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How to control high BP in pregnancy, symptoms and cure for a healthy baby

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Pregnant women are advised ample rest and there’s a good reason for it. In fact, pregnant women undergo constant blood pressure check up so that the doctor can monitor the pressure levels throughout pregnancy. Developing high blood pressure during pregnancy is not always harmful but it could also lead to several complications. “These days high BP during late pregnancies is very common. There is also a high possibility that women have hypertension as a pre-existing condition,” says Dr Anjali Talwalkar, obstetrics and gynecology, Kohinoor Hospital.

These are some of the symptoms that you need to watch out for:

Typically, most women develop high BP during the seventh month, usually after 20 or 24 weeks. This is the time that women need to be careful and lead as healthy a life as possible. “Some of the effects include protein loss in urine, which could lead to kidney damage. At the same time fluid retention (which is very common) can lead to swollen feet,” she adds. High BP could also lead to pre-eclampsia.

According to Dr Bilsi Mittal, MS (obstetrics and gynaecology), Wockhardt Hospital, “Pregnant women should watch out for symptoms like too much weight gain, blurring of vision, turbidity of urine, severe headaches.”

Here’s what high BP means for your growing baby:

Due to the increased pressure, it directly affects the placenta. “This makes the blood vessels shrink leading to reduced blood flow for your baby. The baby can also experience severe intrauterine growth retardation,” says Talwalkar.

She adds, “Accidental haemohrage is also a complication that women should be aware of. This causes the placenta to separate from the uterus and leads to bleeding.”

High BP can be a dangerous condition because sometimes it can also lead to termination of pregnancy. “This situation is rare but occurs if the pregnant woman’s BP doesn’t come under control with treatment,” says Dr Mittal.

So, what are some of the precautionary measures?

Controlling blood pressure is very important. “It is important for mothers-to-be to ensure that they opt for early detection, which helps in better prognosis. Be regular for antenatal visits. Always follow a low salt diet and continue regular intake of calcium and iron tablets,” says Dr Mittal. Most importantly, a mother-to-be should be supported at home and at work places to help her sail through the pregnancy smoothly.

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Vaginal birth after caesarean, here’s what you need to know

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A peaceful vaginal birth with no screaming and tears is how most mothers-to-be envision their perfect birthing story. However, those who’ve given birth even once know this is far from true. Just like every newborn, every birth is different.

For mothers who’ve had a c-section, the most common question is whether they will be able to attempt a vaginal delivery after a caesarean during their previous pregnancy. Throughout evolution and culture, a vaginal birth has been given a righteous status. However, mothers should understand that every birth is unique, every situation is unique and you need to choose what’s right for you and your baby growing inside you.

Is VBAC (vaginal birth after caesarean) risky?

Recently, scientists from the University of Alberta, along with researchers from various other institutions, decided to explore the question and its probable answers. It was found that attempted vaginal birth after caesarean (VBAC) is associated with higher rates of adverse effects or death for mothers and infants.

Although absolute rates were low in mothers who attempted this type of birth. “The absolute rates of adverse maternal and neonatal outcomes are low with both attempted VBAC and elective repeat caesarean delivery,” said researcher Carmen Young. “Both are reasonable options for women in general; however, attempted VBAC continues to be associated with higher relative rates of severe adverse maternal and neonatal outcomes compared with an elective repeat caesarean delivery.”

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High BP before pregnancy may raise miscarriage risk

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High blood pressure before conception and early in pregnancy may increase the risk of pregnancy loss, even if the woman does not have a hypertension diagnosis, new research has found.

“Elevated blood pressure among young adults is associated with a higher risk of heart disease later in life, and this study suggests it may also have an effect on reproductive health,” said lead author of the study Carrie Nobles from Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) in Maryland, US.

Millimeter of mercury, or mm Hg, is the unit of measure used for blood pressure.

The findings, published in the journal Hypertension, showed that for every 10 mm Hg increase in diastolic blood pressure (pressure when the heart is resting between beats), there was 18 per cent higher risk for pregnancy loss among the study population.

The researchers also found a 17 per cent increase in pregnancy loss for every 10 mm Hg increase in mean arterial pressure, a measure of the average pressure in the arteries during full heart beat cycles.

The researcher studied more than 1,200 women who had already experienced one or two pregnancy losses and were trying to become pregnant.

The findings were similar for preconception and early-pregnancy blood pressure.

“The impact of cardiovascular risk factors starts really early in life. Physicians treating women of reproductive age should pay attention to slightly elevated blood pressure because it may have other not-well-recognised effects, such as adverse pregnancy outcome,” said senior author of the study Enrique Schisterman from NICHD.

“Preconception is a previously unrecognized critical window for intervention such as lifestyle changes that can help prevent later heart disease and may also improve reproductive health,” Schisterman said.

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Exercise before pregnancy key for healthy motherhood

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Expectant mothers who are more fit before pregnancy are at lower risk of developing gestational diabetes, a study suggests. Gestational diabetes is a condition in which women develop diabetes during the last half of pregnancy. Women with gestational diabetes are more likely to develop Type 2 diabetes after giving birth. “Women are very careful during pregnancy with what they eat and the exercise they get. But the study shows women should engage in these healthy behaviours before they get pregnant as well,” said co-author Kara Whitaker, Assistant Professor from University of Iowa.

For the study, published in the journal Medicine and Science in Sports and Exercise, the team analysed data from 1,333 women over a 25-year period (1985 to 2011) who enrolled in a National Heart, Lung, and Blood Institute study called Coronary Artery Risk Development in Young Adults (CARDIA). The women completed seven study visits after first being enrolled, reporting whether they had become pregnant or gave birth and whether they developed gestational diabetes.

The researchers also performed a fitness exam during the first study visit by testing whether the women could walk for two-minute intervals on a treadmill at increasing speeds and on steepening inclines. Over the study period, 164 women developed gestational diabetes.
Using that information, the research team determined that pre-pregnant women with high levels of fitness had a 21 per cent lower risk of developing gestational diabetes than did those with lower fitness levels.

“People interested in becoming more fit can do so by engaging in at least 150 minutes of moderate to vigorous physical activity per week — 30 minutes per day, five days per week,” Whitaker said. “Brisk walking would constitute moderate physical activity — jogging would be considered vigorous physical activity,” she added.

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Taking painkillers in pregnancy may harm baby’s fertility

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Taking painkillers during pregnancy may lower the fertility of the unborn child in later life, scientists have warned. The study identifies that these drugs may also affect the fertility of future generations, by leaving marks on DNA.

The findings add to a growing body of evidence that certain medicines, including paracetamol, should be used with caution during pregnancy.

Researchers stress that advice for pregnant women remains unchanged. Current guidelines say that, if necessary, paracetamol – also known as acetaminophen – should be used at the lowest possible dose for the shortest possible time. Ibuprofen should be avoided during pregnancy.

Scientists at the University of Edinburgh in the UK looked at the effects of paracetamol and ibuprofen on samples of human foetal testes and ovaries. They found similar effects using several different experimental approaches, including lab tests on human tissue samples and animal studies.

Human tissues exposed to either drug for one week in a dish had reduced numbers of cells that give rise to sperm and eggs, called germ cells, the study found. Ovaries exposed to paracetamol for one week had more than 40 per cent fewer egg-producing cells. After ibuprofen exposure, the number of cells was almost halved.

This is important because girls produce all of their eggs in the womb, so if they are born with a reduced number it could lead to an early menopause. Painkiller exposure during development could have effects on unborn boys too, the study found.

Testicular tissue exposed to painkillers in a culture dish had around a quarter fewer sperm-producing cells after exposure to paracetamol or ibuprofen. The team also tested the effects of painkiller treatment on mice that carried grafts of human foetal testicular tissue.

These grafts have been shown to mimic how the testes grow and function during development in the womb. After just one day of treatment with a human-equivalent dose of paracetamol, the number of sperm-producing cells in the graft tissue had dropped by 17 per cent. After a week of drug treatment, there were almost one third fewer cells.

Previous studies with rats have shown that painkillers administered in pregnancy led to a reduction in germ cells in female offspring. This affected their fertility and the fertility of females in subsequent generations. The study, published in the journal Environmental Health Perspectives, found that exposure to paracetamol or ibuprofen triggers mechanisms in the cell that make changes in the structure of DNA, called epigenetic marks.

These marks can be inherited, helping to explain how the effects of painkillers on fertility may be passed on to future generations.

Painkillers’ effects on germ cells are likely caused by their actions on molecules called prostaglandins, which have key functions in the ovaries and testes, the researchers found.

“We would encourage women to think carefully before taking painkillers in pregnancy and to follow existing guidelines – taking the lowest possible dose for the shortest time possible,” said Rod Mitchell, from University of Edinburgh, who led the research.

Dr. Rahul Pherwani
Dr. Rahul Pherwani
BHMS, 22 yrs, Pune
Dr. Amar S. Shete
Dr. Amar S. Shete
BAMS, Family Physician, Pune
Dr. Geeta Dharmatti
Dr. Geeta Dharmatti
Specialist, dietetics, 22 yrs, Pune
Dr. DHOLARIYA JAYANTILAL
Dr. DHOLARIYA JAYANTILAL
MD - Allopathy, Family Physician, 8 yrs, Ujjain
Dr. Shrikant Tile
Dr. Shrikant Tile
MBBS, Gynaecologist, 10 yrs, Pune
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