Health - Pregnant

Health - Pregnant
Women come to the GP when they want to become pregnant and it does not work quickly, to establish or confirm pregnancy and because of complaints during their pregnancy.

Health 

 

Women come to the GP when they want to become pregnant and it does not work quickly, to establish or confirm pregnancy and because of complaints during their pregnancy.

 

Medical, environmental and lifestyle factors
Health problems in pregnant women

Common health problems in pregnant women are: urinary tract infections, upset stomach, constipation, fatigue, nausea, frequent urination, vaginal discharge, fluid retention, varicose veins, back or pelvic pain and hard stomach.

 

Specific complications of pregnancy are: (maternity) hypertension and (pregnancy) diabetes. These complications are more common in women with a low SES and in women with a migrant background. Pregnant women with these complications are referred to the gynecologist.

 

Medical factors, environmental factors and lifestyle factors can influence pregnancy, pregnancy and childbirth (see box below and NHG standards for the 2014 practical assistant). Women find it important to give their child a good start. Many pregnant women therefore adjust their behavior.

 

Factors that can affect pregnancy and delivery

Medical aspects

 

  • Chronic conditions such as hypertension, thyroid disorder, asthma, diabetes or epilepsy
  • Problems with previous pregnancies
  • Hereditary disorders
  • Blood relationship
  • Medicine use

 

Environmental factors

 

  • Working conditions
  • Infection risks
  • Living conditions

 

Lifestyle factors

 

  • Smoking
  • Overweight
  • Alcohol consumption
  • Drug use

 

Weight

Women with severe overweight (BMI> 30) have more difficulty getting pregnant and are more prone to complications during pregnancy and childbirth.

 

Vitamins and minerals

About half of the women use folic acid from the moment they try to become pregnant. Folic acid lowers the chance of an open spine (spina bifida). From the moment they know that they are pregnant, more women try to eat healthy. However, less than half of the pregnant women use the recommended vitamin D tablets (10 micrograms per day). Half of the non-western pregnant women and their babies have a vitamin D deficiency. Vitamin D is necessary for healthy (bone) growth and for the defense of the baby. With vitamin D deficiency, the risk of complications with colds (infection with RS virus) is greater.

 

The advice is to use food with at least 1 gram of calcium per day.

 

To smoke

Many pregnant women stop smoking; about 6%, however, continues to smoke. Smoking and second-hand smoke increases the likelihood that the child has a low birth weight, is born prematurely or develops respiratory problems. There are indications that the child is more susceptible to addiction and more likely to develop development disorders. Smoking also increases the chance of the placenta working poorly or releasing it prematurely and that the membranes break too early (http://www.rokeninfo.nl).

 

Alcohol and drugs

Alcohol consumption during pregnancy increases the risk of brain damage and developmental delay in the baby and can sometimes lead to fetal alcohol syndrome (FAS).

 

The consequences of drug use differ per type of drug. The use of heroin, cocaine (crack) and amphetamine is very harmful to the baby. It leads to low birth weight, preterm birth and addiction symptoms in the baby. The consequences of cannabis use in pregnancy are less clear. A low birth weight and preterm birth can also be related to the lifestyle of pregnant women who use cannabis (poor diet, irregular life, smoking cigarettes).

 

Medicines

Pregnant women sometimes use self-care medicines, such as painkillers. Paracetamol is the only painkiller that a pregnant woman can use safely without advice from the doctor, midwife or pharmacist. She must then adhere to the advice in the package leaflet. In addition, 80% of pregnant women use one or more prescribed medicines. The use of medicines that they have been using for a long time, such as anti-migraine, epilepsy and rheumatism, is declining. This also applies to medicines for occasional or short-term use, such as painkillers. Pregnant women with health problems related to their pregnancy use more medicines.

 

Harmfulness of medicines per pregnancy period

0 Weeks 1st Day last menstruation  
<2 Weeks For conception Some means are (or still) harmful to conception. This applies to medicines that are removed from the body very slowly (long half-life)
2 Weeks Conception  
2-4 Weeks Implantation There is little contact in this period between the mother's blood and the fruit that is implanted; after all, there is no placenta yet. If a harmful substance from the mother's blood ends up in the fruit, there are two possibilities: the damage is so great that a miscarriage occurs, or: the fruit is not damaged and continues with its development.
4-10 Weeks Construction of the organs When medicines enter the unborn child via the placenta, they can disrupt the construction of organs. That is called the teratogenic effect
10-40 Weeks Growth and maturation The organs are laid out; harmful substances that end up in the unborn child can especially disrupt the function of the organ that is developing. This is officially called a toxic effect, but sometimes it is also called a teratogenic effect

 

Of the medicines prescribed in the first three months of pregnancy, over 2% may be harmful to the baby. Whether the baby is actually harmed by a drug depends on three factors:

 

  1. The moment in the pregnancy when the woman uses the drug.
  2. The dose of the drug and how long the woman has used the drug. In general, the higher the dose and the longer the medicine is used, the greater the risk of harm to the unborn child, although there are exceptions.
  3. The properties and the administration form of the product. The chemical properties of a drug determine whether it passes easily through the placenta. In addition, the form of administration of a drug also plays a role in the concentration achieved in the blood.

 

Classification of harmfulness of medicines during pregnancy

There are different ways to describe the harmfulness of medicines during pregnancy and then to divide them.

 

Classification of medicines in pregnancy

Rating Example Explanation
Can be used

 - Paracetamol

 - Amoxicillin

These medicines have been studied or used in practice. There are no more birth defects or other harmful effects
Weighing up utility for mother against risks to the baby when used: control

 - Temazepam

 - Paroxetine

 - Carbamazepine

These drugs probably have pharmacological effects on the baby and are likely to increase the chance of birth defects and permanent damage to the baby
Stop (temporarily do not use)

 - Diclofenac

 - Chloramphenicol

 - Tetracycline

 - Isotretinoin

Valproic acid

These medicines can have pharmacological effects on the baby and increase the chance of birth defects and permanent damage to the baby
To weigh; rather a means of which more is known

 - Cholesterol-lowering agents

 - Pantoprazole

 - Newer SSRIs

Of these medicines too little information is available to determine the risks to the pregnancy and the baby

 

Classification of medicines during breastfeeding

Rating Example Explanation
Can be used

 - Amoxicillin

 - Paracetamol

 - Breastfeeding and drug safely combine
Restrict use

 - Oxazepam

 - Codeine

 - Breastfeeding and / or medicine

 - Dosage and / or frequency as low as possible; otherwise, stop breastfeeding temporarily

Weigh

 - Sumatriptan

 - Omeprazole

 - Usefulness for the mother to weigh against the risks for the baby

 - Prefer to choose a safer medicine; otherwise (temporarily) limit or stop breastfeeding

Stop

 - Glimepiride

 - Quinolones

 - Breastfeeding and medication can not be combined safely

 - Prefer to choose a safe medicine; otherwise, stop breastfeeding (temporarily)

 

If medicines are necessary or desirable during pregnancy or during breastfeeding, the following rules apply:

  • The patient must receive good information about the risks that the medicine entails.
  • The doctor preferably chooses a medicine with which there is already a lot of experience and where up to now there are no indications for a higher risk of congenital abnormalities.
  • If possible: do not prescribe for long-term use, do not prescribe high doses and do not prescribe a combination of medicines. The treatment must of course be effective. That is the consideration that the doctor makes in consultation with the pharmacist.

 

Oral health

The old saying 'every pregnancy costs a tooth' is fortunately not true. But during pregnancy the chance of gum problems and caries increases. Good oral care is therefore important, especially when the pregnant woman suffers from (morning) nausea and vomiting.

 

There is little evidence that X-rays of the teeth and anesthesia for a dental procedure are harmful to the mother or child. However, a dentist will prefer not to perform these actions with a pregnant woman if they are not necessary.

 

Screening and early diagnosis

Pregnant women can be screened for risks of Down's syndrome and an open back through the combination test (blood test and neck fold measurement via ultrasound). The test will be reimbursed if there is a medical risk; otherwise, women have to pay the test themselves. If the test shows an increased risk, the pregnant woman is eligible for the NIPT (non-invasive prenatal test, http://www.meerovernipt.nl/), the chorionic test or an amniotic puncture. With the NIPT the syndrome of Down can be detected, as well as other syndromes caused by a different number of chromosomes. Since 2017, all pregnant women can opt for a NIPT, but they have to pay a personal contribution. In 20 weeks of pregnancy, ultrasound examinations for organ abnormalities take place in all pregnant women.