Dr Tanvi Tuteja-Mansukhani, consultant obstetrician and gynaecologist, K J Somaiya Hospital Superspeciality Centre and assistant professor, K J Somaiya Medical College & Research Centre, addresses your pregnancy concerns.

Pregnancy can be a confusing time for most women. However, we’re here to put some of those worries to rest. After all, there are no stupid questions when it comes to the proper care and healthy development of your baby. Read on to know more.

Question 1: How do I know I’m pregnant?

A pregnancy test is the sure shot way. However, subtle signs of pregnancy are fatigue, nausea, frequent urination, aversions to foods that you normally love, morning sickness, breast swelling and tenderness, and a missed period, if you are very regular with menstruation.

Question 2: Can I have sex during pregnancy?
Pregnancy is a normal phenomenon; you are not a patient. Enjoy your pregnancy without unwanted fears. Typically, sex is perfectly safe during pregnancy, right up until delivery. So, put aside your fears that intercourse will hurt your baby. The amniotic sac, the uterus, and the mucus plug in the cervix all provide strong protection for your baby. However, there are some instances where your doctor may tell you to abstain from intercourse altogether, while pregnant. For example, if you risk premature labour, if you suffer from placenta previa (the placenta is too close to the cervix), or vaginal bleeding, it’s best to seek your doctor’s advice before intercourse.

Question 3: How do I know how many weeks of pregnancy I have completed?

The first day of your last menstrual period (LMP) is typically about two weeks before you ovulated and conceived your baby. We count from there, because most women don’t know exactly when they ovulated, but most of them do know when their last period started. Your practitioner counts 280 days from the first day of your LMP to determine your due date. That’s exactly 40 weeks. However, your due date is just an estimate. Only fi ve per cent of babies are born on their due date.

Question 4: Can I exercise during my pregnancy?
Exercising during pregnancy lifts your spirits and prepares you for labour and childbirth, but it’s important to be extra cautious during your workouts. Exercise plays an important role in maintaining good health and should be discussed with your doctor when you are pregnant. If you have been active, you may continue. Exercise at a pace where you can talk comfortably. Do not let your pulse exceed 140 beats per minute. You should not perform any exercise that pulls through the abdomen.

Question 5: What medications or supplements do I need to take?
During your pregnancy, you need to take supplements in form of iron, calcium and folic acid. This is because your baby’s healthy growth and development starts from the time of conception and continutes till he’s ready to greet you.

Question 6: Do I require any special diet during my pregnancy?
Make sure you consume a balanced diet rich in iron, protein, vitamins and calcium. Also, pay attention to the fact that the foods you eat isn’t oily, fried or spicy. Avoiding this is recommended during the first trimester as a means to prevent vomiting or nausea. Regularly take the prenatal vitamins prescribed by your doctor.

Question 7: Can I travel during my pregnancy?
Travel poses no specific risks during pregnancy but you must take due care. Always use a seat belt, avoid long trips and make sure you have access to obstetric care. Most airlines have restrictions during the last month of pregnancy, so please check with the respective airline for specifi cations. When travelling, make sure your drink plenty of fluids and rest whenever possible.

Question 8: How do I know I’m in labour and when should I call my doctor?
When you’re in labour, you will experience a sharp pain that starts from your lower back, moving towards your lower abdomen. The pain will increase in intensity as labour progresses. You may also have a discharge from your vagina, bleeding or water rush.

Question 9: What do I need to carry along with me to the hospital?

Packing in advance saves you a great deal of time, and also ensures you’ll have everything you’ll need to keep you and your baby comfortable in the hospital. Your bag should contain the following items:
♦ Your clothes
♦Sanitary pads
♦Slippers
♦Massage oil or lotion
♦Nursing bras
♦Toiletries
♦Doctors file and papers
♦Sleep suits and vests
♦Baby blankets
♦Nappies or diapers
♦Towels
♦Baby clothes
♦Socks or booties
♦Hats or caps
♦Toiletries for your baby
♦Mops, preferably muslin cloth

Remember, your pregnancy can be a breeze if you’re not afraid to ask the right questions. After all, the health and well-being of both you, and your baby, should be your utmost priority. And as always, we at M&B are always here to answer all your pregnancy concerns. Have a healthy, safe and happy pregnancy! |MB

Most women who get pregnant see their gynecologists only after they have missed their periods. They take it for granted that they are healthy enough to carry on with a nine-month journey, safely. They also take for granted that they have no problem which could potentially harm their growing baby. Now let me ask you this: don’t we plan and don’t we organise ourselves for any long trip we make? Then why this casual attitude towards such an important event in our lives, when the lives of both, the mother and the baby could be at stake?

Planning your pregnancy can help you make wise choices that will benefit, both you and your baby. As soon as you decided to start a family, you should see your gynecologist who will help you determine what steps you may need, to become physically and medically ready for a pregnancy.

Preconceptional care refers to the care prior to conception. This preventive care is one of the most cost-effective and benefi cial interventions which can dramatically improve the chances of a successful pregnancy.

There are various factors, which if addressed preconceptionally, can result in a healthy successful pregnancy.

Age
Adolescent pregnancies, or conception among young women less than 19 years of age, are more likely to result in low birth weight babies. On the other hand, older women are at greater risk for genetic abnormalities and miscarriages. Information about problems associated with age and the necessary intervention, along with management of any existing medical problems, are among the mainstays of treatment of women advanced in age.

Medical history and medications
Women with certain medical conditions may benefit from advice before becoming pregnant. Drugs taken during pregnancy, especially during the first three months, could harm the baby. Hence in conditions like epilepsy, for example, the medications may possibly harm the pregnancy or the unborn child. Hence, the neurologist needs to be consulted when you are planning a pregnancy so that he could prescribe the safest drugs possible to ensure you have a safe and healthy pregnancy. Women with diabetes need to control their sugar strictly because the chances of abnormal babies increases eight times if the sugar is uncontrolled in the first trimester of pregnancy. Medications being taken for skin conditions, for example, retinoic acid, need to be stopped before planning a pregnancy, since it can cause nervous system abnormalities in the baby.

Family history
If you have a family history of babies born with any congenital abnormalites or you have history of babies born with any development disabilities, you need to inform your doctor so that mentally he can carry out appropriate screening tests as soon as you get pregnant.

Reproductive history
Women with recurrent miscarriages, those with advanced age and those with abnormal pregnancies in the past, can benefit by testing their embryos prior to the transfer to the uterus. For example, if the embryo has a genetic disease, it is not transferred to her womb, thus preventing the creation of an abnormal pregnancy. This can improve the chance for the birth of a child without the affected condition.

Weight
Women who are obese have a greater chance of problems during pregnancy. Obesity poses risks for the baby, as well as the mother. The babies are also at an increased risk of being born with a condition called macrosomia, in which a foetus grows too large, causing complications during labour. A woman who is slightly underweight should gain a few pounds to prepare for her pregnancy.

Psychiatric disease
Psychiatric disease warrants good quality pre-pregnancy care and counseling. The estimate is that there is a 10 to 15 per cent risk of schizophrenia in offspring. Risks of instability and potential plans for withdrawing medication must be thoroughly discussed before planning a pregnancy.

Diet
It is advisable to take folic acid tablets at least three months before you become pregnant, even if you are healthy and eat a well-balanced diet. This may reduce the risk of having a baby born with a spine problem such as spina bifi da. After conceiving, you need to be cautious of what you eat. Too much Vitamin A or undercooked meats can cause toxoplasmosis or other parasitic diseases.

Lifestyle
Alcohol: Heavy drinking can cause an increased risk of miscarriage and it may cause serious harm to the baby’s growth and brain development.
Smoking: It is strongly recommended that women stop smoking when trying to get pregnant. Tobacco smoke can slow the baby’s growth. The risks of having a miscarriage, premature birth or still birth are higher in women who smoke.

Oral health
Recent studies have indicated hat gum disease increases the risk of preterm delivery. This is precisely why every woman should have dental care and treatment prior to pregnancy, if possible.

Drug abuse
Drug abuse can be hazardous to the baby. Women who consume heroin can be prescribed methadone to avoid symptoms of withdrawal in the baby.

Vaccines
Infections can harm both the mother and the baby. Some infections in pregnancy can cause birth defects or illnesses in the foetus. Vaccinations can prevent some of these infections. It is important to be vaccinated before becoming pregnant, because some vaccines are not safe to use during pregnancy. All women considering pregnancy should get tested for immunity to rubella, and if not immune, should be offered a rubella vaccination. A rubella infection in pregnancy can lead to devastating effects on the developing foetus. Vaccinations for women susceptible to chicken pox also can be offered, so as to avoid maternal and foetal infections.

Infections
Sexually transmitted diseases come in all types and forms. These diseases not only affect the ability to conceive, but can also infect and harm the baby. For example, HIV. AIDS in pregnant women bears special attention since treatment with antiretroviral or anti HIV drugs, has been shown to reduce the transmission of infection from mother to child. Screening for syphilis can also be done to avoid complications, both maternal and foetal. Gonorrhoea can lead to adverse pregnancy outcomes and infertility, if left untreated. Treatment of both partners prior to pregnancy is preferred, as it prevents unnecessary exposure of to the foetus. The preconception  period is optimal to provide immunisation to women who have not received the hepatitis B vaccine, especially if they are at risk of blood exposure or sexually transmitted diseases.

Genetic screening
Women with a family history  of hemophilia, sickle cell anemia, thalassaemia, muscular dystrophy, etc., can be offered genetic screening to detect any of these hereditary disorders. If the pregnancy is found to be affected, then the patient is counselled for termination of pregnancy.

Conditions in which pregnancy is contraindicated
There are some medical conditions like some cardiac conditions (pulmonary hypertension), respiratory conditions (cystic fibrosis), kidney conditions (severe compromise of kidney function), etc., wherein the woman should be deterred from getting pregnant since these conditions can threaten the mother’s life.

Male periconception care
There is expanding scientific evidence of an association between male-associated health issues and pregnancy outcomes. A couple should attend the periconception visit together and the woman’s partner should be encouraged to be included in periconception counseling and care. Paternal smoking, as well as alcohol consumption, have been associated with decreased fertility and increased frequency of malformations in the baby. It takes an average 10 to 11 weeks for sperm to be produced. This is why, abstaining from alcohol and tobacco is advised three months prior to conception. Sperm production in the testicles requires a temperature that is lower than the core body temperature. Men should refrain from staying too long in saunas or hot tubs, and prevent overheating of testes. They’re also advised to wear loose underwear so as to maximize sperm production. The use of certain lubricants during sex can decrease fertility, and hence they should be avoided.

Pregnancy puts special demands on a woman’s body. As a quality of any crop will depend upon the quality of seeds, the soil and the environment, a healthy baby can only result from the union of a healthy sperm and ova, in the mother’s healthy environment. Always remember, a pregnancy should be by choice and not by chance. Becoming a parent is filled with many challenges, rewards and choices. Making healthy choices before you become pregnant is an important step to a healthy and  happy pregnancy. | MB

BY RUTH DSOUZA PRABHU

The pregnancy belly is starting to show and the excitement for your new arrival continues to grow. But it still does take a whole nine months for your precious bundle to arrive. In the meantime, it is quite natural for partners to continue having a sexual desire for one another. A commonly held opinion is that sex during pregnancy is a complete no-no. Depending on the grandmother myths that you are exposed to, these restrictions sometimes extend all the way up to a year post pregnancy as well. Fact is, sex during pregnancy is perfectly fi ne, provided certain basic aspects are taken care of. Here is what the experts have to say:

Busting myths around sex during pregnancy
Myth No. 1:
No sex during pregnancy
According to Dr Bandita Sinha, gynecologist and infertility specialist, World of Women, Mumbai, “There is no harm in having sex during pregnancy. However, it is essential to avoid sex during the first three months and last two months. Sex in the initial three months can cause complications in pregnancy and in the last two months may lead to early delivery. This makes it essential to focus on personal comfort.”

Myth No. 2
Your baby may ‘see’ something or dad may bump baby’s head
Dr Sonali Santhanam, Birth Basix, Chennai, reiterates that this is absolute hogwash when she says, “The baby is contained in the uterus and this is sealed shut by the mucous plug. Nothing can enter or leave the uterus. It is not mechanically possible to bump baby’s head and the baby certainly will not witness anything.”

Myth No. 3
Having an orgasm or the act of sex can induce labour
Dr N Sapna Lulla, consultant obstetrician and gynaecologist, Motherhood Hospitals, Bengaluru, rubbishes this myth away, saying, “The orgasm stimulates an oxytocin peak which induces uterine contractions, which although insuffi cient to induce labour in pregnancy, may generate discomfort and insecurity for the couple.” This discomfort is perhaps the only reason to abstain.

Myth No. 4
No sex for a year post birth
“Again, there is no truth in this,” says Dr. Bandita. “After four weeks or a month post the delivery, it is advisable to have sex. Off course, this depends on the fact that both partners are comfortable.”

Myth No. 5
Having intercourse may lead to a miscarriage
“If you have a low-risk pregnancy, the placenta is positioned well and is not low lying, and if you do not have a history of miscarriages, you can safely indulge in sex during pregnancy,” says Dr Sonali. “Because of the mucous plug, it is not possible for any bacteria to enter the sterile uterine environment. However, if the partner has an STD, it puts the baby at great risk. It’s always better to screen for this.”

There are certain precautions that one must take before indulging in the act, but sex isn’t off the table if you know the safest positions to try.
“While having sex, a pregnant woman needs to ensure her comfort,” says Dr. Bandita. “Also, any pressure on the back or tummy that hurts or causes any discomfort, is best avoided. It differs for every individual based on their comfort. Hygiene is very important, both before and after sex, as infections can cause complications. It is best to avoid any kind of experiments or having multiple partners during pregnancy.”

Explaining sexual positions that do the trick, Dr Sonali advises that any position that does not put pressure on the growing belly, is a good one. Lying down fl at on the back in the missionary position is not recommended. In this position, an expectant mother can feel faint or black out as major blood vessels get compressed.

Here are some sexual positions that do the trick for almost everyone:
Spooning: Lie side by side with him behind you. This makes for more shallow penetration. You on top: There’s no pressure on your belly, and you can control the speed and depth of penetration.
Side of the bed: You lie on your back on the edge of the bed with your knees bent and feet on the edge. He stands facing you. It’s like classic missionary, but he won’t be resting his body weight on you.

Sofa so good: Kneel on a couch with your belly facing the back of it; use your arms for support. He penetrates from behind.

Runner Runner: Lay on your side with one leg stretched out and the other propped up on two pillows for support. This will allow the pelvis to stay open and your partner can comfortably penetrate you from behind. This position also allows for a good cuddle and foreplay.

When you should abstain
Dr Sapna explains that some women with high-risk pregnancy, low lying placenta, with a previous preterm birth or with threatened abortion, may be adviced by their doctor to avoid sex for part of their pregnancy. Theoretically, pregnant woman are at decreased risk of pelvic infl ammatory disease because of natural barriers created by the mucus plug. However, risk of infection in the fi rst trimester cannot be ruled out. There is little evidence to show that sex at term may help to induce labour but this is considered safe in a low-risk pregnancy. Whether a woman should have sexual intercourse at any stage of pregnancy depends very much on her personal feelings as well as her partner’s.

Dr Sonali adds to this list of precautions saying you need to abstain from having intercourse in case of a high risk pregnancy, threatened pre-term labour, low lying placenta or placenta previa where the placenta completely covers the cervix, have a short or incompetent cervix. If you have had bleeding from vagina during the pregnancy, then you need to abstain. If you partner has an STD and if membranes have ruptured (water broken), sex is a no-no. Having high blood pressure as  a result of pre-eclampsia also means that you need to stay away.

She also cautions that you must avoid putting weight and pressure on the belly. Any bleeding or leakage of water after sex needs to be reported. It is normal to have muddy brown discharge after intercourse because this happens when blood vessels around cervix get bruised and bleed a bit. Bright red bleeding, however, is a red flag. Now, if you are preggers and are feeling a bit frisky, it is absolutely alright to indulge in some great
sex with your partner! After all, once the baby comes, you won’t have much time for anything else, so make the most of the time you have! |MB

Chief pathologist and general manager National Technical Operations, Metropolis Healthcare Ltd., Dr Rajesh Bendre, tells us what it means to be anaemic, and exactly how to take care of yourself, especially during your pregnancy

Women developing anaemia during their child-bearing age, is a common phenomenon. In most cases, deficiency of iron is the primary cause of anaemia during pregnancy. It accounts for almost 80 per cent of the cases. Other factors resulting in anaemia could be lack of folic acid or vitamin B12, which can cause blood loss. Certain diseases or genetic disorders, like sickle cell disease or thalassemia, could also be the causes of anaemia in certain rare cases.

During pregnancy, the risk factors for anaemia are considerably high. Proper mitigation of these risks can ensure that the mother and the baby are in good health. It is advisable to consume a wide variety of whole foods during pregnancy. Mild anaemia is normal during pregnancy due to an increase in blood volume. In case the mother suffers from severe anaemia, the baby can have a tendency to develop anaemia in the later stages of infancy. In addition, if the mother is severely anaemic during the first two trimesters of pregnancy, then it may result in a pre-term delivery for the mother or lead to Low Birth Weight (LBW) in the baby. Anaemic pregnant women have an increased risk of blood loss during labour, making it more difficult to fight infections in the post-pregnancy period. In both, developed and developing countries, women are prone to anaemia during pregnancy. The prevalence of iron defi ciency is far greater than the prevalence of anaemia since iron defi ciency (low serum ferritin and sparse or absent stainable iron in bone marrow) often develops during the latter stages of pregnancy. On account of such findings, there is uncertainty about whether routine iron supplementation for pregnant women is necessary.

A woman is at a higher risk of anaemia during pregnancy if she:
♦ Becomes pregnant consequently within a short span of time.
♦Is pregnant with more than one child.
♦Vomits frequently due to morning sickness.
♦Does not consume
enough iron.
♦Has a heavy pre-pregnancy menstrual fl ow.

Many of the symptoms of anaemia during pregnancy are also symptoms that women may experience even if they are not anaemic, such as:
♦ Feeling tired or weak.
♦ Progressive paleness of the skin.
♦ Rapid heartbeat.
♦ Shortness of breath.
♦ Trouble in concentrating.

Doctors typically perform several tests to check the percentage of red blood cells in the mother’s plasma, and the amount of haemoglobin in the blood. Such tests lend insight into whether the mother has a high risk of anaemia.

The tendency to develop anaemia, signifi cantly, depends on the number of red blood cells that are being produced in the body. A noticeable fall in the haemoglobin levels during pregnancy, is caused by an extensive increase in the volume of plasma cells, as compared with the count of the red blood cells. This imbalance between the rates of increase in plasma and that of red cells (or erythrocytes) is at a peak during the second trimester of pregnancy. Regular tests during this period are medically advised.

Dangers of anaemia
The greatest physical danger associated with anaemia, is the mother’s inability to cope with blood loss during birth. In addition to increased blood loss, if the mother’s body has a deficiency of iron, it can result in reduced oxygen flow throughout the body. Hence,  early diagnosis of anaemia is of paramount importance, so that the body can be fortified with the necessary iron supply, in time. Haemoglobin levels are reported to return to normalcy within five to 12 weeks, post pregnancy. In cases of extreme blood loss and lower iron content in the body,  this process can take longer than usual. Breastfeeding can additionally further deplete the iron content of the mother’s body. In such cases, women are prescribed iron tablets for several weeks after pregnancy, to mitigate the loss. Having low haemoglobin can also increase the risk of depression in mothers.

Tips to prevent anaemia
In order to prevent the risk of anaemia during or after pregnancy, women must:
♦ Consume iron-rich foods such as meat, chicken, fish, eggs, dried beans and fortified grains. The form of iron in meat products, called heme, is more easily absorbed than the iron in vegetables. If you are anaemic and you ordinarily eat meat, increasing the amount of meat you consume is the easiest way to increase the iron your body receives.
♦ Eat foods that are rich in folic acid, such as dried beans, dark green leafy vegetables, wheat germ and orange juice.
♦ Eat foods high in vitamin C, such as citrus fruits and fresh, raw vegetables.
♦ Cook in cast iron pots to add up to 80 per cent more iron to the food.
♦ Take prenatal multivitamins and mineral pills, which contain extra folate.

Once diagnosed, anaemia can be easily cured. In most cases, with the right treatment, the newborn will develop a normal haemoglobin count within a couple of months. It is important to keep track the factors that caused the anaemia. In case of iron defciency in the child, parents must ensure that dietary supplements or natural iron-rich foods are provided until deemed no longer necessary by the doctor. | MB