What to expect when you're expecting (201 page)

Having IBS does put you at a slightly increased risk for premature delivery (so be sure to be alert to any signs of impending preterm contractions; see
page 300
). There’s also a greater chance you might end up delivering via C-section because of your condition.

“My lupus has been pretty quiet lately, but I just became pregnant. Is this likely to bring on a flare-up?”

There are still some unknowns about systemic lupus erythematosus (SLE), particularly when it comes to pregnancy. Studies indicate that pregnancy doesn’t affect the long-term course of this autoimmune disorder. During pregnancy itself, some women find that their condition improves; other women find it worsens. More confusing still, what happens in one pregnancy doesn’t necessarily predict what will happen in subsequent ones. In the postpartum period, there does appear to be an increased risk of flare-ups.

Whether and how SLE affects pregnancy, however, isn’t absolutely clear. It does seem that the women who do best are those who, like you, conceive during a quiet period in their disease. Though the risk of pregnancy loss is slightly increased, in general, their chances of having a healthy baby are excellent. Those with the poorest prognosis are women with SLE who have severe kidney impairment (ideally, kidney function should be stable for at least six months before conception). If you have lupus anticoagulant or related antiphospholipid antibody, daily doses of aspirin and heparin may be prescribed.

Because of your lupus, your pregnancy care will include more, and more frequent, tests, medications (such as corticosteroids), and possibly more limitations. But if you, your obstetrician or maternal-fetal medicine specialist, and the physician who treats your lupus all work together, the odds are very much in favor of a happy outcome that will make all that extra effort completely worthwhile.

“I was diagnosed several years ago as having multiple sclerosis. I’ve only had two episodes of MS, and they were relatively mild. Will the MS affect my pregnancy? Will my pregnancy affect my MS?”

There’s good news for both you and your baby. Women with MS can definitely have normal pregnancies and healthy babies. Good prenatal care, beginning early (and better yet, modifying therapies even before conception), coupled with regular visits to your neurologist, will help you achieve that most wonderful of outcomes. And the good news carries over to childbirth, too. Labor and delivery aren’t usually affected by MS, and neither are pain relief options. Epidurals and other types of anesthesia appear to be completely safe for delivering moms with MS.

As for pregnancy’s effect on MS, some women experience relapses when they’re expecting, as well as in the postpartum period, but most women are back to their prepregnancy condition within about three to six months of baby’s arrival. Some women with ambulatory problems find that as weight gain increases during pregnancy, walking becomes more difficult, not surprisingly. Avoiding excessive weight gain may help minimize this problem. The happy bottom line: Whether or not you experience relapses, pregnancy doesn’t seem to affect the overall lifetime relapse rate or the extent of ultimate disability.

To stay as healthy as possible while you’re expecting, try to minimize stress and get enough rest. Also try to avoid raising your body temperature too much (stay out of hot tubs and too-warm baths, and don’t exercise too hard or outside in hot weather). Do your best to fight off infections, particularly UTIs, which are more common during pregnancy (see
page 498
for preventative measures).

Pregnancy can have some impact on MS treatment. Though low to moderate doses of prednisone are considered safe to use during pregnancy, some other medications used for MS may not be. You’ll need to work out a medication regimen with your doctors that’s safe for your baby and as effective as possible for you.

After delivery, there’s a good chance that you’ll be able to breastfeed, at least partially. If breastfeeding isn’t an option, either because of the meds you need to take or because it’s just too physically stressful, don’t worry. Not only do babies thrive on good formula, they always do best when mom’s feeling well.

Since going back to work early in the postpartum period may increase both exhaustion and stress—which might exacerbate your symptoms—you may want to consider taking that return slowly, finances permitting. If MS does interfere with your functioning while your child is young, see the next page for tips on baby care for parents with disabilities.

One other note: Many women with MS are concerned about passing the disease on to their children. Though there is a genetic component to the disease, placing these children at increased risk of being affected as adults, the risk is really quite small. Between 95 and 98 percent of children of MS mothers end up MS free.

“I was born with PKU. My doctor let me off my low-phenylalanine diet when I was in my teens, and I was fine. But when I talked about getting pregnant, my OB said I should go back on the diet. Is that really necessary?”

A low-phenylalanine diet, which consists of a phenylalanine-free medical formula and precisely measured amounts of fruits, vegetables, bread, and pasta (and which eliminates all high- protein foods, including meat, poultry, fish, dairy products, eggs, beans, and nuts), definitely isn’t tasty or easy to follow. But for pregnant women with phenylketonuria (PKU), it’s absolutely necessary. Not sticking to the diet while you’re pregnant would put your baby at great risk for a variety of problems, including serious mental deficits. Ideally, the low-phenylalanine regimen should be resumed three months before conception, and blood levels of phenylalanine kept low through delivery. (Even starting the diet early in pregnancy may reduce the seriousness of developmental delay in children of mothers with PKU.) And, of course, all foods sweetened with aspartame (Equal or NutraSweet) are absolutely off-limits.

Without a doubt, it’ll be tough to return to the diet after so many years of being off of it—but clearly, the benefits to your developing baby will be well worth the sacrifice. If in spite of this incentive you find yourself slipping off the diet, it might help to get some professional help from a therapist who is familiar with your type of condition. A support group of other mothers with PKU may be even more helpful; the misery of such dietary deprivation definitely benefits from the company of those similarly deprived. For more information, check out pkunetwork.org.

“I’m a paraplegic because of a spinal cord injury, and I use a wheelchair. My husband and I have wanted a baby for a long while, and I’ve finally become pregnant. Now what?”

Like every pregnant woman, you’ll need to deal with first things first: selecting a practitioner. And as with every pregnant woman who falls into a high-risk category, your practitioner should ideally be an obstetrician or maternal-fetal medicine specialist who has experience dealing with women who face the same challenges as you do. That may be easier to find than you’d think because a growing number of hospitals are developing special programs to provide women with physical disabilities better prenatal and obstetrical care. If such a program or practitioner isn’t available in your area, you’ll need a doctor who is willing to learn “on the job” and who is able to offer you and your husband all the support you’ll need.

Just which additional measures will be necessary to make your pregnancy successful will depend on your physical disabilities. In any case, restricting your weight gain to within the recommended range will help minimize the stress on your body. Eating the best possible diet will improve your general physical well-being and decrease the likelihood of pregnancy complications. And keeping up your exercise regimen will help ensure that you have maximum strength and mobility when the baby arrives; water therapy may be particularly helpful and safe.

It should be reassuring to know that, though pregnancy may be more difficult for you than for other pregnant women, it should not be any more stressful for your baby. And no evidence indicates an increase in fetal abnormalities among babies of women with spinal cord injury (or of those with other physical disabilities not related to hereditary or systemic disease). Women with spinal cord injuries, however, are more susceptible to such pregnancy problems as kidney infections and bladder difficulties, palpitations and sweating, anemia, and muscle spasms. Childbirth, too, may pose special problems, though in most cases a vaginal delivery will be possible. Because uterine contractions may be painless, depending on the kind of damage to your spinal cord, you will have to be instructed to note other signs of impending labor—such as bloody show or rupture of the membranes—or you may be asked to feel your uterus periodically to see if contractions have begun.

Long before your due date, devise a fail-safe plan for getting to the hospital, one that takes into account the fact that you may be home alone when labor strikes (you may want to plan to leave for the hospital early in labor to avoid any problems caused by delays en route). You’ll also want to be sure the hospital staff is prepared for your additional needs.

Parenting is always a challenge, particularly in the early weeks, and it’s not surprising that it will be even more so for you and your husband (who will have to be your more-than-equal parenting partner). Planning ahead will help you meet this challenge more successfully. Make any necessary modifications to your home to accommodate child care; sign on help (paid or otherwise) to at least get you started. Breastfeeding, which is usually possible, will make life simpler (no rushing off to the kitchen to prepare bottles and no shopping for formula). Getting your diapers and other baby needs delivered will also save effort and time. The changing table should be tailored for you to use from your wheelchair, the crib should have a drop side so you can take baby in and out easily, and—if you’ll be doing all or some of the baby bathing—the baby tub should be set up somewhere that’s accessible (daily tub baths aren’t a must, so you can sponge baby on the changing table or on your lap on alternate days). Wearing your baby in a carrier or sling will probably be the most convenient way to tote him or her, since it’ll leave your hands free (putting it on first thing in the morning will allow you to slide baby in and out as needed). Joining a support group of parents with disabilities (or checking out online groups) will provide lots of comfort and empathy and also give you a gold mine of ideas and advice.

For more information, contact Through the Looking Glass at (800) 644-2666 or online at lookingglass.org; or the National Spinal Cord Injury Association at (800) 962-9629 or online at spinalcord.org.

“I have rheumatoid arthritis. How will this affect my pregnancy?”

Your condition isn’t likely to affect your pregnancy very much, but pregnancy is likely to affect your condition—and, happily, for the better. Most women with rheumatoid arthritis (RA) notice a significant decrease in the pain and swelling in their joints during pregnancy, though there is also a somewhat greater risk of temporary symptom flare-up in the postpartum period.

The greatest change you may experience while you’re pregnant is in the management of your condition. Because some of the medicines used to treat RA (such as ibuprofen and naproxen) are not safe for use later in pregnancy or at all, your physician will need to switch you over to treatments that are safer, such as steroids.

During labor and delivery, it will be important to choose positions that don’t put too much stress or strain on affected joints. Discuss with the physician who manages your arthritis, as well as with your prenatal practitioner, which positions might work best.

“I was diagnosed with mild scoliosis as a teenager. What effects will the curve of my spine have on my pregnancy?”

Thankfully, not much. Women with scoliosis usually go on to have uneventful pregnancies and deliveries, with healthy babies as the happy outcome. In fact, studies have shown that no significant problems occur during pregnancy that could be specifically attributed to scoliosis.

Women with severe curvature of the spine, or those whose scoliosis involves the hips, pelvis, or shoulders, may experience more discomfort, breathing problems, or weight-bearing difficulties during later pregnancy. If you find your back pain increases during pregnancy, stay off your feet as much as possible, take warm baths, enlist your spouse to give you some back rubs, and try the tips on
page 237
for combating back pain. You can also ask your practitioner for the name of an obstetric physiotherapist who may be able to help you with some exercises specific to your scoliosis-related pain. Also discuss which CAM approaches (
page 85
) might be helpful.

If you think you might want an epidural during labor, talk to your practitioner about finding an anesthesiologist who has experience with moms with scoliosis. Though the condition usually does not interfere with the epidural, it may make it a little more difficult to place. An experienced anesthesiologist, however, should have no problem getting the needle where it needs to go.

“I have sickle cell disease, and I just found out that I’m pregnant. Will my baby be okay?”

Not too many years ago, the answer would not have been reassuring. Today, there’s much happier news. Thanks to major medical advances, women with sickle cell disease—even those with such related complications as heart or kidney disease—have a good chance of having a safe pregnancy and delivery and a healthy baby.

Pregnancy for the woman with sickle cell anemia, however, is usually classified as high risk. The added physical stress of pregnancy increases her chances of having a sickle cell crisis, and the added stress of sickle cell disease increases the risks of certain complications, such as miscarriage, preterm delivery, and fetal growth restriction. Preeclampsia is also more common in women with sickle cell anemia.