PAINFUL PERIODS: A VISUAL GUIDE

Posted in Health by woman2womenblog

What causes menstrual cramps?

Menstrual cramps (also called primary dysmenorrhea) are caused by contractions of the uterus. These contractions are triggered by a substance normally produced by our body called prostaglandin. In some women, these prostaglandins are produced in excess.

What are the symptoms?

Pain in the low abdomen, sometimes very intense, occasionally with some of the following:

Feeling of pressure in the abdomen
Back pain, pain in the hips or thighs
Headache
Nausea or vomits
Diarrhea (loose stools)

What can I do to to relieve menstrual cramps?

Place a heating pad on your abdomen or back
Take a warm bath
Massage your abdomen and your back
Rest
Avoid caffeine and salt, that may worsen pain.

Medications

You may take painkillers such as acetaminophen (also called paracetamol), ibuprofen, mefenamic acid. Medications are more effective if taken as soon as cramping starts, or even better, before pain starts (if you have regular cycles and you know when pain is about to start).

Dietary changes

A low fat diet seems to reduces menstrual pain according to some studies. Other proposed dietary changes:

Increase consumption of :

calcium: almonds, dark green leafy vegetables (spinach, kale), low fat diaries
antioxidants: blueberries, cherries, tomatoes, squash, pepper
proteins: lean meats, cold-water fish, tofu, beans

To avoid:

“bad” carbohydrates: white bread, pasta, sugar, sweets
“bad” fats: french fries, donuts, processed foods.

Herbal products and dietary supplements

These are the supplements that have proved to be effective in several studies:

Omega-3 fatty acids
Thiamine (vitamin B1)
Vitamin B6
Magnesium
Vitamin E

Other interventions

The following help relieving menstrual cramps:

Exercise
Yoga
Acupuncture
Homeopathy (not much scientific evidence, but it seems to help some women)

What if nothing works?

You may discuss with your doctor the following:

Oral contraceptives or other hormonal treatments
Stronger painkillers
Other possible treatments such as surgery (reserved for very severe cases).

Are menstrual cramps always normal?

Sometimes menstrual pains are not normal and indicate a medical problem; this is called secondary dysmenorrhea. Some conditions that can cause painful periods are:

Endometriosis: a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus
Pelvic inflammatory disease: an infection that starts in the uterus and spreads to other reproductive organs
Narrowing of the cervix (stenosis), often caused by scarring
Fibroids: benign tumors of the uterus
Congenital (birth) abnormalities of the uterus or vagina (such as the presence of a diaphragm).

When should I see a doctor?

Most of the times menstrual cramps are not a cause for concern, especially if you started menstruating within the past few years. But you should see a doctor if menstrual cramps:

Interfere with your everyday life every month
Get increasingly worse
Start after age 25
Last more than 2 or 3 days
Are accompanied by heavy bleeding, fever or foul smelling discharge.

Painful periods, whatever the cause, can be treated, so go ahead and get checked!

References

http://emedicine.medscape.com/article/253812-overview
http://www.aafp.org/afp/1999/0801/p489.html
Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. May 13 2006;332(7550):1134-8.
Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):162-71
Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. 2006;51(6):402-9.

17Jan2015

PREGNANCY DO’S AND DON’T’S (Part 3)

Posted in Health, Pregnancy by woman2womenblog

EXERCISE, SEX, WORK AND TRAVEL

The first post on Pregnancy do’s and dont’s analysed what is allowed and what discouraged during pregnancy concerning food, beverages, alcohol and cigarette (see here). The second part dealt with beauty treatments and medications (see here). Check out this third article on do’s and dont’s regarding exercise, sex, working and travel while pregnant…

EXERCISE

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Why to exercise: Beginning or continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes. In fact, exercise may have many health benefits: it lessens some of the discomforts of pregnancy, it helps strengthen the muscles used in labor and delivery, it may give you more energy and make you feel better. There is also some evidence that exercise may prevent pregnancy-related diabetes and high blood pressure. The American College of Obstetrics and Gynecology recommends for pregnant women 30 minutes of moderate exercise per day on most days of the week.

Check with your doctor first! There are certain circumstances in which women should not exercise, such as those with asthma or heart problems, or pregnancies complicated with bleeding, low placenta, weak cervix or premature contractions.

Exercises that are safe: The type of exercise you can do during pregnancy depends on your health and how active you were before getting pregnant. This is not a good time to start a very demanding sport. But if you were active before, you can continue to be, within reason. The following activities, in moderation, are especially good during pregnancy:

Swimming (it should be OK even in chlorinated pools)
Brisk walking
Prenatal exercise classes
Prenatal yoga

Exercises to avoid: Pregnant women should avoid the following:

High-impact or vigorous sports that may involve the risk of abdominal trauma, falls or excessive joint stress.
Holding your breath during activity
Exercises that require lying flat on your back for more than three minutes (especially after the third month of pregnancy)
Heavy exercise spurts followed by periods of no activity
Exercise in hot and humid weather
Activities in hot water (see more here)
Vigorous racquet sports
Activities where falling is likely (e.g. skiing, horseback riding, mountain biking)
Contact sports: football, basketball, volleyball, softball
Scuba diving, which may result in birth defects and fetal decompression disease.

Tips for safe exercise: Even though exercise can be beneficial, you should be careful. During pregnancy, your centre of gravity shifts and your balance changes. Your joints and ligaments get more relaxed. This may put you at a greater risk for falls. You tire more easily. Caution should be the rule!

These are some tips for exercising while pregnant:

Avoid getting overheated.
Limit outdoor exercise in hot weather.
Avoid exercise that makes you very tired, or with high risk of falling or getting an abdominal trauma
Get up slowly after doing floor exercises, to avoid getting dizzy
Drink lots of water
Consume extra calories if you exercise regularly
Wear good support shoes and bra
Don’t push yourself too much! Listen to your body and slow down when you feel tired.

Signs to stop exercising: You should stop exercising and call you doctor if you feel one of the following:

Dizziness, fainting or nauseated
Rapid or irregular heatbeat
Short of breath
Pain in your chest
Recurring abdominal pain or uterine contractions
Swelling in your calf
Intense headache
Blurred vision
Vaginal bleeding
Fluid leaking from your vagina
A decreased or absence of baby’s movements

SEX

Is it safe? Sexual intercourse in pregnancy is not known to be associated with any adverse outcomes; therefore, it can be safely continued throughout pregnancy.

The baby is well protected inside the uterus! The uterine wall, the amniotic sac and the mucus plug (thick mucus that seals the cervical canal to prevent infections) will all keep the baby safe.

Keep in mind that intercourse can cause uterine contractions: the orgasm itself, nipple stimulation and prostaglandins (a substance contained in sperm) will all may make the uterus contract. In general, these contractions are mild and harmless.

Love making has been long proposed as a measure to induce labor at term. Although there is no scientific evidence that sex triggers labor, it may help, and it won’t harm!

Does sex feel the same while pregnant? Sex during pregnancy can be different than before. For some women, it may be more pleasurable, due to the high hormonal levels, genital engorgement and increase in vaginal secretions. For others though, sexual desire may be reduced for many reasons: nausea and dizziness during the first trimester, genital swelling which may sometimes cause discomfort, or you may just feel uneasy with your body changes…

Furthermore, your breasts get very engorged and tender, which may be pleasant for some women, but annoying for others…

Love making in practice… needless to say, certain positions will be uncomfortable, or impossible as your womb gets bigger…You may need to experiment a little bit to find which positions are fine for you… Especially during the third trimester, you should avoid lying flat on your back, because the pressure of the womb on the major blood vessels may cause a drop in blood pressure and dizziness. Although oral sex is fine, blowing into the vagina is to be avoided, as it may cause air embolism (a bubble of air entering the blood circulation), which may have fatal consequences.

When to avoid intercourse: there are certain situations, in which sexual intercourse is discouraged: if you have vaginal bleeding, a history of repeated miscarriages, preterm uterine contractions, or a weak cervix. In addition, you will be told to abstain from sex if you have a diagnosis of placenta previa (when the placenta lyes low in the uterus or covers the cervix). Always check with your doctor to make sure it’s OK for you to have sex.

When to call your doctor: you should call your healthcare provider if, after sex, you have intense abdominal pain, cramping, foul smelling discharge or bleeding coming from the vagina.

WORKING DURING PREGNANCY

Embed from Getty ImagesIf you are a healthy woman and you have a normal pregnancy, most likely it will be safe to continue working during pregnancy. Don’t forget to talk to your doctor about your work environment. There are certain occupations that may be dangerous, and others that may require certain modifications:

Exposure to radiation and radioactivity: there is evidence to support an association between x-rays or radioactivity exposure and miscarriages, birth defects and other pregnancy complications. You should inform right away your doctor and your employer if you receive occupational x-rays or radioactivity exposure.

Exposure to chemicals: Studies results are less conclusive for occupational exposure to chemicals, but there seems to be some increased risk of miscarriages and eventually malformations. Some examples of jobs with chemical exposure are dry-cleaning, painting industries, operating rooms, jobs involving pesticide or heavy metals exposure (lead, mercury). Inconclusive evidence also exists for women working in beauty salons (for more info check here).

Physically demanding work: jobs with prolonged standing (such as cooks, police officers, nurses) and heavy weight lifting may be associated with poor pregnancy outcome, that is, more likely to deliver prematurely, have low-birth-weight-babies and develop high blood pressure.

Stressful jobs and long working hours: Some research has shown that pregnant women who reported high work stress in combination with a long workweek (more than 32 hours a week) have two times higher risk of giving birth to a small baby.

The evidence on prolonged hours and shift working is inconclusive.

Desk jobs: Although some studies in the 80s had suggested that computers may increase the risk of pregnancy complications, many studies have been done since then, and these findings have not been confirmed. In fact the dose of radiation emitted by a computer is extremely low. The problem of a desk job lies mostly in sitting for a long period of time, which may lead to neck, eyes, wrist and back strain. If you have an office job, try to get up frequently and take a break from time to time.

Other possible occupational risks may include exposure to infections or heavy noise.

TRAVEL

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Is it safe? For uncomplicated pregnancies, it is safe to travel throughout most of the pregnancy, usually until the last month (36 weeks). Inform your doctor whether you plan to travel, and precise where and when you plan to go. There are certain women that should not be traveling, such us those with vaginal bleeding, high risk of preterm labor or increased chances of forming blood clots.

Land travel: It is fine to travel by car, train or bus. It is very important that you wear your three-point seatbelt (shoulder and lap), above and below the womb, not over it. Try to avoid very long trips, stop or walk from time to time to stretch your legs in order to keep the blood circulating.

Sea travel: Traveling by boat is safe in pregnancy, but keep in mind that the boat’s motion may accentuate, or provoke, nausea and vomiting. So be prepared for that! In addition, avoid destinations which may not have easy medical access; if you are on a cruise make sure they have a healthcare provider on board.

Air travel:

For most of pregnant women, traveling by plane is permitted. Most of the companies will allow traveling up to 32 weeks of pregnancy, many others up to 36 weeks (you will need to provide a doctor’s permission). Check always with the airline company before making your reservation…
You should’n worry about walking through metal detectors at the airport security check, the radiation dose they emit is extremely low.
In order to avoid heavy luggage lifting, you may prefer to use suitcases with wheels to make travel as easy as possible.
Long-haul air travel is associated with an increased risk of venous thrombosis (blood clots formation), a potentially serious pregnancy complication. This risk is attributed predominantly to immobility during air travel, especially when traveling in economy class, where the space between the seats is very narrow. Precautionary measures include:
- wear loose-fitting clothes and comfortable shoes,
- do isometric calf exercises (stretch your legs from time to time),
- walk regularly around the aircraft cabin,
- avoid dehydration: drink plenty of water, minimise alcohol and caffeine intake,
- check with your healthcare provider the possibility of wearing special elastic stockings in order to improve blood circulation.

Travelling abroad: Travelling overseas may present certain challenges. Keep in mind the following:

Discuss with your doctor possible safety risks for you and your baby.
Certain destinations are best avoided: places with difficult access to health care, or high risk of contracting infections or other diseases.
Special consideration should be taken when travelling to countries where yellow fever vaccination or malaria prevention medication may be needed. Make sure that any vaccines or medications required are not contraindicated in pregnancy. You may check the authoritative site of the US Centers for Disease Control and Prevention (CDC) for useful information (see here), but you must talk about it with your doctor.
You may take with you a copy of your medical records, in case anything is needed in your foreign destination.

References

NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK

HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx#close

http://www.hse.gov.uk/pubns/indg373.pdf

http://www.cdc.gov/niosh/topics/repro/employers.html

http://www.abcd-study.nl

Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 5.

http://wwwnc.cdc.gov/travel

Photo credits

Exercise: Getty images; media3.onsugar.com; sohanews2.vcmedia.vn; Jose Gabriel Lugo, Flickr.com;

Sex: Trevor, Flickr.com; Melissa Segal, Flickr.com;

Work: Getty images; fineartamerica.com; huffpost.com;

Travel: Getty images; globalblue.com; travelingtoworld.com

6Jan2015

REPEATED ABORTIONS

Posted in Inspire me by woman2womenblog

Repeated or recurrent miscarriage is an issue that concerns us particularly because unfortunately is quite common, and causes intense anxiety to couples. A post specifically on this subject will follow later, but today I want to share with you the story of a woman who went through this problem, and fortunately managed to overcome it…

“I’m 30 years old and I just gave birth to my second child, but in order to arrive here we went through a long and hard road.

When we decided with my husband to take a step further with the birth of a child, we encountered some difficulties we did not expect. Our first attempt began with a loss, as the pregnancy suddenly stopped between 6 and 7 weeks of pregnancy. My gynecologist told me that many women start with a missed abortion and that I should not get discouraged. So, we retried but unfortunately our second attempt had the same inglorious end, between 6 and 7 weeks the gestation stopped.

..with faith and confidence in the medical team, we brought into the world our first child…

After this experience, my gynecologist proposed that, before we would try again, it would be a good idea to see more in detail if there was anything that could explain these losses, if something was wrong with us. For that reason, we did a series of tests for thrombophilia, immunological factors, autoimmune diseases, hormonal determinations, and a karyotype of the couple, which may hinder the smooth progress of pregnancy; and with these results on hand we went to consult a hematologist.

The hematologist, in collaboration with my gynecologist, told me that I as soon as I would become pregnant, I would need to follow a special therapy that would help me, and would increase the chances of having a healthy baby.

So when I got pregnant again, with the special treatment, with faith and confidence in the medical team, we brought into the world our first child. With continuous monitoring and support by my gynecologist, but also by the haematologist, I gave birth, with natural delivery, to a healthy baby boy.

No matter what problem you are facing, don’t give up, get informed, learn what you can do, ask help from people who can help you, don’t you stay in the dark and things might work out well for you too.

In the same way I just managed to deliver a beautiful baby girl.

When I decided to discuss the problem with some couples we knew, I found out that exactly the same problem faced two out of four close friends. That scared me, but in the end everything went well for all of us.

No matter what problem you are facing, don’t give up, get informed, learn what you can do, ask help from people who can help you, don’t you stay in the dark and things might work out well for you too. “

A.T.

Do you have any experience to share with us? You may help other women! Send us your story to woman2womenblog@gmail.com

28Dec2014

2014 IN REVIEW: HEALTH HIGHLIGHTS

Posted in Health by woman2womenblog

This is time of the year when everybody reviews the highlights of (almost gone) 2014, and I decided to do the same with health and medicine highlights. We start by taking a look at Google trends for 2014, and we see that two subjects are health-related. Number 3 is Ebola virus disease, number 5 is the ALS Ice Bucket Challenge, which besides raising a lot of money for the cause, helped many people become familiar with ALS (Amyotrophic lateral sclerosis)…At the top of the list though, is the death of Robin Williams, which is not strictly a health matter, but his suicide due to a depression problem increased Google searches on “depression” and people’s awareness on how depression can be a very serious problem…

Needless to say, the majority of us consult regularly “Dr Google” to satiate our curiosity on health matters…The “What is…” list also features among the top 10, four health issues: ” What is Ebola?” What is ALS?” “What is asphyxia?” What is MERS”… We as doctors many times have to deal with “Dr Google’s answers” and we might have endless discussions on all the positive and negative aspects of that…

Regardless of Google trends, for this post I picked 5 health issues that kept us talking during 2014. The reason for choosing them was either because they are medical breakthroughs, or due to their considerable media attention…

1) PARALYSED MAN WALKS AGAIN AFTER CELL TRANSPLANT

Darek Fidyka was paralysed from the chest down since 2010 after being stabbed in the back. He can now walk using a frame thanks to a therapy involving the transplant of cells from his nasal cavity into his spinal cord.The treatment was carried out by surgeons in Poland in collaboration with scientists in London.

This is to date the first person with a severe spinal cord injury to have regained movement and sensation in his lower limbs following a cell transplant.

These results are very encouraging, but like with every revolutionary treatment, it will need to be reproduced in a larger group of patients with a similar problem to proof its value…

2) SOCIAL MEDIA: DO THEY AFFECT OUR MENTAL HEALTH?

The Pew Internet Project on social networking showed that, in the USA, 74% of online adults use social networking sites, and 71% of online adults use Facebook. The rise of smartphones has made social networking even easier to access. Fully 40% of cell phone owners use a social networking site on their phones…

Do social media really make us more happy and social? An earlier study had shown, after surveying British university students, that half of them had feelings of anxiety and inadequacy when compared to their online friends; two thirds of the respondents had difficulty relaxing and sleeping after using social media sites (see here). Later studies have found that Facebook can increase feelings of jealousy (as compared to “social” friends). There are also several reports on social media addiction (see this article), and distraction from work and interpersonal relationships.

But can social media have positive impact on our mental health? New research suggests that happy status updates encourage happy updates from other users (see here). In addition, experts state that social-media exchanges – such as birthday wishes or congratulatory messages after a major life event – may make people feel more connected to their social network and loved. Read more here and here.

3) EGG FREEZING AS AN EMPLOYEE’S BENEFIT?

Facebook and Apple announced last October that they will be paying egg freezing for their female employees. This measure intends to support women workers to alleviate the conflict many of them face between career and family, in a way to somehow “fool” the biological clock . These headlines have raised lots of controversy, between those believing that this is a major, avant-garde move from the companies, and those affirming that it will turn into a boomerang on women, giving companies the right to demand them more commitment, longer hours at work and full time availability to their job…See more here.

4) CELL AND CORDLESS PHONES RELATED TO BRAIN TUMOURS

The relationship between cell and cordless phone use and brain tumour risk has been debatable for years, with studies results being contradictory. This year, cell phones are again in the spotlight, as a Swedish study showed that long-term use of both mobile and cordless phones is associated with an increased risk for glioma, the most common type of brain tumour.

The new study shows that the risk for glioma was tripled among those using a wireless phone for more than 25 years and that the risk was also greater for those who had started using mobile or cordless phones before age 20 years. Read more here.

5) LIVEBIRTH AFTER UTERINE TRANSPLANTATION

Swedish scientists announced the birth of a baby whose mother had received a uterine transplant, as reported in October in the prestigious journal The Lancet. Read my post on this subject here.

Photo Credits

Sunset skipperscove.com.au; 1) i1-news.softpedia-static.com; 2) mkhmarketing.wordpress.com, Flickr.com; 3) Andre Cortes, Flickr.com; 4) John, Flickr.com; 5) sean dreilinger, Flickr.com

21Dec2014

PREGNANCY DO’S AND DONT’S (Part 2)

Posted in Health, Pregnancy by woman2womenblog

BEAUTY TREATMENTS AND MEDICATIONS

In a previous post on Pregnancy do’s and dont’s, we analysed what is allowed and what discouraged during pregnancy concerning food, beverages, alcohol and cigarette (see here). This second part will deal with beauty treatments and medications. A third part with more do’s and dont’s will follow…

BEAUTY TREATMENTS

Pregnancy comes with many body changes: weight gain, swelling…. And on top of that, hormonal shifts causing mood swings… You want to look beautiful! But is it possible to be both pregnant and beautiful? Of course! You will just need to be a little bit more careful and avoid certain things, either because there is some concern that they may be harmful for you baby, or we do not have enough evidence to prove their safety. This guide will help you be both beautiful and safe…

Artificial tanning
Botulinum toxin (Botox)
Essential oils
Hair dye, perms and straightening treatments
Hair removal
Insect repellents
Nail beauty
Skin care and cosmetics
Spa visits
Sunscreens
Teeth whitening

1. Artificial tanning

Fake tan products are generally safe to use during pregnancy; they contain Dihydroxyacetone (DHA), which is not absorbed into the body when applied to the skin as cream, mousse or wipes. But avoid spray tans as the effects of breathing in the spray are not known.

You should stay away from tanning pills, they might be toxic to your baby (they are banned in several countries but they are sold online).

Solarium’s /Tanning Beds: we do not know whether they may affect the unborn baby, but they have been related to skin cancer, so better avoid them. The risk of overheating during pregnancy should also be considered (see below).

Anyhow, keep in mind that your skin is more sensitive while pregnant, therefore some products may cause skin irritations, or you may get burnt more easily.

2. Botulinum toxin (Botox)

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Botox injections, used to smooth wrinkles are not recommended in pregnancy, unless they are done for medical reasons. Although no risk has been demonstrated, there are no adequate studies to prove its safety. In any case, don’t worry on this one, your wrinkles will get naturally smoother as your pregnancy progresses!

3. Essential oils

Essential oils are highly concentrated substances coming from plants. They are used in aromatherapy, either in massage or put in a vaporiser to breathe them in. While some essential oils are safe for use in pregnancy, other can be harmful, either by causing contractions, bleeding or eventually birth defects. Consequently, you should be extremely careful with their use, and always ask advise from your physician or someone specialised in aromatherapy. For a more detailed list of essential oils allowed and discouraged in pregnancy, click here.

4. Hair dye, perms and straightening treatments

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It is not clear whether the chemicals used for hair dying are completely safe during pregnancy, although the risks are likely to be low. Some studies have linked the use of hair dye with a rare type of cancer in babies (neuroblastoma); however, other studies have not corroborated this finding. To be extra cautious, it is usually advised to avoid them during the first trimester. To limit exposure to chemicals, you may prefer highlights. Vegetable dyes may be a good alternative, but be aware that many of those contain the same chemicals than the regular ones.

Regarding perms and straightening treatments, they seem to be safe during pregnancy. Again, it seems wiser to avoid them during the first trimester. You should better stay away from keratin treatments (also called Brazilian keratin treatments) as they contain formaldehyde which might be harmful to the baby (and to you).

There seems to be an increased risk of miscarriage in woman working at a hair salons. If you work at a hair salon and you cannot avoid exposure to chemicals, take the same precautions stated for nail salon workers (see below).

5. Hair removal

There are no studies that evaluate the safety of electrolysis and laser. Electrolysis uses 2 types of currents, thermolysis and galvanic; while the former seems to be safe, galvanic electrolysis should not be used in pregnancy. Laser use during pregnancy has not been evaluated properly, although it seems to be safe. Most specialists will propose to avoid it throughout the whole pregnancy due to lack of information about its safety.

Waxing is safe and should be preferred to creams. Creams and depilatories contain barium sulfide powder and calcium thioglycolate. There is no evidence that they are harmful for pregnancy, but no studies have been conducted to prove their safety.

6. Insect Repellents

When used as recommended, most insect repellents are considered safe during pregnancy. Since there are different types of active ingredients (pesticides) in insect repellents, read the label carefully. The chemical DEET (N, N-ethyl-m-toluaminde or m-DET) is the most effective and best studied product, and is very good at preventing mosquito and tick bites. Both animal and human studies found no increase in babies’ defects, survival, growth, or development in the first year of life. In any case, try to minimise exposure by using a product with the lowest concentration of DEET needed for your protection. When possible, apply the pesticide to your clothing rather than directly to your skin.

Some insect repellent products contain citronella oil. While the American Food and Drug Administration (FDA) considers citronella- containing repellents safe for use, in Europe citronella use is banned due to some concerns on toxicity.

7. Nails beauty

Gel nails, shellac nailpolish, acrylic nails, nail art… so many ways you can adorn your nails… But are they safe? Let’s see in detail…

Nail polish: it is fine to use nail polish every now and then. There are three, potentially toxic substances in nail polish: Dibutyl Phthalate (DBP), Toluene and Formaldehyde. Of particular concern is DBP; the European Union has banned its use, but it is still being found in some nail polishes. Formaldehyde and Toluene should not be a problem if used occasionally, but it may be an issue for pregnant women regularly exposed to them, such as those working in a nail salon. If you want to be on the safe side, use chemical-free products and make sure you paint your nails in a very well ventilated room.

Nail polish remover: It is OK if you use it occasionally. It usually contains acetone, a substance naturally produced by our body (in very small amounts). If you are regularly exposed to large amounts of acetone, there is a slight possibility of increasing your changes of having a miscarriage or a baby with some birth defects. To play safe, you may use acetone-free products.

Acrylic nails: concerns have been raised both on the glue used to stick the nails, and on a substance the nails may contain (methylmetacrylate or MMA, now mostly replaced by a supposedly safer EMA). Again, it should not be a risk if you do it occasionally, in a very well ventilated area. Moreover, you should know that fake nails have been related to higher chances of getting bacterial and fungal nail infections or nail deformities.

Gel nails: gel nails are applied as a gel to the nail, and then set by a UV lamp, or by the application of a chemical. Like acrylic nails, they contain methacrylate monomers, which may be dangerous for pregnant and non pregnant women. In addition, the UV lights used to dry the nails have been linked to skin cancer. The other problem is their removal: you need to keep your hands for 20 minutes in acetone. While the small amount of acetone used to remove the common nail polish seems to be harmless, this extended exposure raises some concern. So, if possible, stay away from gel nails.

Shellac nail polish: Shellac is a resin secreted by a bug, which is applied on the nails and then dried with an UV lamp. While no specific pregnancy-related risks have been observed due to its application, there has been a report on increased risk of skin cancer due to the UV exposure. In addition, the removal needs acetone for 20 minutes (see gel nails). Therefore, you best avoid it.

An issue to consider with these more “permanent” techniques is that, in case of an emergency or hospitalisation, where we may need to check the oxygen level from your thumb, permanent nail polishes will not allow us to do so, as hospitals usually do not have the means to remove it!

Some studies have shown an increased risk of miscarriages in salon workers. Therefore, if possible, you could ask a colleague to take over some of your work while you’re pregnant. If inevitable, take the following precautions:

•wear a face mask and rubber gloves

•work near a window

•take regular breaks for fresh air

8. Skin care and cosmetics

In general you can keep using your usual make-up and skin care regime as there’s no evidence that any cosmetics will be of any harm to your baby, with the exception of some anti-ageing creams (see below).

Cosmetics are covered by very strict safety laws, so you can be quite reassured that your moisturiser, serum, foundation or lipstick are safe to use when pregnant.

Acne medication and anti-ageing creams are related because they can both contain retinoids (a type of vitamin A). Retinoids are known to cause birth defects when taking orally. The main concern is the acne drug isotretinoin, which can be extremely harmful for the baby if taken during pregnancy. Retinoids are also used in some anti-ageing creams as they can speed up skin’s renewal, so stay away from them.

9. Spa visits

You can indulge yourself at a spa, get a massage, make a facial, get a manicure or pedicure. There are certain things, though, that you should avoid while visiting a spa:

saunas
steam rooms
tanning beds
hot springs
whirlpools, hot tubs and spa baths

All the above mentioned pose a risk of overheating, dehydration and fainting; there is a slight possibility that excessive heat may affect your baby’s development. If you are exercising in water, the temperature of the water should not exceed 32 ⁰C, otherwise check that the water temperature is below 35 ⁰C.

10. Sunscreens

Sunscreens are perfectly safe for use in pregnancy. Some of them do not penetrate the skin and others get absorbed but in very low amounts. Sunscreens containing titanium dioxide and zinc oxide may be preferred as they are powerful physical sun blockers and do not penetrate the skin.

11. Teeth whitening

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Teeth whitening involves bleaching your teeth to make them lighter through a peroxide-based whitening agent or a laser. According to the British Dental Health Foundation, teeth whitening in pregnancy is best avoided as we are unaware of the potential side effects on babies.

MEDICATIONS

Few medicines have been established as safe to use in pregnancy. Medications in general should be used as little as possible during pregnancy and should be limited to circumstances whether the benefit outweighs the risk.

It is very important that you mention to your doctor any medicine you may be taking or you take occasionally. Some medicines may harm your baby and will need to be replaced by safer ones, whereas others are indispensable for you and you should keep taking them.

As a rule, do not take unnecessary medications during pregnancy, and this is particularly important during the first trimester, which is the period when the baby’s organs are formed.

Herbal Medicines

“Natural” is not a synonym of “safe”, so do not assume that because something is natural or alternative is devoid of risk…

The only herbal medicines that have been assessed in trials and seem to be safe are ginger (used for nausea and vomiting in pregnancy) and red raspberry leaf (used to tone the uterus). The latter in several studies did not prove to be effective, but some experts propose, just in case, to use it only during the third trimester. You will find a list of herbal medications that seem to be safe and those that are better avoided here.

References

American Family Physician: Evidence-Based Prenatal Care: Part I. General Prenatal Care and Counseling Issues. April 2005, USA. http://www.aafp.org/afp/2005/0401/p1307.html

NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK

HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

http://www.babycentre.co.uk/x536449/is-it-safe-to-use-essential-oils-while-im-pregnant

http://www.nhs.uk/chq/Pages/2402.aspx?CategoryID=54#close

http://www.babycentre.co.uk/a536346/herbal-remedies-in-pregnancy

Photo credits

Intro: Getty images; 1. Miran Rijavec, Flickr.com; 2. Getty images; 3. Wikimedia commons; 4. Getty images; 5. http://www.lingrid.lt/straipsniai/oda.png; 6. Pixabay.com; 7. http://glamradar.com/10-cute-and-easy-nail-designs-ideas/; 8. Joe Hsu, Flickr.com; 9. Casa Velas Hotel, Flickr.com; 10. Arne Hendriks, Flickr.com; 11. Getty images; Medications: Gatis Gributs, Flickr.com; Herbal: Pixabay.com

26Nov2014

PREGNANCY DO’S AND DON’T’S (Part 1)

Posted in Health, Pregnancy by woman2womenblog

FOOD, DRINKS, ALCOHOL AND TOBACCO

Yes!! the pregnancy test is positive! You go and share the good news with your friends and relatives…And that very same moment, people will start “bombarding” you with advices: do this, don’t do that… So you start wondering: What is safe? What can harm my baby?

This post is about the most common “Is it safe….?” questions. Since the subject is extensive, this will be “Part 1”, dealing with food, drinks, alcohol & tobacco. More do’s and dont’s are coming….

FOOD AND DRINKS

Embed from Getty Images

Eating healthy is one of the best things you can do to your baby, and to yourself! There is not a specific diet for pregnancy; you should just follow a healthy, varied, balanced diet: plenty of fruits, grains and vegetables, but also dairy products and meat, which provide iron, calcium, vitamins and proteins. You don’t need to eat for two! Actually, if you have a normal weight, only a few extra calories a day are needed while pregnant: none during the first trimester, about 300 the second, 450 the last trimester!

Try to eat frequent and small meals, and avoid eating a copious meal before bedtime. Although sweets, fatty or processed food should not be in your every day diet, don’t feel bad if you get occasionally tempted! In any case, pay attention to quality, but also to quantity: excessive weight gain may put you at risk of having gestational diabetes, pregnancy-induced hypertension or delivering a macrosomic (too big) baby…Not to mention that you will suffer to lose those extra kilos after birth!

Herein you will find some things you need to know about eating and drinking during pregnancy:

Meat & Eggs

Meat is an excellent source of protein, iron, vitamins and minerals. But you should only eat well-cooked meat. Forget about carpaccio, steak tartare or saignant!

Eating undercooked or raw meat can lead to toxoplasmosis, a severe infection that may harm your baby. Uncooked cured meat, such as salami or prosciutto should also be avoided. Liver and liver products (such as pate) contain high levels of vitamin A, which is toxic for the baby. Indeed, a single serving of cow’s liver contains three times the recommended daily amount of vitamin A allowed in pregnancy, so even if liver is considered to be a healthy food, rich in proteins, iron and vitamins, stay away from it, or consume it no more than once a month.

Undercooked meat, especially poultry can carry salmonella, which may cause a very severe form of food poisoning, so pay special attention to cook well your chicken. Since Salmonella is also present in eggs, the consumption of raw or partially cooked egg is discouraged (this includes homemade mayonnaise, tiramisu, etc).

Fish & Seafood

Fish is an excellent source of proteins, vitamins and the valuable omega 3 fatty acids, which boost your baby’s brain and eye development. However, you should avoid certain fishes, such as shark, swordfish, king mackerel, tilefish, and tuna. These fishes are contaminated with large amounts of mercury, which can be toxic for your baby. To see more details about mercury levels in fish and allowed servings, please click here.

Raw fish and seafood may contain harmful bacteria or viruses. Therefore, do not eat raw fish (includes some varieties of sushi and sashimi) or raw oysters. Octopus, calamari, shrimp are fine as long as are properly cooked. With smoked fish (such as salmon and trout) the opinions are divided: while it is considered to be safe by some experts, others advise against it due to the possibility of contamination with listeria, a bacterium potentially harmful for your baby.

Cheese & Milk

Cheese is a great source of calcium and vitamins, so go ahead and eat cheese as long as it is made of pasteurised milk. You should not eat soft cheeses such as brie, camembert, chevre, roquefort, which may grow the rare, but dangerous listeria. Check the packages, where it usually states states if the cheese is made with raw or pasteurised milk, and avoid homemade cheeses. Hard cheeses are fine. For the same reason, the milk you drink should always be pasteurised.

Coffee

There is some (controversial) evidence that having more than 200 mg of caffeine a day may put you at risk of miscarriage or having a baby with low birth weight. This means that you may drink up to two cups of instant coffee or 1 cup of brewed coffee a day. Don’t forget other sources of caffeine, such as tea, cola, energy drinks or chocolate. For caffeine content of different beverages, please click here.

Herbal teas

Herbal or natural doesn’t necessarily mean “safe”. Most teas are thought to be safe in pregnancy, as long as you don’t drink large amounts. Green tea contains caffeine, so do not exceed the recommended limit of 200 mg of caffeine per day (see above).

There are a couple of teas that you better avoid: Sage tea may be linked to miscarriage and high blood pressure. Parsley tea may increase the risk of miscarriage. Valerian is also best avoided, as well as chamomile in large amounts. Raspberry leaf tea may cause contractions, so do not consume it in early pregnancy, but it may be fine to drink during late pregnancy.

Artificial sweeteners

In general, artificial sweeteners seem to be safe to have in pregnancy, they are though recommended with moderation. Stevia and sucralose should be preferred. Aspartame seems to be safe with moderate consumption, but it should be avoided by anyone with a rare disease called Phenylketonuria (PKU) or by persons with high levels of phenylalanine in blood. Saccharin and cyclamate have been possibly linked to same types of cancer, so they are best avoided in pregnancy.

ALCOHOL AND TOBACCO

Alcohol in large amounts is highly toxic for the unborn baby. For light (social) drinking, the data has been contradictory. According to the British organisation NICE, although there is uncertainty regarding a safe level of alcohol consumption in pregnancy, at this low level there is no evidence of harm to the unborn baby: no more than one or twice a week, 250cc beer or 1 shot (25 ml) spirit or 2 small (125 ml) glasses of wine. Nevertheless, NICE recommends to avoid alcohol consumption during the first trimester due to a possible increased risk of miscarriage.

The dangers of smoking have been widely established. Smoking during pregnancy puts you at higher risk of having a baby with low birth weight, as well as stillborn, sudden infant death syndrome, miscarriage, premature labor and placental abruption. Moreover, later evidence incriminates smoking of causing birth defects. See more information here. The risk includes even secondhand smoke. If you are pregnant and you keep smoking, discuss with your doctor the options you have to quit as soon as possible…

References

American Family Physician: Evidence-Based Prenatal Care: Part I. General Prenatal Care and Counseling Issues. April 2005, USA. http://www.aafp.org/afp/2005/0401/p1307.html

American Family Physician: Evidence-Based Prenatal Care: Part II. Third-Trimester Care and Prevention of Infectious Diseases. April 2005, USA. http://www.aafp.org/afp/2005/0415/p1555.html

ACOG: FAQ – Nutrition During Pregnancy. September 2013, USA. http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy

NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK

HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

Photo credits

1.Getty images; 2.media1.onsugar.com; 3.alachia, Flickr.com; 4.Back East Photography, Flickr.com; 5.Susanne Nilsson, Flickr.com; 6.Steve Nodgrass, Flickr.com; 7.Luz Bratcher, Flickr.com; 8.emdot, Flickr.com; 9.Shrikant Nigam, Flickr.com

11Nov2014

WHY DO I GET BLADDER INFECTIONS ALL THE TIME?

Posted in Health by woman2womenblog

Embed from Getty ImagesAre you one of those women who get cystitis very often? Well, you are not alone! It is estimated that at least 50 % of women will get a urinary infection in their lifetimes; of those, about 30% will get another episode after a short period of time….

Let’s try to understand the problem and learn how to reduce the chances of repeated infections…

What is cystitis?

Cystitis is an inflammation of the bladder, usually caused by a bacterial infection. There is sometimes confusion between urinary infection and cystitis.

Urinary tract infection comprises 3 types of infection:

Urethritis: inflammation of the urethra (the tube from where we urinate)
Cystitis: inflammation of the bladder (by far the commonest)
Pyelonephritis: inflammation of the kidneys

We consider recurrent cystitis at least three episodes of urinary tract infection in one year, or two episodes in 6 months.

Symptoms of cystitis

The symptoms of cystitis include:

Persistent urge to urinate
Intense burning when urinating
Passing small amounts of urine
Usually a small amount of blood while wiping, more rarely red or brown (cola-like) urine
Low abdominal pain
Cloudy or funny-smelling urine

Many times cystitis may be asymptomatic, especially in postmenopausal women.

It should be stressed that cystitis does not cause fever. If you get fever, flank or high abdominal pain, nausea, vomits, then you may have a pyelonephritis and you should seek medical attention.

Causes of cystitis

The most common cause of cystitis is Escherichia coli, a bacterium that belongs to the normal intestinal flora. This means that most of the times, we do not get the bacterium from somewhere or someone else, but from our own body.

But why this happens?

Just because we are women! We have a much shorter urethra than men, which is much closer to the anus. This anatomical disadvantage makes much easier for the bacteria to reach the bladder.
Sexual intercourse. The great majority of women will get cystitis after intercourse. Although several explanations have been proposed for the link between cystitis and sex, most likely it has to do with some micro traumatisms of the urethra, which allow bacteria to go upward.
Not enough fluids, not frequent visits to the toilet. We do it many times: we forget to drink water and we hold back the urine! Both factors predispose to cystitis as they favor bacterial replication inside the bladder.
Menopause. Cystitis tends to be less symptomatic in menopausal than in younger women; thus, the infection may be noticed only when it became pyelonephritis. The lack of the hormone estrogen is responsible for this predisposition, as the genital area becomes very dry and gets traumatised very easily. Occasionally, a relaxation of the pelvic organs may cause urinary incontinence or retention, burdening further the situation.
Pregnancy. Hormonal shifts, together with the pressure of the womb on the bladder and ureters (the tubes that connect the kidneys with the bladder) affect the function of the urinary system.
Other reasons. Urinary tract abnormalities, diabetes, low immune system, etc.

But why do I get cystitis so often?

Most of the recurrent cystitides occur in otherwise healthy women, without urinary tract abnormalities or immune system problems. It is not clear why this happens, though many theories have been proposed: changes in the pH, lower antibodies levels in the genital area, greater adherence of the bacteria to the bladder, anatomical differences (such as shorter distance between the urethra and the anus).

What can I do to prevent recurrences?

Sometimes, making some changes to our life style will be enough to reduce the risk of repeated cystitis. Keep in mind the following:

Drink plenty of fluids: ideally, more than 2 liters per day, especially with warm weather.
Dot hold back the urine: you should try to urinate at frequent intervals, drinking plenty of fluid will help!
Urinate after intercourse: this simple act will reduce the chances of cystitis by washing any bacteria that may be present in the urethra, making more difficult for them to reach the bladder
Wipe from front to back: when you urinate, but especially when you pass stools, remember to wipe yourself from the front to the back, and not the other way around, to avoid transferring bacteria from the anus to the urethra.
Avoid constipation. Many women will feel that being constipated make them more susceptible to cystitis. This may be due to a higher concentration of bacteria in the genital area. Be sure then, to eat plenty of fibers, drink fluids and exercise regularly.
Be careful with the hygiene of the area, but don’t overdo it! It is important to wash the genital area with a mild soap, but avoid antiseptics, bidet use, vaginal douching or excessive washing. We have a normal flora that protects us against the “bad” bacteria. All the above mentioned may affect the normal flora and predispose us to repeated urinary and genital infections.
Avoid excessive heat, humidity and pressure on the area. Tight clothes, synthetic underwear will favor bacterial proliferation. It is also recommended to change your bathing suit after swimming.
Consume cranberries. Both the juice and the extract (the tablet) seem to reduce the episodes of cystitis. According to some studies, the effect seems to be stronger in women with repeated urinary infections.

When nothing works…

Discuss the problem with your physician. If you haven’t done it so far, a urine analysis and culture should be done, to confirm the diagnosis. Urethritis and vaginitis may mimic the symptoms of cystitis.
For the same reason, your doctor may prescribe a vaginal – cervical culture.
In order to rule out any anatomical problem, an ultrasound of the urinary system may be considered. A consultation with an urologist may be needed to run some more sophisticated tests, such as cystoscopy.
A long term therapy with a low dose of antibiotic is sometimes prescribed. If the episodes are clearly linked to intercourse, then a single dose of antibiotic may be used every time within 2 hours of love making.
In menopausal women, a vaginal estrogen therapy may be helpful.

References

http://www.aafp.org/afp/2010/0915/p638.html

http://www.nhs.uk/Conditions/Cystitis/Pages/Introduction.aspx

11Oct2014

FIRST BABY BORN AFTER UTERINE TRANSPLANTATION

Posted in Health by woman2womenblog

A few days ago, Swedish scientists announced the birth of a baby whose mother had received a uterine transplant, as reported in the prestigious journal The Lancet.

The mother, a 36-year-old who was born without the uterus, had received the womb of a 61-year-old donor. Before the surgery, the woman underwent in-vitro fertilization and freezing of the embryos. One and a half month after transplantation she had her first menstruation and about one year later she got one embryo transferred. She became pregnant, received treatment to avoid transplant rejection throughout pregnancy and by end September delivered a healthy baby boy.

According to declarations of Dr. Brannstrom, the leader of the Swedish medical team, both mother and baby are doing fine. The baby was delivered by cesarean section at 8 months because the mother developed high blood pressure (preeclampia) and the baby monitoring revealed that the heart rate was abnormal.

A breakthrough in gynecology

The achievement of a birth after uterine transplant is a veritable breakthrough if we consider the complexity of the procedure. I had the opportunity to follow a lecture by Dr. Brannstrom, where he explained the procedure in detail. The surgery is performed by a multidisciplinary team, and is extremely lengthy. Uterine transplant, as opposed to kidney of heart transplant, has extra challenges: the uterus in its non-pregnant state is about the size of a pear, and weights about 60 grams, but during pregnancy it reaches about 900 grams and gets a very large amount of blood flow, including new vessels that develop during pregnancy.Thus, extreme care should be given to what is called vascular anastomosis (the connection of the vessels). In addition, the uterus needs to be properly anchored to the nearby organs. After surgery, there are other difficulties to overpass such as the possibility of rejection, especially during pregnancy, where the treatment needs to take in consideration both the mother and the developing baby. Needless to say, the Swedish team had done many years of extensive research in animals before deciding to move forward and try in humans.

Women that may benefit

This surgery has very specific indications. The woman that underwent this operation had a very rare disorder called Mayer-Rokitansky-Küster-Hauser syndrome, which means that she was born without the uterus. This condition accounts for 1 in 5000 births (Queen Amalia of Greece had it…). Other candidates for this procedure are women who had their uterus removed due to cancer, fibroids, etc. Up until now, the only options for these women were adoption or surrogacy.

Ethical and medical concerns

This procedure raises several questions. First, unlike the kidneys or the heart, the uterus is not a vital organ. The risks of undergoing such a complex and burdensome surgery, together with the risks of the immunosuppresive therapy which put both the woman and the baby in danger, does it pay? Is it ethical? The possible risks of the donor should also be considered. In addition, the woman will most likely need to remove the uterus after family completion because the immunosuppresive therapy would eventually damage the uterus.

Like any procedure so revolutionary and avant-garde, future will show if it becomes routine care. In any case, the Swedish team should be congratulated for their efforts and contribution to help infertile women.

If you want to see an interview to Dr. Brannstrom and his team:

http://youtu.be/_tWjUYtsUfY

References

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61728-1/fulltext

5Oct2014

SMOKING IN PREGNANCY: MORE DANGEROUS THAN WE THOUGHT

Posted in Health, Pregnancy by woman2womenblog

We knew for many years that smoking during pregnancy was harmful for the baby, as it has been linked to increased risk of miscarriage, preterm labor and low birthweight. But a recent study came to incriminate cigarette smoking for something we were not sure yet: birth defects.

British scientists examined the literature published on the subject the last 50 years, and after putting all the information together in what is called a meta-analysis, they came up with the conclusion that smoking is indeed responsible for certain birth defects.

The higher risk was for a malformation called gastroschisis, in which the baby is born with the intestine or stomach protruding outside the body through a hole in the abdominal wall; for this anomaly, babies of women who smoked during pregnancy had 50% increased risk.

In addition, they found that babies born from mothers that smoked while expecting had higher risk for the following:

Musculoskeletal defects, that is, missing or shortened arms and legs, cleft lips, cleft palate, craniosynostosis (abnormally shaped head): 26% higher risk;
Gastrointestinal malformations: 27% more chances.
Undescended testis in baby boys: 13% higher chances.
Heart problems: 9% excess risk.

That cigarette is toxic for a developing baby does not seen illogical: cigarettes contain more than 7000!! chemicals, most of which can easily cross the placenta. And we know very well that cigarette is highly toxic for adults and children.

The mechanism by which cigarettes may cause all these defects is not clearly understood, but the key seems to be reduced oxygen supply to the baby. Nicotine (the addictive component of cigarettes) causes blood vessels to constrict, this may lead to reduced blood flow to the placenta or to the baby’s tissues; another component, carbon monoxide, binds to hemoglobin (the molecule that carries oxygen in the blood) stronger than oxygen, thus lowering the amount of oxygen in the blood circulation. Maybe, some of the chemicals contained in cigarette have a direct toxic effect on the baby’s tissues.

In light of this information, if you are a smoker you should make every possible effort to quit smoking as soon as you learn you are pregnant, or even better, before conceiving.

Cigarette is addictive, so it may not be easy, but your baby can give you a great motivation to quit….

Reference

Allan Hackshaw, Charles Rodeck, and Sadie Boniface: Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum. Reprod. Update (2011) doi: 10.1093/humupd/dmr022. First published online: July 11, 2011

25Sep2014

WANT TO GET PREGNANT?

Posted in Health, Pregnancy by woman2womenblog

You have decided to get pregnant, that’s great! Before you start trying, here are some tips you may find useful….

Schedule a visit to your gynecologist
Start taking folic acid
Give up drinking, smoking, drugs…
Eat healthy
Reduce caffeine intake
Watch your weight
Exercise, but not too much
Don’t forget your oral health
Reduce your stress levels
Avoid certain infections
Reduce exposure to environmental hazards
Figure out your fertile days

1. Schedule a visit to your gynecologist

Embed from Getty ImagesIt is a good idea, before trying to get pregnant to consult your gynecologist. At that visit, you may want to discuss:

-any medical problem you may have. Some diseases may get better or worse while you are pregnant, some others may affect your baby.

-any medication you are taking. Certain medications are dangerous during pregnancy, and some have to be switched before you even try to conceive.

-your family history. There are diseases that run in families, and you may be able to do some tests to understand if you are at risk. Be sure to mention whether someone in your family has any health problem (e.g. Down syndrome, thalassemia or sickle-cell disease, cystic fibrosis, mental retardation), or if someone was born with a cardiac, neurological or other defect.

-your habits: diet, weight, exercise, any unhealthy habit (such as smoking, drinking, or taking drugs).

If it’s been a year since you had a checkup, you can also expect to have a pelvic exam, eventually an ultrasound and a Pap smear. You may also get tested for sexually transmitted diseases and other bacteria that can reduce your chances of getting pregnant.

Some couples may decide to undergo some prenatal blood exams, including genetic testing for specific conditions, such as hemoglobinopathies (e.g. thalassemia) or cystic fibrosis, based on their ethnic background or family history.

A folic acid supplement may be prescribed at that point.

2. Start taking folic acid

Taking a folic acid supplement is very important. By taking 400 mcg of folic acid a day for at least one month before you conceive and during your first trimester, you reduce your chances of having a baby with some births defects (such as spina bifida) by 50 to 70 percent.

You may also consider some multivitamin supplements that may help you get pregnant. Make sure though, not to exceed the recommended doses of vitamin A (unless it’s in a form called beta-carotene). Getting too much vitamin A can cause birth defects.

3. Give up drinking, smoking, drugs…

If you smoke, drink or take drugs, now’s the time to stop!

Tobacco use can affect fertility both in women and men, and this seems to be true even for secondhand smoking. Smoking or taking drugs while you are pregnant can lead to miscarriage, premature birth, low-birthweight babies and (according to recent studies) congenital malformations.

Alcohol can also reduce fertility, therefore it’s a good idea to cut back when you start trying to get pregnant. Drinking alcohol during pregnancy can cause birth defects and other severe problems to you baby.

4. Eat healthy

It is now a good time to start eating healthy: plenty of fruits and vegetables every day, as well as whole grains and foods that are high in calcium – like milk and yogurt. Eat a variety of protein sources, such as beans, nuts, seeds, and meats.

While fish is an excellent source of omega-3 fatty acids (which are very important for your baby’s brain and eye development), as well as proteins, vitamin D and other nutrients, it also contains mercury, which can be harmful. It is usually recommended that pregnant women eat up to 2 servings a week of fish that are not high in mercury (such as herring, trout, salmon, and sardines), and avoid shark, swordfish, king mackerel, tilefish. The consumption of white canned tuna should be limited to 1 serving per week.

5. Reduce caffeine intake

There seems to be an association between high caffeine consumption and reduced fertility. Too much caffeine has also been linked to a risk of miscarriage in some studies, but not in others. To be on the safe side, it is recommended to limit coffee consumption to 1 cup a day.

6. Watch your weight

You may have an easier time conceiving if you’re at a healthy weight. Being over or under the ideal weight makes it harder for some women to become pregnant.

7. Exercise, but not too much

A fitness program will result in a healthy body, fit for pregnancy. In addition, exercising is a great way to relieve the stress that can be both the cause and consequence of not getting pregnant…

You may consider walking or cycling or swimming, on most days of the week, for about 30 minutes. To increase flexibility, you may try stretching, Pilates or yoga.

But be careful not to overdo it. Very intense exercise seems to have the opposite effect, as it has been related to infertility in some studies.

8. Don’t forget your oral health

Hormonal changes during pregnancy can make women more susceptible to gum disease, causing the gums to bleed easily while flossing or brushing. But if you take care of your oral health before trying to conceive you have less chances of experiencing problems while pregnant.

9. Reduce your stress levels

It is becoming clearer that stress is responsible for infertility; indeed, several studies reveal that relaxation techniques increase the chances of getting pregnant. Furthermore, a recent study confirms something we see in everyday practice: pregnancy is much more likely to occur during months when couples report feeling happy and relaxed and is less likely to happen during the months they report feeling tense or anxious. The influence of stress on infertility, though is not straightforward, and it may vary in different women.

10. Avoid certain infections

You’ll want to stay away from certain foods such as raw and undercooked red meat, fish and poultry, raw eggs, unpasteurised milk and soft cheeses. These foods can cause dangerous infections, such as listeriosis, salmonella and toxoplasmosis.

In order to avoid toxoplasmosis it’s also a good idea to wear gloves when digging in the garden or the cat’s litter box, if you have one.

11.Reduce exposure to environmental hazards

There is some evidence to support that routine exposure to certain chemicals or radiation may be harmful for pregnant women. If you work in such an environment, you’ll need to make some changes before you conceive. In addition, some cleaning products, pesticides, solvents, etc, can be dangerous during pregnancy.

12. Figure out your fertile days

Initially, you may prefer to let fate decide when you will conceive. But if you want to be more precise in calculating your fertile days:

First, you should understand when your ovulation occurs. For that, you may use an ovulation calculator, that is, a web tool or application where you write down your period days for some months and you learn when you are fertile; you will find several online, many are designed for smart phones. With these calculators, you get a rough estimate of your fertile days.

If you want to be even more exact, you may start recording your basal body temperature (BBT) and your cervical mucus changes. If you chart them over several months, you may more easily understand when you’re ovulating each month.

Ovulation predictor kits can also help you figure out when you’re ovulating by detecting a hormone (LH) in your urine.

Once you have a clear picture of your cycle, there’s only one thing left to do — get to work! It is advised to have sex every day or every other day beginning about five days before ovulation, and continuing through the day after ovulation. This is because, though sperm can live as long as five days inside a woman’s body, an egg’s life span is only about 12 to 24 hours. By having intercourse before you ovulate, as well as on the day of and the day after ovulation, you maximize your chances of getting pregnant.

Good luck! And hopefully soon with good news!

More info at gofertile.eu

Photo credits

1. Getty images; 2. @Doug88888 Flickr.com; 3. Paul Heskes Flickr.com; 4. PeterFranz Flickr.com; 5. Adam Selwood Flickr.com; 6. pixabay.com; 7. Richard foster Flickr.com; 8. Wagner Cesar Munhoz Flickr.com; 9. MeditationMusic.net Flickr.com; 10. Joost Nelissen Flickr.com; 11. tk-link Flickr.com; 12..craig Flickr.com