Pregnancy

Prenatal Examination

During the prenatal examination, your medical history will be taken. If you have had a baby before or are registered in a hospital, then they should have most of your history on file.  If you are using a new hospital then you may need to ask for a referral or transfer of your case file to the new hospital. So who do you see? A Ggynaecologist is a doctor whose area of specialization involves women’s reproductive health while an Obstetrician specializes in natal care, childbirth and antenatal care for mothers.

Some pregnancies are termed high-risk because of the increased chances of complications they may have over normal pregnancies. Many times, pregnancies which are termed high-risk go on normally and birth perfectly normal children. Your Gynaecologist should offer guidance and advice if you or your pregnancy is at risk.  During the check, a number of factors will be assessed.

Medical History

Age

BMI: Pre-pregnancy And Pregnancy Weight

Genotype & Genetics

Tests and Vaccinations

Medical History

During your visit, your gynecologist will ask many questions about your health; especially if the hospital does not have your records and carry out a physical exam. Some of the questions might require prior preparation, while others can be answered on the spot. You may need to request for a transfer of records if you are having your second (subsequent) baby in a different hospital. A few of some of the questions include:

  • Menstruation –Age of first menstruation? Date of your last period? What is the length of your cycle? Frequency of periods?
  • Physical wellbeing –occupation, diet, exercise, etc
  • Social habits –Do you smoke or drink? If yes, occasionally/regularly?
  • Previous pregnancies –including abortions, miscarriages, still births, ectopic pregnancies
  • Previous medical conditions or procedures –vaccination history, vaginal infections, cervical screening or pap smear, gestational diabetes, preeclampsia, high blood pressure, STDs/STIs, fibroids, etc
  • Sexual lifestyle
  • Allergic reactions – Are you allergic to drugs, food, health, etc
  • Dental care – have you ever seen a dentist? When last did you see one?

Age

Age 20 -24 is commonly referred to as the most fertile age period in a woman’s life. This does not however mean that women are not fertile outside this age range. Pregnancies of women who are over 35 years of age (or under-aged girls) are termed high-risk pregnancies because of the possible risks they or their foetus may face. Some of the possible factors associated with older/younger aged pregnancies include:

  • Increased chances of delivery through a cesarean section.
  • Increased risk of miscarriages and stillborns.
  • Older women tend to have better diet and health habits than younger ones during pregnancy.
  • Increased incidence of antenatal check-ups and tests (this is mostly seen amongst older women).
  • Increased risk of chromosomal abnormalities like with Down’s syndrome (this is mostly seen amongst older women).

As women grow older, the chances of having a child with Down’s syndrome increases, though many women over 35-40 go on to have normal children.

At age 20, a woman has a 1 in 1500 chance of having a child with Down’s syndrome.

At age 30, a woman has a 1 in 1000 chance of having a child with Down’s syndrome.

The odds increase to 1 in 400 at age 35 and 1 in 100 at age 40. Down’s syndrome can be detected while a child is in the womb and even though no medical cure is currently available, most health issues associated with it can be treated and managed with the right healthcare provision.

Don’t let these statistics scare you; many pregnancies and deliveries go on smoothly without any birth defects or complications.  All pregnant women, regardless of age, are usually offered screening tests for genetic abnormalities like Down’s syndrome. See your medical practitioner if you have any concerns.

Being an older mum does not mean you will not enjoy your pregnancy or enjoy being a mum, many women who are over 35 have perfectly pleasant pregnancies and fulfilling motherhoods. Older mums can find support and share experiences with other older mums who have been there and had their babies. You may find the encouragement you need to get through your pregnancy and beyond see our Community forum for Older Mums.

BMI: Pre-pregnancy And Pregnancy Weight

A good prenatal check up should include height and weight measurements to determine if you are a nice, healthy weight. Many over/under weight women go on to have normal pregnancies but ensuring that you are fit and healthy can help you prevent other complications or diseases during pregnancy and later on in life. Depending on your pre-pregnancy BMI/weight, you may need to either lose some weight or gain a little more than other women with normal weights. Your BMI (Body Mass Index) is a type of body mass measurement which evaluates your weight with respect to your height. To calculate your BMI, you divide your weight in kilograms by the square of your height in metres (i.e. your height multiplied by itself).

I.e. BMI = (Your Weight in kg) / (Your Height in metres) 2

Typically:

  • An underweight  person has a BMI less than 18
  • An overweight  person has a BMI  between 25-29.9
  • An obese person has a BMI greater than 30

If you think that you are over/underweight, start making healthy life changes right now by changing your diet or lifestyle as necessary. The following show typical weight gains during pregnancy:

  • Women who were obese before falling pregnant i.e. those with a BMI of over 30, should gain between 3–8 kilograms during pregnancy; with their medical practitioner’s blessings of course.
  • Women who were overweight before falling pregnant i.e. those whose BMI fall between 25–29.9, should gain between 5–10 kilograms during pregnancy; with their medical practitioner’s blessings of course.
  • Women who were underweight before falling pregnant i.e. those whose BMI fall below 18, might need to gain between 12–19 kilograms during pregnancy; with their medical practitioner’s blessings of course.
  • Women who had a healthy weight before falling pregnant i.e. those whose BMI fall between 18.5–24.9, might need to gain between 12–19 kilograms during pregnancy; with their medical practitioner’s blessings of course.

Not sure of your BMI, why don’t you find out by using our BMI calculator?

Genetics & Genotype

Genetics is the core of our existence; you have dark skin, brown eyes or large hands because of your genetic make-up. You get your genes from your parents at conception and it is an intricately, calculated blend of features from both of them. Advances in medical science means that many couples can know if their foetus is carrying a defective gene even before birth. You may not think that we care much about this type of tests here but almost every woman is given the opportunity to undergo an anomaly ultrasound scan at about 18-22 weeks (4-5months) into her pregnancy. The anomaly or 21-week scan, checks your baby’s growth, her position as well as possible fetal abnormalities e.g. down’s syndrome. Since most women fall pregnant before going to see a gynaecologist, most genetic testing is done during pregnancy. The test is usually offered optionally and is not 100% conclusive but it can predict the probability of having a baby with a genetic defect. Some races/ ethnic groups are more prone to certain genetic diseases than others. People of black or black-related origin may run a higher risk of carrying the following genes:

Sickle Cell Anaemia

Every human being has red and white blood cells. The red blood cells carry oxygenated blood around the body while the white blood cells defend the body against diseases. Red blood cells normally look like circular, round disks but occasionally they are sickle-shaped (crescent shaped). If a person does not have sufficient red blood cells, then that person is said to be anaemic (that is, has anaemia). The circular shape of the red blood cell aids its mobility round the body. When red blood cells are sickle-shaped, they can easily get stuck in blood vessels and this may prevent proper blood flow to major organs. This situation can cause immense pain and it is not uncommon to see people living with sickle cell in a lot of pain –especially in their limbs.  The sickle shape of the red blood cells also singles them out for destruction by the body’s white blood cells; which sees them as enemies. This coupled with the fact that sickle cells have a very short life span (a little over 10 days) means that there can be periods of  short supply of the red blood cells in the body, especially if the body is unable to replenish the lost cells fast enough. Anaemia which is as a result of the sickle shape of the red blood cells is called Sickle Cell Anaemia.

Symptoms of sickle cell anaemia usually show up when an affected child is between 4-6months old. Sickle cell anaemic persons may have:

  • A crisis which may be triggered by: Malaria fever; a change in normal conditions (weather); low fluid intake; malnutrition; etc.
  • Pain in different parts of the body especially in the neck, bones/joints and stomach which may range from mild to severe.
  • Tiredness
  • Increased risk of infections
  • Stunted growth
  • Jaundice –yellowish eyes
  • Painful swellings in hands and feet
  • Reduced life expectancy

Sickle cell genes are passed on to children by parents who are carriers of the genes. Some experts believe that there is a link between the sickle-shaped red blood cells and the carrier’s resistance to Malaria. The red blood cells are taught to have originally mutated to the sickle shape as the body’s way of self-preservation against malaria. The genes are in turn, preferably selected for this reason as well.

When both parents each pass on a sickle cell gene to a child (that is the child gets two (S) genes from both parents), then that child will have sickle cell anaemia or haemoglobin SS disease (HbSS). If the child gets one sickle cell gene (S) and a normal gene (A) from both parents, then that child has a sickle cell trait. People with sickle cell traits are just carriers of the defective genes and normally do not have the sickle cell disease. They can however pass on the sickle cell gene to their own children.

Sickle cell diseases may also be caused by other abnormal, haemoglobin types e.g. haemoglobin C or β- Thalassemia. This occurs when a child gets a sickle cell gene from one parent and some other type of defective gene from the other parent.

Sickle cell anaemia is normally managed with prescribed painkillers and amoxicillin (or penicillin) antibiotics. In more serious instances blood transfusion and bone marrow transplant may be required. A bone marrow transplant is more complicated than the other forms of treatment and requires a donor with stem cells or a bone marrow that matches the recipient’s.

Albinism

We all look different. The colour of your skin, eyes and even hair is different from the next person. The substance in the body that is responsible for skin, hair and eye pigmentation or colour is called Melanin. Normally, people with dark skin (e.g. people of African descent) have higher melanin than people with fairer skin types (e.g. Caucasians). Albinism is a genetic disorder which is caused by the body’s inability to produce sufficient melanin.  Melanin, amongst other things, protects the skin from the harsh rays of the sun and it is also helps to protect the iris. People living with albinism need extra protection due to the insufficient amount of melanin. People with albinism are normally referred to as albinos. Albinism cannot be passed on to children if they get one normal pigment gene and an albinism gene from their parent. It can only be passed on if they get two albinism genes from their parents.

Albinism does not affect a person’s mental or physical state. Albinism is not contagious. And it is definitely not witchcraft or a curse. Many albinos go on and have gone on to live normal productive lives.

Albinos can protect themselves by:

  • Spending limited periods in the sun,
  • Using effective sun glasses, hats and plenty of sunscreen lotion with a Sun Protective Factor (SPF) of at least 15 and up to 70. SPFs protect the body from the harmful ultraviolet rays of the sun.
  • Using natural oils like shea butter and extra virgin olive oil on their skin to keep it supple and healthy.
  • Some albinos might need to wear recommended glasses to shield their eyes from sunlight.

Autism

Autism is a combination of developmental disorders which may be evident as poor or difficult communication, poor social interaction and repetitive motions. It may be diagnosed as early as infancy (if impaired speech is evident amongst other symptoms). It is however more pronounced in toddlers aged 18 to 30 months (especially boys) and proper diagnosis can be made at this age. Although autism currently has no cure or known cause, the symptoms can be managed and treated, with early detection improving chances. It is generally believed to be a congenital brain structure abnormality.

A child MIGHT be autistic if at 18 months:

  • He can’t answer to his name.
  • Finds it really difficult to learn new words.
  • He doesn’t normally respond to a hello or good bye wav.
  • He doesn’t return smiles.
  • He becomes unreasonably upset, resists or gets confused if there is a change in normal routine, food or activity.
  • He has poor social interaction with other children.
  • If he used to babble as an infant but can’t currently manage any words.
  • If he becomes very irate or throws a tantrum when upset.

There have been claims that some vaccinations are linked to a rise in autistic cases; current research as at the time of this write-up showed that these claims have been disproved. While delayed development in a child may be a sign of autism it does not necessarily mean that the child is autistic. Do not confuse delayed developmental milestone achievement with autism, children grow differently. Proper diagnosis can only be made by a qualified medical practitioner.

 

Down’s syndrome

At conception, 46 chromosomes are passed on to the foetus (23 chromosomes from each parent). Down’s syndrome is a genetic disease which occurs when an extra chromosome called chromosome 21 is passed on to a child thereby increasing the total number of chromosomes to 47. It can be detected even while a child is in the womb. A genetic test called Chorionic Villi Sampling is used to detect it during pregnancy. The health issues associated with Down’s can also be treated with early detection and proper care.

Children with Down’s syndrome have distinguishable features which include slant eyes, small ears and protruding foreheads. While some children living with Down’s syndrome may have respiratory and heart diseases or mental disorders, some others have little or no health conditions.

As a woman grows older, the chance of having a child with Down’s syndrome increases. Though many women over 40 have normal children, women over 35 should see a medical practitioner when planning to conceive for proper health assessment.

We would like to add that children with Down’s syndrome can and do grow up to live very productive lives and like any other child, they deserve the very best and should not be abused, abandoned or neglected.

 

Key facts about Genetic disorders

  • A baby cannot inherit a genetic disease if both parents are non-carriers of the genes.
  • A baby has a 1 in 4 chance (25%) of having normal genes, if both parents carry the genetic trait (i.e. if both of them are carriers).
  • A baby has a 1 in 4 (25%) chance of getting the genetic condition, if both parents have the genetic trait (i.e. if both of them are carriers).
  • A baby has a 2 in 4 (50%) chance of being a carrier if both parents have the genetic trait (i.e. if both of them are carriers).

Apart from genes, some other things which may predispose a baby to genetic disorders or birth defects are:

  • Unhealthy levels of exposure to toxic chemicals, radiation, fumes or smoke.
  • Drug abuse or alcohol use during pregnancy.
  • When there are close relatives in the family with a genetic disease.
  • When the parents are closely related by blood.

While tremendous advance has been made in genetic science and engineering, many people still live with genetic disorders. Children born with genetic disorders have the same rights as anyone else. Their condition should never be a reason for discrimination, maltreatment or injustice. They deserve love and care like any other child and with proper nurture and care; they can grow up to live productive lives.

Tests and Vaccinations

If you don’t like needles, this may not be your favourite topic but you will probably need to take an injection or vaccination during your pregnancy. Not to fear though, not all the tests will involve needles. For more on some of the tests you may undergo during pregnancy, see section on, Tests and Scans During Pregnancy.

 

Vaccinations (Immunization)

Your level of immunity is extremely important during pregnancy. Your immunity against certain harmful diseases will not only help keep you and your unborn baby safe during pregnancy. It will also be passed on to your baby and can help protect your baby before he is given his own vaccinations (immunizations) and that is not all, your baby will still keep getting immunity from you through breast milk, if you choose to breastfeed after delivery.

If you cannot remember the immunizations you received as a child (or adult), you might need to ask your parents or guardian, or even get your childhood immunization records. Some vaccines are safe to take during pregnancy, while others are not and should be taken before pregnancy. Vaccines should only be taken during pregnancy, if you and your medical practitioner have weighed the benefits and risks involved.

Generally, as a rule, live (activated) vaccines are not safe for pregnant women while inactivated vaccines may be taken either during pregnancy or before you fall pregnant (see section on this in Physical Examination).

 

VACCINATIONS WHAT IT CAN HELP PREVENT NOTES
Tetanus, Diphtheria and Whooping Cough (DTaP) Cessation in baby’s breathing

Congenital abnormality

·         It is normally given between 27-36 weeks of pregnancy
Hepatitis A, B & C Cancer

Liver infection or long-term liver disease in babies

 

·         Hepatitis A & B can be taken during pregnancy if the benefits and risks have been medically analyzed.

·         There is currently no immunization for Hepatitis C.

·         Hepatitis B & C can be spread through transmission of bodily fluids and blood.

Flu

 

Premature labour

Birth defects

Low weight births

·         Might be important for people travelling to certain countries for holiday, work or delivery (especially during flu/winter season).

·         Most types of flu vaccines can be taken at any time during pregnancy if the benefits and risks have been medically analyzed.

·         Flu vaccines can help protect your newborn for the first few months of life.

Pneumococcal Pneumococcal infections

Ear infections

Sinusitis

meningitis and septicaemia

·         Can be taken at any time during pregnancy.
Meningococcal An infection of the brain and spinal cord which can cause meningitis or septicaemia.

Severe headache and stiff neck

Flu-like symptoms

·         Some variations of the meningococcal vaccine may not be safe, always check first with your medical practitioner before taking any immunizations during pregnancy.

 

Vaccination and Travel

If you are travelling to another country or a different location in the same country, find out what type of vaccinations you will need to take before you embark on your journey.  You should always find out from your medical practitioner if it is safe to take any vaccine before being inoculated. You might need to delay your trip if the country/place of destination is currently going through an epidemic which has no vaccine or if the vaccine available is a live one (activated).

REFRENCES:

  1. Immunization & Pregnancy Flyer. National Center for Immunization and Respiratory Diseases. www.cdc.gov/vaccines.