While disease modifying therapies (DMTs) have been shown generally to reduce relapse rates, none of them are indicated for use during pregnancy and lactation. Therefore, the question of when to restart DMTs postpartum remains a difficult one for physicians counseling MS patients who wish to breastfeed their children.
Trying to predict the risk of relapse for any one individual is very difficult. The risk factors for postpartum attacks include ...
IUDs are plastic devices that are placed in the uterus by a healthcare provider. There are three products available in the U.S.:
For most parents, the newborn period is a time of profound joy, incredible challenges, and LOTS of questions. As pediatricians, some of the questions we are frequently asked are related to a simple blood test done on all infants in Washington State. Commonly referred to as the “newborn screen” or “NBS”, “PKU”, or “newborn metabolic testing”, this test checks for several congenital disorders that are rare but can be life-threatening.
Often parents want to know:
What does the test involve? The newborn screen is done by pricking the heel of the infant at around 24 hours of age, then collecting a few drops of blood onto a piece of test paper. This is dried and then sent to the state lab, where the testing is performed. Because some of the conditions may take several days to show up, the test is repeated at 7-14 days old (usually by your primary care doctor; it can also be done in the hospital if the baby is still there for any reason).
Does it hurt? The needle prick is performed by trained nurses and is done quickly. It may feel similar to pricking your finger to test blood sugar. And you can significantly decrease the discomfort of the quick poke by breastfeeding your baby during or immediately after the test!
Why do we need this? The diseases we check for are typically rare, but if undiagnosed and untreated can cause a variety of complications, including blindness, poor growth, brain damage, and even death. The reason that testing every baby is essential is that babies with these conditions can look and act perfectly healthy even while the disease is damaging their bodies, until they get so sick they need to be hospitalized or have permanent damage. Starting treatment as early as possible can prevent many of the complications.
What are you testing for? The ...
A recent study addressed the outcomes of pregnancy in women with MS who were taking fingolimod (Gilenya). Of 66 pregnancies on the medication, 41 attempted to carry the pregnancy to term. 26 of the 41 had healthy newborns. There were, 9 miscarriages, 24 elective abortion, 4 ongoing pregnancies and 1 with an unknown outcome. Of the elective abortions, four were for fetal malformations. There were 5 cases with abnormal fetal development in the 66 pregnancies. Poor fetal outcomes were found in 14.6% of the pregnancies. This contrasts with a 3% rate of poor outcomes for most pregnancies.
This paper highlights the importance of care in planning pregnancies in MS. It is now known that women with MS have ...
Labor pain is due to contractions of the muscles of the uterus and by pressure on the cervix. This can feel like strong cramping in the abdomen, groin, and back. Some women experience pain in their sides or thighs as well. Women can also feel pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina. Some find the hardest part is not the contraction itself, but the fact that the contractions keep coming.
One of the best ways to alleviate fears for women is to learn about the available strategies for coping with pain. There are both medical and non-medical tools that may be a good match for you.
While you are deciding, think about what appeals to you most. Ask your health care provider these questions:
Love also means keeping them safe.
Advances in maternal-infant health are one of the greatest success stories of the 20th century, with a drop in the death rate of 99%. But some of those dangers only stay in the past through constant vigilance. Behind every screening test and preventive measure is a careful, research-driven rationale. Here are seven newborn tests, screenings, and prevention measures you should know about:
Vitamin K injection
Vitamin K is vital for blood to clot properly. Newborns cannot make Vitamin K and it is poorly transferred in breast milk. Without this injection, babies are at risk for spontaneous bleeding from the umbilical cord, mucus membranes, even in the brain. Giving Vitamin K has greatly reduced this "hemorrhagic disease of the newborn," but rates are increasing as more parents refuse it. Oral Vitamin K has not been shown to prevent this potentially devastating disease.
Hepatitis B vaccine
This is an anti-cancer vaccine. Before this vaccine existed, approximately 10,000 kids under age 10 contracted hepatitis B each year. Most had no known exposure to it. Kids are more likely than adults to get very sick and to have complications. Vaccination at birth has greatly reduced rates of pediatric liver cancer due to hepatitis B.
Antibiotic eye ointment
This prevents bacterial eye infections. Some of these infections are associated with sexually transmitted bacteria, but not all of them are. Negative testing or a monogamous relationship does not ...
The influenza virus, better known as the flu, has been proven over and over to have the potential to cause serious disease in pregnancy. That includes an increased risk that when pregnant women “catch” the flu, they may require admission to the intensive care unit, require a ventilator and, less commonly, even death. It’s serious. Babies of women who are infected with the flu during pregnancy are more likely to be born prematurely and are at increased risk for stillbirth.
We recommend the flu vaccine at any point in pregnancy and offer the single dose, preservative free vaccine in our office to all pregnant women (with the exception of those who have a medical reason not to get it.) A common misconception is that the vaccine causes the flu - it does not. Another misconception is that it is not safe for the developing baby to be exposed to the vaccine itself or the immune response it generates. There is no evidence to support this fear in almost 50 years of administrating this vaccine and close follow up of those receiving it.
We recommend the flu shot, which is an inactivated virus. The Flumist is a live attenuated virus that is not recommended in pregnancy.
Your family members should also receive the vaccine as they can pass the flu on to a newborn who has not yet gotten the vaccine. Babies can suffer severe complications if they are infected with the virus before they can receive the vaccine.
The other vaccine we recommend during pregnancy is the Tdap booster. The benefit of the pertussis booster outweighs any perceived risk. Pertussis, or the whooping cough, is at epidemic levels especially on the west coast including Washington State. That may be ...
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