Q: Im three months pregnant and my fingers are so swollen that I cant get my rings off Will the swelling eventually go down by itself? Im really uncomfortable
It is not unusual to have some fluid retention during pregnancy This condition, called edema, causes fingers, toes, and ankles to swell and, yes, it can be uncomfortable To reduce and prevent further swelling, try drinking at least 8 glasses of water or other noncaffeinated beverage each day, avoid foods with high sodium salt content, wear comfortable clothes, and get some exercise If you should experience swelling in your hands or face, it could signal something more serious Water retention along with high blood pressure may be symptoms of preeclampsia Also known as toxemia, this condition can harm the baby by restricting the flow of blood to the placenta If high blood pressure is allowed to escalate unchecked, it can endanger the lives of both mother and baby Preeclampsia can be dangerous but it doesnt happen often Even though women who develop preeclampsia usually do not have a history of high blood pressure, be aware that if
you or other family members have chronic high blood pressure, you are at greater risk As with any potentially serious disorder, early detection and treatment is key
Nancy Campau, CNM
Midwifery Education Program
Q: I have two housecats who like to sleep with me and lick my face in the morning Now that Im expecting, Im worried Can I catch an infection from them that could harm my baby?
In all likelihood, you have developed immunity to anything they may have A blood test will let you know for sure You can also have your cats tested If they have an active infection, you may want to board them until it clears up The best way to avoid getting a potentially dangerous infection is to stay away from your cats litter box Cat feces, especially those of outdoor cats, can contain a parasite known as Toxoplasma gondii, which produces mild, flu-like symptoms Even though its not dangerous to you, it can cause serious harm to your baby, including blindness, deafness, mental retardation, or stillbirth You also can get toxoplasmosis from eating shellfish or undercooked meat, so cook your food properly and scrub homegrown vegetables well to get rid of any soil that a cat may have
contaminated
Managing Editor : Doris Youdelman, Office of Institutional Advancement Editorial committee : Diane Ashton, MD JoAnn Bradley, EdD Ruth Browne, PhD Jamesetta Halley-Boyce, PhD Susan Herman, MD Design : Photography:
Dorcas Gelabert, Biomedical Communications Ernest A Cuni, Biomedical Communications
Diane Ashton, MD
Obstetrics and Gynocology
WHAT BROOKLYN WOMEN WANT TO KNOW
Please let us know which subjects interest you most Kindly fill out and return the following questionnaire to: SUNY Downstate, 450 Clarkson Avenue, Box 2, Brooklyn, NY 11203, or fax it to: 718-270-3160 We also welcome letters to the editor
Brooklyn Womens Health Questionnaire
1 Were the articles: ___ informative ___ difficult to understand ___ or too general? 2 What interested you the most? __________________________________________________ 3 Tell us more about yourself: my age ____ zip code _______ highest grade completed in school ___________ Please indicate what other health issues you would like to read about: ______________________________ ____________________________________________________________________
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This issue was funded in part by a grant from
CITIGROUP FOUNDATION
Source:neurotodayonline.com
