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MOE104A: Complications During Pre-pregnancy

and Pregnancy

PRE-PREGNANCY COMPLICATIONS
What is lung disease?
Lung disease refers to disorders that affect the lungs, the organs that allow us to breathe.
Breathing problems caused by lung disease may prevent the body from getting enough oxygen.
Examples of lung diseases are:

Asthma,

chronic

bronchitis,

and

emphysema

Infections, such as influenza and


pneumonia

Lung cancer

Sarcoidosis

(sar-KOY-doh-sis)

and

pulmonary fibrosis
Lung disease is a major concern for women.
The number of U.S. women diagnosed with
lung disease is on the rise. More women are
also dying from lung disease.

What types of lung disease are most common in women?


Three of the most common lung diseases in women are asthma, chronic obstructive pulmonary
disease (COPD), and lung cancer.

Asthma
Asthma is a chronic (ongoing) disease of the airways in the lungs called bronchial tubes.
Bronchial tubes carry air into and out of the lungs. In people with asthma, the walls of these
airways become inflamed (swollen) and oversensitive. The airways overreact to things like
smoke,

air

pollution,

mold,

and

many

chemical

sprays.

They

also

can

be

irritated

by allergens (like pollen and dust mites) and by respiratory infections (like a cold). When the
airways overreact, they get narrower. This limits the flow of air into and out of the lungs and

causes trouble breathing. Asthma symptoms include wheezing, coughing, and tightness in the
chest.
Women are more likely than men to have asthma and are more likely to die from it. The
percentage of women, especially young women, with asthma is rising in the United States.
Researchers are not sure why. Many experts think that air pollution and allergens play a role in
this increase. Breathing tobacco smoke also is linked to an increased risk of asthma.

Chronic obstructive pulmonary disease


Chronic obstructive pulmonary disease (COPD) refers to chronic obstructive bronchitis and
emphysema. These conditions often occur together. Both diseases limit airflow into and out of the
lungs and make breathing difficult. COPD usually gets worse with time.
A person with COPD has ongoing inflammation of the bronchial tubes, which carry air into and out
of the lungs. This irritation causes the growth of cells that make mucus. The extra mucus leads to
a lot of coughing. Over time, the irritation causes the walls of the airways to thicken and develop
scars. The airways may become thickened enough to limit airflow to and from the lungs. If that
happens, the condition is called chronic obstructive bronchitis.
In emphysema, the lung tissue gets weak, and the walls of the air sacs (alveoli) break down.
Normally, oxygen from the air goes into the blood through these air sac walls. In a person with
emphysema, the ruined air sac walls means less oxygen can pass into the blood. This causes
shortness of breath, coughing, and wheezing.
More than twice as many women as men are now diagnosed with chronic bronchitis. The rate of
emphysema among women has increased by 5 percent in recent years but has decreased among
men. And more women have died from COPD than men every year since 2000. Researchers are
trying to understand why. Cigarette smoking, a main cause of COPD, has increased among
women. One theory is that cigarette smoke is more damaging to women than to men.

Lung cancer
Lung cancer is a disease in which abnormal (malignant) lung cells multiply and grow without
control. These cancerous cells can invade nearby tissues, spread to other parts of the body, or
both. The two major kinds of lung cancer are named for the way the cells look under a
microscope. They are:

Small cell lung cancer. This kind of lung cancer tends to spread quickly.

Non-small cell lung cancer. This is a term for several types of lung cancers that act in
a similar way. Most lung cancers are non-small cell. This kind of lung cancer tends to
spread more slowly than small cell lung cancer.

In the United States, more women now die from lung cancer than from any other type of cancer.
Tobacco use is the major cause of lung cancer.

Other lung diseases


Less common lung problems that affect women include:

Pulmonary emboli. These are blood clots that travel to the lungs from other parts of the
body and plug up blood vessels in the lungs. Some factors that increase your risk include
being pregnant, having recently given birth, and taking birth control pills or menopausal
hormone therapy. Pulmonary emboli can affect blood flow in the lungs and can reduce
oxygen flow into the blood. Very large emboli can cause sudden death.

Pulmonary hypertension. This is high blood pressure in the arteries that bring blood to
the lungs. It can affect blood flow in the lungs and can reduce oxygen flow into the blood.

Sarcoidosis and pulmonary fibrosis. These inflammatory diseases cause stiffening and
scarring in the lungs.

LAM

(lymphangioleiomyomatosis) (lim-FAN-jee-oh-LEE-oh-MEYE-oh-mah-TOH-sis).

This is a rare lung disease that mostly affects women in their mid-30s and 40s. Musclelike cells grow out of control in certain organs, including the lungs.

Influenza (the flu) and pneumonia. Flu is a respiratory infection that is caused by a
virus and can damage the lungs. Usually, people recover well from the flu, but it can be
dangerous and even deadly for some people. Those at greater risk include older people,
young children, pregnant women, and people with certain health conditions like asthma.
Pneumonia is a severe inflammation of the lungs that can be caused bybacteria, viruses,
and fungi. Fluid builds up in the lungs and may lower the amount of oxygen that the
blood can get from air that's breathed in. People most at risk are older than 65 or
younger than 2, or already have health problems. Vaccines are the best protection
against flu and pneumonia.

What causes lung disease?


Smoking causes lung cancer and many other types of lung disease.
Experts don't know the causes of all types of lung disease, but they do know the causes of some.
These include:

Smoking. Smoke from cigarettes, cigars, and pipes is the number one cause of lung
disease. Don't start smoking, or quit if you already smoke. If you live or work with a
smoker, avoid secondhand smoke. Ask smokers to smoke outdoors. Secondhand smoke is
especially bad for babies and young children.

Radon. This colorless, odorless gas is present in many homes and is a recognized cause
of lung cancer. You can check for radon with a kit bought at many hardware stores. Radon
can be reduced in your home if you find out there are high levels.

Asbestos. This is natural mineral fiber that is used in insulation, fireproofing materials,
car brakes, and other products. Asbestos can give off small fibers that are too small to be
seen and can be inhaled. Asbestos harms lung cells, causing lung scarring and lung
cancer. It can cause mesothelioma (MEZ-oh-THEE-lee-OH-muh), which is a cancer that
forms in the tissue covering the lungs and many other organs of the body.

Air pollution. Recent studies suggest that some air pollutants like car exhaust may
contribute to asthma, COPD, lung cancer, and other lung diseases.

Some diseases that affect the lungs, like the flu, are caused by germs (bacteria, viruses, and
fungi).

Signs of lung disease


Early signs of lung disease are easy to overlook. Often, an early sign of lung disease is not having
your usual level of energy.
The signs and symptoms can differ by the type of lung disease. Common signs are:

Trouble breathing

Shortness of breath

Feeling like you're not getting enough air

Decreased ability to exercise

A cough that won't go away

Coughing up blood or mucus

Pain or discomfort when breathing in or out

Make sure to call your doctor if you have any of these symptoms.

Symptoms of asthma?
Asthma

can

be

hard

to

diagnose.

The

signs

of

asthma

can

seem

like

the

signs

of COPD, pneumonia, bronchitis, pulmonary embolism, anxiety, and heart disease.


Common symptoms of asthma are:

Coughing

Wheezing

Chest tightness

Shortness of breath

To diagnose asthma, the doctor asks about your symptoms and what seems to trigger them,
reviews your health history, and does a physical exam.
To confirm the diagnosis, the doctor may do other tests, such as:

Spirometry (speye-ROM-eh-tree).

The

doctor

uses

medical

machine

called

spirometer. This test measures how much air you can breathe in and out. It also
measures how fast you can blow air out. The doctor may also give you medicines and
then retest you to see if your results improve.

Bronchoprovocation (bron-KOH-prah-vuh-KAY-shun). Your lung function is tested using


spirometry while more stress is put on the lungs. This may be during physical activity or
after you breathe in increasing doses of a special chemical or cold air.

Chest x-ray or EKG (electrocardiogram). These tests can sometimes find out if
another disease or a foreign object may be causing your symptoms.

Other tests. The doctor may want to test for other problems that might be causing the
symptoms. These include stomach acid backing up into the throat, vocal cord problems,
or sleep apnea.

Treatment
Asthma is a chronic disease. Medicines can be used to treat asthma, but they cannot cure it. You
can help control your symptoms by working with your doctor to set up and then follow a personal
asthma action plan. The plan will include possible medications and ways to avoid things that
trigger your asthma.

Following an asthma action plan

Your asthma action plan will show:

The kinds of medicines you should take

When to take your medicines

How to regularly monitor your asthma

Ways to avoid what triggers your asthma

When to call your doctor or go to the emergency room

Taking medicines
Asthma medicines work by opening the lung airways. The medicines used to treat asthma fall into
two groups: long-term control and quick relief.
Long-term control medicines are to be taken every day, usually over a long period of time.
They help prevent symptoms from starting. Once symptoms occur, they do not give quick relief.
These medicines include:

Inhaled corticosteroids. These are the preferred medicines for long-term asthma
control. They relieve airway inflammation and swelling.

Long-acting beta2-agonists. These inhaled medicines are often added to low-dose


inhaled corticosteroids to improve long-term asthma control.

Leukotriene

modifiers. These

pills

help

block

the

chain

reaction

that

causes

inflammation in the airways.

Cromolyn and nedocromil. These inhaled medicines can help keep airways from
reacting in response to an asthma trigger.

Theophylline. This is a pill that helps open the airways.

Quick-relief medicines are used only when needed. These include short-acting inhaled beta 2agonists and short-acting bronchodilators, like albuterol and pirbuteral. Quick-relief medicines
often relieve symptoms in minutes. They do this by quickly relaxing tightened muscles around
the airways. They are taken when symptoms worsen to prevent a full-blown asthma attack and to
stop attacks once they have started.

Avoiding asthma triggers

Avoid things that make your asthma worse. Common asthma triggers are tobacco smoke, animal
dander, dust mites, air pollution, mold, and pollens. You can try "fragrance-free" products if your
asthma is triggered by fragrances. Talk to your doctor about allergy shots if your asthma
symptoms are linked to allergens that you cannot avoid. The shots may lessen or prevent the
symptoms but will not cure the asthma. You can reduce your exposure to air pollution by limiting
your outdoor activities on days when the air quality in your neighborhood is poor.

PREGNANCY AND ASTHMA


If you have asthma and may become pregnant, talk to your doctor. Only in very severe cases
might asthma be a reason to avoid becoming pregnant.
If you have asthma and become pregnant, you and your doctor can discuss the safety of your
medicines. Changes in the medicines can sometimes make good sense. It is very important to
manage your asthma symptoms when you are pregnant. Asthma that gets out of control can
harm your baby.
You should also talk with your doctor about getting a flu shot. Flu can be very serious for anyone
with asthma, but it's even more of a concern for pregnant women with asthma.

Signs and Symptoms of chronic obstructive pulmonary disease (COPD)


People with COPD have symptoms that develop very slowly over many years. As a result, many
people ignore these symptoms until their disease has reached an advanced stage. COPD can be
easily diagnosed and can be managed.
The symptoms of COPD include:

An ongoing cough that often produces large amounts of mucus

Shortness of breath, especially during physical activity

Wheezing

Chest tightness

If you have some or all of these symptoms, make sure to talk to your doctor.
To find out if you have COPD, the doctor will:

Ask about your symptoms

Ask about your medical history, including family history

Ask about your history of exposure to things that can cause COPD, such as tobacco
smoke, air pollution, or chemicals

Do a physical exam, including using a stethoscope to listen for wheezing or other


abnormal chest sounds

The main test to check for COPD is spirometry. For this test, you will be asked to take a deep
breath and blow as hard as you can into a tube that is connected to a spirometer. This machine
measures how much air you breathe out and how fast.
Other tests can include:

Chest x-ray or chest computed tomography (CT) scan. These tests create pictures
of the heart and lungs. The pictures can show signs of COPD. They can also show
whether your symptoms are caused by another condition, such as heart failure.

Arterial blood gas test. This blood test measures the oxygen and carbon dioxide levels
in your blood. It can help determine how severe the COPD is and whether oxygen
therapy is needed.

TREATMENT OF COPD
Damage to the lungs cannot be repaired. The disease can be slowed by avoiding certain
exposures, though. For smokers, the best approach is to stop smoking. You should also limit your
exposure to smoke, dust, fumes, and irritating vapors at home and work. Also limit outdoor
activities during air pollution alerts. Treatment can relieve symptoms. Common medicines are:

Bronchodilators to open up air passages in the lungs

Inhaled steroids to relieve symptoms by reducing inflammation in the lungs

Antibiotics to clear up infections in the lungs

For patients with COPD, doctors may also recommend:

Flu shots. Influenza (flu) can cause serious problems for people with COPD.

Pneumonia shots. The pneumococcal (NOO-muh-kok-uhl) vaccine reduces the risk of


some kinds of pneumonia.

Pulmonary rehabilitation. This treatment helps people cope physically and mentally
with COPD. It can include exercise, training to manage the disease, diet advice, and
counseling.

Oxygen therapy. The patient receives extra oxygen, either through a tube or mask.

Surgery. Sometimes surgery can help people with severe COPD feel better. Lung
transplant surgery is becoming more common for people with severe emphysema.
Another procedure called lung volume reduction surgery is also used to treat some
patients with severe COPD of the emphysema type. In this surgery, the most damaged
part of each lung is removed.

LUNG CANCER

Symptoms lung cancer?


Usually there are no warning signs of early lung cancer. By the time most people with lung cancer
have symptoms, the cancer has become more serious.
Symptoms of lung cancer may include:

A cough that doesn't go away or gets worse

Breathing trouble, like shortness of breath

Coughing up blood

Chest pain

Hoarseness or wheezing

Pneumonia that doesn't go away or that goes away and comes back

In addition, you may feel very tired, have a loss of appetite, or unexplained weight loss. If you
have symptoms of lung cancer, it's important to talk to your doctor. The doctor will ask about
your health history, smoking history, and exposure to harmful substances. He or she will also do
a physical exam and may suggest some tests.
Common tests for diagnosis of lung cancer include:

Chest x-rays. Chest x-rays allow doctors to "see" abnormal growths in the lungs.

Computerized tomography scans (CT scans). CT scans are more powerful than
standard x-rays. The images can show subtle signs of cancer that don't show up on xrays. This can increase the chances of finding the cancer before it spreads further.

Sputum cytology. A sample of mucus that you cough up is studied to see if it has
cancer cells in it.

Bronchoscopy. Doctors pass a special tube called a bronchoscope through the nose or
mouth and down into the lungs. They can see into the lungs and remove small bits of
tissue to test.

Fine-needle aspiration. Doctors pass a needle through the chest wall into the lung to
remove a small amount of tissue or fluid.

Thoracotomy (thohr-uh-KOT-oh-mee). Doctors cut open the chest and remove tissue
from the lungs.

If I smoke, should I get tested for lung cancer?


Testing for cancer before a person has any symptoms is called screening. Screening may help find
cancers early, when they may be easier to treat.
Many studies show that screening smokers with x-rays or sputum cytology does not save lives.
But recently a major study showed that CT scans of older people who smoke a lot (or used to
smoke a lot) can save lives. You can learn more about the results of the study, which is called
the National Lung Screening Trial. Experts are still working to figure out who should get CT
screening. There are risks and benefits to screening for lung cancer.
For now, the U.S. Preventive Services Task Force (USPSTF) makes no recommendation either for
or against routine screening for lung cancer. If you're concerned about your lung cancer risk, talk
to your doctor about whether screening is right for you. Of course, the best way to reduce your
risk of lung cancer is not to smoke.

How is lung cancer treated?


Sometimes lung cancer treatments are used to try to cure the cancer. Other times, treatments
are used to stop the cancer from spreading and to relieve symptoms.
Your specific treatment will depend on:

The type of lung cancer

Where the cancer is and if it has spread to other parts of the body

Your age and overall health

Your doctor may recommend one treatment or a combination of treatments.

Surgery is used to remove the lung tissue that has the cancerous tumor. Sometimes a large part
of a lung or all of it is removed. When the cancer has not spread, surgery can cure the patient.
Radiation therapy uses a machine to aim high-energy x-rays at the tumor. This energy kills
cancer cells. Radiation therapy can relieve pain and make a person feel better.
Chemotherapy uses medicine to kill cancer cells. Chemotherapy medicines can be given through
a vein or taken as a pill.
Targeted therapy uses medicine to block the growth and spread of cancer cells. It can be given
through a vein or taken as a pill.

Can I lower my risk for lung disease?


Things you can do to reduce your risk of lung diseases include:

Stop smoking. If you smoke, the most important thing you can do is stop. Talk to your
doctor about the best way to quit. All kinds of smoking (cigarettes, cigars, pipes, and
marijuana) can boost the chances of lung disease.

Avoid secondhand smoke. If you live or work with people who smoke cigarettes, pipes,
or cigars, ask them to smoke outside. Non-smokers have the right to a smoke-free
workplace.

Test for radon. Find out if there are high levels of the gas radon in your home or
workplace. You can buy a radon test kit at most hardware stores. The U.S. Environmental
Protection Agency offers information on how to deal with radon.

Avoid asbestos. Exposure to asbestos can cause scarring of the lungs, lung cancer, and
other serious lung disease. Asbestos can be a particular concern for those whose jobs put
them in contact with it. This includes people who maintain buildings that have insulation
or other materials that contain asbestos and people who repair car brakes or clutches.
Employers of those who work with asbestos should offer training about asbestos safety
and should regularly check levels of exposure. They also should provide ways to limit
exposure, such as special breathing masks that filter asbestos dust from the air.

Protect yourself from dust and chemical fumes. Working in dusty conditions and
with chemicals can increase your risk of lung disease. And the risk is not just from
industrial chemicals. Many products used at home, like paints and solvents, can cause or
aggravate lung disease. Read labels and carefully follow instructions for use. If possible,
avoid using products that cause eye, nose, or throat irritation. If you can't avoid them,
use them as little as possible and only in a well-ventilated area. Wear protective
equipment such as a special mask. Make sure you know which type of equipment you
need and how to wear it.

Eat a healthy diet. The National Cancer Institute notes that studies show that eating a
lot of fruits or vegetables may help lower the risk of lung cancer. Of course, diet can't
undo the damage caused by unhealthy behaviors like smoking.

Ask your doctor if you should have a spirometry test. Some groups recommend
routine spirometry testing of at-risk people, such as people who are over 45 and smoke
and those who are exposed to lung-damaging substances at work.

Ask your doctor about protecting yourself from flu and pneumonia with
vaccinations.

See your doctor if you have a cough that won't go away, trouble breathing, pain or
discomfort in your chest, or any of the other symptoms described here.

DEPRESSION
What is depression?
Life is full of ups and downs. But when the down times last for weeks or months at a time or keep
you from your regular activities, you may be suffering from depression. Depression is a medical
illness that involves the body, mood, and thoughts. It affects the way you eat and sleep, the way
you feel about yourself, and the way you think about things.
It is different from feeling "blue" or down for a few hours or a couple of days. It is not a condition
that can be willed or wished away.

What are the different types of depression?


Different kinds of depression include:

Major depressive disorder. Also called major depression, this is a combination of


symptoms that hurt a person's ability to work, sleep, study, eat, and enjoy hobbies.

Dysthymic (diss-TIME-ic) disorder. Also called dysthymia, this kind of depression


lasts for a long time (two years or longer). The symptoms are less severe than major
depression but can prevent you from living normally or feeling well.

Some kinds of depression show slightly different symptoms than those described above. Some
may start after a particular event. However, not all scientists agree on how to label and define
these forms of depression. They include:

Psychotic depression, which occurs when a severe depressive illness happens with
some form of psychosis, such as a break with reality, hallucinations, and delusions.

Postpartum depression, which is diagnosed if a new mother has a major depressive


episode within one month after delivery.

Seasonal affective disorder (SAD), which is a depression during the winter months,
when there is less natural sunlight.

What causes depression?


There is no single cause of depression. There are many reasons why a woman may become
depressed:

Genetics (family history) If a woman has a family history of depression, she may be
more at risk of developing it herself. However, depression may also occur in women who
don't have a family history of depression.

Chemical imbalance The brains of people with depression look different than those
who don't have depression. Also, the parts of the brain that manage your mood,
thoughts, sleep, appetite, and behavior don't have the right balance of chemicals.

Hormonal factors Menstrual cycle changes, pregnancy, miscarriage, postpartum


period, perimenopause, and menopause may all cause a woman to develop depression.

Stress Stressful life events such as trauma, loss of a loved one, a bad relationship,
work responsibilities, caring for children and aging parents, abuse, and poverty may
trigger depression in some people.

Medical illness Dealing with serious medical illnesses like stroke, heart attack, or
cancer can lead to depression.

What are the signs of depression?


Not all people with depression have the same symptoms. Some people might only have a few,
and others a lot. How often symptoms occur, and how long they last, is different for each person.
Symptoms of depression include:

Feeling sad, anxious, or "empty"

Feeling hopeless

Loss of interest in hobbies and activities that you once enjoyed

Decreased energy

Difficulty staying focused, remembering, making decisions

Sleeplessness, early morning awakening, or oversleeping and not wanting to get up

No desire to eat and weight loss or eating to "feel better" and weight gain

Thoughts of hurting yourself

Thoughts of death or suicide

Easily annoyed, bothered, or angered

Constant physical symptoms that do not get better with treatment, such as headaches,
upset stomach, and pain that doesn't go away

I think I may have depression. How can I get help?


Below are some people and places that can help you get treatment.

Family doctor

Counselors or social workers

Family service, social service agencies, or clergy person

Employee assistance programs (EAP)

Psychologists and psychiatrists

If you are unsure where to go for help, check the Yellow Pages under mental health, health,
social

services,

suicide

prevention,

crisis

intervention

services,

hotlines,

hospitals, or physicians for phone numbers and addresses.

What if I have thoughts of hurting myself?


Depression can make you think about hurting yourself or suicide. You may hurt yourself to:

Take away emotional pain and distress

Avoid, distract from, or hold back strong feelings

Try to feel better

Stop a painful memory or thought

Punish yourself

Release or express anger that you're afraid to express to others

Yet, hurting yourself does just that it hurts you. If you are thinking about hurting or even
killing yourself, please ask for help! Call 911, 800-273-TALK (8255) or 800-SUICIDE, or check
in your phone book for the number of a suicide crisis center. The centers offer experts who can
help callers talk through their problems and develop a plan of action. These hotlines can also tell
you where to go for more help in person. You also can talk with a family member you trust, a
clergy person, or a doctor. There is nothing wrong with asking for help everyone needs help
sometimes.
You might feel like your pain is too overwhelming to cope with, but those times don't last forever.
People do make it through suicidal thoughts. If you can't find someone to talk with, write down
your thoughts. Try to remember and write down the things you are grateful for. List the people
who are your friends and family, and care for you. Write about your hopes for the future. Read
what you have written when you need to remind yourself that your life is IMPORTANT!

How is depression found and treated?


Most people with depression get better when they get treatment.
The first step to getting the right treatment is to see a doctor. Certain medicines, and some
medical conditions (such as viruses or a thyroid disorder), can cause the same symptoms as
depression. Also, it is important to rule out depression that is associated with another mental
illness called bipolar disorder. A doctor can rule out these possibilities with a physical exam,
asking questions, and/or lab tests, depending on the medical condition. If a medical condition and
bipolar disorder can be ruled out, the doctor should conduct a psychological exam or send the
person to a mental health professional.
Once identified, depression almost always can be treated with:

Therapy

Medicine called antidepressants

Both therapy and medicine

Some people with milder forms of depression do well with therapy alone. Others with moderate to
severe depression might benefit from antidepressants. It may take a few weeks or months before
you begin to feel a change in your mood. Some people do best with both treatments therapy
and antidepressants.

Should I stop taking my antidepressant while I am pregnant?


The decision whether or not to stay on medications is a hard one. You should talk with your
doctor. Medication taken during pregnancy does reach the fetus. In rare cases, some
antidepressants have been associated with breathing and heart problems in newborns, as well as
jitteriness, difficulty feeding, and low blood sugar after delivery. However, moms who stop
medications can be at high risk of their depression coming back. Talk to your doctor about the
risks and benefits of taking antidepressants during pregnancy. Your doctor can help you decide
what is best for you and your baby. In some cases, a woman and her doctor may decide to slowly
lower her antidepressant dose during the last month of pregnancy. Doing so can help the
newborn suffer from fewer withdrawal symptoms. After delivery, a woman can return to a full
dose. This can help her feel better during the postpartum period, when risk of depression can be
greater.

Should I stop taking my antidepressant while breastfeeding?


If you stopped taking your medication during pregnancy, you may need to begin taking it again
after the baby is born. Be aware that because your medication can be passed into your breast
milk, breastfeeding may pose some risk for a nursing infant.
What are SSRIs?
Selective serotonin reuptake inhibitors (SSRIs) are a kind of antidepressant for treating depression
and anxiety disorders.
However, a number of research studies show that certain antidepressants, such as some of the
SSRIs (see box at right) have been used relatively safely during breastfeeding. You should
discuss with your doctor whether breastfeeding is an option or whether you should plan to feed
your baby formula. Although breastfeeding has some advantages for your baby, most
importantly, as a mother, you need to stay healthy so you can take care of your baby.
Before taking medication for an anxiety disorder:

Ask your doctor to tell you about the effects and side effects of the drug.

Tell your doctor about any alternative therapies or over-the-counter medications you are
using.

Ask your doctor when and how the medication should be stopped. Some drugs can't be
stopped abruptly but must be tapered off slowly under a doctor's supervision.

Work with your doctor to determine which medication is right for you and what dosage is
best.

Be aware that some medications are effective only if they are taken regularly and that
symptoms may come back if the medication is stopped.

Is it safe for young adults to take antidepressants?


It may be safe for young people to be treated with antidepressants. However, drug companies
who make antidepressants are required to post a "black box" warning label on the medication. A
"black box" warning is the most serious type of warning on prescription drugs.
It may be possible that antidepressants make children, adolescents, and young adults more likely
to think about suicide or commit suicide. In 2007, the FDA said that makers of all antidepressant
medications should extend the warning to include young adults up through age 24.

The warning says that patients of all ages taking antidepressants should be watched closely,
especially during the first weeks of treatment. Possible side effects to look for are worsening
depression, suicidal thinking or behavior, or any unusual changes in behavior such as
sleeplessness, agitation, or withdrawal from normal social situations. Families and caregivers
should pay close attention to the patient, and report any changes in behavior to the patient's
doctor. The latest information from the FDA on antidepressants can be found on their website.

How can I help myself if I am depressed?


You may feel exhausted, helpless, and hopeless. It may be very hard to do anything to help
yourself. But it is important to realize that these feelings are part of the depression and do not
reflect real life. As you understand your depression and begin treatment, negative thinking will
fade. In the meantime:

Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or


activity that you once enjoyed. Participate in religious, social, or other activities.

Set realistic goals for yourself.

Break up large tasks into small ones, set some priorities and do what you can as you can.

Try to spend time with other people and confide in a trusted friend or relative. Try not to
isolate yourself, and let others help you.

Expect your mood to improve gradually, not immediately. Do not expect to suddenly
"snap out of" your depression. Often during treatment for depression, sleep and appetite
will begin to improve before your depressed mood lifts.

Postpone important decisions, such as getting married or divorced or changing jobs, until
you feel better. Discuss decisions with others who know you well and have a more
objective view of your situation.

Be confident that positive thinking will replace negative thoughts as your depression
responds to treatment.

DIABETES MELLITUS
What is diabetes?
Diabetes means that your blood glucose (sugar) is too high. Your blood always has some glucose
in it because the body uses glucose for energy; it's the fuel that keeps you going. But too much
glucose in the blood is not good for your health.
Your body changes most of the food you eat into glucose. Your blood takes the glucose to the
cells throughout your body. The glucose needs insulin to get into the body's cells. Insulin is a
hormone made in the pancreas, an organ near the stomach. The pancreas releases insulin into
the blood. Insulin helps the glucose from food get into body cells. If your body does not make
enough insulin or the insulin does not work right, the glucose can't get into the cells, so it stays
in the blood. This makes your blood glucose level high, causing you to have diabetes.
If not controlled, diabetes can lead to blindness, heart disease, stroke, kidney failure,
amputations (having a toe or foot removed, for example), and nerve damage. In women,
diabetes can cause problems during pregnancy and make it more likely that your baby will be
born with birth defects.

What is pre-diabetes?
Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range.
It also means you are at risk of getting type 2 diabetes and heart disease. There is good news
though: You can reduce the risk of getting diabetes and even return to normal blood glucose
levels with modest weight loss and moderate physical activity. If you are told you have prediabetes, have your blood glucose checked again in 1 to 2 years.

What are the different types of diabetes?


The three main types of diabetes are:

Type 1 diabetes is commonly diagnosed in children and young adults, but it's a lifelong
condition. If you have this type of diabetes, your body does not make insulin, so you
must take insulin every day. Treatment for type 1 diabetes includes taking insulin shots or
using an insulin pump, making healthy food choices, getting regular physical activity,

taking aspirin daily (for many people), and controlling blood pressure and cholesterol
levels.

Type 2 diabetes is the most common type of diabetes about 9 out of 10 people with
diabetes have type 2 diabetes. You can get type 2 diabetes at any age, even during
childhood. In type 2 diabetes, your body makes insulin, but the insulin can't do its job, so
glucose is not getting into the cells. Treatment includes taking medicine, making healthy
food choices, getting regular physical activity, taking aspirin daily (for many people), and
controlling blood pressure and cholesterol levels. If you have type 2 diabetes, your body
generally produces less and less insulin over time. This means that you may need to
increase your medications or start using insulin in order to keep your diabetes in good
control.

Gestational (jess-TAY-shun-ul) diabetes occurs during pregnancy. This type of


diabetes occurs in about 1 in 20 pregnancies. During pregnancy your body makes
hormones that keep insulin from doing its job. To make up for this, your body makes
extra insulin. But in some women this extra insulin is not enough, so they get gestational
diabetes. Gestational diabetes usually goes away when the pregnancy is over. Women
who have had gestational diabetes are very likely to develop type 2 diabetes later in life.

Who gets diabetes?


About 24 million Americans have diabetes, about half of whom are women. As many as one
quarter do not know they have diabetes.
Type 1 diabetes occurs at about the same rate in men and women, but it is more common in
Caucasians than in other ethnic groups.
Type 2 diabetes is more common in older people, mainly in people who are overweight. It is more
common in African-Americans, Hispanic-Americans/Latinos, and American Indians.

What causes diabetes?


Type 1 and type 2 diabetes The exact causes of both types of diabetes are still not known.
For both types, genetic factors make it possible for diabetes to develop. But something in the
person's environment is also needed to trigger the onset of diabetes. With type 1 diabetes, those
environmental triggers are unknown. With type 2 diabetes, the exact cause is also unknown, but
it is clear that excess weight helps trigger the disease. Most people who get type 2 diabetes are
overweight.

Gestational diabetes Changing hormones and weight gain are part of a healthy pregnancy,
but these changes make it hard for your body to keep up with its need for insulin. When that
happens, your body doesn't get the energy it needs from the foods you eat.

Am I at risk for diabetes?


The risk factors for type 1 diabetes are unknown. Things that can put you at risk for type 2
diabetes include:

Age being older than 45

Overweight or obesity

Family history having a mother, father, brother, or sister with diabetes

Race/ethnicity your family background is African-American, American Indian/Alaska


Native, Hispanic-American/Latino, Asian-American/Pacific Islander and Native Hawaiian

Having a baby with a birth weight more than 9 pounds

Having diabetes during pregnancy (gestational diabetes)

High blood pressure 140/90 mmHg or higher. Both numbers are important. If one or
both numbers are usually high, you have high blood pressure.

High cholesterol total cholesterol over 240 mg/dL

Inactivity exercising less than 3 times a week

Abnormal results in a prior diabetes test

Having other health conditions that are linked to problems using insulin,
like polycystic ovarian syndrome (PCOS)

Having a history of heart disease or stroke

Should I be tested for diabetes?


If you're at least 45 years old, you should get tested for diabetes, and then you should be tested
again every 3 years. If you're 45 or older and overweight (Calculate your Body Mass Index) you

may want to get tested more often. If you're younger than 45, overweight, and have one or more
of the risk factors listed in "Am I at Risk for Diabetes?" you should get tested now. Ask your
doctor for a blood glucose or A1c test. Your doctor will tell you if you have normal blood glucose
(blood sugar), pre-diabetes, or diabetes.

What are the signs of diabetes?

Being very thirsty

Urinating a lot

Feeling very hungry

Feeling very tired

Losing weight without trying

Having sores that are slow to heal

Having dry, itchy skin

Losing feeling in or having tingling in the hands or feet

Having blurry vision

Having more infections than usual

If you have one or more of these signs, see your doctor.

How can I take care of myself if I have diabetes?


Many people with diabetes live healthy and full lives. By following your doctor's instructions and
eating right, you can too. Here are the things you'll need to do to keep your diabetes in check:

Follow your meal plan Eat lots of whole grain foods, fruits, and vegetables.

Get moving Health benefits are gained by doing the following each week:
o

2 hours and 30 minutes of moderate intensity aerobic physical activity


or

1 hour and 15 minutes of vigorous-intensity aerobic physical activity

or
o

A combination of moderate and vigorous-intensity aerobic physical activity


and

Muscle-strengthening activities on 3 days

Test your blood glucose Keep track of your blood glucose levels and talk to your
doctor about ways to keep your levels on target. Many women report that their blood
glucose levels go up or down around their period. If you're going through menopause,
you might also notice your blood glucose levels going up and down.

Take your diabetes medicine exactly as your doctor tells you.

Talk to your doctor about other things you can do to take good care of yourself. Taking care of
your diabetes can help prevent serious problems in your eyes, kidneys, nerves, gums and teeth,
and blood vessels.

How can I take care of myself if I have gestational diabetes?


Taking care of yourself when you have gestational diabetes is very much like taking care of
yourself when you have other types of diabetes. But it can be a little scary when you're pregnant
and you also have a new condition to take care of. Don't worry. Many women who've had
gestational diabetes have gone on to have healthy babies. Here are the things you'll need to do:

Follow your meal plan You will meet with a dietitian or diabetes educator who will
help you design a meal plan full of healthy foods for you and your baby. You will be
advised to:
o

Limit sweets

Eat often three small meals and one to three snacks every day

Be careful about the carbohydrates you eat your meal plan will tell you
when to eat carbohydrates and how much to eat at each meal and snack

Eat lots of whole grain foods, fruits, and vegetables

Get moving try to be active for at least 2 hours and 30 minutes each week. If you're
already active, your doctor can help you make an exercise plan for your pregnancy. If you
haven't been active in the past, talk to your doctor. Your doctor can suggest activities,
such as swimming or walking, to help keep your blood glucose on track.

Test your blood glucose Your doctor may ask you to use a small device called a
blood glucose meter to check your blood glucose levels. You will be shown how to use the
meter to check your blood glucose. Your diabetes team will tell you what your target
blood glucose range is, how often you need to check your blood glucose, and what to do
if it is not where it should be.

The following chart shows blood glucose targets for most women with gestational diabetes. Talk
with your health care team about whether these targets are right for you.

Blood glucose targets for most women with gestational diabetes

On awakening

not above 95 mg/dL

1 hour after a meal

not above 140 mg/dL

2 hours after a meal

not above 120 mg/dL

Each time you check your blood glucose, write down the results in a record
book. Take the book with you when you visit your health care team. If your results are
often out of range, your health care team will suggest ways you can reach your targets.

Take your diabetes medicine exactly as your doctor tells you. You may need to
take insulin to keep your blood glucose at the right level. If so, your health care team will
show you how to give yourself insulin shots. Insulin will not harm your baby it cannot
move from your bloodstream to your baby's.

Is there a cure for diabetes?


There is no cure for diabetes at this time, but there is a great deal of research going on in hopes
of finding cures for both type 1 and type 2 diabetes. Many different approaches to curing diabetes
are being studied, and researchers are making progress.

Is there anything I can do to prevent diabetes?


Yes. The best way to prevent diabetes is to make some lifestyle changes:

Maintain a healthy weight. Being overweight raises your risk for diabetes. Calculate
your Body Mass Index (BMI) to see if you're at a healthy weight. If you're overweight,
start making small changes to your eating habits by adding more whole grain foods,
fruits, and vegetables. Start exercising more, even if taking a short walk is all you can do
for now. If you're not sure where to start, talk to your doctor. Even a relatively small

amount of weight loss 10 to 15 pounds has been proven to delay or even prevent the
onset of type 2 diabetes.

Eat healthy
o

Eat lots of whole grains (such as whole wheat or rye bread, whole grain
cereal, or brown rice), fruits, and vegetables.

Choose foods low in fat and cholesterol. Read food labels. If you eat 2,000
calories per day, you should eat no more than 56 grams of fat each day.

If you drink alcohol, limit it to no more than one or two drinks (one 12ounce beer, one 5-ounce glass of wine, or one 1.5-ounce shot of hard liquor)
a day.

Get moving. Health benefits are gained by doing the following each week:
o

2 hours and 30 minutes of moderate intensity aerobic physical activity


or

1 hour and 15 minutes of vigorous-intensity aerobic physical activity


or

A combination of moderate and vigorous-intensity aerobic physical activity


and

Muscle-strengthening activities on 3 days

Some suggestions for fitting physical activity in:


o

Take the stairs instead of the elevator

Take a brisk walk on your lunch break

Park at the far end of the parking lot and walk

Get off the bus or subway a few stops early and walk the rest of the way

Walk or bicycle whenever you can

SEXUALLY TRANSMITTED INFECTIONS (STI)


What is a sexually transmitted infection (STI)?
It is an infection passed from person to person through intimate sexual contact. STIs are also
called sexually transmitted diseases, or STDs.

How many people have STIs and who is infected?


In the United States about 19 million new infections are thought to occur each year. These
infections affect men and women of all backgrounds and economic levels. But almost half of new
infections are among young people ages 15 to 24. Women are also severely affected by STIs.
They have more frequent and more serious health problems from STIs than men. AfricanAmerican women have especially high rates of infection.

How do you get an STI?


You can get an STI by having intimate sexual contact with someone who already has the
infection. You cant tell if a person is infected because many STIs have no symptoms. But STIs
can still be passed from person to person even if there are no symptoms. STIs are spread during
vaginal, anal, or oral sex or during genital touching. So its possible to get some STIs without
having intercourse. Not all STIs are spread the same way.

Can STIs cause health problems?


Yes. Each STI causes different health problems. But overall, untreated STIs can cause
cancer, pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other
parts of the body, organ damage, and even death.
Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual
behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs
makes it easier for you to get HIV if you are exposed.

What are the symptoms of STIs?


Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are
mistaken for something else, such as urinary tract infection or yeast infection. This is why
screening for STIs is so important. The STIs listed here are among the most common or harmful
to women.

Symptoms of sexually transmitted infections

STI

Bacterial

Symptoms

Most women have no symptoms. Women with symptoms may have:

vaginosis (BV)

Chlamydia

Vaginal itching

Pain when urinating

Discharge with a fishy odor

Most women have no symptoms. Women with symptoms may have:

Abnormal vaginal discharge

Burning when urinating

Bleeding between periods

Infections that are not treated, even if there are no symptoms, can lead to:

Genital herpes

Lower abdominal pain

Low back pain

Nausea

Fever

Pain during sex

Some people may have no symptoms. During an outbreak, the symptoms


are clear:

Small red bumps, blisters, or open sores where the virus entered
the body, such as on the penis, vagina, or mouth

Vaginal discharge

Fever

Headache

Muscle aches

Pain when urinating

Itching, burning, or swollen glands in genital area

Pain in legs, buttocks, or genital area

Symptoms may go away and then come back. Sores heal after 2 to 4
weeks.

Gonorrhea

Symptoms are often mild, but most women have no symptoms. If symptoms

are present, they most often appear within 10 days of becoming infected.
Symptoms are:

Pain or burning when urinating

Yellowish and sometimes bloody vaginal discharge

Bleeding between periods

Pain during sex

Heavy bleeding during periods

Infection that occurs in the throat, eye, or anus also might have symptoms in
these parts of the body.
Hepatitis B

HIV/AIDS

Some women have no symptoms. Women with symptoms may have:

Low-grade fever

Headache and muscle aches

Tiredness

Loss of appetite

Upset stomach or vomiting

Diarrhea

Dark-colored urine and pale bowel movements

Stomach pain

Skin and whites of eyes turning yellow

Some women may have no symptoms for 10 years or more. About half of
people with HIV get flu-like symptoms about 3 to 6 weeks after becoming
infected. Symptoms people can have for months or even years before the
onset of AIDS include:

Fevers and night sweats

Feeling very tired

Quick weight loss

Headache

Enlarged lymph nodes

Diarrhea, vomiting, and upset stomach

Mouth, genital, or anal sores

Dry cough

Rash or flaky skin

Short-term memory loss

Women also might have these signs of HIV:

Vaginal yeast infections and other vaginal infections, including


STIs

Pelvic inflammatory disease (PID) that does not get better with
treatment

Human

Menstrual cycle changes

Some women have no symptoms. Women with symptoms may have:

papillomavirus
(HPV)

Visible warts in the genital area, including the thighs. Warts can
be raised or flat, alone or in groups, small or large, and sometimes
they are cauliflower-shaped.

Pubic lice

Growths on the cervix and vagina that are often invisible.

Symptoms include:

(sometimes called
"crabs")

Itching in the genital area

Finding lice or lice eggs

Syphilis

Syphilis progresses in stages. Symptoms of the primary stage are:

A single, painless sore appearing 10 to 90 days after infection. It


can appear in the genital area, mouth, or other parts of the body.
The sore goes away on its own.

If the infection is not treated, it moves to the secondary stage. This stage
starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage
are:

Skin rash with rough, red or reddish-brown spots on the hands


and feet that usually does not itch and clears on its own

Fever

Sore throat and swollen glands

Patchy hair loss

Headaches and muscle aches

Weight loss

Tiredness

In the latent stage, symptoms go away, but can come back. Without
treatment, the infection may or may not move to the late stage. In the
late stage, symptoms are related to damage to internal organs, such as
the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.
Some people may die.

Trichomoniasis

Many women do not have symptoms. Symptoms usually appear 5 to 28 days

(sometimes called

after exposure and can include:

"trich")

Yellow, green, or gray vaginal discharge (often foamy) with a


strong odor

Discomfort during sex and when urinating

Itching or discomfort in the genital area

Lower abdominal pain (rarely)

How do you get tested for STIs?


There is no one test for all STIs. Ask your doctor about getting tested for STIs. She or he can tell
you what test(s) you might need and how it is done. Testing for STIs is also called STI screening.
Testing (or screening) for STIs can involve:

Pelvic and physical exam Your doctor can look for signs of infection, such as warts,
rashes, discharge.

Blood sample

Urine sample

Fluid or tissue sample A swab is used to collect a sample that can be looked at under
a microscope or sent to a lab for testing.

Who needs to get tested for STIs?


If you are sexually active, talk to your doctor about STI screening. Which tests you might need and
how often depend mainly on your sexual history and your partners. Talking to your doctor about your
sex life might seem too personal to share. But being open and honest is the only way your doctor can
help take care of you. Also, dont assume you dont need to be tested for STIs if you have sex only
with women. Talk to your doctor to find out what tests make sense for you.

How are STIs treated?


The treatment depends on the type of STI. For some STIs, treatment may involve taking
medicine or getting a shot. For other STIs that cant be cured, like herpes, treatment can help to
relieve the symptoms.
Only use medicines prescribed or suggested by your doctor. There are products sold over the
Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human
papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will
give you. But this is not true, and the safety of these products is not known.

What can I do to keep from getting an STI?


You can lower your risk of getting an STI with the following steps. The steps work best when used
together. No single strategy can protect you from every single type of STI.

Dont have sex. The surest way to keep from getting any STI is to practice abstinence.
This means not having vaginal, oral, or anal sex. Keep in mind that some STIs, like
genital herpes, can be spread without having intercourse.

Be faithful. Having a sexual relationship with one partner who has been tested for STIs
and is not infected is another way to lower your risk of getting infected. Be faithful to
each other. This means you only have sex with each other and no one else.

Use condoms correctly and every time you have sex. Use condoms for all types of
sexual contact, even if intercourse does not take place. Use condoms from the very start
to the very end of each sex act, and with every sex partner. A male latex condom offers
the best protection. You can use a male polyurethane condom if you or your partner has
a latex allergy. For vaginal sex, use a male latex condom or a female condom if your
partner wont wear a condom. For anal sex, use a male latex condom. For oral sex, use a
male latex condom. A dental dam might also offer some protection from some STIs.

Know that some methods of birth control, like birth control pills, shots,
implants, or diaphragms, will not protect you from STIs. If you use one of these
methods, be sure to also use a condom correctly every timeyou have sex.

Talk with your sex partner(s) about STIs and using condoms before having
sex. Its up to you to set the ground rules and to make sure you are protected.

Dont assume youre at low risk for STIs if you have sex only with women. Some
common STIs are spread easily by skin-to-skin contact. Also, most women who have sex
with women have had sex with men, too. So a woman can get an STI from a male
partner and then pass it to a female partner.

Talk frankly with your doctor and your sex partner(s) about any STIs you or
your partner has or has had. Talk about symptoms, such as sores or discharge. Try not
to be embarrassed. Your doctor is there to help you with any and all health problems.
Also, being open with your doctor and partner will help you protect your health and the
health of others.

Have a yearly pelvic exam. Ask your doctor if you should be tested for STIs and how
often you should be retested. Testing for many STIs is simple and often can be done
during your checkup. The sooner an STI is found, the easier it is to treat.

Avoid using drugs or drinking too much alcohol. These activities may lead to risky
sexual behavior, such as not wearing a condom.

How do STIs affect pregnant women and their babies?

STIs can cause many of the same health problems in pregnant women as women who are not
pregnant. But having an STI also can threaten the pregnancy and unborn baby's health. Having
an STI during pregnancy can cause early labor, a woman's water to break early, and infection in
the uterus after the birth.
Some STIs can be passed from a pregnant woman to the baby before and during the babys
birth. Some STIs, like syphilis, cross the placenta and infect the baby while it is in the uterus.
Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the
mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the
placenta during pregnancy and infect the baby during the birth process.
The harmful effects to babies may include:

Low birth weight

Eye infection

Pneumonia

Infection in the babys blood

Brain damage

Lack of coordination in body movements

Blindness

Deafness

Acute hepatitis

Meningitis

Chronic liver disease

Cirrhosis

Stillbirth

Some of these problems can be prevented if the mother receives routine prenatal care, which
includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if
needed. Other problems can be treated if the infection is found at birth.

What can pregnant women do to prevent problems from STIs?

Pregnant women should be screened at their first prenatal visit for STIs, including:

Chlamydia

Gonorrhea

Hepatitis B

HIV

Syphilis

In addition, some experts recommend that women who have had a premature delivery in the
past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a
woman has been tested for STIs in the past, she should be tested again when she becomes
pregnant.
Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics
during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral
medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For
women who have active genital herpes lesions at the onset of labor, a cesarean delivery (Csection) can lower the risk of passing the infection to the newborn. For women who are HIV
positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the
newborn to less than 2 percent. C-section is also an option for some women with HIV. Women
who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.
Pregnant women also can take steps to lower their risk of getting an STI during pregnancy.

Is there any research being done on STIs?


Yes. Research on STIs is a public health priority. Research is focused on prevention, diagnosis,
and treatment.
With prevention, researchers are looking at strategies such as vaccines and topical microbicides
(meye-KROH-buh-syds). One large study is testing a herpes vaccine for women. Topical
microbicides could play a big role in protecting women from getting STIs. But so far, they have
been difficult to design. They are gels or creams that would be put into the vagina to kill or stop
the STI before it could infect someone. Researchers are also looking at the reasons some people
are at higher risk of STIs, and ways to lower these risks.
Early and fast diagnosis of STIs means treatment can start right away. Early treatment helps to
limit the effects of an STI and keep it from spreading to others. Researchers are looking at quick,
easy, and better ways to test for STIs, including vaginal swabs women can use to collect a sample

for testing. They also are studying the reasons why many STIs have no symptoms, which can
delay diagnosis.
Research also is underway to develop new ways to treat STIs. For instance, more and more
people are becoming infected with types of gonorrhea that do not respond well to drugs. So
scientists are working to develop new antibiotics to treat these drug-resistant types. An example
of treatment research success is the life-prolonging effects of new drugs used to treat HIV.

COMPLICATIONS OF PREGNANCY

Complications of pregnancy are health problems that occur during pregnancy. They can involve
the mother's health, the baby's health, or both. Some women have health problems before they
become pregnant that could lead to complications. Other problems arise during the pregnancy.
Keep in mind that whether a complication is common or rare, there are ways to manage
problems that come up during pregnancy.

Health problems before pregnancy


Before pregnancy, make sure to talk to your doctor about health problems you have now or have
had in the past. If you are receiving treatment for a health problem, your doctor might want to
change the way your health problem is managed. Some medicines used to treat health problems
could be harmful if taken during pregnancy. At the same time, stopping medicines that you need

could be more harmful than the risks posed should you become pregnant. Be assured that you
are likely to have a normal, healthy baby when health problems are under control and you get
good prenatal care.

Health problems before pregnancy

Condition

Asthma

How it can affect pregnancy

Poorly controlled asthma may increase risk of preeclampsia, poor weight gain in
the fetus, preterm birth, cesarean birth, and other complications. If pregnant
women stop using asthma medicine, even mild asthma can become severe.

Depression

Depression that persists during pregnancy can make it hard for a woman to care
for herself and her unborn baby. Having depression before pregnancy also is a risk
factor for postpartum depression.

Diabetes

High blood glucose (sugar) levels during pregnancy can harm the fetus and
worsen a woman's long-termdiabetes complications. Doctors advise getting
diabetes under control at least three to six months before trying to conceive.

Eating disorders

Body image changes during pregnancy can cause eating disorders to worsen.
Eating disorders are linked to many pregnancy complications, including birth
defects andpremature birth. Women with eating disorders also have higher rates
of postpartum depression.

Epilepsy and

Seizures during pregnancy can harm the fetus, and increase the risk

other

of miscarriage or stillbirth. But using medicine to control seizures might cause

seizure disorders

birth defects. For most pregnant women with epilepsy, using medicine poses less
risk to their own health and the health of their babies than stopping medicine.

High blood

Having chronic high blood pressure puts a pregnant woman and her baby at risk

pressure

for problems. Women with high blood pressure have a higher risk
of preeclampsiaand placental abruption (when the placenta separates from the
wall of the uterus). The likelihood of preterm birth and low birth weight also is
higher.

HIV

HIV can be passed from a woman to her baby during pregnancy or delivery. Yet
this risk is less than 2 percent if a woman takes certain HIV medicines during
pregnancy. Women who have HIV and want to become pregnant should talk to
their doctors before trying to conceive. Good prenatal care will help protect a
womans baby from HIV and keep her healthy.

Migraine

Migraine symptoms tend to improve during pregnancy. Some women have no


migraine attacks during pregnancy. Certain medicines commonly used to treat
headaches should not be used during pregnancy. A woman who has severe
headaches should speak to her doctor about ways to relieve symptoms safely.

Overweight and

Recent studies suggest that the heavier a woman is before she becomes

Obesity

pregnant, the greater her risk of a range of pregnancy complications, including


preeclampsia and preterm delivery. Overweight and obese women who lose
weight before pregnancy are likely to have healthier pregnancies.

Sexually

Some STIs can cause early labor, a woman's water to break too early, and

transmitted

infection in the uterus after birth. Some STIs also can be passed from a woman to

infections (STIs)

her baby during pregnancy or delivery. Some ways STIs can harm the baby
include: low birth weight, dangerous infections, brain damage, blindness,
deafness, liver problems, or stillbirth.

Thyroid disease

Uncontrolled hyperthyroidism (overactive thyroid) can be dangerous to the


mother and cause health problems such as heart failure and poor weight gain in
the fetus. Uncontrolled hypothyroidism (underactive thyroid) also threatens the
mother's health and can cause birth defects.

Uterine fibroids

Uterine fibroids are not uncommon, but few cause symptoms that require
treatment. Uterine fibroids rarely cause miscarriage. Sometimes, fibroids can
cause preterm or breech birth. Cesarean delivery may be needed if a fibroid
blocks the birth canal.

Pregnancy related problems


Sometimes pregnancy problems arise even in healthy women. Some prenatal tests done
during pregnancy can help prevent these problems or spot them early. Use this chart to learn
about some common pregnancy complications. Call your doctor if you have any of the symptoms
on this chart. If a problem is found, make sure to follow your doctor's advice about treatment.
Doing so will boost your chances of having a safe delivery and a strong, healthy baby.

Health problems during pregnancy

Problem

Symptoms

Treatment

Treating the underlying cause of the


Anemia Lower than normal

number of healthy red blood

Feel tired
or weak

cells

anemia will help restore the number of


healthy red blood cells. Women with
pregnancy related anemia are helped by

Look pale

taking iron and folic acid supplements.


Your doctor will check your iron levels

Feel faint

Shortness

throughout pregnancy to be sure anemia


does not happen again.

of breath

Depression Extreme
sadness during pregnancy or

Women who are pregnant might be

Intense
sadness

after birth (postpartum)

Helplessne

helped with one or a combination of


treatment options, including:

Therapy

Support groups

Medicines

ss and
irritability

Appetite
changes

Thoughts
of harming
self or baby

A mother's depression can affect her


baby's development, so getting
treatment is important for both
mother and baby. Learn more about
depression during and after
pregnancy.

Ectopic (ek-TOP-ihk)
pregnancy When a

With ectopic pregnancy, the egg cannot

Abdominal
pain

fertilized egg implants outside


of the uterus, usually in
the fallopian tube

develop. Drugs or surgery is used to


remove the ectopic tissue so your organs
are not damaged.

Shoulder
pain

Vaginal ble
eding

Feeling
dizzy or faint

Fetal problems Unborn


baby has a health issue, such

Treatment depends on results of tests to

Baby

monitor baby's health. If a test suggests a

as poor growth or heart

moving less

problem, this does not always mean the

problems

than normal

baby is in trouble. It may only mean that

(Learn how to

the mother needs special care until the

count your

baby is delivered. This can include a wide

baby's

variety of things, such as bed rest,

movements o

depending on the mother's condition.

n our Prenatal

Sometimes, the baby has to be delivered

care and tests

early.

page.)

Baby is
smaller than
normal for
gestational
age

Some
problems have
no symptoms,
but are found
with prenatal
tests

Gestational diabetes Too


high blood sugar levels during

Most women with pregnancy related

pregnancy

Usually,

diabetes can control their blood

there are no

sugar levels by a following a healthy

symptoms.

meal plan from their doctor. Some

Sometimes,

women also need insulin to keep

extreme

blood sugar levels under control.

thirst, hunger,

Doing so is important because poorly

or fatigue

controlled diabetes increases the risk


of:

Screening
test shows

Preeclampsia

Early delivery

Cesearean birth

Having a big baby, which can

high blood
sugar levels

complicate delivery

Baby born with low blood


sugar, breathing problems,
and jaundice

High blood
pressure(pregnancy

The health of the mother and baby are

High blood

related) High blood

pressure

pressure that starts after 20

without other

weeks of pregnancy and goes

signs and

away after birth

symptoms of

closely watched to make sure high blood


pressure is not preeclampsia.

preeclampsia

Hyperemesis
gravidarum(HEYE-pur-EM-

Dry, bland foods and fluids together is the

Nausea

first line of treatment. Sometimes,

uh-suhss grav-uh-DAR-

that does not

medicines are prescribed to help nausea.

uhm) (HG) Severe,

go away

Many women with HG have to be

persistent nausea and


vomiting during pregnancy

hospitalized so they can be fed fluids and

Vomiting

nutrients through a tube in their veins.

more extreme than "morning

several times

Usually, women with HG begin to feel

sickness"

every day

better by the 20th week of pregnancy. But


some women vomit and feel nauseated

Weight loss

Reduced

throughout all three trimesters.

appetite

Dehydratio
n

Feeling
faint or
fainting

Miscarriage Pregnancy loss

Signs of a

In most cases, miscarriage cannot be

from natural causes before 20

miscarriage can

prevented. Sometimes, a woman must

weeks. As many as 20 percent

include:

undergo treatment to remove pregnancy

of pregnancies end in
miscarriage. Often,

tissue in the uterus. Counseling can help

Vaginal spo

miscarriage occurs before a

tting or

woman even knows she is

bleeding*

pregnant

with emotional healing. See our section on


Pregnancy loss.

Cramping
or abdominal
pain

Fluid or
tissue passing
from the
vagina

* Spotting early in
pregnancy doesn't
mean miscarriage
is certain. Still,
contact your
doctor right away
if you have any
bleeding.

Placenta previa Placenta


covers part or entire opening

If diagnosed after the 20th week of

of cervix inside of the uterus

Painless va

pregnancy, but with no bleeding, a woman

ginal bleeding

will need to cut back on her activity level

during second

and increase bed rest. If bleeding is

or third

heavy, hospitalization may be needed

trimester

until mother and baby are stable. If the


bleeding stops or is light, continued bed

For some,
no symptoms

rest is resumed until baby is ready for


delivery. If bleeding doesn't stop or
if preterm labor starts, baby will be
delivered by cesarean section.

Placental
abruption Placenta

When the separation is minor, bed rest for

Vaginal ble
eding

separates from uterine wall


before delivery, which can
mean the fetus doesn't get

a few days usually stops the bleeding.


Moderate cases may require complete bed
rest. Severe cases (when more than half

enough oxygen.

Cramping,

of the placenta separates) can require

abdominal

immediate medical attention and early

pain, and

delivery of the baby.

uterine
tenderness

Preeclampsia (pree-eeCLAMP-see-uh) A condition

The only cure is delivery, which may not

High blood

be best for the baby. Labor will probably

starting after 20 weeks of

be induced if condition is mild and the


pressure

pregnancy that causes high


blood pressure and problems
with the kidneys and other

woman is near term (37 to 40 weeks of


pregnancy). If it is too early to deliver, the

organs. Also called toxemia.

Swelling of

doctor will watch the health of the mother

hands and

and her baby very closely. She may need

face

medicines and bed rest at home or in the


hospital to lower her blood pressure.

Too much
protein in

Medicines also might be used to prevent


the mother from having seizures.

urine

Stomach
pain

Blurred
vision

Dizziness

Headaches

Preterm labor Going into


labor before 37 weeks of

Medicines can stop labor from

pregnancy

Increased

progressing. Bed rest is often advised.

vaginal

Sometimes, a woman must deliver early.

discharge

Giving birth before 37 weeks is called


"preterm birth." Preterm birth is a major

Pelvic

risk factor for future preterm births.

pressure and
cramping

Back pain
radiating to
the abdomen

Contractio
ns

Infections during pregnancy


During pregnancy, your baby is protected from many illnesses, like the common cold or a passing
stomach bug. But some infections can be harmful to your pregnancy, your baby, or both. This
chart provides an overview of infections that can be harmful during pregnancy. Learn the

symptoms and what you can do to keep healthy. Easy steps, such as hand washing, practicing
safe sex, and avoiding certain foods, can help protect you from some infections.

Infections during pregnancy

Infection

Symptoms

Bacterial vaginosis (BV)

Prevention and treatment


How to prevent BV is unclear.

Grey or whitish

BV is not passed through

A vaginal infection that is

discharge that has

sexual contact, although it is

caused by an overgrowth

a foul, fishy odor

linked with having a new or

of bacteria normally found


in the vagina.

more than one sex partner.

BV has been linked

Burning when
passing urine or

Women with symptoms should

itching

be tested for BV.

topreterm birth and low


birth weight babies.

Some women
have no symptoms

Cytomegalovirus (SEYEtoh-MEG-uh-loh VEYE-

Antibiotics are used to treat


BV.

Good hygiene is the best way

Mild illness that

to keep from getting CMV.

may include fever,

ruhss) (CMV)

sore throat,

No treatment is currently

A common virus that can

fatigue, and

available. But studies are

cause disease in infants

swollen glands

looking at antiviral drugs for

whose mothers are


infected with CMV during

use in infants. Work to create

Some women
have no symptoms

pregnancy. CMV infection

a CMV vaccine also is


underway.

in infants can lead to


hearing loss, vision loss,
and other disabilities.

Group B strep (GBS)

You can keep from passing

No symptoms

GBS to your baby by getting

Group B strep is a type of

tested at 35 to 37 weeks. This

bacteria often found in the

simply involves swabbing the

vagina and rectum of

vagina and rectum and does

healthy women. One in

not hurt.

four women has it. GBS


usually is not harmful to

If you have GBS,

you, but can be deadly to

an antibiotic given to you

your baby if passed during

during labor will protect your

childbirth.

baby from infection. Make


sure to tell the labor and
delivery staff that you are a
group B strep carrier when
you check into the hospital.

Hepatitis B virus (HBV)


A viral infection that can

There may be no

Lab tests can find out if the

symptoms. Or

mother is a carrier of hepatitis

symptoms can include:

B.

be passed to baby during


birth. Newborns that get

Nausea,

You can protect your baby for

infected have a 90 percent

vomiting, and

life from HBV with the

chance of developing

diarrhea

hepatitis B vaccine, which is a

lifelong infection. This can


lead to liver damage and

series of three shots:

Dark urine and

liver cancer. A vaccine can

pale bowel

keep newborns from

movements

B vaccine plus HBIG shot


given to baby at birth

getting HBV. But 1 in 5


newborns of mothers who

First dose of hepatitis

Whites of eyes

are HBV positive dont get

or skin looks

the vaccine at the hospital

yellow

Second dose of
hepatitis B vaccine given
to baby at 1-2 months

before leaving.

old

Third dose of hepatitis


B vaccine given to baby
at 6 months old (but not
before 24 weeks old)

Influenza (flu)

Getting a flu shot is the first

Fever

and most important step in

Flu is a common viral

(sometimes) or

protecting against flu. The flu

infection that is more likely

feeling

shot given during pregnancy

to cause severe illness in

feverish/chills

is safe and has been shown to

pregnant women than in


women who are not

protect both the mother and

Cough

pregnant. Pregnant woman


with flu also have a

from flu. (The nasal spray

Sore throat

greater chance for serious


problems for their unborn
baby, including premature

her baby (up to 6 months old)


vaccine should not be given to
women who are pregnant.)

Runny or stuffy
nose

labor and delivery.

If you get sick with flu-like

Muscle or body
aches

symptoms call your doctor


right away. If needed, the
doctor will prescribe an

Headaches

antiviral medicine that treats


the flu.

Feeling tired
Vomiting and
diarrhea
(sometimes)

Listeriosis (lih-steer-eeOH-suhss)

Avoid foods that can harbor

Fever, muscle

listeria.

aches, chills
An infection with the
harmful bacteria called

Antibiotics are used to treat

Sometimes

Learn more from our

refrigerated and ready-toeat foods. Infection can

listeriosis.

diarrhea or nausea

listeria. It is found in some

If progresses,

Pregnancy food don'ts

cause early delivery or

severe headache

Print-and-go guide (PDF, 126

miscarriage.

and stiff neck

KB).

Parvovirus B19 (fifth


disease)

No specific treatment, except

Low-grade
fever

Most pregnant women who


are infected with this virus

Tiredness

Rash on face,
trunk, and limbs

infect the fetus. This raises


during the first 20 weeks
of pregnancy. Fifth disease
can cause
severe anemia in women
who have red blood cell
disorders like sickle cell
disease or immune system
problems.

systems or with red blood cell


disorders. There is no vaccine to

small chance the virus can


the risk of miscarriage

be needed for people who have


problems with their immune

do not have serious


problems. But there is a

for blood transfusions that might

Painful and
swollen joints

help prevent infection with this


virus.

Sexually transmitted
infection (STI)

STIs can be prevented by

Symptoms

practicing safe sex. A woman

depend on the

can keep from passing an STI

An infection that is passed

STI. Often, a

to her baby by being screened

through sexual contact.

woman has no

early in pregnancy.

Many STIs can be passed

symptoms, which

to the baby in the womb

is why screening

Treatments vary depending on

or during birth. Some

for STIs during

the STI. Many STIs are

effects

pregnancy is so

treated easily with antibiotics.

include stillbirth, low birth

important.

weight, and lifethreatening infections.

For more

STIs also can cause a

information, see

woman's water to break

our Sexually

too early or preterm labor.

transmitted
infections fact
sheet.

Toxoplasmosis (TOKsoh-plaz-MOH-suhss)

You can lower your risk by:

Mild flu-like
symptoms, or

Washing hands with

This infection is caused by

possibly no

soap after touching soil

a parasite, which is found

symptoms.

or raw meat

in cat feces, soil, and raw


or undercooked meat. If

Washing produce
before eating

passed to an unborn baby,


the infection can cause
hearing loss, blindness, or

Cooking meat
completely

intellectual disabilities.

Washing cooking
utensils with hot, soapy
water

Not cleaning cats'


litter boxes

Medicines are used to treat a


pregnant woman and her
unborn baby. Sometimes, the
baby is treated with medicine
after birth.

Urinary tract
infection(UTI)

UTIs are treated with antibiotics.

Pain or burning
when urinating

Bacterial infection in
urinary tract. If untreated,

Frequent
urination

it can spread to the


kidneys, which can
cause preterm labor.

Pelvis, back,
stomach, or side
pain

Shaking, chills,
fever, sweats

Yeast infection

Vaginal creams and suppositories

Extreme

An infection caused by an

itchiness in and

overgrowth of bacteria

around the vagina

are used to treat yeast infection


during pregnancy.

normally found in the


vagina. Yeast infections

Burning,

are more common during

redness, and

pregnancy than in other

swelling of the

times of a woman's life.

vagina and

They do not threaten the

the vulva

health of your baby. But


they can be uncomfortable

Pain when

and difficult to treat in

passing urine or

pregnancy.

during sex

A thick, white
vaginal discharge
that looks like
cottage cheese
and does not have
a bad smell

When to call the doctor or midwife


When you are pregnant don't wait to call your doctor or midwife if something is bothering or
worrying you. Sometimes physical changes can be signs of a problem.
Call your doctor or midwife as soon as you can if you:

Are bleeding or leaking fluid from the vagina

Have sudden or severe swelling in the face, hands, or fingers

Get severe or long-lasting headaches

Have discomfort, pain, or cramping in the lower abdomen

Have a fever or chills

Are vomiting or have persistent nausea

Feel discomfort, pain, or burning with urination

Have problems seeing or blurred vision

Feel dizzy

Suspect your baby is moving less than normal after 28 weeks of pregnancy (If you count
less than 10 movements within two hours. Learn how to count your baby's movements on
our Prenatal care and tests page.)

Have thoughts of harming yourself or your baby