Pregnant Health

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Title: | Overview of pregnancy health | Pregnancy process and periods | Follow-up stages and importance in pregnant health | Routine tests during pregnancy | Pregnant education in pregnancy health | Oral and dental health during pregnancy, periodontal awareness | The importance of nutrition in pregnant health | Recommended supplements during pregnancy | Diseases that threaten the health of pregnant women and their treatments | "Diabetes" is the biggest threat to pregnant women's health | Safe use of medicines during pregnancy | Vaccine use in pregnancy and approach to vaccination | Pregnancy misconceptions | What can be done for a healthy pregnancy?

Overview of pregnancy health

Do you know how important physical activities, dietary habits, stress, and other factors during pregnancy are for pregnant women's health? Pregnant women's health is a sensitive and important process for problems that may occur after childbirth. Daily routines, changing hormone levels, mood swings, etc. affect the health of the pregnant woman. Medications used during pregnancy, food supplements, oral care, pregnancy monitoring and education are important priorities. Let's take a more detailed look at the pregnancy process together.

Pregnancy process and periods

An ideal pregnancy is on average 40 weeks or 280 days. Premature birth is when the baby is born before the 37th week of pregnancy. We can divide the pregnancy process into 3 equal periods of 3 months. These 3-month periods are called trimesters. As the trimester progresses, the risk and side effects of the drugs used may change. The risk of teratogenicity is highest during the embryonic period (between the 4th and 8th week). This risk is lower in the first 3 weeks and fetal period (from the 9th week until birth). Teratogenicity refers to abnormal conditions and defects in the fetus caused by chemical or environmental agents.

Follow-up stages and importance in pregnant health

The main purpose of pregnancy monitoring is to determine the health status of the pregnant woman and the baby and to create an appropriate care plan. Pregnancy follow-up consists of 4 stages. 1st follow-up is performed at 0-14 weeks, 2nd follow-up at 18-24 weeks, 3rd follow-up at 30-32 weeks, 4th follow-up at 36-38 weeks. General condition is evaluated. Monitoring includes height-weight measurement, blood pressure monitoring, control of anemia findings, evaluation of the appropriateness of the gestational week and uterus size, risk assessment for risky pregnancies, various laboratory tests, information and counseling, nutrition, and supplementation recommendations. As a result of these follow-ups, complications that may occur in the pregnant woman and the baby during pregnancy can be prevented or detected. In addition, women who want to become pregnant can be provided with pre-pregnancy counseling services to have a healthier pregnancy process.

Routine tests during pregnancy

Failure to perform the tests that should be performed during pregnancy negatively affects both the health of the pregnant woman and the health of the baby. Routine tests that should be done during pregnancy;

• Beta-HCG test

• Determination of blood groups

• Complete blood count

• HbA1c

• TIT (Complete urinalysis)

• Urine culture

• Thyroid functions

• Infection screening tests

- Toxoplasma, Cytomegalovirus (CMV), Rubella IgG and IgM antibodies

- Hepatitis B and C

• Binary test

• First trimester detailed USG examination

• Triple test

• Quadruple test

• Maternal plasma cell-free DNA testing

• Second trimester Doppler USG

• PPG and OGTT tests

The beta-HCG test is a biochemical confirmation of pregnancy. The double test, usually performed in the first trimester of pregnancy, determines the baby's risk status for down syndrome or other chromosomal genetic disorders. In the quadruple test, the baby is examined for down syndrome, neural tube defects, trisomy 18 and spina bfida. The HbA1c test shows glucose levels over the last 3 months and is important in identifying diabetes. Another more effective test for diabetes is the OGTT test, or oral glucose loading test. All pregnant women in their 6th month should have this test. Regular blood pressure measurement and weight monitoring should be done for pregnant women's health. Blood pressure and blood sugar should be stable and blood pressure should be checked until the 12th week of pregnancy at the latest.

Pregnant education in pregnancy health

Another important issue is education in pregnant health. By educating the pregnant woman, many factors that can threaten her health can be prevented. Comprehensive education on nutrition, supplements and weight gain can be provided. Pregnant women can be made more conscious by providing information on avoiding smoking, alcohol, and substances with high risk of addiction, light exercises, vaccinations, oral care and protection against infections. In terms of protection from infections, sexually transmitted diseases can be prevented by using condoms, toxoplasma can be prevented by limiting the consumption of raw meat, vegetables and fruits contaminated with soil, cytomegalovirus (CMV) can be prevented by paying attention to hand hygiene and reducing the use of common objects with young children, varicella can be prevented by stopping contact with people who have varicella and Zika virus can be prevented and protected by limiting travel to risky areas.

Oral and dental health during pregnancy, periodontal awareness

One study examined "Knowledge, Awareness and Behaviors of Postpartum Mothers Regarding Oral and Dental Health and Periodontal Disease during Pregnancy" and concluded that women reported changes in periodontal health status during pregnancy compared to the pre-pregnancy period and that most women had inadequate knowledge and awareness of periodontal disease, pregnancy and birth outcomes. Pregnant women need more information on oral disease prevention and oral health education programs. Intensification of oral hygiene practice instructions may play an important role in reducing the symptoms of gingivitis during pregnancy. It has been reported that oral health education programs to be implemented in pregnancy follow-up and maternity care centers can change the effects on the behavior of pregnant women, but further studies are needed to evaluate the long-term effects. As a result of this study, we can see that pregnant women do not have adequate education on oral and dental health. Pregnant women should be reminded that oral and dental care is important in pregnant women's health, the use of medication in any dental disease that may occur during pregnancy should be minimized for the health of the mother and the baby and the importance of education on this issue should be emphasized.

The importance of nutrition in pregnant health

All pregnant women require nutritious diets with adequate energy, protein, vitamins and minerals to ensure a healthy pregnancy and a healthy outcome. Meeting these nutritional needs during pregnancy may require an approach that includes counseling about adequate and balanced nutrition, monitoring of appropriate weight gain and micronutrient supplementation. The mother's habits, lifestyle and diet during pregnancy are important for her health and that of her baby. The main goal of adequate and balanced nutrition is to provide the energy and nutrients needed for the growth and development of the baby while maintaining the nutrient stores of the pregnant woman. There are studies showing that the use of probiotics or consumption of probiotic-containing foods during pregnancy doesn't harm or benefit the baby, but is significantly beneficial to the health of the mother. High amounts of caffeine consumption should be avoided during pregnancy. Pregnant women should avoid nicotine and alcohol for their own health and the health of the baby.

According to the American Academy of Pediatrics, the nutrition of mother and baby during the first 1000 days of life is crucial. The first 1000 days represent a critical period from the beginning of pregnancy until the child's second birthday. During the first 1000 days, developmental activity is at its peak. Since nutrient values and amounts are extremely important for healthy growth and development, immune system formation and brain development during this period, it is important to ensure that mothers and their babies receive the nutrients and support they need. Foods rich in zinc, iron, protein, folic acid, iodine, and vitamins can be consumed.

Recommended supplements during pregnancy

Supplements, also referred to as supplements or food supplements, refer to the direct intake of vitamins and minerals in formulations such as tablets, capsules. The use of vitamin and mineral supplements has led to a reduction in clinical conditions characterized by deficiencies in pregnant women. Anemia and iron deficiency are frequently seen in pregnant women and these deficiencies should be brought to normal levels. Folic acid deficiency in pregnant women adversely affects the mental development of the baby. Pregnant women should take vitamin D supplements in case of low sun exposure and vitamin D deficiency in the body. Folic acid, iron and vitamin D should be among the supplements that must be taken during pregnancy. The first of these supplements, folic acid, should be used to prevent neural tube defects in the baby. Although folic acid supplementation during pregnancy is not for therapeutic purposes, it should be given for prophylaxis. It is recommended in the first 12 weeks of pregnancy and high doses of folic acid are required in pregnant women with epilepsy. Another supplement is vitamin D. In Turkey, the use of vitamin D during pregnancy is encouraged within the scope of the "Ministry of Health Vitamin D Support Program for Pregnant Women".

Iron deficiency, the most common nutritional disorder, can cause anemia in pregnant women. This is because iron is necessary for blood production. Iron should be started from the 2nd trimester of pregnancy and continued for some time during lactation. To reduce the side effects of iron, pregnant women can take iron supplements with orange juice or vitamin C. Multivitamin therapy is usually recommended for pregnant women who have problems with weight gain or pregnant women living in low-income countries. Taking more than a certain dose of vitamin A carries the risk of teratogenicity. Therefore, multivitamins containing vitamin A should be taken with caution. Pregnant women should consume fresh fish 2-3 times a week. It reduces the risk of preterm birth with the omega-3 fatty acid it contains. However, consumption of canned tuna by pregnant women may be risky because tuna is a deep-sea fish and the number of heavy metals it contains is uncertain.

Diseases that threaten the health of pregnant women and their treatments

Although nausea and vomiting, I mean morning sickness, may not seem very serious, severe pregnancy vomiting can cause fluid and electrolyte loss in pregnant women and cause related health problems. Ginger can be used as a non-drug treatment to prevent nausea. Constipation can be prevented by exercising. Hypertension in pregnant women can cause premature birth. Hypertension occurs in 2 forms. Hypertension that occurs in the first 3 months of pregnancy (chronic hypertension) and gestational hypertension due to pregnancy that develops after the 20th week. As a result of gestational hypertension, successive contractions called preeclampsia may occur in pregnant women. Severe contractions may cause placental insufficiency because of increased blood pressure and may lead to the death of the baby. Therefore, medication is strongly recommended in high-risk patients. Major depression and bipolar disorders can also occur in pregnant women. In the treatment of these diseases, medication is generally not recommended, electroconvulsive therapy is safe and effective. Another disease that threatens the health of pregnant women is diabetes. Let's examine diabetes in detail.

"Diabetes" is the biggest threat to pregnant women's health

There are 2 types of diabetes risk in pregnant women. These are diabetes that can occur at the beginning of pregnancy and gestational diabetes that occurs due to pregnancy. The first choice and safe drug in diabetes is insulin. In a study conducted in Norway for gestational diabetes, the prevalence of GDM in pregnancy increased from 2.6% in 2010 to 6.0% in 2016 and then stabilized, reaching 6.3% in 2020. A similar pattern was seen across BMI, age and education strata. In general, prevalence increased with higher BMI, higher age and lower education, and prevalence also increased in parallel with the rise in obesity and Type 2 Diabetes. In recent years, maternal vitamin D deficiency has also been recognized as an important risk factor for GDM. The risk of congenital anomaly in gestational diabetes is lower than in normal diabetic pregnant women, but pregnant women with gestational diabetes have a high risk of developing type 2 diabetes later in pregnancy. Therefore, it is recommended that they be tested at least every 3 years for life. In conclusion, gestational diabetes may be associated with adverse pregnancy outcomes such as having a large-for-gestational-age baby, cesarean delivery, preterm delivery, low apgar score and macrosomia.

Safe use of medicines during pregnancy

Pregnant women may be exposed to medication during pregnancy for the treatment of long-term conditions or acute illnesses. Drug safety is therefore a major concern for the fetus and mother. Non-steroidal anti-inflammatory drugs (NSAIDs) should not be used in the last 3 months of pregnancy, i.e. in the 3rd trimester. Patent ductus arteriosus (PDA) is a vessel between the anterior left pulmonary artery and the aorta that should close after birth. However, PDA may close early or not close at all because of NSAID use in the last trimester of pregnancy. Antidepressants and antipsychotics are considered first-line drugs in the treatment of depression and are second line after psychotherapy in pregnancy. Up to 20% of women experience depression during pregnancy and pregnant women with untreated depression are at high risk of poor obstetric and neonatal outcomes. Symptoms of depression during pregnancy can occur in any trimester. The use of antipsychotic drugs in the last trimester of pregnancy can be dangerous and their safety at this stage is controversial. The use of antiepileptics, antihypertensives, antidiabetic drugs and antibiotics during pregnancy may cause side effects and adverse outcomes.

Vaccine use in pregnancy and approach to vaccination

Tetanus and diphtheria vaccines can be administered if the pregnant woman has not been vaccinated in the last 10 years. ACOG recommends that all pregnant patients receive a Tdap vaccine during each pregnancy to prevent pertussis in infants, as the pertussis vaccine series doesn’t start until 2 months of age. Hepatitis A and B vaccine can be given if necessary. Flu (influenza) vaccine is also recommended. Vaccines not recommended during pregnancy are mumps, measles, rubella, and varicella vaccines. In a study, a large group of pregnant patients were followed up after inactivated influenza vaccination. It found no link between vaccination and adverse pregnancy outcomes, including caesarean section, preterm birth or medical conditions of infants up to 6 months of age. In addition, influenza vaccination during pregnancy was associated with a reduced risk of preterm birth and low birth weight babies. Despite the importance of vaccination, rates of influenza vaccination in pregnant women are low. Environmental factors and people can influence the decisions of patients considering influenza vaccination. Vaccination can play an important role in protecting pregnant women and infants from the disease and should be emphasized.

Pregnancy misconceptions

1. Gynecological examination during pregnancy is harmful and causes miscarriage.

Gynecological examination does not trigger miscarriage. A gynecological examination is recommended at the beginning of pregnancy. The examination may reveal genital infections and genital pathology that need to be treated.

2. Frequent ultrasound is harmful to the baby.

Ultrasound works with sound waves that the human ear cannot hear. Since there is no evidence to date that these sound waves damage living tissue, it can be said that ultrasound during pregnancy doesn’t harm the expectant mother or the baby.

3. Medication cannot be used during pregnancy.

In some cases such as nausea-vomiting, upper respiratory tract infection, urinary tract infection, stomach complaints that develop during pregnancy, many drugs that have been found to have no negative effects on the baby can be used safely.

4. Sexual intercourse during pregnancy is harmful.

Sexual intercourse during pregnancy is not objectionable unless there is a problem during pregnancy and there are some special conditions.

5. Cell phones, microwaves, computer monitors, and security doors can harm pregnancy.

Security doors work with a metal detector. There is no X-ray beam. It is therefore not harmful to pass through security gates.

Cell phones, computer monitors and microwave ovens; there have not been enough scientific studies on the harm of the waves of these devices on the human body and pregnancy. Since the rays emitted from computers are not ionizing, it is thought that they will not have a negative effect on pregnancy.

6. Sports are harmful during pregnancy.

There is no evidence that sports have a negative effect on the course of pregnancy. Restriction of movement is not recommended in a routine and well-running pregnancy.

7. Misconceptions about nutrition, some foods should not be consumed because they cause miscarriage.

Some pregnant women are prejudiced against certain foods due to social pressure, beliefs and values and do not consume them during pregnancy. Therefore, they can’t get enough of the nutrients they need. Pregnancy is a period when physiological nutrient needs increase considerably. Balanced and adequate nutrition is very important to meet the increasing needs of the mother and to prevent "nutritional stress".

What can be done for a healthy pregnancy?

• Pay attention to a healthy and balanced diet.

• Supplements recommended by a doctor or pharmacist should be used regularly.

• Do not stay sedentary for a long time, exercise regularly.

• Daily caffeine consumption should be within a certain limit.

• Addictive substances such as smoking and alcohol should be avoided.

• Pay attention to weight gain to prevent the risk of diabetes.

• The use of medication should be within the doctor's advice and knowledge.

• Fiber foods can be consumed against constipation and hemorrhoids.

• Necessary oral and dental care should be done before conception.

• Before conception, pregnancy education should be carried out for the health of both the baby and the pregnant woman.

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