Most common questions

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

• Achy muscles
• Belly pain
• Fatigue (feeling tired all the time)
• Fever
• Sore throat
• Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Last reviewed July 2012

Anemia

Anemia occurs when the number or size of a person’s red blood cells are too low. Red blood cells are important because they carry oxygen from your lungs to all parts of your body. Without enough oxygen, your body cannot work as well as it should, and you feel tired and run down.

Anemia can affect anyone, but women are at greater risk for this condition. In women, iron and red blood cells are lost when bleeding occurs from very heavy or long periods (menstruation).

Anemia is common in pregnancy because a woman needs to have enough red blood cells to carry oxygen around her body and to her baby. So it's important for women to prevent anemia before, during and after pregnancy. Women will probably be tested for anemia at least twice during pregnancy: during the first prenatal visit and then again between 24 and 28 weeks.

Causes of anemia

Iron deficiency

Usually, a woman becomes anemic (has anemia) because her body isn’t getting enough iron. Iron is a mineral that helps to create red blood cells. About half of all pregnant women don’t have enough iron in their body (iron deficiency). In pregnancy, iron deficiency has been linked to an increased risk of preterm birth and low birthweight.

Illness or disease

Some women may have an illness that causes anemia. Diseases such as sickle cell anemia or thalassemia affect the quality and number of red blood cells the body produces. If you have a disease that causes anemia, talk with your health provider about how to treat anemia.

Signs of anemia

Anemia takes some time to develop. In the beginning, you may not have any signs or they may be mild. But as it gets worse, you may have these symptoms:

• Fatigue (very common)
• Weakness (very common)
• Dizziness
• Headache
• Numbness or coldness in your hands and feet
• Low body temperature
• Pale skin
• Rapid or irregular heartbeat
• Shortness of breath
• Chest pain
• Irritability
• Not doing well at work or in school

Because your heart has to work harder to pump more oxygen-rich blood through the body, all of these signs and symptoms can occur.

Getting enough iron

Before getting pregnant, women should get about 18 milligrams (mg) of iron per day. During pregnancy, the amount of iron you need jumps to 27 mg per day. Most pregnant women get this amount from eating foods that contain iron and taking prenatal vitamins that contain iron. Some women need to take iron supplements to prevent iron deficiency.

Iron-rich foods

You can help lower your risk of anemia by eating foods that contain iron during your entire pregnancy. These foods include:

• Poultry (dark meat)
• Dried fruits (apricots, prunes, figs, raisins, dates)
• Iron-fortified cereals, breads and pastas
• Oatmeal
• Whole grains
• Blackstrap molasses
• Liver and other meats
• Seafood (learn about the safe kinds of seafood you can eat during pregnancy)
• Spinach, broccoli, kale and other dark green leafy vegetables
• Baked potato with skin
• Beans and peas
• Nuts and seeds

Foods containing vitamin C can increase the amount of iron your body absorbs. So it's a good idea to eat foods like orange juice, tomatoes, strawberries and grapefruit every day.

Coffee, tea, egg yolks, milk, fiber and soy protein can block your body from absorbing iron. Try to avoid these when eating iron-rich foods.

Iron supplements

If you are anemic, your health care provider may prescribe an iron supplement. Some iron supplements may cause heartburn, constipation or nausea. Here are some tips to avoid or reduce these problems:

• Take the pills with meals.
• Start with small doses and work your way up to the full dose slowly. For example, try taking one pill a day for a few days, then two pills until you aren't bothered by that amount. Increase the number of pills until you're taking the amount your health care provider recommends.
• Try different brands to see which works best for you. Be sure to discuss any changes with your health care provider ahead of time.
• Avoid taking iron pills at bedtime.

Reduce constipation by drinking more water and by eating more fiber. Fiber is found in whole grain foods, breakfast cereals, fruits and vegetables.

April 2009

Asthma during pregnancy

Asthma is a lung disease that causes your airways to tighten up, making it hard for you to breathe. There’s no cure for asthma. Even if you have asthma and feel healthy, asthma flares (when symptoms become severe) can happen at any time.

Most people with asthma can keep the disease under control and avoid serious health problems. If you’re pregnant, it’s really important to work with your health care provider to manage your asthma and get medical care, if needed.

How does asthma affect pregnancy?
Asthma affects 4 to 8 out of 100 pregnant women (4 to 8 percent). If you keep your asthma under control, it probably won’t cause any problems during your pregnancy.

If you don’t control your asthma, you may be at risk for a serious health problem called preeclampsia. Preeclampsia is a certain kind of high blood pressure that only pregnant women can get.

If you don’t control your asthma, your baby may not get enough oxygen. He may be at higher risk for health problems like:

• Premature birth, birth that happens before 37 completed weeks of pregnancy
• Poor growth
• Low birthweight (less than 5½ pounds)

Babies who are born too small and too soon are more likely to have newborn health problems. They can have trouble breathing and lasting disabilities, such as intellectual disabilities and cerebral palsy.

What are the signs and symptoms of asthma?
You may have one or more asthma symptoms. Signs and symptoms include:

• Tightness in the chest
• Constant cough (especially at night or in the early morning)
• Shortness of breath
• Wheezing (a whistling sound when you breathe)

What causes asthma symptoms?
One or more things can trigger your asthma. Some of the most common things that bring on asthma symptoms are:

Allergens
About 7 out of 10 people with asthma (70 percent) have allergies. An allergy is a reaction to something you touch, eat or breathe in that makes you sneeze, get a rash or have trouble breathing.

Allergens are things that cause you to have allergy symptoms. Many also cause asthma symptoms. Common allergens are pollens, molds, animal dander (small flakes of dead skin), dust mites and cockroaches. Limit your contact with allergens. If you still have asthma symptoms, talk to your health care provider.

Your provider may recommend that you take an allergy medicine. If you’re already getting allergy shots, you can keep taking them during pregnancy. But if you aren’t getting allergy shots, don’t start taking them when you’re pregnant because you could have a serious allergic reaction called anaphylaxis.

Irritants
Irritants are things in your environment that may hurt your lungs and trigger asthma symptoms, including air pollution, cigarette smoke and smoke from wood-burning stoves or fireplaces, cold air and strong smells, like paint or perfumes.

Infections
Infections like a cold, the flu or viral pneumonia, can trigger asthma symptoms in some people.

Exercise
Exercise can cause asthma symptoms in some people. If your asthma is under control, you probably can exercise without any problems. But if exercising during pregnancy sets off your asthma, talk to your health care provider.

How is asthma diagnosed?
Asthma can be hard to diagnose. To find out if you have asthma, your health care provider takes your health history, does a physical exam and listens to your breathing.

You also may get a lung function test called spirometry. This is a test that checks how well your lungs work. During the test, you take a deep breath and exhale (blow) into a machine called a spirometer. This machine measures the amount of air you breathe in and out. It also measures how fast you can breathe. When you’re pregnant, normal changes in your body can make you short of breath. This test can help your provider know if shortness of breath is a common complication of pregnancy or if it’s caused by asthma.

How is asthma treated during pregnancy?
Your health care provider needs to monitor your lungs while you are pregnant so he can adjust your asthma medicines, if needed. Tell your provider if your symptoms improve or get worse. By limiting your contact with allergens and other asthma triggers, you may need to take less medicine to control your symptoms.

Is it safe to take asthma medicine during pregnancy?
Asthma symptoms that don’t stop or that get worse can be a risk to your and your baby. If you were taking asthma medicine before pregnancy, don’t stop taking it without talking to your provider first.

If you’re diagnosed with asthma during pregnancy, talk to your provider about the best way to treat or manage it.

If you’re already getting allergy shots, you can keep taking them during pregnancy. But if you aren’t getting allergy shots, don’t start taking them when you’re pregnant because you could have a serious allergic reaction called anaphylaxis.

Can asthma symptoms change during pregnancy?
Yes, asthma symptoms often change during pregnancy. Sometimes they get better and sometimes they get worse. We don’t really understand what causes these changes.

Getting the flu can set off serious asthma symptoms. Be sure to get a flu shot in October or November every year.

Heartburn also can make your symptoms worse. Here’s what you can do to help with heartburn symptoms:

• Sleep with your head up on a pillow (elevated).
• Eat smaller meals several times a day.
• Don’t eat within 2 hours of bedtime.
• Ask your provider about medicines you can take.

Do you need any special tests if you’re pregnant and have asthma?
If your asthma is under control and mild, you may not need any special tests. If your asthma is not well controlled or if your asthma is moderate to severe, your provider may recommend repeated ultrasounds to check to make sure your baby’s growing normally. Ultrasound uses sound waves and a computer screen to make a picture of a baby in the womb. Your provider may start these at around 32 weeks of pregnancy.

Your provider also may recommend taking your baby’s heart rate with a fetal heart monitor. This allows him to check on your baby’s well-being.

Test results can alert your provider if you or your baby needs special care.

Can labor and birth set off asthma symptoms?
Only about 1 in 10 pregnant women with asthma (10 percent) have symptoms during labor and birth. Take your usual asthma medicines during labor and birth. If you still have asthma symptoms, your health care provider can help control them.

Are asthma medicines safe when you’re breastfeeding?
Asthma medicines do get into your breast milk, but the amounts are very low and are safe for the baby. If you take high doses of certain asthma medicines, like theophylline, your baby may become irritable or have trouble sleeping. To help prevent this, take your asthma medicines 3 or 4 hours before the next feeding. Your provider and your baby’s provider can help you adjust your medicine schedule so you and your baby can get the health benefits of breastfeeding.

Last reviewed November 2011

Bacterial Vaginosis

What you need to know
Bacterial vaginosis (BV) is caused by an overgrowth of bacteria that are naturally present in the vagina. BV affects about 16 out of 100 pregnant woman. Doctors don’t know what causes BV. Bacterial vaginosis is sometimes called vaginitis. It appears to be more common in women who:

• Have new sex partners
• Have more than one sex partner
• Douche
• Use an IUD for birth control

Some women with BV have a discharge from the vagina that smells fish-like. This discharge is usually white or gray. Women with BV may also have burning when they urinate or itching around the outside of the vagina. Some women have no symptoms at all.

Health care providers diagnose BV by examining the woman's vagina and by doing lab tests.

BV is treated with antibiotics.

What you can do
Tell your health care provider if you have:

• Vaginal discharge that smells bad
• Burning when you urinate
• Itching around your genital area

If your provider gives you antibiotics, be sure you take them as directed.

For more information

• CDC information line
  (800) 232-4636
  In English and Spanish
  TTY for the deaf and hard of hearing (888) 232-6348
• American Social Health Association

Bleeding and spotting from the vagina during pregnancy

Out of every 10 women who are pregnant, two or three have some bleeding early in pregnancy. Bleeding doesn't always mean there's a problem, but it can be a sign of miscarriage or other serious complications. It's very important to be aware of how you're bleeding so that your provider can tell if it's dangerous to you or your baby. Keep track of whether the bleeding is increasing or decreasing and how many pads you are using. Don't ever use a tampon, douche, or have sexual intercourse while you're bleeding.

First trimester
Light bleeding in the first trimester is common. There are many different reasons you could be spotting.

Implantation bleeding
You may bleed a little when the embryo attaches to the lining of your uterus. This may occur 10-14 days after fertilization. Although this spotting is usually earlier and lighter than a menstrual period, some women don't notice the difference, and don't even realize they're pregnant.

Changes in the cervix
Your cervix changes during pregnancy to prepare for delivery. More blood flows to your cervix while you're pregnant, so the area is sensitive. You may have some light bleeding after sex or after a pelvic exam.

Miscarriage
Miscarriage usually happens during the first 12 weeks of pregnancy. Bleeding doesn't always mean miscarriage. At least half of women who have spotting or light bleeding early in pregnancy don't miscarry. Other signs of miscarriage include cramps (stronger than menstrual cramps) and tissue coming out of the vagina. If you think you may have had a miscarriage, call your health care provider. For more information, read Miscarriage.

Molar pregnancy
This is a rare condition in which tissue grows in the uterus, but the embryo is abnormal or missing. With molar pregnancy, bleeding may be dark brown in color. Other symptoms include severe nausea and vomiting and cramping in the belly. If you have any of these symptoms, call your health care provider right away. For more information, read Molar Pregnancy.

Later in pregnancy
Bleeding later in pregnancy can be caused by many things. Tell your health care provider immediately if you have bleeding in the second half of pregnancy.

Bleeding later in pregnancy may be caused by a number of health conditions.

Cervical problems
An infection, inflammation, or growths on the cervix can cause vaginal bleeding. For a few women, light bleeding is a sign of cervical insufficiency (CI), also known as cervical incompetence, in which the cervix opens without warning. This can result in preterm labor and delivery. Cervical insufficiency or incompetence is most common between 18-23 weeks. It requires immediate medical attention.

Preterm labor
Light bleeding may be a sign of preterm labor. If you have any of the following signs or symptoms, call your health care provider right away:

• Contractions (your abdomen tightens like a fist) every 10 minutes or more often
• Change in vaginal discharge (leaking fluid or bleeding from your vagina)
• Pelvic pressure—the feeling that your baby is pushing down
• Low, dull backache
• Cramps that feel like your period
• Abdominal cramps with or without diarrhea

Miscarriage
Miscarriage usually happens in the first trimester, but it can occur at any time before 20 weeks of pregnancy.

Placenta previa
Heavy bleeding late in pregnancy may be a sign of placenta previa. If you have heavy bleeding, go to the hospital right away. With placenta previa, the placenta is attached too low in the uterus. It partly or completely covers the birth canal. This is a serious condition. The main sign is painless, bright red vaginal bleeding. The bleeding may stop on its own, but then come back a few days or weeks later.

Placental abruption
A few pregnant women have placental abruption, in which the placenta separates from the wall of the uterus before birth. This leads to bleeding within the uterus. The woman often also has pain in her belly. Placental abruption usually occurs in the last 12 weeks of pregnancy. If you have heavy bleeding, go to the hospital right away.

Uterine rupture
For women who've had a previous c-section, a tear in the scar in the uterus may cause bleeding. This opening is very dangerous. The woman will feel intense pain and tenderness in her belly.

A sign of normal labor
"Bloody show" is normal at the very end of pregnancy. If you have thick discharge that is pink or slightly bloody 1-2 weeks before your due date, your body is probably taking the first step to prepare for labor.
Other causes of bleeding may be unrelated to the pregnancy itself.

When to call your health provider
Contact your health care provider if you have:

• Unusually strong cramps
• Severe pain in your belly
• Heavy blood flow
• Continual bleeding for more than 24 hours straight
• Fever or chills
• Contractions, even if they're not painful (your belly tightens like a fist)
• Discharge containing tissue

May 2007

Cervical insufficiency

Cervical insufficiency (CI) means that a woman's cervix opens too early, before the baby is full term. This condition is also called incompetent cervix. The cervix is the opening to the uterus that sits at the top of the vagina. When the cervix is healthy, it thins out and opens at the end of pregnancy when labor begins. The baby then moves through the cervix and birth canal (vagina) to be born.

With CI, the cervix opens without labor starting. Usually the woman has no symptoms. Few women know they have cervical insufficiency until they have a miscarriage or premature birth. The woman may give birth to the baby without feeling contractions.

If you've had a pregnancy affected by CI, the condition is likely to happen again in later pregnancies.

What causes CI?
Medical experts do not always know why incompetent cervix occurs. Theories include damage to the cervix during surgery, injury during a previous birth, and exposure to certain drugs.

Cervical length appears to be a factor. The shorter the cervix, the more likely you are to have cervical insufficiency. Ask your health care provider about having an ultrasound to check for short cervix.

How is CI diagnosed?
Providers have not found a reliable way to routinely check all women for cervical insufficiency. If a woman has previously lost a pregnancy in the second or third trimester, vaginal ultrasound during the next pregnancy may help predict she's at risk for preterm birth.

How is CI treated?
Providers sometimes recommend:

• Bed rest and reduced physical activity. While these methods are common, research has not proven them to be effective.
• Pelvic rest. This means no sex, tampons or douching.
• Cerclage. The doctor puts a stitch in the cervix to keep it from opening too early. The stitch is removed at about 37 weeks of pregnancy. Join the discussion group about cerclage on the March of Dimes online community Share Your Story.

Last reviewed April 2012

Chickenpox during pregnancy

Chickenpox (also called varicella) is a common infection in children. It can be harmful to your unborn baby or newborn if you get it during pregnancy. But you don’t need to worry about getting chickenpox if you:

• Had chickenpox before
• Had a vaccine for chickenpox. A vaccine is a medicine you get that protects against certain diseases.

In either of these cases, you’re immune to chickenpox. Immune means being protected from an infection. If you're immune to an infection, it means you can't get it. About 9 out of 10 pregnant women (90 percent) are immune to chickenpox.

Many women don’t know if they’re immune to chickenpox. If you’re not sure, talk to your health care provider about chickenpox during your first prenatal visit.

What is chickenpox?
Chickenpox is caused by a virus. People usually get it during childhood. Its symptoms include an itchy rash, blisters and fever. These symptoms show up about 2 weeks after you get the chickenpox virus. The infection usually isn’t dangerous in children. But 1 to 2 out of 10 pregnant women (about 10 to 20 percent) who get chickenpox get a dangerous form of pneumonia (a kind of lung infection).

You can get chickenpox by being in contact with someone else’s chickenpox rash. It’s also spread through the air when someone with chickenpox coughs or sneezes. An infected person can spread chickenpox starting 1 to 2 days before the rash appears and until the rash stops spreading and is covered by dry scabs. This usually is about 5 days after the rash starts.

How do you know if you have chickenpox?
Tell your provider right away if you come into contact with someone who has chickenpox.

Your provider can tell you if you have chickenpox by doing a physical exam. Sometimes, your provider takes a swab of the rash and sends it to a laboratory for testing to be sure it’s chickenpox.

Can chickenpox hurt your baby during pregnancy?
Yes, but most likely your baby will be born healthy. But some babies may get congenital varicella syndrome. This is a group of birth defects that can include:

• Scars
• Problems with muscles and bones
• Arms or legs that are paralyzed or not formed correctly
• A head that’s smaller than normal
• Blindness
• Seizures
• Learning problems

Only about 1 or 2 out of 100 babies (1 to 2 percent) whose mothers had chickenpox during the first 20 weeks of pregnancy get congenital varicella syndrome. Your provider can do an ultrasound to check for some birth defects caused by chickenpox.

Birth defects are very rare when you get infected with chickenpox after 20 weeks of pregnancy. But your baby could have problems with his central nervous system (brain and spinal cord) if you get infected in the third trimester of pregnancy.

Infection after 20 weeks of pregnancy also may cause shingles in your baby during the first 1 to 2 years of life. Shingles (also called herpes zoster) is an infection caused by the same virus that causes chickenpox. A person with shingles has painful clusters of blisters that usually appear on a small area of the body. Shingles doesn’t seem to cause birth defects or infections in your baby.

Can chickenpox hurt your newborn baby?
It depends on when the infection happens. If you get a chickenpox rash about 1 to 3 weeks before giving birth, there’s some chance that you can pass the infection to your baby. But if that happens, the infection is usually mild.

But if you get a chickenpox rash the week before you give birth or within a couple days after giving birth, there is up to a 3 in 10 chance (30 percent) that your baby will get a serious, even deadly, form of the infection.

How is chickenpox treated during pregnancy?
If you get chickenpox while you’re pregnant, your provider gives you an antiviral called acyclovir to help with the symptoms. An antiviral is a medicine that kills infections caused by viruses. Studies have shown that this medicine is safe during pregnancy. If you start to get any signs of pneumonia, you need to be hospitalized and treated with a higher amount of antivirals through an IV (when medicine is given through a needle into a vein.).

How is chickenpox treated in your newborn baby?
If your newborn has the serious form of the infection, your provider treats your baby right after birth with medicine that has chickenpox antibodies. Antibodies are cells in the body that fight off infection. The medicine can help prevent chickenpox in your baby or make it less dangerous.

If your baby still gets chickenpox after getting treated, she can be treated with an antiviral like acyclovir.

How can you avoid chickenpox during pregnancy if you aren’t immune?
First, get a blood test to find out if you’re immune to chickenpox. Get tested if you’re pregnant or planning to get pregnant. If you’re not immune, you can get a vaccine. It’s best to wait 1 month after the vaccine before getting pregnant.

If you’re already pregnant, don’t get the vaccine until after you give birth. In the meantime, avoid contact with anyone who has chickenpox or shingles.

If you’re not immune to chickenpox and you come into contact with someone who has it, tell your provider right away. Your provider can treat you with medicine that has chickenpox antibodies. It’s important to get treatment within 4 days after you’ve come into contact with chickenpox to help prevent the infection or make it less serious.

Also, tell your provider if you come in contact with a person who has shingles. Your provider can treat you with the antiviral acyclovir.

Can you get chickenpox from a child who just had a vaccine?
Not usually, but it can happen if a child gets sores after having the vaccine. Sores can appear around the area where the child got the vaccine. Make sure your children are vaccinated for chickenpox at ages 12 to 15 months and at 4 to 6 years. Your chances of getting chickenpox from a child who recently had a vaccine are much lower than the chances of getting it from a child who doesn’t have the vaccine.

What are the chances of getting chickenpox during pregnancy?
About 1 out of 1,000 pregnant women in the United States gets chickenpox. Most children get chickenpox vaccines, so the chances of getting it are becoming even lower.

Nine out of 10 pregnant women (90 percent) who aren’t immune to chickenpox get the infection when someone else in their home has it.

Last reviewed November 2011

See also: Vaccinations and pregnancy

Chlamydia

Chlamydia is a bacterial infection. About 3 million new cases occur each year in both men and women. Chlamydia is one of the most common sexually transmitted infections. If a pregnant woman gets chlamydia and goes untreated, she may have a premature baby. If a baby becomes infected during delivery, he or she may develop eye infections (pink eye, conjunctivitis) or breathing problems.

Chlamydia is known as a "silent" disease because about 3 out of 4 women who are infected don't have symptoms. Some women have a change in vaginal discharge or pain when they urinate.

Health care providers use lab tests to diagnose chlamydia in women. Some tests use a urine sample. Other tests use a sample taken from the woman's cervix.

Chlamydia is treated with antibiotics.

What you can do
Ask your health care provider to screen you for chlamydia early in pregnancy. If you are infected, you can get antibiotics to treat the infection. This will prevent any complications for you and your baby.

Be sure your partner is also screened. Partners can pass the infection back and forth between themselves.

While you're pregnant, you can avoid chlamydia by not having sex. If you do have sex:

• Have sex with only one partner who is having sex only with you, has been tested for chlamydia, and is not infected
• Use a latex condom

If your provider gives you antibiotics, be sure to take them as directed.

For more information

• CDC information line
  (800) 232-4636
  In English and Spanish
  TTY for the deaf and hard of hearing (888) 232-6348
• American Social Health Association

Cystic Fibrosis and pregnancy

Cystic fibrosis (CF) is a condition that affects breathing and digestion. It’s caused by very thick mucus that builds up in the body.

Mucus is a fluid that normally coats and protects parts of the body. It’s usually slippery and slightly thicker than water. But In CF, the mucus is thicker and sticky. It builds up in the lungs and digestive system and can cause problems with how you breathe and digest food.

What causes CF?
CF is inherited. This means it’s passed from parent to child through genes. A gene is a part of your body’s cells that stores instructions for the way your body grows and works. Genes come in pairs — you get one of each pair from each parent.

Sometimes the instructions in genes change. This is called a gene change or a mutation. Parents can pass gene changes to their children. Sometimes a gene change can cause a gene to not work correctly. Sometimes it can cause birth defects or other health conditions. A birth defect is a health condition that is present in a baby at birth.

You have to inherit a gene change for CF from both parents to have CF. If you inherit the gene change from just one parent, you have the gene change for CF, but you don’t have the condition. When this happens, you’re called a CF carrier. A CF carrier has the gene but doesn’t have the condition.

If you and your partner both carry the gene change for CF, your baby may get two CF gene changes (one from each of you) and have CF.

Can you pass CF to your children?
Yes. But it depends on both you and your partner. If you and your partner both have CF, your baby will have CF.

If you and your partner are both CF carriers, there is a:

• 3-in-4 chance (75 percent) that your baby won’t have CF
• 1-in-2 chance (50 percent) that your child won’t have CF but will be a CF carrier
• 1-in-4 chance (25 percent) that your child will have CF
• 1-in-4 chance (25 percent) that your child will not have CF and not be a carrier

A genetic counselor can help you understand your chances of passing CF to your baby. A genetic counselor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby's health.

Ask your health care provider if you need help finding a genetic counselor. Or contact the National Society of Genetic Counselors.

How can you find out if you’re a CF carrier?
There are two types of tests that can tell you if you have CF or if you’re a carrier. Both are safe to take during pregnancy. Your partner can have the tests, too.

• A blood test
• A swab of cells inside your mouth. This means your provider rubs a cotton swab against the inside of your cheek to get some cells.

Your provider sends the blood or swab sample to a lab for testing.

The American College of Obstetricians and Gynecologists (ACOG) recommends that health care providers make CF carrier screening available to all couples. It’s often done as a routine prenatal test in early pregnancy.

About 1 of 31 people in the United States is a CF carrier. You and your partner may want to have CF carrier testing if:

• CF runs in either of your families. You also may want to get genetic counseling. Genetic counseling can help you understand your chances of having a baby with CF and what kind of treatment he may need if he does.
• You are:
  • Caucasian and your family comes from Northern Europe. About 1 of every 25 people with this ancestry is a CF carrier.
  • Hispanic. One out of every 62 Hispanics in the United States is a CF carrier.
  • African-American. One out of every 65 African-Americans in the United States is a CF carrier.
  • Asian American. One out of every 94 Asian Americans in the United States is a CF carrier.

Can you find out during pregnancy if your baby has CF or is a CF carrier?
Yes. If you or your partner has CF or is a CF carrier, you can have a prenatal test to find out if your baby has the condition or is a carrier.

You can have either of these tests:

• Chorionic villus sampling (also called CVS). This test checks tissue from the placenta for birth defects and genetic conditions. You can get CVS at 10 to 12 weeks of pregnancy.
• Amniocentesis (also called amnio). This test checks amniotic fluid from the amniotic sac around your baby for birth defects and genetic conditions. You can get this test at 15 to 20 weeks of pregnancy.

Talk to your provider or genetic counselor if you’re thinking of having either of these tests.

Can CF cause problems with pregnancy?
Some women with CF may have trouble getting pregnant, but many can get pregnant and have a healthy pregnancy. Some men with a mutation in the same gene that is responsible for CF may be infertile. This means they can’t get their partner pregnant. They may or may not have CF symptoms. If you and your partner are having trouble getting pregnant, ask your provider or genetic counselor about this.

Women with CF may have a higher risk of getting gestational diabetes. Diabetes is when you have too much sugar in your blood. Too much sugar in your blood can damage organs in your body, including blood vessels, nerves, eyes and kidneys. Diabetes must be treated during pregnancy for the health of the mother and the baby, and after pregnancy for the health of the mother.

How is CF treated in pregnancy?
If you have CF and are thinking about getting pregnant, talk to your provider. You need ongoing care throughout pregnancy from your provider and other specialists experienced with CF.

For more information

Cystic Fibrosis Foundation

Last reviewed January 2013

See also: Cystic fibrosis, Genetic counseling, Newborn screening, Your family health history

Cytomegalovirus and pregnancy

Cytomegalovirus (also called CMV) is a kind of herpesvirus. There are many kinds of herpeviruses. Some are sexually transmitted diseases, some can cause problems like cold sores and some can cause infections like CMV. Many people get CMV at some point in their lives, most often during childhood.

If you have CMV during pregnancy, you have a 1-in-3 chance (33 percent) of passing it to your baby. CMV is the most common virus passed from mothers to babies during pregnancy. About 1 to 4 in 100 women (1 to 4 percent) have CMV during pregnancy. Most babies born with CMV don’t have health problems caused by the virus. But CMV can cause problems for some babies.

You can pass CMV to your baby at any time during pregnancy. It’s more likely to cause problems for your baby if it happens in the early part of pregnancy. You also can pass CMV to your baby during labor and birth and during breastfeeding. If your baby gets the virus during these times, he’s less likely to have health problems than if he gets the virus during pregnancy.

About half of all pregnant women have had CMV in the past. If you’ve already had it, you don’t need to worry about getting it again. Once you’ve been infected, CMV stays in your body for life. You can still pass it to your baby, but this is rare and usually doesn’t cause any harm to your baby.

How do you know if you have CMV?
Most people with CMV have no signs or symptoms. But some may have:

• A sore throat
• A fever for a few days
• Swollen glands
• Fatigue (feeling tired all the time)

Tell your health care provider if you think you may have CMV. Your provider can give you a blood test to see if you have it.

If you have a weak immune system, CMV can cause serious health problems, including pneumonia or eye infections. For example, CMV can cause these kinds of problems for people with HIV.

How is CMV treated during pregnancy?
If your blood test is positive for CMV, your provider can test your baby for the virus using amniocentesis (also called amnio). During this test, your provider pushes a thin needle through your belly to remove a small amount of amniotic fluid. Amniotic fluid is the fluid that surrounds your baby in the womb. A lab tests the fluid for CMV. Your provider also may use ultrasound to check for physical signs that your baby is infected. An ultrasound uses sound waves and a computer screen to make a picture of a baby in the womb.

Scientists are working to develop a vaccine for CMV. They’re also looking for other ways to prevent babies from being born with CMV.

How do you get infected with CMV?
You can get CMV by coming in contact with bodily fluid from a person who caries the virus. Bodily fluids include saliva, breast milk, semen, mucus, urine and blood.

Women usually get infected by having sex with someone who has CMV or by having contact with young children with CMV. As many as 7 in 10 children (70 percent) between 1 and 3 years of age who go to day care may have CMV. They can pass it on to their families, caretakers and other children.

You may be more likely than other people to get CMV if you:

• Have young children at home
• Work with young children, for example as a child care worker or a teacher
• Work in health care. If you’re a health care worker in contact with people who have CMV, including newborns, use standard precautions to keep from getting infected yourself. You may want to get tested before pregnancy to see if you’ve had CMV.

How can you protect yourself from CMV?
Here are some things you can do:

• If you’re around children, wash your hands well after being in contact with their body fluids. For example, wash your hands after changing diapers, wiping noses and picking up toys.
• Carefully throw away used diapers and tissues.
• Don’t kiss young children on the mouth or cheek.
• Don’t share food, glasses, cups, forks or other utensils with young children or with anyone who may have CMV.
• If your partner has CMV, use a latex condom during sex.

More information
cmvfoundation.org
stopcmv.org

Last reviewed November 2012

Depression

As many as 1 out of 5 women have symptoms of depression during pregnancy. For some women, those symptoms are severe. In pregnancy, women who have been depressed before are at higher risk of depression than other women.

Depression is a serious medical condition. It poses risks for the woman and her baby. But a range of treatments are available. These include therapy, support groups and medications.

It is usually best for a team of health care professionals to work with a pregnant woman who is depressed or who has a history of depression. Team members include:

• The provider who is caring for her during her pregnancy
• A mental health professional
• The provider who will take care of the baby after birth

Together, the team and the woman decide what is best for her and her baby.

Often a pregnant woman wonders whether antidepressant drugs, such as Zoloft and Prozac, will harm her baby or herself. There are no simple answers. Each woman and her health care providers must work together to make the best decision for her and her baby. The drugs used to treat depression have both risks and benefits.

IMPORTANT: If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health provider. Call him or her as soon as you discover that you are expecting. It may be unhealthy to stop taking an antidepressant suddenly.

What is depression?
Depression is an illness that involves the body, mood and thought. It affects the way a woman feels about herself and the way she thinks about things. This article addresses two types of depression:

Major depression is a serious illness that interferes with a person's ability to work, study, sleep, eat and enjoy oneself. It may appear once in a person's life, but more often occurs several times.

Milder forms of depression are less severe. Persons may still have long-term symptoms. They are able to conduct day-to-day activities, but they don't always function well or feel good. They may also have episodes of major depression.

The risks of untreated depression during pregnancy
Depression, especially if it isn't treated, carries serious risks for the pregnant woman and her baby. These risks include:

• Poor prenatal care
• Preeclampsia, a type of high blood pressure that occurs during pregnancy
• Poor weight gain
• Unhealthy eating habits
• Use of drugs or alcohol to self-medicate
• Suicide

Depressed mothers are often less able to care for themselves or their children, or to bond with their children.

Babies born to women with depression may be more irritable, less active and less attentive than other babies. They may also be born prematurely or have low birthweight.

What are the symptoms of depression?
A woman who is depressed feels sad or "blue" and has other symptoms that last for 2 weeks or longer. The other symptoms include the following:

• Trouble sleeping
• Sleeping too much
• Lack of interest
• Feelings of guilt
• Loss of energy
• Difficulty concentrating
• Changes in appetite
• Restlessness, agitation or slowed movement
• Thoughts or ideas about suicide

It may be hard to diagnose depression during pregnancy. Some of its symptoms are similar to those normally found in pregnancy. For instance, changes in appetite and trouble sleeping are common when a woman is pregnant. Other medical conditions have symptoms similar to those for depression. For instance, a woman who has anemia or a thyroid problem may lack energy but not be depressed.If you have any of the symptoms listed, talk to your health care provider. He or she will check to see what might be causing your symptoms.

Treatment without medication
Depression can be treated in several ways. Support groups may help. Some women go to therapy or counseling with a mental health professional (such as a social worker, psychotherapist or psychiatrist). For women with mild foms of depression, individual or group therapy may be all the treatment they need.

Some people suffer from a type of depression that comes on during the fall or winter, when there is less sunlight. This is called seasonal affective disorder (SAD). This condition is treated with light therapy. In her home, the patient looks into a box with special light bulbs. The health provider recommends how many times a day and for how long the patient needs to use the light box.

Another form of treatment is electroconvulsive therapy (ECT). During this treatment, electric current is passed through the brain. ECT may be recommended in cases of severe depression.

Medication: Antidepressants
Most antidepressants can be categorized into one of two groups. (Use of trade names is for identification only and does not imply endorsement.)

Group 1: Selective serotonin uptake inhibitors (SSRIs). This group of drugs includes:

• Prozac (fluoxetine)
• Lexapro (escitalopram)
• Zoloft (sertraline)
• Celexa (citalopram)
• Effexor (venlafaxine)
• Paxil (paroxetine)
• Cymbalta (duloxetine)

Group 2: Tricyclic antidepressants (TCAs). This group of drugs includes:

• Elavil (amitriptyline)
• Tofranil (imipramine)
• Pamelor (Aventyl, nortriptyline)

If a woman is taking an antidepressant and wants to get pregnant, she should talk to her health care provider beforehand. Together, they will decide whether she should keep taking the medication, change the medication, gradually reduce the dose or stop taking it.

What research tells us about antidepressants
It's challenging to study and understand the risks of any drug given to pregnant women. During pregnancy, two patients—the mother and the fetus—are exposed to the drug. Medications that are safe for a woman are sometimes risky for a fetus. Because of this, researchers have not studied many drugs during pregnancy. Here is what we know from research.

Several drugs have been used for many years without any obvious signs of serious risk to the baby. For instance, TCAs have been around for many years, so we have more information about them than about SSRIs. SSRIs are a newer group of drugs than TCAs. Researchers are continuing to study them.

Some antidepressants, but not all, have been linked to problems for the baby. Examples include heart problems, low birthweight, and high blood pressure in the arteries that supply blood to the lungs (pulmonary hypertension).

Women who are depressed are very likely to become ill again if they stop taking their medications.

Some women benefit from a combination of therapy and antidepressants.

Choosing an antidepressant
This decision is difficult because we don't know all the answers. No drug is entirely safe. A woman and her health care team must look at her case and carefully weigh:

• The risks and benefits of various drugs
• The risks and benefits of other types of treatment
• The risk of untreated depression for the woman and her baby

St. John's wort and other herbal remedies
St. John's wort is an herb that some people use to treat depression. According to the National Center for Complementary and Alternative Medicine, some research has shown that St. John's wort may be useful for treating mild to moderate depression. Other studies have shown that it is does not help one type of major depression.

Herbal products, such as St. John's wort, vary in strength and quality from product to product. We need more research to help us know whether St. John's wort is useful and safe for treating depression in pregnant women.

IMPORTANT: We know very little about the effect of St. John's wort on the fetus. Do no take this herb or other herbal remedies without first speaking to your health provider.

Resources
The Organization of Teratology Information Services (OTIS), (866) 626-6847. Provides fact sheets on pregnancy and specific antidepressants, including Prozac and Zoloft.

Depression During and After Pregnancy, a resource for women, their families and friends, provided by the U.S. Department of Health and Human Services.

Depression During and After Pregnancy, provided by the Maternal and Child Health Library.

September 2009

Fifth disease and pregnancy

Fifth disease is a common childhood illness that’s usually pretty mild. But if you get infected during pregnancy, it may hurt your baby.

What causes fifth disease?
Fifth disease is caused by a virus called parvovirus B19. It’s called fifth disease because many years ago, it appeared fifth in a list of common causes of childhood rash and fever. It usually spreads through the air from an infected person's cough or sneeze.

What problems does fifth disease cause in pregnancy?
Most unborn babies are not harmed if their mother gets fifth disease. But some babies do become infected. The virus can make it hard for babies to make red blood cells, which can lead to:

• A dangerous form of anemia. Anemia is when you don’t have enough healthy red blood cells to carry oxygen to the rest of your body.
• Heart failure
• Miscarriage, when a baby dies in the womb before 20 weeks of pregnancy
• Stillbirth, when a baby dies in the womb before birth, but after 20 weeks of pregnancy

What are the symptoms of fifth disease?
Symptoms in children include:

• A rash on the face that looks like a slapped cheek. Rash also can appear on a child’s arms, legs and torso (trunk of the body). Rash is the most common sign in children.
• Fever
• Headache
• Sore throat
• Joint pain

Infected adults often have pain and swelling in their joints and sometimes mild flu-like symptoms. Adults usually don’t get a rash. Symptoms in both children and adults generally appear between 4 and 21 days after infection.

If you think you’ve come in contact with fifth disease or have symptoms that may be caused by it, tell your health care provider immediately. If you have a rash, your health care provider may be able to diagnose fifth disease during a physical exam. If you don’t have a rash, blood tests can help determine if you have fifth disease.

Who is at risk of getting fifth disease?
People with young children and who work with children (such as child care providers and teachers) are most likely to come in contact with fifth disease and get infected.

How can you avoid fifth disease during pregnancy?
Here are some ways to protect yourself from getting infected:

• Wash your hands well after being around children.
• Carefully throw away tissues used by children.
• Don’t share drinking glasses, cups, forks or other utensils with anyone who has fifth disease or who is in contact with someone who has fifth disease.

How is fifth disease treated?
There is no treatment. Fifth disease usually is mild and goes away on its own.

If you’re pregnant and become infected, your health care provider monitors your pregnancy carefully for problems with your baby. He may recommend that you have an ultrasound once a week or every other week for 8 to 12 weeks. If ultrasound doesn’t show any problems, you don’t need any more testing.

If an ultrasound shows that your baby is having problems, your provider may recommend amniocentesis to confirm the infection. If your baby has fifth disease, chances are the infection will go away on its own. Your provider may monitor your baby’s health during routine prenatal care visits.

Fifth disease causes severe anemia in the babies of fewer than 5 percent of infected pregnant women. Severe anemia can cause hydrops, a buildup of fluid in your baby’s body. Hydrops can lead to a baby’s heart failure and death. If an ultrasound shows that your baby has hydrops, your provider may use a special procedure called cordocentesis to check the severity of your baby’s anemia. During this test, your provider inserts a thin needle into an umbilical cord vein to take a small sample of your baby’s blood for testing.

If your baby has severe anemia, your provider may be able to treat it by giving her a blood transfusion through the umbilical cord. Blood transfusion is having new blood put into your body. In most cases, the anemia isn’t severe and your provider may simply monitor your baby for any new health problems before birth.

If your baby has hydrops from fifth disease during the third trimester, you may need to be induced to give birth early. Your provider can talk to you about birth and treatment options for your baby.

How common is fifth disease?
About 6 in 10 adults (60 percent) had the infection as children. If you already had fifth disease, you can’t get it again.

About 1 in 400 women in the United States gets infected with fifth disease during pregnancy.

Last reviewed March 2012

Genital herpes

Genital herpes is a sexually transmitted infection (STI) that can cause serious health problems in infected newborns. Approximately 45 million Americans have genital herpes (1). Up to 1 million new cases occur each year (2), including about 1,200 to 1,500 in newborns (3).

While most women with genital herpes have healthy babies, a small number pass the virus on to their babies during labor and delivery. For this reason, it is especially important for pregnant women to recognize the symptoms of genital herpes and to seek immediate medical treatment if they think they could be infected. Pregnant women should tell their health care provider if they have had herpes in the past, so the provider can take any necessary steps to protect their babies from the infection.

What causes genital herpes?
Herpes is caused by herpes simplex viruses (HSVs), which are similar to the viruses that cause chickenpox and shingles. After the initial infection, HSVs can hide within nerve cells, where the body’s immune system cannot reach them. Then, under the right conditions, the viruses can launch new attacks.

There are two main kinds of HSVs:

• HSV-1, which usually causes cold sores around the mouth and lips
• HSV-2, which usually causes genital sores.

However, either type can infect oral or genital areas, and pregnant women with genital sores caused by either form of HSV can pass the infection on to their babies.

Environmental influences—such as heat, friction, sexual intercourse, menstruation, fever or emotional stress—may trigger a new outbreak of sores. The average infected person experiences four or five recurrences a year. The outbreaks tend to become less frequent and less severe with time.

How is herpes transmitted?
Herpes infections are transmitted by direct contact with an infected person. A person can become infected with genital herpes during:

• Sexual intercourse
• Oral-to-genital contact with an infected person

An infected person can spread the virus from one part of the body to another with unwashed hands. For example, persons who have cold sores always should wash their hands thoroughly after any contact with saliva before touching the genital area.

Children often become infected with HSV-1 during the first years of life. This may occur when a child has direct contact with:

• Herpes sores (for example, being kissed by a person with a cold sore)
• Virus-containing saliva (for example, touching their lips with their fingers after contact with infected saliva)

What are the symptoms of genital herpes?
Shortly after a person contracts herpes, clusters of small blisters may appear in the genital area. These blisters itch and become painful. Then they break, leaving painful ulcers. Fever, fatigue, aches and pains, and a urethral or vaginal discharge often occur.

Health care providers diagnose herpes by:

• Examining the sores
• Doing a swab of the blisters, then ordering lab tests

The lab tests may be a culture or, sometimes, a newer test called polymerase chain reaction (PCR). The provider also may do a blood test to help confirm the diagnosis.

The first, or primary, attack may last as long as 2 to 4 weeks. Recurrent outbreaks generally are shorter and milder.

Most herpes infections, both primary and recurrent, do not produce any symptoms. These symptomless (sometimes called silent) infections generally go undiagnosed. As a result, about 90 percent of people who are infected with genital herpes do not know they have it (3). However, individuals with symptomless infections can pass the virus on to others, including a newborn baby.

How is genital herpes treated in adults?
There is no cure for herpes, but three antiviral drugs can shorten the duration of an attack and help relieve symptoms:

• Acyclovir
• Valacyclovir
• Famciclovir

A provider may recommend one of these drugs when an individual has a primary or recurrent attack of herpes with severe symptoms. The provider also may recommend daily treatment with one of these drugs to help reduce the number of attacks in individuals who have them often.

Pregnant women who have a primary attack of herpes often are treated with acyclovir (3, 4). This drug appears safe in pregnancy and has not been associated with birth defects with more than 20 years of use (3, 5). Valacyclovir and famciclovir usually are not recommended in pregnancy because less is known about their safety (3).

What risks does herpes pose during pregnancy?
About 1 in 4 pregnant women is infected with genital herpes, although most do not know it (3). Fortunately, only a small number pass the infection on to their babies.

Women who acquire genital herpes for the first time near the time of delivery have a 30 to 50 percent chance of passing the infection on to their babies during a vaginal delivery, whether or not they have symptoms (4). The risk is so high because a newly infected pregnant woman has not yet produced disease-fighting antibodies that could help protect her baby during delivery. Studies suggest that about 2 percent of pregnant women acquire herpes for the first time during pregnancy (3).

Women who have had herpes before pregnancy and have a flare-up or silent infection at the time of vaginal delivery have only about a 3 percent chance of infecting their babies (3). Sometimes, what appears to be a first, severe episode of herpes during pregnancy actually can be a flare-up of an old silent infection. These women have a low risk of infecting their babies. Blood tests sometimes can help determine whether a woman has a new infection or a recurrence of an old one.

Are there other ways in which a baby can become infected?
While most babies get herpes from their mothers at delivery, on rare occasions, a baby can become infected before birth (3). A small number of babies acquire herpes after birth (for example, if someone with a cold sore kisses them). A person with a cold sore should not kiss a baby or touch a baby after touching the cold sore.

What are the symptoms of herpes infection in the newborn?
Some infected newborns develop skin or mouth sores or eye infections. When the infection remains limited to these organs, most infected babies develop normally, although serious permanent damage to nerves or the eyes can occur.

However, herpes infections in newborns often spread to the brain and many internal organs. Infected babies may appear irritable, eat poorly and have seizures. Even with treatment, about 30 percent of infants with widespread infections involving the internal organs die, as do about 4 percent of those with brain infections (3). Many babies who survive widespread infections and brain infections develop lasting disabilities, such as intellectual disabilities, cerebral palsy, seizures, and vision or hearing loss.

How are infected newborns treated?
Infected newborns are treated with acyclovir (4, 6). This drug is quite successful in treating localized infections of the eyes, skin or mouth. It is important to treat infected babies early, before the infection spreads, because acyclovir is less effective once the infection has spread to the brain and other internal organs.

How can the baby be protected from infection if the mother has herpes?
If a pregnant woman has a history of genital herpes, her health care provider examines her carefully for any signs of infection when she goes into labor. When a woman has an active infection (primary or recurrent) at the time of delivery, her baby usually can be protected from infection by a cesarean delivery (3, 5). A vaginal delivery is safe for most women with recurrent herpes as long as they don’t have signs of infection at delivery.

Some providers recommend that women with a primary infection during pregnancy or with recurrent flare-ups take acyclovir for the last month of pregnancy. Some studies suggest that this treatment may help prevent active infections during labor and delivery and help reduce the need for cesarean delivery (3, 5).

However, most mothers of infants with newborn herpes infections have no signs or symptoms of active herpes infection at delivery (3). Providers have not yet developed a good way to protect babies when their mothers have silent infections at delivery. Virus-culture tests are not helpful during labor and delivery because results are not available for 1 to 3 days. Researchers are seeking to develop vaccines, as well as blood tests that may offer rapid diagnosis during labor, in order to prevent more newborn infections.

How can a woman avoid getting genital herpes during pregnancy?
A pregnant woman who does not have a history of genital herpes should take special precautions to stay infection-free, especially in the last trimester, when risk to the baby is highest. If her partner has a history of herpes, she may want to ask her health care provider about taking a blood test to find out whether or not she is infected (she could have had a silent infection). If she does not have herpes, her provider may recommend that she avoid intercourse and oral-genital contact in the last trimester. Before the last trimester, she and her partner should avoid intercourse when he has symptoms of infection, and he should wear a condom when he does not have symptoms (because he cannot tell if he has a silent infection). He also can ask his provider about taking preventive antiviral treatment, which can reduce the risk of passing on the infection to his partner.

Does the March of Dimes fund research on newborn herpes infections?
The March of Dimes has supported a number of grants aimed at preventing and treating newborn herpes infections. For example, one recent grantee is seeking to develop a vaccine for newborns that can boost their immune response and help prevent brain damage and deaths resulting from newborn herpes infection. Another is investigating how the virus invades the newborn’s central nervous system in order to develop antiviral drugs that can prevent complications of newborn herpes infections.

References

1. Centers for Disease Control and Prevention (CDC). Genital Herpes Fact Sheet. Updated 1/4/08.
2. Gardella, C., and Brown, Z.A. Serologic Testing for Herpes Simplex Virus. Contemporary Ob/Gyn, October 2007, pages 54-58.
3. American College of Obstetricians and Gynecologists (ACOG). Management of Herpes in Pregnancy. ACOG Practice Bulletin, number 82, June 2007.
4. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases Treatment Guidelines 2006. Morbidity and Mortality Weekly Report, volume 55, RR-11, August 4, 2006.
5. Brown, Z.A., et al. Genital Herpes Complicating Pregnancy. Obstetrics and Gynecology, volume 106, number 4, October 2005, pages 845-856.
6. Kimberlin, D.W., et al. Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era. Pediatrics, volume 108, number 2, August 2001.

August 2008

Genital warts

If the warts grow large or uncomfortable while a woman is pregnant, a health care provider can treat them. Pregnant women who have HPV infection usually do not give it to their babies. Most women are diagnosed with HPV when they have an abnormal Pap test. Very rarely, HPV infection results in certain types of cancers.

What you can do

• Tell your health care provider if you think you have genital warts.
• Do not use over-the-counter wart treatments in the genital area.
• While you're pregnant, you can avoid HPV infection by not having sex. If you do have sex, have sex with only one partner who is only having sex with you, has been tested for HPV infection, and is not infected. Condoms may not protect against infection because they don't always cover all infected areas.
• If you or your partner has genital warts, do not have sex until they have been treated.

For more information

• CDC information line
  (800) 232-4636
  In English and Spanish
  TTY for the deaf and hard of hearing (888) 232-6348
• National HPV and Cervical Cancer Prevention Hotline
  (919) 361-4848
• American Social Health Association

Gestational diabetes

Gestational diabetes is a kind of diabetes that can happen during pregnancy. Four out of every 100 pregnant women (4 percent) develop gestational diabetes. Like other kinds of diabetes, gestational diabetes is a condition in which your body has too much sugar (called glucose) in the blood. Glucose is your body's main source of fuel for energy.

Gestational diabetes usually goes away after you give birth. But if you have it in one pregnancy, you’re more likely to have it in your next pregnancy. You’re also more likely to develop diabetes later in life. Being active, eating healthy foods that are low in sugar and losing weight may help reduce your chances of developing diabetes later in life.

Can gestational diabetes cause problems during pregnancy?
Most of the time gestational diabetes can be controlled and treated during pregnancy to protect both mom and baby. If untreated, though, it can cause serious health problems for you and your baby. If gestational diabetes is left untreated, your baby is more likely to:

• Be born very large. Large babies can get hurt during vaginal birth. You may need to have a cesarean section (c-section) to keep your baby safe. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb).
• Have birth defects. A birth defect is a health condition that is present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
• Have health complications after birth, including breathing problems, low blood sugar and jaundice. Jaundice is a medical condition in which a baby's eyes and skin look yellow. A baby has jaundice when his liver isn't fully developed or isn't working well.
• Be stillborn. This is death of a baby in the womb after 20 weeks of pregnancy but before birth.

Who is more likely to have gestational diabetes?
You may be more likely than other women to develop gestational diabetes during pregnancy if:

• You’re 30 years old or older.
• You’re overweight or you gained a lot of weight during pregnancy.
• You have a family history of diabetes. This means that one or more of your family members has diabetes.
• You’re African-American, Native American, Asian, Hispanic or Pacific Islander. These ethnic groups are more likely to have gestational diabetes than other groups.
• You had gestational diabetes in a previous pregnancy.
• In your last pregnancy, you gave birth to a baby who weighed more than 9 1/2 pounds or was stillborn.

Even women without any of these risk factors can develop gestational diabetes. This is why health care providers test you during pregnancy to see if you have this condition.

How do you know if you have gestational diabetes?
Your health care provider tests you for gestational diabetes with a prenatal test called a glucose tolerance test. You get the test at 24 to 28 weeks of pregnancy. Your provider may give you the test earlier if he thinks you’re likely to develop gestational diabetes.

If you do have gestational diabetes, eating healthy foods and being physically active may be enough to control your blood sugar levels. Women with gestational diabetes may need to check their blood sugar several times a day. You can do this with a special finger-stick device. Some women with gestational diabetes need treatment with medicine or insulin shots. Insulin is a hormone that helps the body control its blood sugar level.

Last reviewed October 2012

Gonorrhea

What you need to know
Gonorrhea is a sexually transmitted infection. It is caused by a bacterium. More than 700,000 people in the United States are infected each year. The bacteria can grow in several places in the body, including the cervix (opening to the womb), uterus (womb), urethra (urine canal), mouth, throat, eyes and anus.

Most women who have gonorrhea do not have symptoms. Some women:

• Feel pain or burning when they urinate
• Have more discharge from the vagina than usual
• Have bleeding or spotting from the vagina

Women who have gonorrhea can develop serious complications if the infection is untreated. They can get pelvic inflammatory disease (PID). PID is an infection of the uterus, fallopian tubes and ovaries in the woman's pelvis. It can cause pain and, if the tubes scar, infertility. Untreated gonorrhea can also spread to the blood or joints. This condition can be life threatening.

Health care providers use lab tests to diagnose gonorrhea.

Gonorrhea is treated with antibiotics.

Babies can get the infection during birth as they pass through the birth canal. In babies, gonorrhea can cause blindness, joint infection, or a life-threatening blood infection.

What you can do
Ask your health care provider to screen you for gonorrhea early in pregnancy. Many providers do this routinely as part of prenatal care. If you do have gonorrhea, you can get antibiotics to treat the infection. This will prevent any complications for you and your baby.

Be sure your partner is also screened. Partners can pass the infection back and forth between themselves.

While you're pregnant, you can avoid gonorrhea by not having sex. If you do have sex:

• Have sex with only one partner who is only having sex with you, has been tested for gonorrhea, and is uninfected.
• Use a latex condom.
• If your provider gives you antibiotics, be sure to take them as directed. Take all of the antibiotics the provider gives you, even if your symptoms go away quickly.

For more information

• CDC information line
  (800) 232-4636
  In English and Spanish
  TTY for the deaf and hard of hearing (888) 232-6348
• American Social Health Association

2010

Group B strep infection

Group B streptococcus (also called Group B strep or GBS) is a common type of bacteria (tiny organisms that live in and around your body) that can cause infection. Usually GBS is not serious for adults, but it can hurt newborns.

Many people carry Group B strep bacteria and don’t know it. It may never make you sick. GBS in adults usually doesn’t have any symptoms, but it can cause some minor infections, like a bladder or urinary tract infection (UTI).

While GBS may not be harmful to you, it can be very harmful to your baby. If you’re pregnant, you can pass it to your baby during labor and childbirth.

About 1 out of 4 pregnant women (25 percent) carry GBS bacteria. The best way to know if you have GBS is to get tested. If you do have GBS, though, there’s good news: your health care provider can give you treatment during labor and birth that protects your baby from GBS.

How do you get GBS?
GBS bacteria live in the intestines and the urinary and genital tracts. It lives in the body naturally. As an adult, you can’t get it from food, water or things you touch. You can’t catch it from another person, and you can’t get it from having sex.

How do you know if you have GBS?
Your provider tests you for GBS at 35 to 37 weeks of pregnancy. Testing for GBS is simple and painless. Your provider takes a swab of your vagina and rectum and sends the sample to a laboratory. Your test results are usually available in 1 to 2 days.

Your provider also can use some quick screening tests during labor to test you for GBS. But these should not replace the regular GBS test that you get at 35 to 37 weeks of pregnancy.

How can you protect your baby from GBS?
If your GBS test at 35 to 37 weeks shows you have the infection, your provider gives you medicine called an antibiotic during labor and birth through an IV (through a needle into a vein). You also may be treated if you have any risk factors for GBS and you don’t know your GBS test results or you haven’t been tested yet. Treatment with antibiotics helps prevent your baby from getting the infection.

Penicillin is the best antibiotic for most women. Another antibiotic called ampicillin also can be used. These medicines usually are safe for you and your baby. But some women (up to 1 in 25 women, or 4 percent) treated with penicillin have a mild allergic reaction, like a rash. About 1 in 10,000 women have a serious allergic reaction that needs to be treated right away. If you’re allergic to penicillin, your provider can treat you with a different medicine.

If your test shows you have GBS, remind your health care providers at the hospital when you go to have your baby. This way, you can be treated quickly. Treatment works best when it begins at least 4 hours before childbirth.

If you have GBS and you’re having a scheduled cesarean birth (c-section) before labor starts and before your water breaks, you probably don’t need antibiotics.

It’s not helpful to take oral antibiotics before labor to treat GBS. The bacteria can return quickly, so you could have it again by the time you have your baby.

If you have GBS, what are the chances that you can pass it to your baby?
If you have GBS during childbirth and it’s not treated, there is a 1 to 2 in 100 chance (1 to 2 percent) that your baby will get the infection. The chances are higher if you have any of these risk factors:

• Your baby is premature. This means your baby is born before 37 completed weeks of pregnancy.
• Your water breaks (also called ruptured membranes) 18 hours or more before you have your baby.
• You have a fever (100.4 F or higher) during labor.
• You’ve already had a baby with a GBS infection.
• You had a UTI during your pregnancy that was caused by GBS.

If you have GBS and you’re treated during labor and birth, your treatment helps protect your baby from the infection.

If your baby gets GBS, do signs of infection or other problems show up right after birth?
Not always. It depends on the kind of GBS infection your baby has. There are two kinds of GBS infections:

1. Early-onset GBS: Signs like fever, trouble breathing and drowsiness start during the first 7 days of life, usually on the first day. Early-onset GBS can cause pneumonia, sepsis or meningitis. If you have GBS, you can pass this kind of infection to your baby. But treatment with antibiotics during labor and birth can help prevent your baby from getting it. About half of all GBS infections in newborns are early-onset.
2. Late-onset GBS: Signs like coughing or congestion, trouble eating, fever, drowsiness or seizures usually start when your baby is between 7 days and 3 months old. Late-onset GBS can cause sepsis or meningitis. If you have GBS, you can pass this kind of infection to your baby during or after birth. Treatment with antibiotics during labor and birth does not prevent late-onset GBS. After birth, your baby also can get GBS from other people who have the infection.

What problems can GBS cause in newborns?
Babies with a GBS infection can have one or more of these illnesses:

• Meningitis, an infection of the fluid and lining around the brain
• Pneumonia, a lung infection
• Sepsis, a blood infection

Pneumonia and sepsis in newborns can be life-threatening.

Most babies who are treated for GBS do fine. But even with treatment, about 1 in 20 babies (5 percent) who have GBS die. Premature babies are more likely to die from GBS than full-term babies (born at 39 to 41 weeks of pregnancy).

GBS infection may lead to health problems later in life. For example, about 1 in 4 babies (25 percent) who have meningitis caused by GBS develop:

• Cerebral palsy (A group of disorders that can cause problems with brain development. These problems affect a person's ability to move and keep their balance and posture.)
• Hearing problems
• Learning problems
• Seizures

If your baby has GBS infection, how is he treated?
It’s important to try and prevent a newborn from getting GBS. But if a baby does get infected with early-onset GBS or late-onset GBS, he is treated with antibiotics through an IV.

If you’re treated for GBS during labor, does your baby need special treatment?
Probably not. But if you have a uterine infection (an infection in your uterus) during labor and birth, your baby should be tested for GBS. Your baby’s provider can treat your baby with antibiotics while you wait for the test results.

Can GBS cause problems for mom during and after pregnancy?
GBS can cause a uterine infection during and after pregnancy. Symptoms of a uterine infection include:

• Fever
• Pain in your belly
• Increased heart rate (During pregnancy, it also can cause your baby’s heart rate to increase.)

If you have a uterine infection, your provider can give you antibiotics, and the infection usually goes away in a few days. Some women have no symptoms, so they don’t get treatment. Without treatment, infection during pregnancy may increase your chances of:

• Premature rupture of the members – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts
• Preterm labor – Labor that happens too early, before 37 completed weeks of pregnancy
• Stillbirth – When a baby dies in the womb before birth, but after 20 weeks of pregnancy

If you’re treated for GBS during labor and birth, you probably won’t get a uterine infection after your baby is born.

GBS also can cause a UTI during pregnancy. A UTI can cause fever or pain and burning when you urinate. Sometimes a UTI doesn’t have any symptoms. If you have a UTI, you may find out about it from a urine test during one of your prenatal visits.

If you have a UTI caused by GBS, your provider gives you antibiotics to take by mouth during pregnancy. You also get antibiotics through an IV during labor and birth, because you may have high levels of GBS in your body.

Is there a vaccine for GBS?
No. But researchers are making and testing vaccines to prevent GBS infection in mothers and their babies.

More information
Centers for Disease Control and Prevention (CDC)

HELLP syndrome

Some pregnant women with high blood pressure develop a condition called HELLP syndrome. HELLP stands for these blood and liver problems:

• H--Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
• EL--Elevated liver enzymes. High levels of these chemicals can be a sign of liver problems.
• LP--Low platelet count. Platelets help the blood clot.

HELLP syndrome is rare but serious. It happens in about 1 to 2 of 1,000 pregnancies. About 2 in 10 pregnant women (20 percent) with preeclampsia or eclampsia have HELLP.

What are the signs and symptoms of HELLP syndrome?
Signs and symptoms can appear during pregnancy or after giving birth. Most women with HELLP have signs and symptoms before 37 weeks of pregnancy. But some women don’t have them until the week after they give birth.

Signs and symptoms include:

• Blurry vision
• Fatigue (feeling really tired)
• Quick weight gain and swelling
• Headache
• Nausea or throwing up
• Nosebleed or other bleeding that doesn’t stop easily
• Seizures
• Upper belly pain

If you have any of these signs or symptoms, call your health care provider or go for medical care immediately.

How is HELLP syndrome diagnosed?
Your provider does a physical exam to check you for:

• Belly pain or soreness, especially in the upper right side
• Enlarged liver
• High blood pressure
• Swelling in your legs

Your provider also may use a liver function test to check your liver enzyme levels or blood tests to check your platelet count. A CAT scan can show bleeding into the liver. A CAT scan is a test that uses X-rays and computers to take pictures of your body.

Many women are diagnosed with preeclampsia before they have HELLP. Preeclampsia is a kind of high blood pressure that only pregnant women can get. Sometimes HELLP symptoms are the first sign of preeclampsia.

How is HELLP syndrome treated?
If you have HELLP, your provider may give you medicine to control your blood pressure and prevent seizures. Sometimes women also need a blood transfusion. This is when you have new blood put into your body.

Women who have HELLP syndrome almost always need to give birth as soon as possible, even if the baby is born prematurely, before 37 completed weeks of pregnancy. Early birth is necessary because HELLP complications can get worse and harm both mom and baby.

If you have HELLP syndrome, your provider may give your corticosteroid medicines to help speed your baby’s lung growth. He also may induce your labor. This means he gives you medicines to make labor begin. Some women need a cesarean section (c-section). A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

Without early treatment, 1 out of 4 women (25 percent) with HELLP syndrome has serious complications. Without any treatment, a small number of women die.

What causes HELLP syndrome?
We don’t know what causes HELLP. But if you’ve had it before, you may have it again in 1 out of 4 future pregnancies (25 percent).

You may be able to reduce your risk of having HELLP syndrome by getting prenatal care early and throughout your pregnancy. Getting regular prenatal care allows your provider to find and treat any problems like HELLP early.

Last reviewed April 2012

See also: High blood pressure during pregnancy, Preeclampsia

High blood pressure during pregnancy

Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. If the pressure in your arteries becomes too high, you have high blood pressure. High blood pressure also is called hypertension.

Your blood pressure reading is given as two numbers: the top (first) number is the pressure when your heart contracts and the bottom (second) number is the pressure when your heart relaxes. A healthy blood pressure is 110/80. High blood pressure happens when the top number is 140 or greater, or when the bottom number is 90 or greater.

High blood pressure can stress your heart and cause problems during pregnancy. Some women have high blood pressure before they get pregnant. Others have high blood pressure for the first time during pregnancy. About 8 in 100 women (8 percent) have some kind of high blood pressure during pregnancy.

What kinds of high blood pressure can happen during pregnancy and how are they treated?
There are four main kinds of high blood pressure during pregnancy:

1. Chronic hypertension. This is high blood pressure you already have before you get pregnant or that develops before 20 weeks of pregnancy. It doesn’t go away once you give birth.
   
   During pregnancy, your health care provider makes sure your blood pressure is under control. Without treatment, chronic hypertension can lead to health problems like heart failure or stroke. He also checks for signs of preeclampsia.
   
   Your provider changes any medicine you take if it’s not safe for your baby. Some blood pressure medicines, called ACE inhibitors and angiotensin receptor blockers, can harm your baby during pregnancy. You may be able to stop taking your medicine during the first half of pregnancy. Blood pressure tends to fall during this time. Don’t stop taking any medicine, though, before you talk to your health care provider.
   
   Your provider may use ultrasound and fetal heart rate testing to check your baby’s growth and health. You may need to give birth early if your hypertension gets worse or if you go on to have preeclampsia.
2. Preeclampsia. This is a high blood pressure that only pregnant women can get. It happens when you have both high blood pressure and protein in your urine. It usually starts after 20 weeks of pregnancy and goes away after you give birth.
   
   Preeclampsia can be a serious medical condition. In rare cases, it can become a life-threatening condition called eclampsia. Eclampsia causes seizures and can lead to coma. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse. Without treatment, preeclampsia can cause kidney, liver and brain damage. Treatment depends on how severe your preeclampsia is. Treatment can range from careful monitoring by your provider to inducing labor.
3. Gestational hypertension. This is high blood pressure that only pregnant women can get. Unlike preeclampsia, women with gestational hypertension don’t have protein in their urine. This condition starts after 20 weeks of pregnancy and goes away after you give birth. Some women with gestational hypertension have preeclampsia later in pregnancy.
   
   We don’t know how to prevent gestational hypertension. But if you’re overweight or obese, reaching a healthy weight before pregnancy may lower your chances of having this condition.
   
   During pregnancy, your provider checks your blood pressure and urine at every prenatal visit to monitor your hypertension. She may use ultrasound and fetal heart rate testing to check your baby’s growth and health.
4. Chronic hypertension with preeclampsia. About 1 in 4 women with chronic hypertension (25 percent) have preeclampsia later in her pregnancy.
   
   During pregnancy, your provider montiros your conditiona at every prenatal visit. She may use ultrasound and fetal heart rate testing to check your baby's development.

What pregnancy complications can high blood pressure cause?
If you have high blood pressure during pregnancy, your provider can help you manage most health problems through regular prenatal care. Pregnant women with high blood pressure are more likely than women without high blood pressure to have these complications:

• Low birthweight. This is when a baby weighs less than 5 pounds, 8 ounces. High blood pressure can narrow blood vessels in the uterus (womb). Your baby may not get enough oxygen and nutrients, causing him to grow slowly.
• Premature birth. This is birth that happens too early, before 37 completed weeks of pregnancy. Even with treatment, a pregnant woman with severe high blood pressure or preeclampsia may need to give birth early to avoid serious health problems for her and her baby.
• Placental abruption. In this condition the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If you have vaginal bleeding during pregnancy, contact your health care provider immediately.

How is high blood pressure diagnosed during pregnancy?
Most women with high blood pressure during pregnancy have no symptoms. So it’s important to go to all your prenatal care visits. Your provider measures your blood pressure and checks your urine for protein at every visit. If you have high blood pressure, your provider can help you manage it.

What can you do about high blood pressure before pregnancy?
If you have chronic hypertension before pregnancy, go for a preconception checkup before you try to get pregnant. Making healthy choices before pregnancy can help you manage your blood pressure. For example, do something active and eat healthy foods every day to help you get to or stay at a healthy weight. If you smoke, quit. Smoking is dangerous for people with high blood pressure because it damages blood vessel walls. Making these changes can help you have a safer pregnancy.

Last reviewed March 2012

See also: HELLP syndrome, Preeclampsia

HIV

HIV stands for human immunodeficiency virus. It’s a virus that attacks the body’s immune system. In a healthy person, the immune system protects the body from infections, cancers and some diseases. Over time, HIV can destroy the cells in the immune system so that it can’t protect the body. When this happens, HIV can lead to AIDS (acquired immune deficiency syndrome).

More than 1 million people in the United States live with HIV. There are about 50,000 new infections each year.

Nearly 30 percent (3 in 10) of new cases of HIV infection in the United States each year are in women. More than 250,000 women, most of childbearing age (15 to 44), live with HIV. Many don’t know they have it.

Nearly all children living with HIV get the virus from their mother during pregnancy, the process of birth or later through breastfeeding.

Although there is no cure for HIV or AIDS, powerful medicines can help protect those who have HIV from developing AIDS.

If you’re pregnant, get tested for HIV. Proper treatment usually can prevent you from passing HIV to your baby.

How is HIV spread?
You get HIV by coming in direct contact with body fluids from a person who is infected with HIV. Body fluids that can contain HIV include:

• Blood
• Breast milk
• Semen
• Vaginal fluids

HIV can be transmitted sexually. This means you can get it from having unprotected sex (sex without a condom) with an infected person. This is how women are most likely to get infected. The Centers for Disease Control and Prevention (CDC) says:

• Most (about 80 percent or 8 in 10) new HIV infections in women come from having sex with a man who is infected. Women are more likely than men to get infected through sex.
• About 20 percent (2 in 10) of new HIV infections in women come from sharing drug needles.

Women most likely to become infected include:

• Women whose partners use intravenous (IV) street drugs. This means the partners inject street drugs into their body through a needle into a vein.
• Women whose partners also have sex with men
• Women who have sex with more than one partner.

A small number of women get HIV from blood transfusions or tissue transplanted from an infected person.

If you have HIV, can you pass it to your baby?
Yes. Babies can get HIV from their mothers:

• Before birth, when the virus crosses the placenta and infects the baby. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord.
• During labor and birth from contact with their mother’s blood and vaginal fluids
• After birth through breast milk

There are ways to keep your baby from coming in contact with HIV in your body fluids during pregnancy. For example, your provider may recommend that you don’t get certain prenatal tests like amniocentesis or fetal-scalp blood sampling.

Studies show that you may lessen the chance of passing HIV to your baby by having a cesarean birth (c-section) before labor begins and your water breaks, instead of vaginal birth. The U.S. Public Health Service and the American College of Obstetricians and Gynecologists recommend that health providers offer women with HIV a c-section at 38 completed weeks of pregnancy.

What are the signs and symptoms of HIV?
Many people who are infected with HIV don’t have symptoms at first. It can take 5 years or more for some people to have symptoms. Early signs and symptoms are:

• Fever
• Headache
• Tiredness
• Enlarged lymph nodes (swollen glands in the neck and groin)

How is HIV diagnosed?
Health care providers diagnose HIV with a blood test. After HIV enters your blood, your body begins to make antibodies to fight it. A blood test can find these antibodies and show that you are infected.

All women need to be aware of their HIV status before getting pregnant. The CDC recommends that all pregnant women get tested for HIV. It also recommends getting tested again later in pregnancy if you live in an area where HIV is common or if you do things that put you at risk for HIV, like having unprotected sex or injecting street drugs. Women with HIV can get treatment and help protect their babies from becoming infected.

If you haven’t had an HIV test during pregnancy, you can be checked during labor and birth with a quick test. If this test shows you have HIV, you can get treatment to help protect your baby from infection.

Where can you get tested for HIV?
You can get an HIV test from:

• Your health care provider
• The local health department
• Hospitals
• Clinics
• Special testing sites

The CDC provides information and referrals to local testing sites, including free and anonymous testing, at hivtest.org. Or call (800) CDC-INFO (232-4636).

How is HIV treated?
People with HIV usually are treated with combinations of medicines that fight HIV. These medicines often slow the spread of HIV in the body. Pregnant woman with HIV need treatment with these medicines throughout pregnancy.

Some medicines used to treat HIV may be harmful to a baby during pregnancy. And some medicines are too new, so we don’t yet know if they’re safe to take during pregnancy. To find out about the safety of medicines used to treat HIV during pregnancy, see the Department of Health and Human Services info sheet.

Talk with your health care provider about treatment options to help prevent you from passing the infection to your baby. If you’re pregnant and already taking HIV medicines, tell your provider about all the medicines you take.

How are babies with HIV treated?
Babies with HIV may look healthy at birth. But if they are not treated, about 15 percent become seriously ill and may die during the first year of life. Thanks to good HIV treatment, more than 95 percent survive and can live a full life.

If you have HIV during pregnancy, get your baby tested for the virus:

• At 2 to 3 weeks after birth
• At 1 to 2 months of age
• At 4 to 6 months of age

Some providers test babies within 48 hours of birth. This test can find most infected babies by 1 month and all by 4 months.

The U.S. Public Health Service recommends that all infants infected with HIV be treated with a combination of anti-HIV medicines. The medicines can slow the infection and help them survive.

Most babies infected with HIV can get all routine childhood vaccinations. But some of these babies shouldn’t get live-virus vaccines, such as the chickenpox, mumps, rubella and measles vaccines. They should be vaccinated against polio, but only with the injectable Salk vaccine and not the oral vaccine. Talk to your baby’s provider to find out which vaccines are safe for your baby.

How can you protect yourself from HIV?
Try to avoid all possible sources of HIV infection. Here’s how:

• Have safe sex. Use latex condoms for protection.
• Have sex with only one person who is not infected with HIV and who has no other sex partners.
• Don’t use needles, razors or other items that may come in contact with another person’s blood.

Last reviewed May 2012

Influenza (flu) and pregnancy

Influenza is a serious disease. It’s more than just a runny nose and sore throat. Instead, it can cause a person to be very sick.

Influenza is commonly called the “flu.” Many people say they have the flu when they really have just a cold or a cough. If you do have influenza, it can cause serious illness. And for some people, it can be life-threatening. It can be especially harmful to pregnant women. Pregnant women are at high risk of having serious health problems from influenza.

Influenza is easily spread from person to person. When someone with influenza coughs, sneezes or speaks, the virus spreads through the air. You can get infected with influenza if you breathe it in. You also can get infected if you touch something (like a door handle or a phone) that has the influenza virus on it and then you touch your nose, eyes or mouth.

The best way to protect yourself from influenza is to get the influenza vaccine (flu shot) each year before flu season starts in October. You can get the shot from your health care provider. Many pharmacies and work places also offer it each fall. Even though you’re more likely to get influenza during flu season (October through May), you can get it any time of year.

What are symptoms of influenza?
You may have the influenza if you:

• Have a fever
• Have chills
• Have a cough
• Have a sore throat
• Have a runny or stuffy nose
• Have muscle or body aches
• Have headaches
• Feel very tired
• Have vomiting and diarrhea (more common in children)

For most people, symptoms last for a few days. But some people, including children, people older than 65 and pregnant women, can be sick from influenza for a longer time.

How can influenza harm your pregnancy?
Health complications from influenza, such as pneumonia, can be serious and even deadly, especially if you’re pregnant. Pregnant women who get influenza are more likely than women who don’t get it to have preterm labor and premature birth. These are labor and birth that happen too early, before 37 completed weeks of pregnancy. Premature birth can cause serious health problems for your baby.

Influenza can be harmful during pregnancy because pregnancy affects your immune system. Your immune system is your body’s way of protecting itself from illnesses and diseases. When your body senses something like a virus that can harm your health, your immune system works hard to fight the virus.

When you’re pregnant, your immune system isn’t as quick to respond to illnesses as it was before pregnancy. Your body knows that pregnancy is OK and that it shouldn’t reject your baby. So, your body naturally lowers the immune system’s ability to protect you and respond to illnesses so that it can welcome your growing baby. But a lowered immune system means you’re more likely to catch illnesses like influenza.

Another reason influenza can be harmful during pregnancy is that your lungs need more oxygen, especially in the second and third trimesters, for you and your baby. Your growing belly puts pressure on your lungs, making them work harder in a smaller space. You may even find yourself feeling shortness of breath at times. Your heart is working hard, too. It’s busy supplying blood to you and your baby. All of this means your body is stressed during pregnancy. This stress on your body can make you more likely to get an illness like influenza.

Is it safe to get a flu shot during pregnancy?
Yes. The influenza vaccine is safe at any time during pregnancy. Almost all women who are or will be pregnant during flu season can get the shot. Getting the flu shot can help protect you from getting influenza and spreading it to others.

Getting a flu shot during pregnancy is good for your baby, too. Babies born to women who get the vaccine during pregnancy are less likely to get sick with influenza.

Some pregnant women shouldn’t get the shot because they have a health problem that can be affected by the vaccine. For example, if you’re allergic to eggs, don’t get the shot because it’s made with eggs. Your health care provider can tell you if there are any reasons why you shouldn’t get the shot. But it’s safe for most pregnant women.

The 2012-2013 influenza vaccine protects you against seasonal flu and the H1N1 flu that spread around the world in 2009. It’s important to get the vaccine every year because the viruses are always changing, so protection from the vaccine only lasts about a year. You can get the vaccine from your health care provider or at places like local health clinics, health departments and pharmacies.

Pregnant women shouldn’t get the nasal influenza mist vaccine. It’s not effective for pregnant women and may cause health problems.

How is influenza treated?
If you have influenza symptoms, call your health care provider right away. He can give you medicines to help protect you and your baby from the infection. Some medicines can help fight influenza, but you need a prescription for them from your health care provider. It’s important to start these medicines right away.

The Centers for Disease Control and Prevention (CDC) recommends two medicines for influenza:

1. Oseltamivir (Tamiflu)
2. Zanamivir (Relenza)

Talk to your provider to see which medicine is right for you.

Fever and most other symptoms can last a week or longer. If you’re uncomfortable from fever, ask your health care provider if you can take acetaminophen (Tylenol®).

If you have influenza, get lots of rest and drink plenty of fluids. You may not want to eat much. Try eating small meals to help your body get better.

When should you call your health care provider?
Call your provider right away if you have any of these symptoms:

• Trouble breathing or shortness of breath
• Pain or pressure in the belly or chest
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Symptoms that get better but then come back with fever and worse cough
• High fever that doesn’t go down after taking acetaminophen
• Feeling your baby move less, or not at all

How can you stop influenza from spreading?
When you have influenza, you can spread it to others. Here’s what you can do to help prevent it from spreading:

• Stay home when you’re sick.
• Limit your contact with others.
• Don’t kiss anyone.
• Cough or sneeze into a tissue or your arm. Throw used tissues in the trash.
• Try not to touch your eyes, nose and mouth.
• Wash your hands with soap and water before touching anyone. You also can use alcohol-based hand rubs (sanitizers).
• Use hot, soapy water or a dishwasher to wash your dishes and utensils.
• Don’t share your dishes, glasses, utensils or toothbrush.

For more information
Flu.gov

Last reviewed October 2012

See also: Flu and your baby, Vaccinations during pregnancy

Listeriosis

Listeriosis is a kind of food poisoning. Food poisoning is caused by harmful germs in something you eat or drink. It can cause nausea, vomiting, diarrhea, fever and headache.

There are about 1,600 new cases of listeriosis each year in the United States. Most healthy people don’t get sick from listeriosis. It mostly affects people with a weak immune system, including newborns, elderly people and people with health conditions, like diabetes or HIV.

Pregnant women are about 20 times more likely than others to get listeriosis. If you get listeriosis during pregnancy, it can cause serious and even life-threatening health problems for your growing baby.

What causes listeriosis?
Listeriosis is caused by bacteria called Listeria. Bacteria are tiny organisms that live in and around your body. Some bacteria are good for your body. Others, like Listeria, can make you sick. Listeria may be found in the soil, water, animals and animal poop.

Most people get listeriosis by eating food that is contaminated with Listeria. Food can come in contact with Listeria in soil, water, animals or animal poop.

Foods that may have Listeria include:

• Vegetables that come in contact with animal poop in the soil or in fertilizer
• Meats, including beef, pork and chicken
• Unpasteurized milk and foods made with it. If a food has been pasteurized, it’s been heated to kill bad germs. Milk and juices often are pasteurized. Look for the word “pasteurized” on the product label.
• Hot dogs (and juice from hot dogs) and deli meats, like ham, turkey, salami and bologna
• Pre-made or cold salads from delis or salad bars
• Pates or meat spreads that have been kept in a refrigerator. Canned meat spreads are safe.
• Soft cheeses, like feta, Brie, Camembert, Roquefort, blue-veined, queso blanco, queso fresco or Panela
• Smoked fish (nova style, lox, kippered or jerky) that has been kept in a refrigerator. Smoked fish is safe if it’s canned or you use it in a cooked dish (like a casserole).

Foods can cross contaminate each other. Cross contamination is the transfer of harmful bacteria from one thing to another. For example, if you use the same knife to cut raw chicken and tomatoes and don’t wash the knife in between, it can pass Listeria from the chicken to the tomatoes. Or if you get juice from a hot dog package on a knife, it can pass Listeria from the knife to the next food you cut.

You may hear news stories about foods that have been recalled (not allowed to be sold) because of listeriosis. If you’ve eaten one of these foods, call your health care provider right away.

How do you know if you have listeriosis?
Signs and symptoms of listeriosis usually start a few days after you’ve eaten infected food. But it can take up to 2 months for them to appear. To test for listeriosis, your provider takes a sample of your blood or urine, or fluid from your spine. Your provider sends the sample to a lab for testing.

Listeriosis usually causes mild, flu-like symptoms including:

• Fever
• Muscle aches
• Chills
• Nausea
• Diarrhea

If listeriosis infection spreads to your nervous system (brain and spinal cord), symptoms may include:

• Headache
• Stiff neck
• Being confused
• Trouble with balance
• Seizures

Call your health care provider if you think you may have listeriosis. Treatment depends on your symptoms. During pregnancy, quick treatment with antibiotics can keep listeriosis from harming your baby. Antibiotics are medicines that kill infections caused by bacteria.

What problems can listeriosis cause during pregnancy?
If you’re pregnant and get listeriosis, you can pass the infection to your baby. This can cause problems like:

• Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy. Having listeriosis early in your pregnancy can increase your chances of having a miscarriage.
• Stillbirth. This is when a baby dies in the womb before birth, but after 20 weeks of pregnancy. Having listeriosis late in your pregnancy can increase your chances for stillbirth.
• Premature birth. This is birth that happens too early, before 37 completed weeks of pregnancy.
• Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.
• Life-threatening infections in your baby. If you have listeriosis late in your pregnancy, your baby may be at risk for serious infections, like bacteremia (bacteria in the blood) and . Meningitis is an infection that causes swelling in the brain and spinal cord. Infected newborns may have health problems, including seizures, blindness and problems with the brain, heart and kidneys.

How can you protect yourself and your baby from listeriosis?
Here are some things you can to help prevent listeriosis:

• Handle foods safely when you wash, prepare, cook and store them.
• Wash your hands well with soap and water after contact with animals, animal food, bedding, tanks or animal poop.
• Wash your hands well with soap and water after using the bathroom.
• Watch out for cross contamination between yourself, food and any utensils or supplies you use when preparing or eating food.

Last reviewed March 2013

See also: Salmonellosis, Handling food safely, Eating healthy during pregnancy

Liver disorders

Intrahepatic cholestasis of pregnancy
What is ICP?
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related liver disorder in which there are abnormalities in the flow of bile (a substance produced by the liver that aids in the digestion and absorption of fats). These abnormalities lead to a build-up of bile acids (components of bile) in the mother's blood, resulting in symptoms such as severe skin itching.

What are the symptoms of ICP?
The symptoms of ICP can range from mild to severe. Symptoms usually start in the second or third trimester of pregnancy. The most common symptoms include:

• Skin itching: Itching often is most severe on the palms of the hands and soles of the feet, but many affected women itch all over their bodies. It often gets progressively worse and may interfere with sleep and daily activities.
• Jaundice: This yellowing of the skin and whites of the eyes occurs in 10 to 20 percent of women with ICP (1). Jaundice is caused by a build-up of a chemical called bilirubin in the blood, resulting from the liver disorder and decreased bile flow.

A pregnant woman should call her health care provider if she has these symptoms.

How common is ICP?
In the United States, ICP affects less than 1 percent of women (1).

What are the risks of ICP in pregnancy?
ICP can be very uncomfortable for the pregnant woman. It also can hurt the baby. Up to 60 percent of women with ICP deliver prematurely (before 37 completed weeks of pregnancy) (2). Premature babies are at increased risk for health problems during the newborn period and for lasting disabilities and death. ICP also increases the risk for stillbirth, though the risk is small (1 to 2 percent) (1). It is important to diagnose and treat ICP to help prevent these potential problems.

How is ICP diagnosed?
There are a number of skin disorders of pregnancy that can cause itching; most do not harm the mother or baby. Blood tests can tell if a woman's itching is due to ICP. These often include a blood test that measures various chemicals that show how well a woman's liver is functioning and the amount of bile acids in her blood.

How is ICP treated?
ICP often is treated with a medication called ursodeoxycholic acid (Actigall). This medication relieves skin itching, helps correct liver function abnormalities and may help prevent stillbirth.

The health care provider monitors the baby closely (with ultrasound and tests that measure heart rate) to see if the baby appears to be developing any difficulties, such as heart rate abnormalities, due to ICP. If the baby is having difficulties, the provider may recommend early delivery to help reduce the risk of stillbirth. The provider also may do a test called amniocentesis when the baby is at about 36 weeks gestation to see if the lungs are mature. If the baby's lungs are mature enough for the baby to breathe on his own, the provider may induce labor at 36 to 38 weeks to help prevent stillbirth (1).

What causes ICP?
The cause of ICP is not well understood. Pregnancy hormones and heredity appear to play a role. ICP appears to be more common in twin (or other multiple) pregnancies, possibly due to increased hormone levels (1). About half of women with ICP have a family history of related liver disorders (3).

Does ICP go away after giving birth?
Symptoms of ICP generally clear up on their own by about 2 days after a woman gives birth. However, about 60 to 70 percent of affected women develop ICP again in another pregnancy (1).

Hepatitis
What is hepatitis?
Hepatitis is inflammation of the liver, usually caused by a virus. Several viruses can cause hepatitis. The most common are called hepatitis A, B and C.

What are the symptoms of hepatitis?
Symptoms of hepatitis can range from mild to severe. Some infected individuals have no symptoms at all. Common symptoms include:

• Jaundice
• Fatigue
• Nausea and vomiting
• Upper-abdominal discomfort
• Low-grade fever

What is chronic hepatitis?
Some individuals who contract hepatitis B or hepatitis C do not clear the virus from their bodies, and the virus can remain in their systems for life. Individuals with a chronic hepatitis infection are at increased risk for severe liver disease or liver cancer. About 10 to 15 percent of individuals with hepatitis B, and at least 50 percent with hepatitis C, develop chronic infections (4). Individuals with hepatitis A do not develop chronic infections.

How is hepatitis treated?
There are no medications to treat acute (recently acquired) hepatitis infections. There are medications to treat chronic hepatitis B and C, but these usually are not recommended during pregnancy (5).

There are at least six antiviral drugs that can be used to treat hepatitis B. Little is known about the safety of these drugs in pregnancy. Some are suspected of increasing the risk of birth defects and miscarriage. Women should tell their health care provider before starting any of these drugs if they are planning pregnancy. Women who become pregnant while taking any of these drugs should call their provider. These drugs also are not recommended during breastfeeding.

Chronic hepatitis C can be treated with a combination of two antiviral drugs (ribavirin and pegylated interferon alfa-2a). These drugs are believed to contribute to birth defects and miscarriage. Women should avoid pregnancy while taking them and for six months after completing treatment. A woman should notify her provider immediately if she becomes pregnant while taking these drugs. They also should not be used during breastfeeding, or by male partners of pregnant women.

What are the risks of hepatitis in pregnancy?
Hepatitis A generally does not pose a risk to the baby when the mother contracts it during pregnancy. It is rarely passed from mother to baby during delivery (6).

Hepatitis B poses the greatest risk in pregnancy. Women who carry the virus in their system (acute or chronic infection) can pass it on to their babies during labor and delivery. In most cases, the risk is about 10 to 20 percent, though it can be higher if the woman has high levels of the virus in her body (4). Babies who are infected at birth usually develop chronic hepatitis B infection and face a high risk of serious liver disease and liver cancer as adults.

Hepatitis C is passed along to the baby during labor and delivery in only about 4 percent of cases (5).

How can hepatitis infection be prevented in babies?
The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for hepatitis B with a blood test (5). If the blood test shows that a woman has acute or chronic hepatitis B, her baby should receive the hepatitis B vaccine and immune globulin (which contains hepatitis-fighting antibodies) within 12 hours of birth. This treatment prevents infection in more than 90 percent of babies at risk (5). The baby also should have two more doses of the vaccine in the first 6 months of life. The CDC also recommends that all babies be vaccinated against hepatitis B before leaving the hospital and at 1 to 2 months and 6 to 18 months (5).

There is currently no way to prevent a mother from passing hepatitis C to her baby.

How does a person get infected with a hepatitis virus?
Hepatitis A usually is spread through contaminated food and water. People who travel to developing countries are at increased risk. Hepatitis B and C occur after contact with blood or body fluids of an infected person. This may occur by sharing needles used to inject drugs or by having sex with an infected person (though hepatitis C is spread infrequently through sexual contact).

How can a pregnant woman protect herself from hepatitis?
The best defense against hepatitis A and B is vaccination. Women who are planning to travel to a developing country should ask their provider if they should be vaccinated against hepatitis A. The hepatitis A vaccine has not been studied for safety during pregnancy, but it is not believed to pose a risk (6).

The hepatitis B vaccine is considered safe in pregnancy. Health care workers, public safety workers and others at high risk (such as women living with an infected partner) should consider getting the hepatitis B vaccine before or during pregnancy.

There is no vaccine against hepatitis C. Women also can help protect themselves from hepatitis B and C by following safe sex practices, avoiding illicit injected drugs, and not sharing personal care items that might have blood on them (razors, toothbrushes).

HELLP syndrome
What is HELLP syndrome?
HELLP syndrome is a dangerous pregnancy complication characterized by liver and blood abnormalities. HELLP stands for hemolysis (breakdown of red blood cells), elevated liver enzymes, and low platelet (blood cell fragments needed for blood clotting) count. It is a form of severe preeclampsia, a pregnancy disorder characterized by high blood pressure and protein in the urine. HELLP syndrome occurs in about 10 percent of pregnancies complicated by severe preeclampsia (7).

What are the symptoms of HELLP syndrome?
Symptoms of HELLP syndrome usually occur in the third trimester of pregnancy, though they can begin earlier. Symptoms also may appear in the first 48 hours after delivery. A pregnant woman should contact her health care provider if she experiences these symptoms:

• Pain in the stomach or upper-right abdomen
• Nausea or vomiting
• General malaise
• Headache

How common is HELLP syndrome?
HELLP syndrome affects less than 1 percent of pregnant women (8).

What are the risks of HELLP syndrome?
Unless treated promptly, HELLP syndrome can cause serious risks for mother and baby. In the mother, it can cause liver damage and, rarely, rupture; kidney failure; bleeding problems; stroke; and even death. When the mother develops serious complications, the baby's life also may be in danger. HELLP syndrome increases the risk for placental abruption (when the placenta peels away from the uterus before delivery), which can threaten the life of both mother and baby, as well as premature delivery.

How is HELLP syndrome diagnosed?
HELLP syndrome is diagnosed with blood tests that look at levels of platelets and red blood cells and various chemicals that show how well a woman's liver is functioning.

How is HELLP syndrome treated?
Women with HELLP syndrome may be treated with medications to control blood pressure and prevent seizures, and sometimes with platelet transfusions. Women who develop HELLP syndrome almost always require prompt delivery to prevent serious complications. If a woman is at less than 34 weeks of pregnancy, delivery may be postponed for about 48 hours so that she can be treated with medications called corticosteroids (9). These medications help speed maturity of the fetal lungs and help prevent complications of prematurity. Some studies suggest that treating the pregnant woman for up to 48 hours with higher levels of corticosteroids than are used to speed fetal lung maturity may improve her symptoms (10).

What causes HELLP syndrome?
The cause of HELLP syndrome is not known.

Does HELLP syndrome go away after delivery?
In most cases, blood and liver abnormalities clear up within a few days after delivery. Women who have had HELLP syndrome usually have less than a 5 percent chance of it occurring again in another pregnancy (9). They do appear to have an increased risk for other pregnancy complications, such as preeclampsia, placental abruption and preterm delivery (9).

Acute fatty liver of pregnancy
What is acute fatty liver of pregnancy?
Acute fatty liver of pregnancy is a rare, life-threatening complication of pregnancy. About 1 in 10,000 to 1 in 15,000 pregnant women are affected by this disorder, which is characterized by a build-up of fat in liver cells (11).

What are the symptoms of acute fatty liver of pregnancy?
Symptoms of this disorder generally begin in the third trimester of pregnancy and may resemble those seen in HELLP syndrome. A pregnant woman should call her health care provider if she has any of these symptoms:

• Persistent nausea and vomiting
• Pain in the stomach or upper-right abdomen
• General malaise
• Jaundice
• Headache

What are the risks of acute fatty liver of pregnancy?
Without prompt treatment, acute fatty liver of pregnancy can lead to coma, organ failure and death of mother and baby.

How is acute fatty liver of pregnancy diagnosed?
Acute fatty liver of pregnancy can be diagnosed with blood tests that measure a number of factors related to liver and kidney functions.

How is acute fatty liver of pregnancy treated?
The mother may require blood transfusions to stabilize her condition. The baby is delivered as soon as possible to prevent serious complications.

What causes acute fatty liver of pregnancy?
The cause of this condition is not well understood. Genetics may play a role. A recent study found that 16 percent of women had this condition when their babies had certain inherited errors in body chemistry (fatty acid oxidation defects) (8). These disorders prevent an affected individual from properly processing certain fats. Babies with these disorders can develop life-threatening liver, heart and neuromuscular problems unless they are fed special low-fat foods. These findings suggest that all babies of women with acute fatty liver of pregnancy be tested for fatty acid oxidation defects so they can receive prompt treatment. (Many babies are routinely screened for these disorders as part of a panel of newborn screening tests. However, states vary in the newborn screening tests they require.)

Does acute fatty liver go away after pregnancy?
Most women start to improve within a few days of delivery and suffer no lasting harm from the condition. Women who carry a gene for a fatty acid oxidation defect (including women who have had an affected baby) have an increased risk of fatty liver occurring again in another pregnancy; the recurrence risk is unknown in other women (11).

Is the March of Dimes supporting research on liver diseases?
Yes. Several March of Dimes grantees are seeking to identify genes that may contribute to preeclampsia, a pregnancy-related form of high blood pressure that is related to HELLP syndrome. The goal of this research is to improve diagnosis and treatment of these disorders. Another recent grantee is seeking to develop treatment to stimulate liver regeneration in children with liver disease, including those with complications resulting from hepatitis.

References

1. Riely, C.A., Bacq, Y. Intrahepatic Cholestasis of Pregnancy. Clinics in Liver Disease, volume 8, 2004, pages 167-176.
2. Lammert, F., et al. Intrahepatic Cholestasis of Pregnancy: Molecular Pathogenesis, Diagnosis and Management. Journal of Hepatology, volume 33, 2000, pages 1012-1021.
3. Kroumpouzos, G. and Cohen, L.M. Specific Dermatoses of Pregnancy: An Evidence-Based Systematic Review. American Journal of Obstetrics and Gynecology, volume 188, number 4, April 2003, pages 1083-1092.
4. American College of Obstetricians and Gynecologists (ACOG). Viral Hepatitis in Pregnancy. ACOG Practice Bulletin, number 86, October 2007.
5. Centers for Disease Control and Prevention (CDC). Viral Hepatitis. Accessed 11/29/07.
6. Centers for Disease Control and Prevention (CDC). Planning for a Healthy Pregnancy and Traveling While Pregnant. Accessed 11/30/07.
7. Moldenhauer, J.S., Sibai, B.M. Hypertensive Disorders of Pregnancy. In Scott, J.R., et al. (eds.): Danforth's Obstetrics and Gynecology, Ninth Edition, Philadelphia, Lippincott Williams & Wilkins, 2003, pages 257-271.
8. Browning, M.F., et al. Fetal Fatty Acid Oxidation Defects and Maternal Liver Disease in Pregnancy. Obstetrics and Gynecology, volume 107, 2006, pages 115-120.
9. Barton, J.R., Sibai, B.M. Diagnosis and Management of Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome. Clinics in Perinatology, volume 31, 2004, pages 807-833.
10. Martin, J.N., et al. Understanding and Managing HELLP Syndrome: The Integral Role of Aggressive Glucocorticoids for Mother and Child. American Journal of Obstetrics and Gynecology, volume 195, 2006, pages 914-934.
11. Sibai, B.M. Imitators of Severe Preeclampsia. Obstetrics and Gynecology, volume 109, 2007, pages 956-966.

February 2008

Lupus and pregnancy

Lupus, also called systemic lupus erythematosus or SLE, is an autoimmune disorder that can cause health problems during pregnancy. Autoimmune disorders are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue just about anywhere in the body by mistake.

Lupus and other autoimmune disorders can cause swelling, pain and sometimes organ damage. Lupus also can affect joints, skin, kidneys, lungs and blood vessels.

Lupus affects more than 160,000 people in this country. Women are more likely to have autoimmune disorders like lupus than men. It often develops in women of childbearing age (16 to 44) and can affect a pregnancy. Fortunately, with the right care, you can still have a healthy pregnancy if you have lupus.

What causes lupus?
We’re not sure what causes lupus. Your genes may play role, along with other things, like viruses. Genes are the part of your cells that stores instructions for the way your body grows and works.

What are the symptoms of lupus?
Symptoms often include:

• Swollen or painful joints
• Muscle pain
• Skin rash – A red, butterfly-shaped rash across the nose and cheeks is common.
• Fever
• Tiredness
• Chest pain when taking a deep breath

The symptoms can be mild to severe with periods of remission (few or no symptoms) and flares (many or intense symptoms).

What problems can lupus cause during pregnancy?
Lupus may increase the risk of these problems during pregnancy:

• Lupus flares. You may experience flares during pregnancy or in the first few months after giving birth. If your lupus is in remission or under good control, you’re less likely to have flares.
• Preeclampsia. This is a certain kind of high blood pressure that only pregnant women can get.
• Premature birth. This is birth that happens too early, before 37 completed weeks of pregnancy.
• Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.

If you’ve been in remission or had your condition under good control for at least 6 months before pregnancy, you’re less likely to have complications. Talk with your health care provider before getting pregnant about the safest time for pregnancy.

What problems can lupus cause in your baby?
Most babies of mothers with lupus are healthy. However, some babies may face health risks, like:

• Premature birth. About 3 in 10 babies (30 percent) of mothers with lupus are born prematurely. Premature babies may need to stay in the hospital longer or have more health problems than babies born full term (39 to 41 weeks of pregnancy).
• Neonatal lupus. About 3 in 100 babies (3 percent) are born with this temporary form of lupus. This condition causes a rash and blood problems but usually clear up by 6 months of age. However, up to half of these babies have a heart problem called heart block. This is a condition that causes a slow heartbeat. Heart block is often permanent. Some babies need a pacemaker to help make their heart beat regularly.

How do you know if you have lupus?
If you’re experiencing the symptoms of lupus, talk to your provider. To find out if you have lupus, your provider looks at your symptoms, your health history and the results of some tests, including:

• A physical exam
• Blood tests to look for certain antibodies that often are seen in people with lupus
• Urine tests to see how well your kidneys are working
• A biopsy, testing a small sample of tissue, skin or kidneys to check for inflammation and damage

How is lupus treated?
Lupus can be treated with many different medicines. If you’re being treated for lupus, talk to your provider about the medicines you’re taking before you get pregnant. Your provider may want to change your medicine while you’re pregnant.

Medicines used to treat lupus include:

• Anti-inflammatories. Aspirin, ibuprofen (Motrine® or Advil®) and naproxen (Aleve®) can help relieve joint pain and fever. Talk to your provider to find out if you can take these during pregnancy.
• Malaria medicines. Hydoxychloroquine (Plaquenil®) and other malaria medicines can help prevent flares and relieve joint pain, tiredness and other symptoms. These medicines are safe to use during pregnancy.
• Corticosteroids. Prednisone (Sterapred®), methylprednisolone (Medtrol®) and related medicines can help reduce inflammation and relieve symptoms. These medicines can only be used for a short time because of side effects. They are fairly safe to use during pregnancy, but they may increase the risk of cleft palate. This is a birth defect in which the roof of a baby’s mouth doesn’t form completely and has an opening in it.
• Immunosuppressives. Cyclophosphamide (Cytoxan®) and methotrexate (Folex®, Mexate®, Rheumatrex®) are cancer-fighting medicines. Azathioprine (Imuran®) and mycophenolate mofetil (CellCept®) are medicines used in organ transplant patients to help prevent organ rejection. Your provider may treat you with immunosuppressive medicines if you have serious lupus symptoms. These medicines may cause serious side effects, such as increased risk of serious infection. They’re not safe take if you’re pregnant. Both cyclophosphamide and methotrexate are associated with birth defects. We don’t know how safe azathioprine and mycophenolate mofetil are during pregnancy.

Do you need special medical care during pregnancy?
Yes. Your provider closely monitors your pregnancy so that any lupus flares or problems can be treated quickly. In general, you should be cared for by:

• High-risk obstetrician, a doctor who specializes in taking care of women with serious pregnancy complications
• Rheumatologist, a doctor who specializes in disorders having to do with inflammation or pain in muscles and joints

Most likely your baby will be born healthy, but you may want to plan to give birth in a hospital that is equipped to care for premature or sick babies.

For more information:

• Centers for Disease Control and Prevention (CDC)
• National Institute for Arthritis and Musculoskeletal and Skin Diseases

Maternal PKU

Phenylketonuria (also called PKU) is a condition in which your body can’t break down an amino acid called phenylalanine. Amino acids help build protein in your body. Without treatment, phenylalanine builds up in the blood and causes health problems.

Maternal PKU means that a woman who has PKU is pregnant. About 3,000 women of childbearing age in the United States have PKU.

What causes PKU?

PKU is inherited. This means it’s passed from parent to child through genes. A gene is a part of your body’s cells that stores instructions for the way your body grows and works. Genes come in pairs — you get one of each pair from each parent.

Sometimes the instructions in genes change. This is called a gene change or a mutation. Parents can pass gene changes to their children. Sometimes a gene change can cause a gene to not work correctly. Sometimes it can cause birth defects or other health conditions. A birth defect is a health condition that is present in a baby at birth.

You have to inherit a gene change for PKU from both parents to have PKU. If you inherit the gene from just one parent, you have the gene change for PKU, but you don’t have PKU. When this happens, you’re called a PKU carrier. A PKU carrier has the gene change but doesn’t have PKU.

Can you pass PKU to your children?

Yes. But it depends on both you and your partner. If you and your partner both have PKU, your baby will have PKU.

If you and your partner are both PKU carriers, there’s a:

• 3-in-4 chance (75 percent) that your baby won’t have PKU
• 1-in-2 chance (50 percent) that your baby won’t have PKU but will be a PKU carrier
• 1-in-4 chance (25 percent) that your baby will have PKU
• 1-in-4 chance (25 percent) that your baby will not have PKU and not be a carrier

A genetic counselor can help you understand your chances of passing PKU to your baby. A genetic counselor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby's health.

Ask your health care provider if you need help finding a genetic counselor. Or contact the National Society of Genetic Counselors.

Can maternal PKU cause problems for your baby?

Yes. When a pregnant woman’s phenylalanine levels get too high, they can cause serious problems in her baby, including:

• Intellectual disabilities
• Small head size
• Heart defects
• Low birthweight

How can you find out if you’re a PKU carrier?

You may not know if you’re a PKU carrier. If you’re a carrier, you don’t have any signs or symptoms of PKU and you do not have PKU.

There are two types of tests that can tell you if you’re a PKU carrier. Both are safe to take during pregnancy. Your partner can have the tests, too.

1. A blood test
2. A swab of cells inside your mouth. This means your provider rubs a cotton swab against the inside of your cheek to get some cells.

You and your partner may want to be tested if PKU runs in either of your families. To help you find out, take your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in both of your families have had. Use this family health history form and share it with your health care provider.

Can you find out during pregnancy if your baby has PKU or is a PKU carrier?

Yes. If you or your partner has PKU or is a PKU carrier, you can have a prenatal test to find out if your baby has PKU or is a carrier. You can have either of these tests:

• Chorionic villus sampling (also called CVS). This test checks tissue from the placenta for birth defects and genetic conditions. You can get CVS at 10 to 12 weeks of pregnancy.
• Amniocentesis (also called amnio). This test checks amniotic fluid from the amniotic sac around your baby for birth defects and genetic conditions. You can get this test at 15 to 20 weeks of pregnancy.

Talk to your provider or genetic counselor if you’re thinking of having either of these tests.

How is maternal PKU treated in pregnancy?
The good news is that most pregnant women who have PKU can have healthy babies if they follow their PKU meal plan. This is a special meal plan that is low in phenylalanine.

PKU meal plans are different for each person and depend on how much phenylalanine your body can take. Health care providers at a medical center or clinic that has a special program to treat PKU can help you create a PKU meal plan. These providers can monitor your pregnancy and help you change your meal plan to help keep your blood phenylalanine at the right level. Ask your health care provider for information on a medical center or clinic that treats PKU.

Your health care provider may order ultrasound tests during your pregnancy to check on your baby’s growth.

Be sure to follow your PKU meal plan at least 3 months before getting pregnant and throughout pregnancy. If you just found out you’re pregnant, go back to your PKU meal plan right away. You can get weekly blood tests during pregnancy to make sure your phenylalanine levels aren’t too high.

Last reviewed January 2013

See also: PKU (Phenylketonuria), Genetic counseling, Your family health history, Newborn screening

Oligohydramnios

Oligohydramnios is when you have too little amniotic fluid. Amniotic fluid is the fluid that surrounds your baby in your uterus (womb). It’s very important for your baby’s development.

How do you know if you have oligohydramnios?
If you notice that you are leaking fluid from your vagina, tell your health care provider. It may be a sign of oligohydramnios. Your provider watches out for other signs, such as if you’re not gaining enough weight or if the baby isn’t growing as fast as he should.

Your health care provider uses ultrasound to measure the amount of amniotic fluid. There are two ways to measure the fluid: amniotic fluid index (AFI) and maximum vertical pocket (MPV).

The AFI checks how deep the amniotic fluid is in four areas of your uterus. These amounts are then added up. If your AFI is less than 5 centimeters, you have oligohydramnios.

The MPV measures the deepest area of your uterus to check the amniotic fluid level. If your MPV is less than 2 centimeters, you have oligohydramnios.

Ask your health provider if you have questions about these measurements.

What problems can oligohydramnios cause?
If oligohydramnios happens in the first 2 trimesters (first 6 months) of pregnancy, it is more likely to cause serious problems than if it happens in the last trimester. These problems can be:

• Birth defects – Problems with a baby’s body that are present at birth
• Miscarriage – When a baby dies in the womb before 20 weeks of pregnancy
• Premature birth – Birth before 37 completed weeks of pregnancy
• Stillbirth – When a baby dies in the womb after 20 weeks of pregnancy

If oligohydramnios happens in the third trimester of pregnancy, it can cause:

• The baby to grow slowly
• Problems during labor and birth, such as the umbilical cord being squeezed. The umbilical cord carries food and oxygen from the placenta to the baby. If it’s squeezed, the baby doesn’t get enough food and oxygen.
• A greater chance of needing a cesarean section (when your baby is born through a cut the doctor makes in your belly and uterus)

What causes oligohydramnios?
Sometimes the causes of oligohydramnios are not known. Some known causes are:

• Health problems, such as high blood pressure or preexisting diabetes (having too much sugar in the blood before pregnancy)
• Certain medications, like those used to treat high blood pressure – If you have high blood pressure, talk to your provider before getting pregnant to make sure your blood pressure is under control.
• Post-term pregnancy – A pregnancy that goes 2 or more weeks past the due date. A full-term pregnancy is one that lasts 39 to 41 weeks.
• Birth defects, especially ones that affect the baby’s kidneys and urinary tract.
• Premature rupture of the membranes (PROM) – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts.

How is oligohydramnios treated?
If you have a healthy pregnancy and get oligohydramnios near the end of your pregnancy, you probably don’t need treatment. Your provider may want to see you more often. She may want to do ultrasounds weekly or more often to check the amount of amniotic fluid.

Sometimes amnioinfusion can help prevent problems in the baby. Amnioinfusion is when the provider puts a saline solution (salty water) into the uterus through your cervix (the opening to the uterus that sits at the top of your vagina). This treatment can help prevent some problems, such as the umbilical cord being squeezed. If the umbilical cord is squeezed, the baby doesn’t get enough food and oxygen.

If the fluid gets too low or if your baby is having trouble staying healthy, your provider may recommend starting labor early to help prevent problems during labor and birth. However, with regular prenatal care, chances are that your baby will be born healthy.

What can you do if you have oligohydramnios?
Drinking lots of water may help increase the amount of amniotic fluid. Your provider may recommend less physical activity or going on bed rest.

Is oligohydramnios common?
About 4 out of 100 (4 percent) pregnant women have oligohydramnios. It can happen at any time during pregnancy, but it’s most common in the last trimester (last 3 months). It happens in about 12 out of 100 (12 percent) women whose pregnancies last about 2 weeks past their due dates. This is because the amount of amniotic fluid usually decreases by that time.

Last reviewed June 2011

See also: Polyhydramnios

Placenta previa

The placenta attaches to the wall of the uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.

Placenta previa happens in about 1 in 200 pregnancies. If you have placenta previa early in pregnancy, it usually isn’t a problem. However, it can cause serious bleeding and other complications later in pregnancy.

Normally, the placenta grows into the upper part of the uterus wall, away from the cervix. It stays there until your baby is born. During the last stage of labor, the placenta separates from the wall, and your contractions help push it into the vagina (birth canal). This is also called the afterbirth.

During labor, your baby passes through the cervix into the birth canal. If you have placenta previa, when the cervix begins to efface (thin out) and dilate (open up) for labor, blood vessels connecting the placenta to the uterus may tear. This can cause severe bleeding during labor and birth, putting you and your baby in danger.

What are the symptoms of placenta previa?
The most common symptom of placenta previa is painless bleeding from the vagina during the second half of pregnancy. Call your health care provider right away if you have vaginal bleeding anytime during your pregnancy. If the bleeding is severe, go to the hospital.

Not all women with placenta previa have vaginal bleeding. In fact, about one-third of women with placenta previa don’t have this symptom.

How is placenta previa diagnosed?
An ultrasound usually can find placenta previa and pinpoint the placenta’s location. In some cases, your provider may use a transvaginal ultrasound instead.

Even if you don’t have vaginal bleeding, a routine, second trimester ultrasound may show that you have placenta previa. Don’t be too worried if this happens. Placenta previa found in the second trimester fixes itself in most cases.

How is placenta previa treated?
Treatment depends on how far along you are in your pregnancy, the seriousness of your bleeding and the health of you and your baby. The goal is to keep you pregnant as long as possible. Providers recommend cesarean birth (c-section) for nearly all women with placenta previa to prevent severe bleeding.

If you are bleeding as a result of placenta previa, you need to be closely monitored in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible.

If you have a lot of bleeding, you may be treated with blood transfusions. A blood transfusion is having new blood put into your body. Your provider also may give you medicines called corticosteroids. These medicines help speed up development of your baby’s lungs and other organs.

Your provider may want you to stay in the hospital until you give birth. If the bleeding stops, you may be able to go home. If you have severe bleeding due to placenta previa at about 34 to 36 weeks of pregnancy, your provider may recommend an immediate c-section.

At 36 to 37 weeks, your provider may suggest an amniocentesis to test the amniotic fluid around your baby to see if her lungs are fully developed. If they are, your provider may recommend an immediate c-section to avoid risks of future bleeding.

At any stage of pregnancy, a c-section may be necessary if you have dangerously heavy bleeding or if you and your baby are having problems.

What causes placenta previa?
We don’t know what causes placenta previa. However, you may be at higher risk for placenta previa if:

• You smoke cigarettes.
• You use cocaine.
• You’re 35 or older.
• You’ve been pregnant before.
• You’re pregnant with twins, triplets or more.
• You’ve had surgery on your uterus, including a c-section or a D&C (dilation and curettage). A D&C is when a doctor removes tissue from the lining of a woman's uterus. Some women have a D&C after a miscarriage.

If you’ve had placenta previa before, what are your chances of having it again?
If you’ve had placenta previa in a past pregnancy, you have a 2 to 3 in 100 (2 to 3 percent) chance of having it again.

How can you reduce your risk for placenta previa?
We don’t know how to prevent placenta previa. But you may be able to reduce your risk by not smoking and not using cocaine. You also may be able to lower your chances of having placenta previa in future pregnancies by having a c-section only if it’s medically necessary. If your pregnancy is healthy and there are no medical reasons for you to have a c-section, it’s best to let labor begin on its own. The more c-sections you have, the greater your risk of placenta previa.

Last reviewed January 2012

See also: Placental abruption, Placental accreta, increta and percreta

Placental abruption

The placenta attaches to the wall of the uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have serious bleeding.

Normally, the placenta grows onto the upper part of the uterus and stays there until your baby is born. During the last stage of labor, the placenta separates from the uterus, and your contractions help push it into the vagina (birth canal). This is also called the afterbirth.

About 1 in 100 pregnant women (1 percent) have placental abruption. It usually happens in the third trimester, but it can happen any time after 20 weeks of pregnancy. Mild cases may cause few problems. An abruption is mild if only a very small part of the placenta separates from the uterus wall. A mild abruption usually isn’t dangerous.

If you have severe placental abruption (greater separation between the placenta and the uterus), your baby is at higher risk for:

• Growth problems
• Premature birth – birth that happens too early, before 37 completed weeks of pregnancy
• Stillbirth – when a baby dies in the womb before birth, but after 20 weeks of pregnancy

Placental abruption is related to about 1 in 10 premature births (10 percent). Premature babies (born before 37 completed weeks of pregnancy) are more likely than babies born later to have health problems during the first weeks of life, lasting disabilities, and even death.

What are the symptoms of placental abruption?
The main symptom of placental abruption is vaginal bleeding. You also may have discomfort and tenderness or sudden, ongoing belly or back pain. Sometimes, these symptoms may happen without vaginal bleeding because the blood is trapped behind the placenta. If you have any of these symptoms, call your health care provider.

How is placental abruption diagnosed?
If your provider thinks you are having an abruption, you may need to get checked at the hospital. Your provider can look for abruption by doing a physical exam and an ultrasound. An ultrasound can find many, but not all, abruptions.

How is placental abruption treated?
Treatment depends on how serious the abruption is and how far along you are in your pregnancy.
Your provider may simply monitor you and your baby. But sometimes you may need to give birth right away.

If you need to give birth right away, your provider may give you medicines called corticosteroids. These medicines help speed up development of your baby’s lungs and other organs.

Mild placental abruption
If you have a mild abruption at 24 to 34 weeks of pregnancy, you need careful monitoring in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible. Your provider may want you to stay in the hospital until you give birth. If the bleeding stops, you may be able to go home.

If you have a mild abruption at or near full term, your provider may recommend inducing labor or cesarean birth (c-section). You may need to give birth right away, if:

• The abruption gets worse.
• You are bleeding heavily.
• Your baby is having problems.

Moderate or severe placental abruption
If you have a moderate to severe abruption, you usually need to give birth right away. Needing to give birth quickly may increase your chances of having a c-section.

If you lose a lot of blood due to the abruption, you may need a blood transfusion. It’s very rare, but if you have heavy bleeding that can’t be controlled, you may need a hysterectomy. A hysterectomy is when your uterus is removed by surgery. A hysterectomy can prevent deadly bleeding and other problems in your body. But it also means that you can’t get pregnant again in the future.

What causes placental abruption?
We don’t really know what causes placental abruption. You may be at higher risk for placental abruption if:

• You smoke cigarettes.
• You use cocaine.
• You’re 35 or older.
• You have high blood pressure.
• You have an infection in your uterus.
• Your water breaks before 37 weeks.
• You had an abruption in a previous pregnancy.
• You have problems with the uterus or umbilical cord.
• You have more fluid around the baby than is normal.
• You’re pregnant with twins, triplets or more.
• Your belly is harmed from a car accident or physical abuse.

If you’ve had a placental abruption before, what are your chances of having it again?
If you’ve had a placental abruption in a past pregnancy, you have about a 1 in 10 (10 percent) chance of it happening again in a later pregnancy.

How can you reduce your risk for abruption?
In most cases, you can’t prevent abruption. But you may be able to reduce your risk by getting treatment for high blood pressure, not smoking or using street drugs, and always wearing a seatbelt when riding in a car.

Last reviewed January 2012

See also: Placenta Previa, Placental accreta, increta and percreta

Placental accreta, increta and percreta

The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Normally, the placenta grows onto the upper part of the uterus and stays there until your baby is born. During the last stage of labor, the placenta separates from the wall of the uterus, and your contractions help push it into the vagina (birth canal). This is also called the afterbirth.

Sometimes the placenta attaches itself into the wall of the uterus too deeply. This can cause problems, including:

• Placenta accreta – The placenta attaches itself too deeply and too firmly into the uterus.
• Placenta increta – The placenta attaches itself even more deeply into the muscle wall of uterus.
• Placenta percreta – The placenta attaches itself and grows through the uterus, sometimes extending to nearby organs, such as the bladder.

In these conditions, the placenta doesn’t completely separate from the uterus after you give birth. This can cause dangerous bleeding. These conditions happen in about 1 in 530 births each year.

What are the signs of these placental conditions?
Placental conditions often cause vaginal bleeding in the third trimester. Call your health care provider right away if you have vaginal bleeding anytime during your pregnancy. If the bleeding is severe, go to the hospital right way.

How are these placental conditions diagnosed?
These conditions usually are diagnosed using ultrasound. In some cases, your provider may use magnetic resonance imaging (MRI). MRI uses magnets and computers to make a clear picture that may be hard to see on an ultrasound. The test is painless and safe for you and your baby.

How are these placental conditions treated?
When these conditions are found before birth, your provider may recommend a cesarean section (also called c-section) immediately followed by a hysterectomy. This can help prevent bleeding from becoming life threatening. A c-section is surgery in which your baby is born through a cut that your provider makes in your belly and uterus. A hysterectomy is when your uterus is removed by surgery. Without a uterus, you can’t get pregnant again in the future.

If you have a placental condition, the best time for you to have your baby is unknown. But your provider may recommend that you give birth at around 34 to 38 weeks of pregnancy to help prevent dangerous bleeding. If you want to have future pregnancies, she may use special treatments before the c-section to try to control bleeding and save your uterus.

If your provider finds these conditions at birth, she may try to remove the placenta in surgery to stop the bleeding. However, a hysterectomy is often necessary.

What causes these placental conditions?
We don’t know what causes these kinds of placental conditions. But they often happen where you have a scar from a surgery, like removing a fibroid or having a c-section. A fibroid is a tumor that grows in the wall of the uterus (womb). If you’ve had a c-section, you’re more likely than if you had a vaginal birth to have these kinds of conditions. And the more c-sections you’ve had, the more likely you are to have these placental problems.

Things that may make you more likely to have these kinds of placental conditions include:

• Smoking cigarettes
• Being 35 or older
• Being pregnant before
• Having placenta previa

How can you reduce your risk for placental conditions?
One way to reduce your chances for having these kinds of placental conditions in future pregnancies is to have your babies by vaginal birth instead of c-section. Have a c-section only if there are health problems with you or your baby that make it medically necessary. For some moms and babies, health problems make c-section safer than vaginal birth. But if your pregnancy is healthy, it’s best to stay pregnant until labor begins on its own. Don’t schedule a c-section for non-medical reasons, like wanting to have your baby on a certain day or because you’re uncomfortable and want to have your baby earlier than your due date.

Even if you’ve already had a c-section, you may be able to have your next baby by vaginal birth. This is called vaginal birth after cesarean (VBAC). You may be able to have a VBAC depending on what kind of incision (cut) you had in your c-section and your overall pregnancy health. Talk to your provider if you think VBAC may be right for you.

What are some other placental problems?
In some cases, the placenta doesn’t develop correctly or work as well as it should. It may be too thin, too thick or have an extra lobe. The umbilical cord may not be attached correctly. Problems like infections, blood clots and infarcts (an area of dead tissue, like a scar) can happen during pregnancy and damage the placenta.

Placental problems like these can lead to health risks for you and your baby. Some of these risks include:

• You may have a miscarriage.
• Your baby doesn’t grow as well as she should during pregnancy.
• You may have bleeding at birth.
• You may have a premature birth. This is birth that happens too soon, before 37 completed weeks of pregnancy.
• Your baby may have birth defects.

Your provider checks the placenta after birth. Sometimes the placenta is sent for testing in a lab, especially if the baby has certain health problems, like poor growth.

Last updated January 2012

See also: Placental abruption, Placenta previa

Polyhydramnios

Polyhydramnios is when you have too much amniotic fluid. Amniotic fluid is the fluid that surrounds your baby in your uterus (womb). It’s very important for your baby’s development.

How do you know if you have polyhydramnios?
Many women with polyhydramnios don’t have symptoms. If you have a lot of extra amniotic fluid you may have belly pain and trouble breathing. This is because the uterus presses on your organs and lungs.

Your health care provider uses ultrasound to measure the amount of amniotic fluid. There are two ways to measure the fluid: amniotic fluid index (AFI) and maximum vertical pocket (MPV).

The AFI checks how deep the amniotic fluid is in four areas of your uterus. These amounts are then added up. If your AFI is more than 24 centimeters, you have polyhdramnios.

The MPV measures the deepest area of your uterus to check the amniotic fluid level. If your MPV is more than 8 centimeters, you have polyhdramnios.

Ask your provider if you have questions about these measurements.

What problems can polyhydramnios cause?
Polyhydramnios may increase the risk of these problems during pregnancy:

• Premature birth – Birth before 37 completed weeks of pregnancy
• Premature rupture of the membranes (PROM) – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts
• Placental abruption – When the placenta partially or completely peels away from the wall of the uterus before birth
• Stillbirth – When a baby dies in the womb after 20 weeks of pregnancy
• Postpartum hemorrhage – Severe bleeding after birth
• Fetal malposition – When a baby is not in a head-down position and may need to be born by cesarean section

What causes polyhydramnios?
In about half of cases, we don’t know what causes polyhydramnios. In other cases, we can identify a cause. Some known causes are:

• Birth defects, especially those that affect the baby’s swallowing. A baby’s swallowing keeps the fluid in the womb at a steady level.
• Diabetes – Having too much sugar in your blood
• Mismatch between your blood and your baby’s blood, such as Rh and Kell diseases
• Twin-to-twin transfusion syndrome (TTTS) – If you’re carrying identical twins, this is when one twin gets too much blood flow and the other gets too little.
• Problems with the baby’s heart rate
• An infection in the baby

How is polyhydramnios treated?
When an ultrasound shows you have too much amniotic fluid, your provider does a more detailed ultrasound to check for birth defects and TTTS.

Your provider also may recommend a blood test for diabetes and an amniocentesis. Amniocentesis is a test that takes some amniotic fluid from around the baby to check for problems, like birth defects.

In many cases, slight polyhydramnios goes away by itself. Other times, it may go away when the problem causing it is fixed. For example, if your baby’s heart rate is causing the problem, sometimes your provider can give you medicine to fix it.

If you have polyhydramnios, you usually have ultrasounds weekly or more often to check amniotic fluid levels. You may also have tests to check your baby’s health.

Having too much amniotic fluid may make you uncomfortable. Your provider may give you medicine called indomethacin. This medicine helps lower the amount of urine that your baby makes, so it lowers the amount of amniotic fluid. Amniocentesis also can remove extra fluid.

If you have slight polyhdramnios near the end of your pregnancy but tests show that you and your baby are healthy, you usually don’t need any treatment.

Is polyhydramnios common?
About 1 out of 100 (1 percent) pregnant women have too much amniotic fluid. It usually happens when fluid builds up slowly in the second half of pregnancy. In a small number of women, fluid builds up quickly. This can happen as early as 16 weeks of pregnancy, and it usually causes very early birth.

Last reviewed June 2011

See also: Oligohydramnios

Preeclampsia

Preeclampsia is a condition that happens only during pregnancy (after the 20th week) or right after pregnancy. It’s when a pregnant woman has both high blood pressure and protein in her urine.

Most women with preeclampsia have healthy babies, but it can cause severe problems for moms. Without treatment, preeclampsia can cause kidney, liver and brain damage. It also may affect how the blood clots and cause serious bleeding problems.

In rare cases, preeclampsia can become a life-threatening condition called eclampsia. Eclampsia is when a pregnant woman has seizures following preeclampsia. Eclampsia sometimes can lead to coma.

What are the signs and symptoms of preeclampsia?
Signs and symptoms of preeclampsia include:

• High blood pressure
• Protein in the urine
• Severe headaches
• Vision problems, like blurriness, flashing lights, or being sensitive to light
• Pain in the upper right belly area
• Nausea or vomiting
• Dizziness
• Sudden weight gain (2 to 5 pounds in a week)
• Swelling in the legs, hands, and face

Many of these signs and symptoms are normal discomforts of pregnancy. But if you have severe headaches, blurred vision or severe upper belly pain, call your health care provider.

What pregnancy complications can preeclampsia cause?
If you have preeclampsia, your health care provider can help you manage most health complications through regular prenatal care. Pregnant women with preeclampsia are more likely than women who don’t have preeclampsia to have these complications:

• Low birthweight. This is when a baby weighs less than 5 pounds, 8 ounces. High blood pressure can narrow blood vessels in the uterus (womb) and placenta. The placenta grows in the uterus and supplies your baby with food and oxygen through the umbilical cord. Your baby may not get enough oxygen and nutrients, causing him to grow slowly.
• Premature birth. This is birth that happens too early, before 37 completed weeks of pregnancy. Even with treatment, a pregnant woman with preeclampsia may need to give birth early to avoid serious health problems for her and her baby.
• Placental abruption. In this condition the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If you have vaginal bleeding during pregnancy, contact your health care provider immediately.

How is preeclampsia diagnosed?
Your provider measures your blood pressure and checks your urine for protein at every visit. Because you can have mild preeclampsia without symptoms, it’s important to go to all of your prenatal care visits.

How is preeclampsia treated?
The cure for preeclampsia is the birth of your baby. Treatment depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse.

Mild preeclampsia before 37 weeks. Some women in this condition can stay at home, but others need to stay in the hospital. Your provider checks your blood pressure and urine regularly to make sure your preeclampsia doesn’t get worse.

If your preeclampsia does get worse, your provider may induce labor. This means your provider gives you medicine or breaks your water (amniotic sac) to make you start labor. Inducing labor can help prevent possible problems from preeclampsia that gets worse.

Your provider also checks your baby’s health using:

• Ultrasound. This is a prenatal test that uses sound waves and a computer screen to make a picture of your baby in the womb. Ultrasound checks that your baby is growing at a normal rate. It also lets your provider look at the placenta and the amount of fluid around your baby to make sure your pregnancy is healthy.
• Nonstress test. This test checks your baby’s heart rate.
• Biophysical profile. This test combines the nonstress test with an ultrasound.

Mild preeclampsia at 37 weeks or beyond. Most women in this condition don’t have serious health problems.

Severe preeclampsia at 34 weeks or beyond. This condition requires you to be in the hospital, and your provider may induce labor.

Severe preeclampsia before 34 weeks. This condition requires you to stay in the hospital for close monitoring. Your provider may treat you with a medicine called corticosteroid. This medicine helps speed up the growth of your baby’s lungs. If your preeclampsia gets worse, you may need to give birth early. Most babies of moms with severe preeclampsia before 34 weeks of pregnancy do better in a NICU than if they stay in the uterus.

Severe preeclampsia and HELLP syndrome. HELLP syndrome is a rare but life-threatening liver disorder. It happens in about 1 to 2 of 1,000 pregnancies. About 2 in 10 women (20 percent) with severe preeclampsia develop HELLP syndrome.

If you have HELLP syndrome early in your pregnancy, you almost always need to give birth early to prevent serious health problems. You may need medicine to control your blood pressure and prevent seizures. Some women also need blood transfusions. A blood transfusion means you have new blood put into your body.

If you have preeclampsia, can you have a vaginal birth?
Yes. A vaginal birth may be better than a cesarean birth (c-section) for a woman with preeclampsia. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. Having a vaginal birth lets you avoid the stress of surgery. It’s safe for most women with preeclampsia to have an epidural to cope with pain during labor and birth as long as her blood can clot normally.

What causes preeclampsia?
We don’t know what causes preeclampsia. But you may be more likely than other women to have preeclampsia if:

• It’s your first pregnancy.
• You had preeclampsia in a previous pregnancy.
• You have a family history of preeclampsia. This means that other people in your family have had preeclampsia.
• You have high blood pressure, kidney disease, diabetes, certain blood-clotting disorders, lupus or other autoimmune disorders.
• You’re pregnant with multiples (twins, triplets or more).
• You’re older than 35.
• You’re African-American.
• You’re overweight or obese.

If you’ve had preeclampsia before, what are your chances of having it again?
If you’ve had preeclampsia before, you’re more likely than other women to have it again in another pregnancy. The earlier in pregnancy you had preeclampsia, the higher your risk is to have it again in another pregnancy. Women who are overweight may be more likely to develop preeclampsia in another pregnancy than women at a healthy weight.

How can you reduce your risk for preeclampsia?
There’s no way to prevent preeclampsia. But if you’re overweight or obese, getting to a healthy weight before pregnancy may help lower your chances of having preeclampsia.

Last reviewed October 2012

See also: High blood pressure during pregnancy, HELLP syndrome

Preexisting diabetes

About 9 out of 100 women (9 percent) in the United States have diabetes. Diabetes is a condition in which your body has too much sugar (called glucose) in the blood. Glucose is your body's main source of fuel for energy.

Unlike gestational diabetes, preexisting diabetes (diabetes you have before pregnancy) doesn’t happen just during pregnancy. You can develop it any time in your life.

If you have diabetes and are pregnant or trying to get pregnant, your health care provider needs to take extra special care of you. Pregnancy for a woman with preexisting diabetes is called high risk. This means you may have complications during pregnancy, so your provider needs to monitor you and your baby closely.

Just because your pregnancy is called high risk doesn’t mean for sure that you’ll have problems. It just means that your provider pays special attention to your health and may work with other specialized health providers to help you have a healthy pregnancy.

Can diabetes cause problems for a baby during pregnancy?
Yes. Women who have diabetes are almost as likely as women who don’t have diabetes to have a healthy baby. But they need to control their blood sugar levels before and during pregnancy. Here’s why:

• High blood sugar levels can be harmful to babies during the first few weeks of pregnancy. This is the time when a baby’s brain, heart, kidneys and lungs begin to form.
• Babies of women with preexisting diabetes are more likely than other babies to have a birth defect, including heart defects and neural tube defects. A birth defect is a health condition that is present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works. The neural tube is the part a developing baby that becomes the brain and spinal cord.
• The baby may be very large—10 pounds or more. This weight makes vaginal birth more difficult and puts the baby in danger of getting injured during birth.
• Women with preexisting diabetes are more likely than women who don’t have diabetes to have a miscarriage or stillbirth. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy but before birth.

If you have diabetes, what can you do before you get pregnant to help you have a healthy pregnancy?
If you’re planning to get pregnant, here’s what you can do to help you get ready for pregnancy:

• Get your diabetes under control 3 to 6 months before trying to get pregnant. It’s important for anyone living with diabetes to manage their blood sugar. But it’s really important for women who want to get pregnant.
• Take a multivitamin with 400 micrograms of folic acid in it every day. Because you have diabetes, your health care provider may increase your daily dose of folic acid to help reduce the risk of birth defects. A birth defect is a health condition that is present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
• Tell your health provider about any medicines you take to make sure they’re OK to take during pregnancy. Your provider may want to change some medicines if they’re not safe for you and your baby.
• Stay physically active. If you’re not, talk to your provider about adding physical activity to your daily routine.
• Talk to a dietitian or a diabetes educator to help you create a healthy meal plan. These people have special training in helping people with diabetes choose healthy foods to keep their blood sugar under control.
• Meet with any specialists that your health provider recommends. These experts can help you manage your diabetes and any complications that may come up during pregnancy. Specialists include a perinatologist, who treats women with high-risk pregnancies, and an endocrinologist, who treats women with diabetes and other health conditions.

How is preexisting diabetes treated during pregnancy?
During pregnancy, the safest diabetes treatment is insulin. Insulin is a hormone that helps the body control its blood sugar. Some people with diabetes have trouble making or responding to insulin and may need other treatment.

Your health provider can work with you to create a personal plan for your insulin treatment:

• If you’re taking diabetes pills, your provider can switch you to insulin. Diabetes pills aren’t recommended during pregnancy.
• During pregnancy, some women with preexisting diabetes become less able to respond to insulin. This is called insulin resistance. If you’re insulin resistant, you may need to change the kind and amount of insulin you take.
• As you get farther along in your pregnancy, your body may need more insulin than it did in early pregnancy. You may need double or even triple the amount of insulin you normally use.

Here are some other things you can do to help manage your diabetes and have a healthy pregnancy:

• Tell your provider about all medicines you take, even medicines that aren’t related to your diabetes. Some medicines aren’t safe for your or your baby during pregnancy. Your provider may need to change some of your medicines to ones that are OK for use during pregnancy.
• If you don’t already have a dietician, find one. Your provider can recommend one for you. A dietician can help you learn what, how much and how often you should eat. She can help you make meal plans and help you know the right amount of weight to gain during pregnancy. Check with your insurance company to see if it covers treatment from a dietician.
• Do something active every day. With your health provider’s OK, daily physical activity can help you manage your diabetes. It also can help with other health conditions you may have, such as high blood pressure or high cholesterol. Most healthy pregnant women need at least 2 1/2 hours of physical activity every week.

If you have preexisting diabetes, is it OK to breastfeed?
Yes. If you have diabetes, it’s safe to breastfeed your baby. Breast milk is the best food for your baby during the first year of life. It helps him grow healthy and strong.

Here are some tips about breastfeeding if you have preexisting diabetes:

• Talk to your dietician about breastfeeding. You may need help to create a new meal plan to make sure you get all the calories you need to support breastfeeding.
• Talk to your provider about the amount of insulin you need. You may need less insulin than usual for a few days after giving birth. And breastfeeding can lower the amount even further. It’s safe to take insulin while breastfeeding.
• Don’t take diabetes pills. They’re not recommended for breastfeeding moms.
• Eat a healthy snack before or after breastfeeding.
• Monitor your blood sugar closely. You provider may want you to check your glucose more often than usual.

What are hypoglycemia and hyperglycemia?
Hypoglycemia (also called low blood glucose) is when blood glucose levels are too low. When blood glucose levels are low, your body can’t get the energy it needs. Hyperglycemia (also called high blood glucose) is when your body doesn’t have enough insulin or can’t use insulin correctly. Both of these conditions are common in women with preexisting diabetes.

Hypoglycemia is usually mild and easily treated by eating or drinking something with sugar in it. If it’s not treated, it can cause you to pass out. Hypoglycemia can be caused by:

• Not eating enough. This may mean eating meals or snacks that are too small, or skipping or delaying meals or snacks.
• Taking too much insulin
• Getting too much physical activity

If you have hyperglycemia, you may need to change the amount of insulin you take, your meal plan or the amount of physical activity you get. You may have hyperglycemia if you:

• Need to go to urinate often
• Are thirsty
• Lose weight suddenly

Hyperglycemia can be caused by:

• Problems with the amount of food you eat and diabetes medicine you take
• Eating the wrong kinds of foods or more food than usual
• Being less active than usual
• Having an illness
• Stress

Your provider can monitor you for these conditions during pregnancy to make sure you and your baby stay healthy.

Last reviewed October 2012

Rubella and pregnancy

Rubella, also called German measles, is an infection that causes mild flu-like symptoms and a rash on the skin. Only about half of people infected with rubella have these symptoms. Others have no symptoms and may not even know they’re infected.

Rubella is only harmful to an unborn baby in the womb. If you get infected during pregnancy, rubella can cause serious problems for your baby.

Rubella has been eliminated in the United States because of routine vaccination of children. Vaccination protects a person against rubella for life. Only five cases of rubella were reported in this country between 2001 and 2004. But women who were never vaccinated as children can get infected.

Rubella is common in many other countries. Travelers can bring it into the United States, or you can get it when travelling outside the country.

It’s important to get vaccinated for rubella. Talk to your health care provider to make sure you’re protected against it.

What are signs and symptoms of rubella?
About half of people with rubella have signs and symptoms, and half don’t. Rubella is usually mild with flu-like symptoms followed by a rash. The rash often lasts about 3 days. Flu-like symptoms include:

• Low-grade fever
• Headache
• Runny nose
• Red eyes
• Swollen glands
• Muscle or joint pain

What causes rubella?
Rubella is caused by a virus (a tiny organism that can make you sick). It’s very contagious and is spread through the air from an infected person’s cough or sneeze.

What problems can rubella cause during pregnancy?
Rubella can be a serious threat to your pregnancy, especially during the first and second trimesters. Having rubella during pregnancy increases the risk of:

• Congenital rubella syndrome (CRS) – This is a condition that happens when a mother passes rubella to her baby during pregnancy. It may cause a baby to be born with one or more birth defects, including heart problems, vision problems, hearing problems, intellectual disability, bone problems, growth problems, and liver and spleen damage.
• Miscarriage – This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth – This is when a baby dies in the womb after 20 weeks of pregnancy.
• Premature birth – This is birth that happens too early, before 37 completed weeks of pregnancy.

Can you pass rubella to your baby during pregnancy?
Yes. The best way to protect your baby is to make sure you’re immune to rubella. Immune means being protected from an infection. If you're immune to an infection, it means you can't get the infection.

Most likely you’re immune to rubella because you were vaccinated as a child or you had the illness during childhood. A blood test can tell whether or not you’re immune to rubella. If you’re thinking about getting pregnant and aren’t sure if you’re immune, talk to your health care provider about getting a blood test.

If you’re not immune to rubella, here’s what you can do to help protect your baby:

Before pregnancy. Get the measles, mumps and rubella (MMR) vaccine. Wait 1 month before trying to get pregnant after getting the shot.

During pregnancy. You can be tested at a prenatal visit to make sure you’re immune to rubella. If you’re not immune, the MMR vaccine isn’t recommended during pregnancy. But there are things you can do to help prevent getting infected with rubella:

• Stay away from anyone who has the infection.
• Tell your health care provider right away if you’ve been in contact with someone who has rubella.

After pregnancy. Get the MMR vaccination after you give birth. Being protected from the infection means you can’t pass it to your baby before she gets her own MMR vaccination at about 12 months. It also prevents you from passing rubella to your baby during a future pregnancy.

What are the chances of passing rubella to your baby during pregnancy?
You’re more likely to pass rubella to your baby the earlier you become infected during pregnancy. For example:

• If you get rubella in the first 12 weeks of pregnancy, your baby has about an 8 to 9 in 10 chance (85 percent) of getting infected.
• If you get rubella at 13 to 16 weeks of pregnancy, your baby has about a 1 in 2 chance (50 percent) of being infected.
• If you get rubella at the end or your second trimester or later, your baby has about a 1 in 4 chance (25 percent) of getting infected.

If you have rubella during pregnancy, your baby’s provider carefully monitors your baby after birth to catch any problems early.

Last reviewed March 2012

See also: Rubella and your baby, Vaccinations and pregnancy

Salmonellosis

Salmonellosis is a kind of food poisoning. Food poisoning is caused by harmful germs in something you eat or drink. It can cause nausea, vomiting, diarrhea, fever and headache.

There are about 40,000 new cases of salmonellosis each year in the United States. Most people don’t have serious health problems from salmonellosis. But if you get salmonellosis during pregnancy, it can cause serious and even life-threatening problems for you and your growing baby.

What causes salmonellosis?
Salmonellosis is caused by bacteria called Salmonella. Bacteria are tiny organisms that live in and around your body. Some bacteria are good for your body. Others, like Salmonella, can make you sick.

Salmonella germs live in the digestive tracts of humans and animals. The digestive tract includes organs like the stomach and colon. These organs help your body break down the food you eat. Salmonella can be found in poop of infected animals and people.

You can get infected with Salmonella in two ways:

1. By touching an infected animal. Salmonella can be found in poop, soil, water (including fish tank water), food and bedding of infected animals, including pets. Salmonella germs can spread easily to the animal’s fur, feathers and scales. Animals that are most likely to carry Salmonella include reptiles (turtles, lizards, snakes) and poultry (chickens, ducks, geese).
2. By eating foods that are contaminated with Salmonella. These foods may look and smell normal, even if they’re contaminated.

Foods that often have Salmonella include:

• Raw or undercooked poultry, meat or fish. Cooking these items fully kills Salmonella.
• Raw or undercooked eggs and foods made with them. Salmonella can pass from chickens to their eggs. Even eggs that look normal can have Salmonella. Don’t eat food made with raw eggs, including homemade mayonnaise, hollandaise sauce, Caesar salad dressing, cookie dough, frostings and homemade ice cream.
• Unpasteurized milk, milk products and juice, or foods made from them. If a food has been pasteurized, it’s been heated to kill bad germs. Milk and juice often are pasteurized. Look for the word “pasteurized” on the product label.
• Foods that come in contact with animal poop in the soil or water where they grow. These include mushrooms, fruits, vegetables and vegetable sprouts, like alfalfa, clover, radish and mung beans.
• Food that comes into contact with Salmonella while you’re making or serving it. For example, if you’re infected and don’t wash your hands after using the bathroom, you can spread the infection to food you handle. Or if you use the same knife to cut raw chicken and tomatoes and don’t wash the knife in between, it can pass Salmonella from the chicken to the tomatoes. These are examples of cross contamination, which means the transfer of harmful bacteria from one thing to another.

You may hear news stories about foods that have been recalled (not allowed to be sold) because of Salmonella. If you’ve eaten one of these foods, contact your health care provider right away.

How do you know if you have salmonellosis?
Signs and symptoms of salmonellosis usually start 12 to 72 hours (3 days) after infection. You may be sick for 4 to 7 days. To test for salmonellosis, your provider takes a stool sample (a sample of your poop) from you and sends it to a lab for testing.

Call your health care provider if you have any of these signs or symptoms:

• Diarrhea
• Belly pain, nausea or throwing up
• Fever
• Chills
• Headache
• Muscle pains
• Blood in your stool
• Dehydration

How is salmonellosis treated?
Salmonellosis usually goes away on its own without treatment. But diarrhea from salmonellosis can cause dehydration. This means you don’t have enough water in your body. If you have salmonellosis, drink lots of liquids.

If you have severe salmonellosis, diarrhea may be so bad that you need to go to a hospital for treatment. Without quick treatment with antibiotics, a person with severe salmonellosis can die. Antibiotics are medicine that kills infections caused by bacteria. People with severe salmonellosis also may need intravenous (IV) fluids. This is when liquids are given through a needle into a vein.

What problems can salmonellosis cause during pregnancy?
Salmonellosis can lead to health complications during pregnancy, including:

• Dehydration
• Bacteremia (bacteria in the blood). This can lead to problems, like . Meningitis is an infection that causes swelling in the brain and spinal cord.
• Reactive arthritis (also called Reiter’s syndrome). This can cause swelling or pain in joints, like the knees, ankles and toes.
  You can pass salmonellosis to your baby during pregnancy. If your baby is born with salmonellosis, she may have diarrhea and fever after birth. She also may develop meningitis.

How can you protect yourself from salmonellosis?
You may be more likely to get salmonellosis than other women if you:

• Take antacids (medicines used for heartburn). Antacids, like Tums®, lower the amount of acid in your stomach. This makes it easier for Salmonella to grow.
• Have inflammatory bowel disease (also called IBD). IBD is a digestive condition that harms the lining of your intestines, which makes it easy for Salmonella to grow there.
• Have recently used antibiotics. Antibiotics are medicines that kill infections caused by bacteria. Antibiotics can kill the good bacteria that fight off Salmonella.
• Have a weak immune system or an illness like HIV, sickle cell disease or malaria. These diseases can weaken your immune system so that your body can’t fight off Salmonella.
• Travel to places that don’t have good sanitation systems. Sanitation systems include toilets and clean water for cooking and washing. Salmonella can spread quickly without good sanitation systems. Try not to be in places without good sanitation during pregnancy.
• Have a pet bird or reptile. Many chicks and young birds carry Salmonella. Reptiles often have Salmonella on their scales.
• Live and eat in group housing. Group housing is housing for a large number of people. For example, a college dorm is a kind of group housing. In group housing, you may come in contact with germs from many other people. Foods served in group housing often are made in large batches to feed many people. If one portion of meat is infected with Salmonella, it can ruin the whole batch.

Here are some things you can do to help prevent salmonellosis:

• Handle foods safely when you wash, prepare, cook and store them.
• Wash your hands well with soap and water after contact with animals, animal food, bedding, tanks or animal poop.
• Wash your hands well with soap and water after using the bathroom.
• Watch out for cross contamination between yourself, food and any utensils or supplies you use when preparing or eating food.

Last reviewed March 2013

See also: Listeriosis, Handling foods safely, Eating healthy during pregnancy

Sexually transmitted diseases

Each year in the United States, about 19 million individuals contract a sexually transmitted disease (STD) (1). STDs are infections a person can get by having sex (genital, oral or anal) with someone who has one of these infections. Many infected individuals do not know they have an STD because some STDs cause no symptoms.

STDs pose special risks for pregnant women and their babies. These infections can cause:

• Miscarriage
• Ectopic pregnancy (when the embryo implants outside of the uterus, usually in a fallopian tube)
• Preterm delivery (before 37 completed weeks of pregnancy)
• Stillbirth
• Birth defects
• Illness in the newborn period (first month of life)
• Death

Most frequently a baby becomes infected during delivery, while passing through an infected birth canal. However, a few of these infections can cross the placenta and infect the baby.

It is important for a pregnant woman to find out whether she has an STD. During an early prenatal visit, her health care provider will screen her for some of these infections, including HIV (the virus that causes AIDS) and syphilis. Some STDs can be cured with drug treatment, but not all. However, if a woman has an STD that cannot be cured, steps usually can be taken to protect her baby.

What is chlamydia?
Chlamydia is a bacterium. A chlamydial infection contracted before or during pregnancy can cause reproductive problems. About 2.8 million new cases of this infection occur yearly in the United States in both sexes, making this one of the most common STDs (1). It is most frequent in people under age 25.

Chlamydia usually causes no symptoms, although a minority of infected women experience vaginal discharge and burning on urination (2). Untreated, chlamydia can spread to the upper genital tract (uterus, fallopian tubes and ovaries), resulting in pelvic inflammatory disease (PID), often with a superinfection with other bacteria. PID can damage a woman's fallopian tubes and lead to ectopic pregnancy or infertility.

About 10 percent of pregnant women in the United States are infected with Chlamydia (3). Untreated, they face an increased risk of premature rupture of the membranes (PROM) (bag of waters) and preterm delivery (3). Babies of untreated women often become infected during vaginal delivery. Infected babies can develop eye infections and pneumonia, which require treatment with antibiotics.

The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for chlamydia infection at the first prenatal visit (4). Testing is done on a urine sample or vaginal fluid obtained with a swab. Chlamydial infection can be cured with antibiotics that prevent complications for mother and baby. Partners of an infected women also should be treated, because the infection can be passed back and forth between sexually active couples.

What is gonorrhea?
Gonorrhea is a common bacterial infectious disease that causes reproductive problems much like those caused by chlamydia. In the United States, about 600,000 new cases occur each year (4). Like infection with chlamydia, gonorrhea often causes no symptoms in infected women, although some experience vaginal discharge, burning on urination or abdominal pain. Many infected women also develop PID. Unlike chlamydial infection, gonorrhea in men causes intense burning on urination and even obstruction of urinary flow.

Pregnant women with untreated gonorrhea are at increased risk for miscarriage, PROM and premature delivery. Their babies frequently contract this infection during vaginal delivery. It can affect their eyes and joints and even cause life-threatening blood infections. Antibiotics offer effective treatment.

The CDC recommends that all pregnant women who are at risk for gonorrhea or live in an area where it is common should be tested at the first prenatal visit (4). Testing can be done on a urine sample or vaginal fluid taken with a swab. Treatment with antibiotics is usually effective and prevents complications. Because gonorrhea and chlamydia often occur together, health care providers test individuals with one of these infections for the other.

What is syphilis?
Syphilis is an STD caused by a bacterium that can cross the placenta and infect the fetus. This infection is among the most serious STDs, although it is substantially less common than the other STDs. In 2005, about 1,300 women in the United States were diagnosed with this infection (5).

Syphilis begins with a hard, painless sore called a "chancre" that usually occurs in the genital or vaginal area. Without treatment, infected individuals develop a rash, fever and other symptoms months later. If still untreated, years later some infected individuals can develop heart problems, brain damage, blindness, insanity and death.

Without treatment, syphilis during pregnancy can result in fetal or infant death in up to 40 percent of cases (5). It also can result in preterm delivery. Some infected infants show no symptoms at birth, but without immediate antibiotic treatment, they develop brain damage, blindness, hearing impairment, bone and tooth abnormalities and other problems.

The CDC recommends that all women have a blood test to screen for syphilis during the first prenatal visit (4). A single injection (shot) of penicillin can cure syphilis if a woman has had the STD for less than a year; other women require longer periods of treatment (4). When a pregnant woman is treated before the third trimester of pregnancy (about 28 weeks of pregnancy), her baby usually is not be harmed by the infection (6).

What is bacterial vaginosis?
Bacterial vaginosis (BV), which affects 16 percent of pregnant women in the United States, is caused by an overgrowth of bacteria that occur naturally in the vagina (7). The cause of BV is not known, although it appears more common in women who have had multiple sexual partners. Some women with BV experience vaginal discharge that has an unpleasant odor, burning on urination and genital itching. Some women have no symptoms.

Studies suggest that BV may increase a woman's chances of PROM and preterm delivery (4). Women with symptoms of BV are treated with antibiotics to help reduce this risk. Some studies suggest that treating high-risk pregnant women with BV (even if they have no symptoms) may reduce their risk for preterm birth. Because treatment does not appear to reduce the risk of preterm delivery in low-risk women with symptomless BV, routine testing is not currently recommended (4).

What is trichomoniasis?
Trichomoniasis is a parasitic infection that causes yellow-green, foul-smelling vaginal discharge, genital itching and redness and, sometimes, pain during intercourse and urination. Each year 7.4 million individuals in this country become infected (8).

Ten percent of pregnant women in the United States have trichomoniasis (9). This STD may increase the risk of PROM and preterm delivery.

Trichomoniasis is diagnosed by testing vaginal fluid obtained with a swab. Treatment with a drug called metronidazole eliminates the infection, but it may not reduce the risk of preterm delivery (4, 8). A pregnant women should discuss with her provider whether or not she should be treated. If she is treated, her partner also should be treated.

What is genital herpes?
Genital herpes is a viral STD. Twenty-five percent of American women are infected, but most do not know it because they have no symptoms (10).

A small number of infected individuals develop blisters in the genital area that itch and become painful. Someone who contracts genital herpes for the first time also may develop fever, fatigue, swollen glands and body aches. The virus remains in the body forever and can cause repeated outbreaks of blisters. Providers usually diagnose herpes by looking at the sores. But in some cases, they may take a swab of the blisters for testing.

Fewer than 1 percent of women with a repeated outbreak of herpes at term pass the virus on to their babies (4). The risk is highest (30 to 50 percent) when the pregnant woman contracts herpes (whether or not she has symptoms) for the first time late in pregnancy (4). Some infected infants develop skin or mouth sores, which usually can be effectively treated with antiviral drugs. However, in spite of treatment, the infection sometimes spreads to the brain and other organs, resulting in brain damage, blindness, intellectual disabilities and even death. If a woman has symptoms of herpes at the time of delivery, her provider may recommend a cesarean section to protect her baby. Some women who have repeated outbreaks of herpes infection can be treated with an antiviral drug that may prevent such outbreaks (4).

What are genital warts?
Genital warts are pink, white or gray swellings in the genital area caused by a large group of viruses called human papillomaviruses (HPVs). Some of the viruses also increase the risk of cervical cancer. About 6.2 million individuals in this country become infected each year (11).

A vaccine against four major types of HPV is now routinely recommended for girls ages 11 to 12 years and girls and women between the ages of 13 and 26 who have not been previously vaccinated (11). This vaccine can prevent most cases of cervical cancer and genital warts. Pregnant women should not get the vaccine.

Genital warts often appear in small, cauliflower-shaped clusters that may itch or burn. About 1 percent of all sexually active adults have genital warts (11).

Sometimes pregnancy-related hormones cause genital warts to grow. Occasionally, they may grow so large that they block the birth canal, making a cesarean section necessary. Rarely, an infected mother can pass the virus on to her baby, causing warts to grow on the baby's vocal cords. A cesarean section is not recommended to protect the baby because this complication is rare, and the preventive effectiveness of cesarean delivery is not known.

If the warts grow large or make the woman uncomfortable, they can be safely removed during pregnancy with laser surgery or cryotherapy (freezing).

What is HIV?
HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immune deficiency syndrome). AIDS damages the immune system and threatens the lives of those who are infected, including mothers and babies. In the United States, 127,000 women are living with HIV (12). The majority were infected sexually, although intravenous drug use is another common source of the infection.

The CDC recommends that all pregnant women be tested for HIV early in pregnancy as part of the routine panel of prenatal tests (4). Women who learn that they carry the virus can get treatment to help protect their babies from contracting the infection. New drug treatments reduce the risk of a mother passing HIV to her baby to 2 percent or less, compared to 15 to 25 percent for untreated mothers (4).

What is hepatitis B?
Hepatitis B is one of several viruses that infect the liver. About 1 in every 500 to 1 in 1,000 pregnant women has hepatitis B at the time of delivery and can pass the infection on to her baby during labor and birth (13). In most cases, the risk is about 10 to 20 percent, though it can be higher if the woman has high levels of the virus in her body (14).

Symptoms of hepatitis B can range from mild to severe. Some infected individuals have no symptoms at all. Common symptoms include: jaundice (yellowing of skin), fatigue, nausea and vomiting, upper-abdominal discomfort and low-grade fever.

About 10 to 15 percent of individuals with hepatitis B do not clear the virus from their bodies and develop chronic hepatitis (14). These individuals are at increased risk for severe liver disease or liver cancer. Babies who are infected at birth usually develop chronic hepatitis B infection and face a high risk for serious liver disease and liver cancer as adults.

However, hepatitis usually can be prevented in babies. The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for hepatitis B with a blood test (15). If the blood test shows a woman has hepatitis B, her baby should receive the hepatitis B vaccine and immune globulin (which contains hepatitis-fighting antibodies) within 12 hours of birth. This treatment prevents infection in more than 90 percent of babies at risk (15). The baby should have two more doses of the vaccine in the first 6 months of life. The CDC also recommends that all babies be vaccinated against hepatitis B before leaving the hospital and at 1 to 2 months and 6 to 18 months.

Besides sexual contact, hepatitis B can be spread by contact with blood or saliva of infected individuals (13). Women can help protect themselves from hepatitis B by following safe sex practices, avoiding illicit injected drugs, and not sharing personal care items that might have blood or saliva on them (razors, toothbrushes).

However, the best defense against hepatitis B is vaccination. The hepatitis B vaccine is considered safe in pregnancy (13, 15). Health care workers, public safety workers and others at high risk (such as women living with an infected partner) should consider getting the hepatitis B vaccine before or during pregnancy.

How can a pregnant woman protect her baby from STIs?
A pregnant woman can help protect her baby from STIs by making sure she doesn't contract one of these infections during pregnancy. The most effective prevention is having only one sexual partner who does not have an STD.

If her partner has a history of herpes and she does not, she should avoid intercourse during the third trimester when the risk of passing on the infection to the baby is highest (4). Throughout pregnancy, a woman should avoid intercourse when her partner has symptoms. He should use a condom even when he has no sores, because the infection may be active but cause no symptoms. Condoms also help to protect against HIV and other STIs.

A pregnant woman should contact her health care provider right away if she:

• Suspects she has an STD
• Has had sex with a partner who may have an STD

In this way she can be treated promptly, if necessary, to protect her health and that of her baby.

Does the March of Dimes support research on STIs in pregnancy?
The March of Dimes offers research grants aimed at answering these questions:

• How do STDs adversely affect pregnancy?
• How can affected pregnancies be managed to prevent infections in newborns?
• When infections can't be prevented in newborns, how can they be treated?

One grantee is seeking to identify genetic differences that may cause some pregnant women to be more susceptible to upper genital tract infections following BV. Because upper genital tract infections can increase the risk of preterm delivery, this study could lead to better ways to identify women at increased risk of preterm delivery, allowing early treatment to help prevent it.

Another grantee is analyzing how networks of genes in Chlamydia and other bacteria act to cause dangerous infections in newborns, such as meningitis and blood infection.

Other researchers are seeking to develop improved drug treatment for congenital herpes infections in order to prevent brain damage and lasting disabilities in newborns.

For more information

• The CDC Web site
• The CDC National STD Hotline
  (800) 227-8922 or (800) 342-2437
  Spanish (800) 344-7432
• American Social Health Association
  (800) 227-8922

References

1. Centers for Disease Control and Prevention (CDC). Trends in Reportable Sexually Transmitted Diseases in the United States, 2005. December 2006.
2. Centers for Disease Control and Prevention (CDC). Chlamydia Fact Sheet. Accessed 5/17/07.
3. Cunningham, F.G., et al. Sexually Transmitted Diseases, in Williams Obstetrics, 22nd Edition. New York, McGraw-Hill Medical Publishing Division, 2005, pages 1301-1325.
4. Workowski, K.A., Berman, S.M. Sexually Transmitted Disease Treatment Guidelines, 2006. Morbidity and Mortality Weekly Report, volume 55, RR11, August 4, 2006.
5. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance 2005 Supplement, Syphilis Surveillance Report. December 2006.
6. American Academy of Pediatrics. Red Book: 2006 Report of the Committee on Infectious Diseases, 27th Edition. Elk Grove Village, IL, 2006, pages 631-644.
7. Centers for Disease Control and Prevention (CDC). Bacterial Vaginosis Fact Sheet. Accessed 5/18/07.
8. Centers for Disease Control and Prevention (CDC). Trichomoniasis Fact Sheet. Accessed 5/18/07.
9. Okun, N., et al. Antibiotics for Bacterial Vaginosis or Trichomonas Vaginalis in Pregnancy: A Systematic Review. Obstetrics and Gynecology, volume 105, 2005, pages 857-868.
10. Centers for Disease Control and Prevention (CDC). Genital Herpes Fact Sheet. Accessed 5/18/07.
11. Centers for Disease Control and Prevention (CDC). Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, volume 56, RR02, March 23, 2007.
12. Centers for Disease Control and Prevention (CDC). HIV/AIDS Among Women. March 2007.
13. American College of Obstetricians and Gynecologists (ACOG). Hepatitis B Virus in Pregnancy. ACOG Patient Education Pamphlet, April 2008.
14. American College of Obstetricians and Gynecologists (ACOG). Viral Hepatitis in Pregnancy. ACOG Practice Bulletin, number 86, October 2007.
15. Centers for Disease Control and Prevention (CDC). Viral Hepatitis. Updated 7/26/07.

August 2008

Shoulder dystocia

Shoulder dystocia occurs when a baby's head is delivered through the vagina, but his shoulders get stuck inside the mother's body. This creates risks for both mother and baby. Dystocia means "slow or difficult labor or delivery."

Shoulder dystocia can happen when:

• A baby is unusually large. Overweight women and women with diabetes are at risk for having large babies.
• The mother's pelvic opening is too small for the baby's shoulders to come out.

Although there are risk factors for shoulder dystocia, health care providers cannot usually predict or prevent it. They often discover it only after labor has begun.

Risk factors
A pregnant woman may be at risk for shoulder dystocia if:

• Her baby is very large. (But in most cases of shoulder dystocia, the baby's weight is normal. And for most very large babies, shoulder dystocia doesn't occur.)
• She has diabetes.
• She is pregnant with more than one baby.
• She is obese.
• She delivers after the baby's due date.
• She has had shoulder dystocia or a very large baby during a past delivery.

Shoulder dystocia may occur when the woman has no risk factors.

What happens in the delivery room
In most cases, the baby is delivered safely. Here are some things that may be done:

• Pressing the mother's thighs against her belly.
• Applying pressure to the mother's belly.
• Rolling the mother onto all fours.
• Turning the baby's shoulder while it is still inside the mother.
• Gently cutting a wider opening in the woman's vagina (an episiotomy).
• Performing a cesarean section after labor has begun. Because shoulder dystocia is hard to predict, a planned c-section is usually not recommended to prevent it.

Complications
Usually, the mother and the baby do well and have no permanent damage. But there may be some complications. For the baby, risks include:

• Injury to the nerves of the shoulder, arms and hand. This may cause shaking or paralysis. In most cases, the problems go away in 6 to 12 months.
• A broken arm or collarbone.
• Lack of oxygen. In the most severe cases, which are rare, this can cause brain damage and even death.

Complications for the mother include:

• Heavy bleeding after delivery
• Tearing of the uterus, vagina, cervix or rectum
• Bruising of the bladder

In most cases, complications can be treated and managed.

December 2007

Sickle cell disease and pregnancy

Sickle cell disease (also called SCD) is a condition in which the red blood cells in your body are shaped like a sickle (like the letter C). Red blood cells carry oxygen to the rest of your body. In a healthy person, red blood cells are round and flexible. They flow easily in the blood. A person with SCD has red blood cells that are stiff and can block blood flow. This can cause pain, infections and, sometimes, organ damage and strokes.

CD is a kind of anemia. Anemia happens when you don’t have enough healthy red blood cells to carry oxygen to the rest of your body.

What causes SCD?

SCD is inherited. This means it’s passed from parent to child through genes. A gene is a part of your body’s cells that stores instructions for the way your body grows and works. Genes come in pairs — you get one of each pair from each parent.

Sometimes the instructions in genes change. This is called a gene change or a mutation. Parents can pass gene changes to their children. Sometimes a gene change can cause a gene to not work correctly. Sometimes it can cause birth defects or other health conditions. A birth defect is a health condition that is present in a baby at birth.

You have to inherit a gene change for sickle cell from both parents to have SCD. If you inherit the gene change from just one parent, you have sickle cell trait. This means that you have the gene change for SCD, but you don’t have SCD. When this happens, you’re called a carrier. A carrier has the gene change but doesn’t have the condition.

Sickle cell trait cannot become SCD. Rarely people with sickle cell trait show signs of SCD, but this is unusual. Most don’t.

Can you pass SCD or sickle cell trait to your children?

Yes. But it depends on both you and your partner. If you and your partner both have SCD, your baby will have SCD.

If you and your partner both have sickle cell trait, there’s a:

• 3-in-4 chance (75 percent) that your baby won’t have SCD
• 1-in-2 chance (50 percent) that your baby will have sickle cell trait
• 1-in-4 chance (25 percent) that your baby will have SCD
• 1-in-4 chance (25 percent) that your baby won’t have SCD or sickle cell trait

A genetic counselor can help you understand your chances of passing SCD or sickle cell trait to your baby. A genetic counselor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby's health.

Ask your health care provider if you need help finding a genetic counselor. Or contact the National Society of Genetic Counselors.

How can you find out if you have SCD or sickle cell trait?
There are two types of tests that can tell you if you have SCD or sickle cell trait. Both are safe to take during pregnancy. Your partner can have the tests, too.

1. A blood test
2. A swab of cells inside your mouth. This means your provider rubs a cotton swab against the inside of your cheek to get some cells.

You and your partner may want to be tested if:

• SCD or sickle cell trait runs in either of your families. To help you find out, take your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in both of your families have had. Use this family health history form and share it with your health care provider.
• You’re black or Hispanic. In the United States, SCD is most common among these groups. SCD affects about 1 in 500 black births and about 1 in 36,000 Hispanic births in this country.
• Your family’s ancestors are from Africa, the Caribbean, Greece, India, Italy, Malta, Sardinia, Saudi Arabia, Turkey, or South or Central America.

Can you find out if your baby has SCD or sickle cell trait during pregnancy?

Yes. If you or your partner has SCD or sickle cell trait, you can have a prenatal test to find out if your baby has SCD or sickle cell trait.

You can have either of these tests:

• Chorionic villus sampling (also called CVS). This test checks tissue from the placenta for birth defects and genetic conditions. You can get CVS at 10 to 12 weeks of pregnancy.
• Amniocentesis (also called amnio). This test checks amniotic fluid from the amniotic sac around your baby for birth defects and genetic conditions. You can get this test at 15 to 20 weeks of pregnancy.

Talk to your provider or genetic counselor if you’re thinking of having either of these tests.

Can SCD cause problems during pregnancy?
With regular prenatal care, most women with SCD can have a healthy pregnancy. But if you have SCD, you’re more likely than other women to have health complications that can affect your pregnancy. These complications include pain episodes, infection and vision problems.

During pregnancy, SCD may become more severe, and pain episodes may happen more often. Pain episodes usually happen in the organs and joints. They can last a few hours to a few days, but some last for weeks.

During pregnancy, SCD may increase your risk of:

• Miscarriage, when a baby dies in the womb before 20 weeks of pregnancy
• Premature birth, when birth happens too early, before 37 completed weeks of pregnancy
• Having a baby with low birthweight (less than 5 pounds, 8 ounces)

How is SCD treated during pregnancy?

If you have SCD and you’re pregnant or planning to get pregnant, talk to your health care provider about the medicines you’re taking. Your provider may change your medicine to one that’s safe for your baby during pregnancy.

For example, hydroxyurea is a medicine that may help prevent red blood cells from sickling. It’s used to treat SCD pain episodes. However, it isn’t recommended during pregnancy because it may increase the risk of birth defects.

Your provider also can treat other problems related to SCD and pregnancy. For example, your provider can help you find ways to treat pain episodes that are safe during pregnancy.

For more information

Centers for Disease Control and Prevention (CDC)

National Heart, Lung and Blood Institute

Sickle Cell Disease Association of America

Last reviewed January 2013

See also: Sickle Cell Disease, Carrier screening, Genetic counseling, Your family health history, Newborn screening

Syphilis

What you need to know
Syphilis is a serious sexually transmitted infection (STI). It is caused by a bacterium. Syphilis can infect both a woman and her baby during pregnancy.

Syphilis is less common than other STIs in the United States. In 2002, health officials reported over 32,000 cases of syphilis.

Syphilis begins with a painless sore, often in the genital or vaginal area. Sores can also appear on the anus, in the mouth or on the lips. Weeks or months later, infected persons can develop a rash, fever and other symptoms. If the disease is untreated, the heart, brain and other organs can be damaged.

Health care providers diagnose syphilis by examining material from a sore under the microscope. Blood tests are also used.

Syphilis is treated with antibiotics.

Most pregnant women are tested for syphilis at an early prenatal visit. A single injection of penicillin can cure syphilis if the woman has had the infection for less than one year. Older infections require more treatment.

If a pregnant woman has syphilis and she is not treated, her baby can become infected and may even die. Infected babies who are not treated soon after birth are at risk for serious health problems, including brain damage and blindness.

What you can do
Ask your health care provider to screen you for syphilis early in pregnancy. This is usually done routinely as part of prenatal care. If you do have syphilis, you can get antibiotics to treat the infection. This will help protect both you and your baby.

Be sure your partner is also screened.

While you're pregnant, you can avoid syphilis by not having sex. If you do have sex:

• Have sex with only one partner who is only having sex with you, has been tested for syphilis and is uninfected.
• Use a latex condom.

For more information

• CDC information line
  (800) 232-4636
  In English and Spanish
  TTY for the deaf and hard of hearing (888) 232-6348
• American Social Health Association

Thrombophilias

The thrombophilias are a group of disorders that promote blood clotting. Individuals with a thrombophilia tend to form blood clots too easily, because their bodies make:

• Too much of certain proteins, called blood clotting factors or
• Too little of anti-clotting proteins that limit clot formation

A thrombophilia can be inherited or acquired later in life. About 15 percent of people in the United States have an inherited thrombophilia (1, 2). Acquired thrombophilias are less common. Thrombophilias may pose special risks in pregnancy.

What are the symptoms of a thrombophilia?
Most people with a thrombophilia have no symptoms. However, some develop a thrombosis, a blood clot where it does not belong. Often, blood clots form in veins in the lower leg, causing swelling, redness and discomfort. This condition, called deep vein thrombosis, is often diagnosed with ultrasound or other imaging tests. Clots are generally treated with anticoagulant (blood-thinning) drugs.

Clots can become life-threatening if they break off and travel through the bloodstream to vital organs. This is called venous thromboembolism (VTE). When the VTE blocks blood vessels in the lungs, it is called a pulmonary embolus. It can cause serious breathing difficulties and sometimes death. VTEs that block blood vessels in the brain or heart can cause stroke or heart attack.

Clots are more likely to develop when a person with a thrombophilia has other risk factors, including:

• Having a family history of VTE in a parent, sibling or child
• Being pregnant or in the postpartum period (up to 6 weeks after delivery)
• Requiring immobilization (due to a bone fracture, for example) or surgery

What are the most common types of thrombophilias?
The inherited thrombophilias include:

• Factor V Leiden and prothrombin mutations: These are the most common inherited thrombophilias. They occur in 2 to 7 percent and 2 percent, respectively, of Caucasians, and are less common in African-Americans and Asians (2).
• Antithrombin, protein C and protein S deficiencies. Each affects less than 1 percent of people in the United States (2).

All of these are inherited in an autosomal dominant pattern, meaning that an affected person needs to inherit the gene from only one parent. Each child of an affected parent has a 50 percent chance of inheriting the thrombophilia.

The most common acquired thrombophilia is antiphospholipid syndrome (APS). APS occurs in up to 5 percent of pregnant women (3). In APS, the body makes antibodies that attack certain fats (phospholipids) that line the blood vessels, sometimes leading to blood clots. APS is an autoimmune disorder, like arthritis and systemic lupus erythematosus (SLE). Up to 40 percent of women with SLE have antiphospholipid antibodies in their blood, which may contribute to their increased risk of pregnancy complications (3).

What are the risks of a thrombophilia during pregnancy?
Most women with a tendency to develop clotting have healthy pregnancies. However, these pregnant women may be more likely than other pregnant women to develop deep vein clots and certain other pregnancy complications.

Even pregnant women without a clotting problem may be more likely than non-pregnant women to develop deep vein clots and emboli. This is due to normal pregnancy-related changes in blood clotting that limit blood loss during labor and delivery. However, studies suggest that at least 50 percent of pregnant women who develop a pulmonary embolus or other VTE have an underlying thrombophilia (1, 2). Pulmonary embolus is the leading cause of maternal death in the United States (2).

The thrombophilias also may contribute to pregnancy complications including (1):

• Repeated miscarriage, usually occurring after the tenth week of pregnancy
• Stillbirth in the second or third trimesters
• Placental abruption, a condition in which the placenta peels away from the uterine wall, partially or completely, before delivery. This can cause heavy bleeding that is dangerous for mother and baby.

APS contributes to 10 to 20 percent of repeated pregnancy losses (3, 4). APS also is associated with other pregnancy complications (4, 5):

• Preeclampsia. This pregnancy-associated form of high blood pressure can pose a number of risks for mother and baby.
• Poor fetal growth
• Premature delivery (before 37 completed weeks of pregnancy)

Health care providers believe that these problems may be caused by blood clots in placental vessels that reduce blood flow to the fetus. It is not yet known whether the inherited thrombophilias contribute to these pregnancy complications. To date, the risk, if any, appears low (1, 6).

How are the thrombophilias diagnosed?
Providers do blood tests to find out whether or not a person has a thrombophilia.

Which pregnant women should be tested for thrombophilias?
All pregnant women who have had a blood clot should be offered testing (1, 5). Health care providers also may recommend testing if a woman has:

• A family history of VTE before age 50
• A history of pregnancy complications, including two or more miscarriages after 10 weeks gestation, stillbirth, early or severe preeclampsia or severe unexplained fetal growth problems (1, 5)

How is a thrombophilia treated during pregnancy?
Treatment depends on the specific type of thrombophilia and whether or not a woman has had a blood clot in the past. Some women with a thrombophilia may not need treatment.

Women with a thrombophilia who have a history of blood clots are usually treated with an anticoagulant during pregnancy and the postpartum period. Women with certain severe, inherited thrombophilias (such as antithrombin deficiency) also are usually treated, even if they have not experienced blot clots (7). During pregnancy, these women are generally treated with an anticoagulant called heparin (given by injection one or more times daily) or a newer version of the drug called low-molecular weight heparin. These drugs do not cross the placenta and are safe for the baby. After delivery, some women with a thrombophilia may be treated for about 6 weeks with an oral anticoagulant called warfarin, in addition to, or instead of, heparin. Warfarin is safe to take during breastfeeding, but it is not recommended during pregnancy because it crosses the placenta and can cause birth defects.

Women with APS who have a history of blood clots and/or repeated pregnancy loss are usually treated with anticoagulants during pregnancy and the postpartum period. Low doses of aspirin may be recommended along with heparin for some women with APS. Studies suggest that the combination is more effective than either medication alone in preventing pregnancy loss (5, 7).

Not all women with a thrombophilia need treatment during pregnancy. A woman and her health care provider should discuss her individual risks of blood clots and pregnancy complications and the severity of her thrombophilia before deciding whether or not she needs treatment. Heparin treatment does pose some risk of side effects, including bone loss and potentially dangerous blood changes. The risks appear lower with low-molecular weight heparin.

Treatment may not be recommended for pregnant women with one of the less severe thrombophilias (such as factor V Leiden or prothrombin mutations) who have no personal or family history of blood clots (1, 7). The risk of VTE is less than 0.2 percent (1 in 500) in pregnant women with factor V Leiden with no personal or strong family history of VTE (1). In some cases, treatment may be recommended after a cesarean delivery.

Does the March of Dimes support research related to the thrombophilias?
Yes. March of Dimes grantees are studying the underlying genetic basis of various inherited blood diseases, some of which affect blood clotting. What they learn may lead to improved treatments for inherited blood diseases, possibly including the thrombophilias.

References

1. Lockwood, C.J. and Bauer, K.A. Inherited Thrombophilias in Pregnancy. UpToDate, January 30, 2009.
2. Marik. P.E. and Plante, L.A. Venous Thromboembolic Disease and Pregnancy. New England Journal of Medicine, volume 359, number 19, November 6, 2008, pages 2025-2033.
3. National Human Genome Research Institute. Learning About Antiphospholipid Syndrome (APS). Updated February 25, 2009.
4. Schur, P. The Antiphospholipid Syndrome. UptoDate, January 18, 2009.
5. American College of Obstetricians and Gynecologists (ACOG). Antiphospholipid Syndrome. ACOG Practice Bulletin, number 68, November 2005 (reaffirmed 2007).
6. Rodger, M.A., et al. Inherited Thrombophilias and Pregnancy Complications Revisited. Obstetrics and Gynecology, volume 112, number 2, August 2008, pages 320-324.
7. Bates, S.M., et al. Venous Thromboembolism, Thrombophilia, Antithrombotic Therapy, and Pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest, volume 133, number 6, June 2008 supplement, page 844S-886S.

July 2009

Thyroid conditions

What you should know
The thyroid is a butterfly-shaped gland located in your neck, in front of your windpipe. This tiny gland plays a huge role in your health. The hormones produced by the thyroid gland influence your heart rate, your metabolism, and many other aspects of your health.

Sometimes the thyroid gland produces too much or too little of the thyroid hormone (thyroxine) that keeps the body functioning normally.

• Hyperthyroidism is the disorder that occurs if the thyroid gland is too active.
• Hypothyroidism is the disorder that occurs if the thyroid gland isn't active enough.
  In the U.S., about 8 million women have either hyperthyroidism or hypothyroidism that is unrecognized and untreated.

Some women have a thyroid disorder that began before pregnancy. Others develop thyroid problems for the first time during pregnancy or soon after delivery.

An untreated thyroid disorder during pregnancy is a danger to both mother and baby. For mothers, the risks include a pregnancy-related form of high blood pressure (called preeclampsia) and other pregnancy complications. For babies, the risks include preterm birth, decreased mental abilities, thyroid disorder and even death. But with proper treatment, most women with thyroid disorders can have a healthy baby.

What you can do
If you have a thyroid condition, be sure to tell the health care provider who will take care of you during your pregnancy. It's best if you do this before you become pregnant.

If you are already pregnant, continue taking your medication and talk to your provider as soon as possible. Many medications used to treat thyroid disease in pregnancy are safe for a baby. But radioactive iodine, which is sometimes used to treat hyperthyroidism, should not be taken during pregnancy. In addition, your blood levels need to be monitored and the amount of medication you take may need to be adjusted as your pregnancy progresses.

Health care providers do not routinely perform thyroid screening for women who are planning to get pregnant or who are newly pregnant. If you think you might have a thyroid condition—or if you have a family history of thyroid disease—ask your provider if you should be tested.

Symptoms of hyperthyroidism

• Nervousness, anxiety attacks, or irritability
• Sudden weight loss
• Rapid heartbeat, irregular heartbeat, or pounding of the heart (palpitations)
• Shaking hands and fingers
• Inappropriate sweating
• Increased sensitivity to heat
• More frequent bowel movements
• Changes in menstrual patterns
• Fatigue
• Muscle weakness
• Difficulty sleeping

Symptoms of hypothyroidism

• Unexplained weight gain
• Constipation
• Increased sensitivity to cold
• Dry skin
• Hoarseness
• Heavier than normal menstrual periods
• Depression
• Muscle and joint aches
• Muscle weakness

Many of these symptoms are also related to other health conditions. So having some of them does not always mean you have thyroid disease. Still, if you have any of these symptoms, be sure to tell your health care provider.

For more information, contact the American Thyroid Association, (703) 998-8890.

January 2007

Toxoplasmosis

Toxoplasmosis is an infection. It’s caused by a parasite called Toxoplasma gondii. The parasite is so tiny you can’t see it.

More than 60 million people in the United States may have the parasite. Very few people have symptoms because a healthy immune system usually keeps the parasite from causing infection. But toxoplasmosis can cause big health problems for your baby during pregnancy.

How do you get infected with toxoplasmosis?
You can come in contact with the parasite that causes the infection through:

• Eating raw or undercooked meat
• Eating unwashed fruits and vegetables
• Touching cat poop
• Touching kitchen utensils and cutting boards used to prepare raw or undercooked meat and fruits and vegetables
• Touching dirt or sand

What are the signs and symptoms of toxoplasmosis?
You may not know if you have the infection. Lots of times there are no symptoms. For some people, it feels like the . Symptoms can include:

• Achy muscles
• Headache
• Fatigue (tiredness)
• Fever
• Discomfort
• Swollen glands

These symptoms can last for a month or longer. If you think you have toxoplasmosis, talk to your health care provider. Your provider can give you a blood test to find out if you have the infection. Even though blood tests are a regular part of prenatal care, you don’t’ usually get testing for toxoplasmosis. So be sure to talk to your provider if you think you have the infection.

Can toxoplasmosis cause problems before pregnancy?
If you have toxoplasmosis within 6 months of getting pregnant, you may be able to pass it to your baby during pregnancy. Talk to your health care provider about being tested.

Can toxoplasmosis cause problems during pregnancy?
Yes. Pregnancy complications caused by toxoplasmosis include:

• Preterm birth – Birth before 37 completed weeks of pregnancy
• Stillbirth – The death a baby in the womb before birth but after 20 weeks of pregnancy

If you get toxoplasmosis during pregnancy, you have a 3 in 10 chance (30 percent) of passing the infection to your baby. The later in your pregnancy you get infected, the more likely it is that your baby gets infected. But the earlier in pregnancy you get infected, the more serious the baby’s problems may be after birth. For example, he could have damage of the brain and eyes. Some infected babies may die.

If you have toxoplasmosis during pregnancy, your health care provider may suggest a test called amniocentesis (also called amnio) to see if your baby is infected. Amnio is a test that takes some amniotic fluid from around your baby in the uterus. You can get this test at 15 to 20 weeks of pregnancy.

The fluid can be tested to see if your baby has toxoplasmosis. It also can be tested for other problems with the baby, like birth defects or genetic problems. Birth defects are problems with a baby’s body that are present at birth. Genetic conditions may be passed from parents to children through genes and include certain diseases and birth defects.

Can toxoplasmosis during pregnancy harm your baby?
Most babies born with toxoplasmosis have no symptoms. But about 1 in 10 babies (10 percent) with the infection are born with problems, including:

• Eye infections
• Enlarged liver and spleen
• Jaundice (yellowing of the skin and the whites of the eyes)
• Pneumonia

Without treatment, 8 or 9 out of 10 newborns (85 percent) may develop problems later in life, even if they show no symptoms earlier. These problems include:

• Intellectual disabilities
• Vision problems
• Cerebral palsy (a group of disorders that can cause problems with brain development that can affect a person’s balance, posture and ability to move)
• Seizures
• Hearing loss

Each year, between 400 and 4,000 babies in the United States are born with toxoplasmosis. If you think you had toxoplasmosis during pregnancy, be sure your baby is tested. Your baby can have a blood test to check for this infection.

How is toxoplasmosis treated during pregnancy?
Getting treatment with certain antibiotics helps reduce the chance of your baby getting toxoplasmosis. Antibiotics are medicines that kill some types of organisms that cause infections. This treatment also helps reduce the seriousness of any symptoms your baby may have.

If you’re infected before 18 weeks of pregnancy, your provider may give you an antibiotic called spiramycin. This medicine helps reduce the chance of your baby getting the infection.

If you’re infected after 18 weeks of pregnancy, your provider may give you different antibiotics called pyrimethamine and sulfadiazine. These medicines are recommended for use after 18 weeks of pregnancy. This is because if you take them before 18 weeks of pregnancy, they may cause birth defects in your baby.

How is toxoplasmosis treated in your baby after birth?
If your baby shows symptoms of toxoplasmosis, she gets treated with the antibiotics pyrimethamine and sulfadiazine. She continues these antibiotic treatments through her first birthday, sometimes even longer.

How can you prevent toxoplasmosis?
Here’s how to protect yourself from toxoplasmosis:

• Don’t eat raw or undercooked meat, especially lamb or pork. Cooked meat should not look pink, and the juices should be clear.
• Wash your hands with soap and water after handling fruits, vegetables or raw meat.
• Don’t touch your eyes, nose or mouth when handling raw meat.
• Clean cutting boards, work surfaces and utensils with hot, soapy water after using them with fruits, vegetables or raw meat.
• Peel or thoroughly wash all raw fruits and vegetables before eating.
• Use work gloves when you’re gardening. Wash your hands afterwards.
• Don’t let your cat go outside your home where it may come in contact with the parasite.
• Ask someone else to clean your cat’s litter box. If you have to do it yourself, wear gloves. Wash your hands thoroughly when you’re done emptying the litter.
• Stay away from children’s sandboxes. Cats like to use them as litter boxes.

Last updated February 2012

See also: Eating healthy during pregnancy

Trichomoniasis

What you need to know
Trichomoniasis (also called "tric") is a sexually transmitted infection (STI). It is caused by a parasite. Some women who have trichomoniasis have these symptoms:

• A frothy, yellow-green discharge from the vagina with a strong odor
• Itching and irritation in the genital area
• Discomfort when they urinate or have sex

More than 7 million women and men in the United States are infected with trichomoniasis each year.

Health care providers diagnose trichomoniasis with a physical exam and a lab test.

Trichomoniasis can usually be cured with one dose of an antibiotic called metronidazole (Flagyl).

What you can do
Tell your health care provider if you have:

• A frothy, yellow-green discharge from the vagina with a strong odor
• Itching and irritation in the genital area
• Discomfort when they urinate or have sex

If your provider gives you antibiotics, be sure to take them as directed.

Be sure your partner gets tested.

While you're pregnant, you can avoid trichomoniasis by not having sex. If you do have sex:

• Have sex with only one partner who is only having sex with you, has been tested for trichomoniasis, and is uninfected.
• Use a latex condom.

For more information

• CDC information line
  (800) 232-4636
  In English and Spanish
  TTY for the deaf and hard of hearing (888) 232-6348
• http://www.ashastd.org/merican Social Health Association

Umbilical cord abnormalities

The umbilical cord is a narrow tube-like structure that connects the developing baby to the placenta. The cord is sometimes called the baby's “supply line” because it carries the baby's blood back and forth, between the baby and the placenta. It delivers nutrients and oxygen to the baby and removes the baby's waste products.

The umbilical cord begins to form at 5weeks after conception. It becomes progressively longer until 28 weeks of pregnancy, reaching an average length of 22 to 24 inches (1). As the cord gets longer, it generally coils around itself. The cord contains three blood vessels: two arteries and one vein.

• The vein carries oxygen and nutrients from the placenta (which connects to the mother's blood supply) to the baby.
• The two arteries transport waste from the baby to the placenta (where waste is transferred to the mother's blood and disposed of by her kidneys).

A gelatin-like tissue called Wharton's jelly cushions and protects these blood vessels.

A number of abnormalities can affect the umbilical cord. The cord may be too long or too short. It may connect improperly to the placenta or become knotted or compressed. Cord abnormalities can lead to problems during pregnancy or during labor and delivery.

In some cases, cord abnormalities are discovered before delivery during an ultrasound. However, they usually are not discovered until after delivery when the cord is examined directly. The following are the most frequent cord abnormalities and their possible effects on mother and baby.

What is single umbilical artery?
About 1 percent of singleton and about 5 percent of multiple pregnancies (twins, triplets or more) have an umbilical cord that contains only two blood vessels, instead of the normal three. In these cases, one artery is missing (2). The cause of this abnormality, called single umbilical artery, is unknown.

Studies suggest that babies with single umbilical artery have an increased risk for birth defects, including heart, central nervous system and urinary-tract defects and chromosomal abnormalities (2, 3). A woman whose baby is diagnosed with single umbilical artery during a routine ultrasound may be offered certain prenatal tests to diagnose or rule out birth defects. These tests may include a detailed ultrasound, amniocentesis (to check for chromosomal abnormalities) and in some cases, echocardiography (a special type of ultrasound to evaluate the fetal heart). The provider also may recommend that the baby have an ultrasound after birth.

What is umbilical cord prolapse?
Umbilical cord prolapse occurs when the cord slips into the vagina after the membranes (bag of waters) have ruptured, before the baby descends into the birth canal. This complication affects about 1 in 300 births (1). The baby can put pressure on the cord as he passes through the cervix and vagina during labor and delivery. Pressure on the cord reduces or cuts off blood flow from the placenta to the baby, decreasing the baby's oxygen supply. Umbilical cord prolapse can result in stillbirth unless the baby is delivered promptly, usually by cesarean section.

If the woman's membranes rupture and she feels something in her vagina, she should go to the hospital immediately or, in the United States, call 911. A health care provider may suspect umbilical cord prolapse if the bay develops heart rate abnormalities after the membranes have ruptured. The provider can confirm a cord prolapse by doing a pelvic examination. Cord prolapse is an emergency. Pressure on the cord must be relieved immediately by lifting the presenting fetal part away from the cord while preparing the woman for prompt cesarean delivery.

The risk of umbilical cord prolapse increases if:

• The baby is in a breech (foot-first) position.
• The woman is in preterm labor.
• The umbilical cord is too long.
• There is too much amniotic fluid.
• The provider ruptures the membranes to start or speed up labor.
• The woman is delivering twins vaginally. The second twin is more commonly affected.

What is vasa previa?
Vasa previa occurs when one or more blood vessels from the umbilical cord or placenta cross the cervix underneath the baby. The blood vessels, unprotected by the Wharton's jelly in the umbilical cord or the tissue in the placenta, sometimes tear when the cervix dilates or the membranes rupture. This can result in life-threatening bleeding in the baby. Even if the blood vessels do not tear, the baby may suffer from lack of oxygen due to pressure on the blood vessels. Vasa previa occurs in 1 in 2,500 births (4).

When vasa previa is diagnosed unexpectedly at delivery, more than half of affected babies are stillborn (4). However, when vasa previa is diagnosed by ultrasound earlier in pregnancy, fetal deaths generally can be prevented by delivering the baby by cesarean section at about 35 weeks of gestation (4).

Pregnant women with vasa previa sometimes have painless vaginal bleeding in the second or third trimester. A pregnant woman who experiences vaginal bleeding should always report it to her health care provider so that the cause can be determined and any necessary steps taken to protect the baby.

A pregnant woman may be at increased risk for vasa previa if she:

• Has a velamentous insertion of the cord (the umbilical cord inserts abnormally into the fetal membranes, instead of the center of the placenta)
• Has placenta previa (a low-lying placenta that covers part or all of the cervix) or certain other placental abnormalities
• Is expecting more than one baby

What is a nuchal cord?
About 25 percent of babies are born with a nuchal cord (the umbilical cord wrapped around the baby's neck) (1). A nuchal cord, also called nuchal loops, rarely causes any problems. Babies with a nuchal cord are generally healthy.

Sometimes fetal monitoring shows heart rate abnormalities during labor and delivery in babies with a nuchal cord. This may reflect pressure on the cord. However, the pressure is rarely serious enough to cause death or any lasting problems, although occasionally a cesarean delivery may be needed.

Less frequently, the umbilical cord becomes wrapped around other parts of the baby's body, such as a foot or hand. Generally, this doesn't harm the baby.

What are umbilical cord knots?
About 1 percent of babies are born with one or more knots in the umbilical cord (1). Some knots form during delivery when a baby with a nuchal cord is pulled through the loop. Others form during pregnancy when the baby moves around. Knots occur most often when the umbilical cord is too long and in identical-twin pregnancies. Identical twins share a single amniotic sac, and the babies' cords can become entangled.

As long as the knot remains loose, it generally does not harm the baby. However, sometimes the knot or knots can be pulled tight, cutting off the baby's oxygen supply. Cord knots result in miscarriage or stillbirth in 5 percent of cases (1). During labor and delivery, a tightening knot can cause the baby to have heart rate abnormalities that are detected by fetal monitoring. In some cases, a cesarean delivery may be necessary.

What is an umbilical cord cyst?
Umbilical cord cysts are outpockets in the cord. They are found in about 3 percent of pregnancies (2).

There are true and false cysts:

• True cysts are lined with cells and generally contain remnants of early embryonic structures.
• False cysts are fluid-filled sacs that can be related to a swelling of the Wharton's jelly.

Studies suggest that both types of cysts are sometimes associated with birth defects, including chromosomal abnormalities and kidney and abdominal defects (2). When a cord cyst is found during an ultrasound, the provider may recommend additional tests, such as amniocentesis and a detailed ultrasound, to diagnose or rule out birth defects.

Does the March of Dimes support research on umbilical cord abnormalities?
The March of Dimes continues to support research aimed at preventing umbilical cord abnormalities and the complications they cause. One grantee is studying the development of blood vessels in the umbilical cord for insight into the causes of single umbilical artery and other cord abnormalities. The goals of this study are to:

• Develop a better understanding of the causes of birth defects
• Develop treatments to help prevent oxygen deprivation before and during delivery, which may contribute to cerebral palsy and other forms of brain damage

References

1. Cruikshank, D.W. Breech, Other Malpresentations, and Umbilical Cord Complications, in: Scott, J.R., et al. (eds.), Danforth's Obstetrics and Gynecology, 9th Edition. Philadelphia, Lippincott Williams and Wilkins, 2003, pages 381-395.
2. Morgan, B.L.G. and Ross, M.G. Umbilical Cord Complications. emedicine.com, March 1, 2006.
3. Gossett, D.R., et al. Antenatal Diagnosis of Single Umbilical Artery: Is Fetal Echocardiography Warranted? Obstetrics and Gynecology, volume 100, number 5, November 2002, pages 903-908.
4. Oyelese, Y. and Smulian, J.C. Placenta Previa, Placenta Accreta, and Vasa Previa. Obstetrics and Gynecology, volume 107, number 4, April 2006, pages 927-941.

February 2008

Uterine and ovarian abnormalities

Abnormalities of the female reproductive organs can cause infertility, miscarriage, premature birth (before 37 completed weeks of pregnancy) and other pregnancy complications. Reproductive tract abnormalities can be congenital (present at birth) or acquired (develop later in life).

Many women with reproductive tract abnormalities have no symptoms and do not know they have an abnormality. Some women with reproductive tract abnormalities are able to become pregnant and have normal, full-term pregnancies. Others may learn that they have a reproductive tract abnormality if they have difficulty becoming pregnant or develop pregnancy complications. In some cases, treatment can improve the chances for a healthy pregnancy.

What are congenital uterine abnormalities?
The uterus is a hollow muscular organ shaped like an upside-down pear. The narrow, lower end of the uterus is called the cervix. About 3 in 100 women are born with an abnormality in the size, shape or structure of the uterus (1). In the female embryo, the uterus is formed from two small tubes called Mullerian ducts. At about 10 weeks gestation, these two tubes come together and fuse, forming a single uterine cavity. When the Mullerian ducts do not fuse at all or fuse incompletely, a uterine abnormality can result.

Some women with a congenital uterine abnormality have normal, full-term pregnancies. However, these abnormalities can increase the risk of a number of reproductive problems, including:

• Miscarriage (pregnancy loss that occurs before 20 weeks of pregnancy)
• Premature birth
• Poor fetal growth
• Abnormal presentation, such as breech position (the baby is in a position other than head down)
• Cesarean birth

The risk may be different for each one of these problems, depending on the specific uterine abnormality.

Congenital uterine abnormalities include:

• Septate uterus. This is the most common congenital uterine abnormality and is most commonly associated with adverse pregnancy outcomes, especially miscarriage (1, 2). In a septate uterus, the uterus is divided into two sections by a band of muscle or tissue. This tissue is the remainder of the joined Mullerian tubes, which the body did not break down and absorb as it should have.
• Bicornate uterus. In this condition, the uterus has two partially or completely joined cavities, instead of one large cavity. This abnormality is caused by incomplete fusion of the Mullerian tubes.
• Didelphic uterus (double uterus). The Mullerian tubes fail to join, resulting in two separate uterine cavities and two cervices. Each uterine cavity may be smaller than normal.
• Unicornate uterus. One Mullerian duct fails to form, resulting in absence of half of the uterus.

How are congenital uterine abnormalities diagnosed?
Congenital uterine abnormalities usually are diagnosed using imaging tests. Sometimes more than one of these tests is needed to distinguish between uterine abnormalities. It is important to make the correct diagnosis because certain uterine abnormalities (such as septate and bicornate uterus) appear similar on some imaging tests but are treated differently. Imaging tests include (1, 3):

• Vaginal ultrasound. A tampon-sized probe is placed in the vagina. The probe uses sound waves to show pictures of the uterus and other pelvic organs. A new form of ultrasound, called three-dimensional ultrasound, is highly accurate in diagnosing uterine abnormalities.
• Sonohysterogram. The health care provider inserts salt water into the uterus through the cervix and then performs a vaginal ultrasound. The salt water allows a clearer picture of the uterine cavity.
• Hysterosalpingogram. The health care provider inserts a dye into the cervix and then follows the path of the dye with a uterine x-ray. This exam shows the condition of the cervix, the uterine cavity and fallopian tubes. This test uses radiation and cannot distinguish between septate and bicornate uterus.
• Magnetic resonance imaging (MRI). This test uses strong magnets and a computer to create detailed images of organs. It provides a clear picture of the uterine cavity and is highly accurate in diagnosing most uterine abnormalities, including septate and bicornate uterus.

How are congenital uterine abnormalities treated?
Some congenital uterine abnormalities can be corrected with surgery. The provider may recommend surgery for a woman who has a congenital uterine abnormality and a history of miscarriage or premature birth. Surgery usually is not recommended if the woman has no history of pregnancy problems because some women with uterine abnormalities have normal, full-term pregnancies.

Studies suggest that more than 80 percent of women with septate uterus have successful pregnancies after surgical removal of the septum (1). Surgery for this abnormality generally can be done during hysteroscopy. In a hysteroscopy, the provider inserts a thin, telescope-like instrument through the vagina and cervix into the uterus to see inside the uterine cavity. The provider inserts a small instrument through the hysteroscope to remove the septum. Surgery to correct bicornate uterus and other congenital uterine abnormalities involves more extensive surgery through an incision (cut) in the abdomen.

What are acquired uterine abnormalities?
Acquired uterine abnormalities are those that develop later in life. Acquired uterine abnormalities that affect pregnancy include:

• Fibroids
• Uterine adhesions (scars)
• Cervical insufficiency and short cervix

What are fibroids?
Fibroids are benign (non-cancerous) growths made up of muscle tissue. They range from pea-size to 5 to 6 inches across. About 20 to 40 percent of women develop fibroids during their reproductive years, most frequently in their 30s and 40s (4). Many women with fibroids have no symptoms, while others have symptoms such as (5):

• Heavy menstrual bleeding
• Anemia (resulting from heavy menstrual bleeding)
• Abdominal or back pain
• Pain during sex
• Difficulty urinating or frequent urination

The health care provider may first detect fibroids during a routine pelvic exam. The diagnosis can be confirmed with one or more imaging tests.

Do fibroids cause pregnancy complications?
Small fibroids usually do not cause problems during pregnancy and usually require no treatment. However, fibroids occasionally break down during pregnancy, resulting in abdominal pain and low-grade fever. Treatment includes bedrest and pain medication. Multiple or large fibroids may need to be surgically removed, generally before pregnancy, to avoid potential complications associated with pregnancy. Due to pregnancy hormones, fibroids sometimes grow larger during pregnancy. Rarely, large fibroids may block the uterine opening, making a cesarean birth necessary.

Most women with fibroids have healthy pregnancies. However, fibroids can increase the risk of certain pregnancy complications, including (2, 5):

• Infertility
• Miscarriage
• Preterm labor
• Abnormal presentation (such as breech position)
• Cesarean birth (usually due to breech position)
• Placental abruption (separation of the placenta from the wall of the uterus before birth)
• Heavy bleeding after birth

If the health care provider determines that a woman’s infertility or repeated pregnancy losses are probably caused by fibroids, he may recommend surgery to remove the fibroids. This surgery is called a myomectomy. In some cases, myomectomy can be done during hysteroscopy.

What are uterine adhesions?
Uterine adhesions, sometimes called Asherman syndrome, are scar tissue that can damage the uterine lining (endometrium). The damage may range from mild to severe. Causes of uterine adhesions can include (2, 6):

• D&C (dilation and curettage), which may be done after a miscarriage (this is a surgical procedure, in which the cervix is dilated and the uterus is emptied with suction or with an instrument called a curette)
• Other uterine surgery
• Severe infection of the uterine lining (endometritis)

Some women have no symptoms, while others may have light or infrequent menstrual periods. Adhesions can contribute to infertility, repeat miscarriage and premature birth (2, 6). Imaging tests and hysteroscopy can diagnose adhesions. Adhesions can be removed during hysteroscopy, improving the chances of a normal pregnancy (2).

What are cervical insufficiency and short cervix?
Cervical insufficiency (sometimes called incompetent cervix) refers to a cervix that opens too early during pregnancy, usually without pain and contractions. This usually occurs in the second or early third trimester of pregnancy, resulting in late miscarriage or premature birth. A woman may be diagnosed with cervical insufficiency based largely on this history. There is no specific diagnostic test.

Medical experts do not always know why cervical insufficiency occurs. Factors that may contribute include (7):

• Uterine defects. Women with certain uterine defects, such as bicornate uterus, are more likely to have cervical insufficiency than women without these defects (1, 2).
• History of surgical procedures involving the cervix. These include LEEP (loop electrosurgical excision procedure), which is used to diagnose and treat abnormal cells found during a Pap test.
• Injuries during a previous birth
• Short cervix. The shorter the cervix, the more likely the woman is to have cervical insufficiency. In some cases, a short cervix can be congenital.

Miscarriage and premature birth due to cervical insufficiency frequently happens again in another pregnancy. These problems can sometimes be prevented with a procedure called cerclage, in which the provider places a stitch in the cervix to keep it from opening too early. The provider removes the stitch when the woman is ready to give birth.

It is not always clear which women will benefit from cerclage. This is because there is no specific test for cervical insufficiency, and many women who have had a late miscarriage or early premature birth go on to have normal pregnancies without treatment. Some studies suggest that cerclage is most likely to be beneficial in women who have had three or more late miscarriages or premature births (7). In some cases, providers may monitor a woman suspected of having cervical insufficiency with repeated vaginal ultrasounds to see if her cervix is shortening or showing other signs that she may give birth soon. The provider may recommend cerclage if these changes occur.

Some women learn that they have a short cervix during a routine ultrasound. Most of these women do not end up having a premature birth. However, short cervix, especially a very short cervix (less than 15 millimeters), does increase her risk of premature birth (8, 9). Studies suggest that treatment with the hormone progesterone may help reduce the risk of premature birth in women with a very short cervix (8, 9). According to the American College of Obstetricians and Gynecologists (ACOG), progesterone treatment may be considered for these women (8). However, ACOG does not recommend routine cervical-length screening for low-risk women.

Does a retroverted (tipped) uterus pose pregnancy risks?
Almost never. About 20 percent of women have a uterus that tips slightly backward (10). This is considered a normal variant of uterine positioning in most women, though some women may develop a retroverted uterus due to fibroids or scar tissue in the pelvis. Generally, the uterus straightens by early in the second trimester and does not contribute to pregnancy complications.

At about 12 weeks of pregnancy, the top of the uterus normally extends past the pelvic cavity. Rarely, a retroverted uterus may become trapped in the pelvis. This is called uterine incarceration and can cause pain and difficulty passing urine (10). An ultrasound can diagnose retroverted uterus in women with these symptoms. Simple treatments, including bladder drainage, positioning exercises the woman can do at home, or gentle manipulation by the health care provider, usually can restore the uterus to its normal position. Occasionally, an untreated incarcerated uterus may contribute to second-trimester miscarriage.

What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormones and ovaries. PCOS affects up to 7 percent of women of childbearing age and is the leading cause of female infertility (12). Some women learn they have PCOS when they have problems becoming pregnant.

Women with PCOS have high levels of male hormones (androgens), which may interfere with normal ovarian function. Affected women often do not ovulate regularly. PCOS also affects other bodily systems, increasing a woman’s risk for diabetes and heart disease (11, 12). Signs and symptoms of PCOS include (11, 12):

• Irregular or absent menstrual periods
• Ovaries containing many small cysts (fluid-filled sacs)
• Increased facial hair
• Acne
• Weight gain or obesity
• Male-pattern baldness
• Abnormal blood sugar levels or diabetes

How is PCOS diagnosed?
There is no specific diagnostic test for PCOS. Diagnosis is usually based on:

• Signs and symptoms, including menstrual irregularities
• Physical examination
• Blood tests to check androgen and blood sugar levels
• Ultrasound of the ovaries

How is PCOS treated?
Women with PCOS who are overweight or obese should attempt to lose weight. Women who lose even 10 percent of their body weight can improve menstrual irregularities, lower androgen levels and reduce the risk of diabetes (11, 12). Weight loss also can improve fertility (11).

Women who do not wish to become pregnant right away can be treated with birth control pills. This treatment often helps regulate menstrual cycles and reduce androgen levels. In some cases, the woman may be treated with an oral diabetes drug called metformin (Glucophage), instead of or in addition to birth control pills. Metformin also helps reduce androgen levels and may help with weight loss.

Women who are having difficulty conceiving can be treated with medications that stimulate ovulation, usually starting with clomiphene citrate (Clomid, Serophene). If clomiphene treatment is not successful, the woman can be treated with injected fertility drugs (gonadotropins) or in vitro fertilization (IVF). In IVF, eggs are combined with sperm in the laboratory to create embryos which are transferred into the woman’s uterus. All fertility treatments increase the risk of multiple gestation (twins, etc.), which increases the risk for premature birth and other complications.

Does PCOS increase the risk of pregnancy complications?
Studies suggest that women with PCOS are at increased risk of , preeclampsia (a pregnancy-related form of high blood pressure) and premature birth (11, 12, 13). Obesity also can increase the risk of these complications, so women with PCOS may be able to reduce their risk by reaching a healthy weight before they become pregnant. Women with PCOS should see their health care provider before pregnancy to make sure any health problems, such as diabetes, are under control, and that any medications they take are safe in pregnancy. When they become pregnant, they should go to all their so that any complications can be diagnosed and managed before they become serious.

Does the March of Dimes support research on uterine and ovarian abnormalities and pregnancy?
The March of Dimes supports a number of grants on uterine and ovarian abnormalities and the pregnancy complications they may cause. One grantee is seeking to identify cell-to-cell signaling pathways that may help trigger shortening of the cervix before labor, in order to develop new treatments aimed at preventing premature birth. Another is studying the role of androgens in normal ovarian growth and fertility, in order to develop improved fertility treatments for PCOS.

References

1. Rackow, B.W. & Arici, A. (2007). Reproductive Performance of Women with Mullerian Anomalies. Current Opinion in Obstetrics and Gynecology, 19, 229-337.
2. Wold, A.S.D., Pham, N. & Arici, A. (2006). Anatomic Factors in Recurrent Pregnancy Loss. Seminars in Reproductive Medicine, 24 (1), 25-32.
3. Syed, I., Hussain, H.K., Weadock, W. & Ellis, J. (2008). Uterus, Mullerian Duct Abnormalities. EMedicine. Retrieved October 14, 2009.
4. Klatsky, P.C., Tran, N.D., Caughey, A.B. & Fujimoto, V.Y. (2008). Fibroids and Reproductive Outcomes: A Systematic Literature Review from Conception to Delivery. American Journal of Obstetrics and Gynecology, 198 (4), 357-366.
5. American College of Obstetricians and Gynecologists (ACOG). (2009). Uterine Fibroids. Retrieved October 14, 2009.
6. American Society for Reproductive Medicine. (2005). Patient’s Fact Sheet: Intrauterine Adhesions. Retrieved October 14, 2009.
7. American College of Obstetricians and Gynecologists (ACOG). (2003). Clinical Management Guidelines for Obstetrician-Gynecologists, Number 48: Cervical Insufficiency. Obstetrics and Gynecology, 102 (5), 1091-1099.
8. American College of Obstetricians and Gynecologists (ACOG). (2008). ACOG Committee Opinion, Number 419: Use of Progesterone to Reduce Preterm Birth. Obstetrics and Gynecology, 112 (4), 963-965.
9. Da Fonseco, E.B., Damiao, R. & Nicholaides, K. (2009). Prevention of Preterm Birth Based on Short Cervix: Progesterone. Seminars in Perinatology, 33 (5), 334-337.
10. O’Grady, J.P. (2008). Malposition of the Uterus. EMedicine. Retrieved November 9, 2009.
11. American College of Obstetricians and Gynecologists (ACOG). (2009). Clinical Management Guidelines for Obstetrician-Gynecologists, Number 108: Polycystic Ovary Syndrome. Obstetrics and Gynecology, 114 (4), 936-949.
12. U.S. Department of Health and Human Services. (2007). Polycystic Ovary Syndrome. Retrieved October 13, 2009.
13. Boomsma, C.M., Eijkemans, M.J.C., Hughes, E.G., Visser, G.H.A., Fauser, B.C.J.M., et al. (2006). A Meta-Analysis of Pregnancy Outcomes in Women with Polycystic Ovary Syndrome. Human Reproduction Update, 12 (6), 673-683.

March 2010