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PROBLEMS DURING PREGNANCY
1. Nausea and vomiting
Generally it is mild and occurs during early pregnancy and is commonly called 'morning sickness' as it tends to occur early in the day but may occur at any time and can be improved by frequent small meals. If the condition develops to hyperemesis gravidarum, characterised by a severe prolonged persistent vomiting , then careful oral feeding and sometimes parenteral nutrition may be essential.
The pressure of the enlarging uterus on the lower portion of the intestine in addition to the muscle relaxant effect of placental hormones on the gastro intestinal tract and physical inactivity may make elimination difficult. Limited activity and exercise, insufficient fluid intake and insufficient bulk in diet may also be the causes of constipation.
Intake of plenty of fluids, foods rich in fibre helps to relieve constipation. Sometimes the weight of the foetus and downward pressure on veins leads to development of haemorrhoids.
3. Heart burn
Some pregnant women may complain of 'feeling of fullness' or 'heart burn' during later half of pregnancy. This is usually due to the pressure of the enlarging uterus crowding the stomach which in combination with the relaxation of the oesophagal sphincter may cause regurgitation of stomach contents into the oesophagus. This may cause a burning sensation due to gastric acid mixed with the food mass.
This feeling of fullness occuring due to gastric pressure, lack of space or gas formation can be avoided by taking small frequent meals and drinking fluids inbetween meals.
4. Oedema and leg cramps
Mild oedema due to physiological changes is usually present in the extremities in the third trimester. This may be caused by the pressure of the enlarging uterus on the veins returning fluid from the legs. This oedema does not require sodium restriction or other dietary changes. Also the common occurance of cramps during night manifested by sudden contractions of the muscle is thought to be related to decline in the serum calcium levels, which is in turn related to calcium imbalance.
Pica refers to the compulsion for persistent ingestion of unsuitable substances that have little or no nutritional value like starch, clay and chalk.
A pregnant woman is labelled anaemic if the blood haemoglobin is less than 10g/100ml from the 28th week onwards.
A significant fall in birth weight due to increase in prematurity rate and intrauterine growth retardation can occur if the haemoglobin level goes below 8 g / 100 ml. The demand for folate is increased due to increased cellular proliferation. Low folate levels are due to deficient intake. Megaloblastic anaemia due to folate deficiency results in intensified nausea, vomiting and anorexia.
7. Pregnancy Induced Hypertension (PIH)
PIH is a syndrome characterized by hypertension, proteinuria and oedema, convulsions or coma. The condition develops in the third trimester. Pre-eclempsia and eclempsia are the two stages which differ with the degree of symptoms, eclampsia denoting a severe stage. PIH is defined by systolic pressure of 140 mm Hg or diastolic pressure of 90 mmHg or both. A rise in systolic pressure by 20-30 mm Hg or diastolic pressure of 10-15 mmHg or both in two or more occasions six hours apart is diagnostic of PIH.
The extent of proteinuria varies with the degree of PIH. Oedema of pre-eclampsia may be associated with dizziness, headache, visual disturbances, facial oedema, anorexia, nausea and vomiting. In severe state of eclampsia convulsions occur near time of delivery. Optimal nutrition is the fundamental aspect of treatment.
9. Gestational diabetes mellitus:
Due to increased blood volume and corresponding metabolite load some glucose is excreted in urine. Most of these women revert to normal glucose tolerance after delivery. But they have a high chance of developing NIDDM after 40 years of age. The incidence of preclempsia is high in pregnant women with diabetes mellitus.
10. Ill effects of alcohol, caffiene, drugs and tobacco
Alcohol consumption during pregnancy leads to abnormal physical and mental development of foetus defined as Foetal Alcoholic Syndrome (FAS). Infants with FAS are premature and have low birth weight. They have distinct physical characteristics like small head, short eye slits which make the eyes looking far apart, flat mid face, thin upper lip and high evidence of central nervous system dysfunction.
Caffiene can cross the placenta and enter foetal circulation. Pregnant women who are heavy coffee drinkers are considered at risk for miscarriages, premature deliveries and may give birth to small for date infants.
Drugs used during pregnancy whether medicinal or recreational leads to numerous problems. Recreational drugs like heroin, LSD, marujuana lead to poor prenatal weight, short or prolonged labour and other perinatal problems. Self use of medicinal drugs especially during early stages of pregnancy may lead to malformation of the foetus.
Smoking during pregnancy results in placental abnormalities and foetal damage including prematurity and low birth weight. This is mainly due to reduced blood flow, which affects the oxygen and nutrient transport through the placenta.
Too early (teenage pregnancy) or too late (35 yrs and above) or too close (less than two years spacing) are not safe or conducive both to the health of the mother and infant.
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