What to expect when you're expecting (198 page)

If you’d like to feel like a natural woman during your pregnancy, look into other natural therapies that do not include ingesting anything (such as CAM treatments like acupuncture, massage, and meditation).

Once you’ve made certain that a prescribed drug is considered safe for use during pregnancy, don’t hesitate to take it because you’re still afraid it might somehow harm your baby. It won’t, but delaying treatment might.

A
NYONE WHO’S LIVED WITH A
chronic condition knows that life can get pretty complicated, what with special diets, medications, and/or monitoring. Add pregnancy into the mix, and you’ve got your hands even fuller, with the special diet needing to be tweaked, medications modified, and monitoring stepped up. Happily, with some extra precautions and extra effort, most chronic conditions are now completely compatible with pregnancy.

Just how your chronic condition will be affected by pregnancy and how pregnancy will affect your chronic condition will depend on plenty of factors, many of them uniquely yours. This chapter outlines general recommendations for pregnant women with common chronic conditions. Use this alphabetized list as a guide, but be sure to follow your doctor’s orders, since they’ve probably been tailored to your specific needs.

“I’ve had asthma since I was a child. I’m concerned that the attacks and the medication I take for them might be harmful now that I’m expecting.”

Finding out you’re pregnant can take any woman’s breath away—but when you’re asthmatic, being breathless and pregnant can understandably bring up some extra concerns. While it’s true that a severe asthmatic condition does put a pregnancy at somewhat higher risk, fortunately, this risk can be almost completely eliminated. In fact, if you’re under close, expert medical supervision—by a team that includes your obstetrician, your internist, and/or your asthma doctor—your chances of having a normal pregnancy and a healthy baby are about as good as a nonasthmatic’s (which means you can breathe a little easier now).

Though well-controlled asthma has only a minimal effect on pregnancy, pregnancy can have an effect on asthma, but the effect varies from expectant mom to expectant mom. For about a third of pregnant asthmatics, the effect is positive: Their asthma improves. For another third, their condition stays about the same. For the remaining third (usually those with the most severe disease), the asthma worsens. If you’ve been pregnant before, you’re likely to find that your asthma behaves pretty much the same way in this pregnancy as it did in earlier ones.

It’s not surprising that getting your asthma under control before you conceive or as early in pregnancy as possible is the best strategy for you and your baby. The following steps will help you do that, if you haven’t yet:

Identify environmental triggers. Allergies are a major cause of asthma, and you probably already know which ones trigger problems for you. Avoid them, and you’ll find the breathing a lot easier during your pregnancy (see
page 205
for tips on avoiding allergens). Common offenders are pollen, animal dander, dust, and mold. Such irritants as tobacco smoke, household cleaning products, and perfumes can also provoke a reaction, so it’s a good idea to steer clear of them (and, of course, you should quit smoking if you’re a smoker—ditto for your spouse). If you were started on allergy shots before pregnancy, you’ll be able to continue.

Exercise with care. If your asthma is exercise-induced, prescribed medication taken before your workout or any other kind of exertion can usually prevent an attack. Talk to your practitioner about other exercise guidelines.

Stay healthy. Try to avoid colds, flu, and other respiratory infections, which are also asthma triggers (for tips on staying well, see box,
page 505
). Your doctor may give you medication to ward off an asthma attack at the beginning of a cold, and will probably want to treat any but the most minor bacterial respiratory infections with antibiotics. A flu shot—recommended for every expectant mom—is especially important for you, as is a vaccine for pneumococcal infection, if you’re considered high risk (ask your doctor). If you suffer from chronic sinusitis or reflux—both of which are more common in pregnancy anyway—be sure to ask your doctor for a treatment plan, because both conditions can interfere with the management of your asthma.

Keep a close eye on your peak flow. Follow your doctor’s directions to make sure you’re getting the oxygen you and your baby need. Monitor your breathing with a peak-flow meter, according to your physician’s directions.

Take a fresh look at your meds. All the medication rules change when you’re expecting, so be sure you use only those that your physician has prescribed during your pregnancy. If your symptoms are mild, you may be able to get away without any medication. If they’re moderate to severe, you’ll be given one of the several medications that are considered safe during pregnancy (in general, inhaled medications appear to be safer than oral medication). Don’t hesitate to take medication that you need—remember, you’re breathing for two now.

If you do have an asthma attack, treating it promptly with your prescribed medication will help ensure that your baby isn’t shortchanged of oxygen. But if the medication doesn’t help, call your doctor or head for the nearest emergency room immediately. Asthma attacks may trigger early uterine contractions, but the contractions usually stop when the attack does (which is why it’s so important to stop it quickly).

Because of your breathing problems history, you may find the breathlessness that typically comes with late pregnancy especially concerning. But don’t worry—it’s normal, and it isn’t dangerous. Keep in mind, though, that as your growing uterus begins to crowd your lungs, you may notice that your asthmatic flare-ups worsen. Just be sure you treat these attacks quickly.

How will asthma affect your labor and delivery? If you’re considering going without medication, you’ll be happy to hear that asthma usually doesn’t interfere with the breathing techniques of Lamaze and other childbirth education methods. If it’s an epidural you have your heart set on, that shouldn’t be a problem either (but narcotic analgesics, such as Demerol, will probably be avoided because they may trigger an asthma attack). Though asthma flare-ups during childbirth are rare, your doctor will probably recommend that you continue your regular medications when you’re in labor; if your asthma has been serious enough to require oral steroids or cortisone-type medications, you may also require IV steroids to help you handle the stress of labor and delivery. Your oxygenation will be checked when you are admitted to the hospital, and if it is low, preventive medications may be given. Though some babies of moms with asthma experience rapid breathing after delivery, that’s usually only temporary.

Cancer in Pregnancy

Cancer isn’t common during pregnancy, but it happens, just as it can happen during any other time of life. Pregnancy doesn’t cause cancer or increase your chances of developing cancer. They’re just two life events, one joyous and one challenging, that sometimes take place at the same time.

Treatment for cancer during pregnancy is a delicate balancing act between providing the best treatment for the mother and limiting any possible risk to the fetus. The type of treatment you’ll get will depend on many factors: how far the pregnancy has progressed; the type of cancer; the stage of the cancer; and, of course, on your wishes. The decisions you may face in balancing your well-being against your baby’s may be emotionally wrenching, and you’ll need plenty of support in making them.

Because some cancer treatments can harm the fetus, especially during the first trimester, doctors usually delay any treatment until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait until after the baby is born to begin treatment, or they may consider inducing labor early. The reassuring news is that women diagnosed during pregnancy respond just as well to cancer treatment as women who are not pregnant, all other factors being equal.

For more help, contact the National Cancer Institute:
cancer.gov
, as well as pregnantwithcancer.org or (800) 743-4471, a support system for expectant women with cancer.

As for your asthma postpartum, chances are you’ll find your symptoms will return to the way they were prepregnancy within three months after delivery.

“I have cystic fibrosis, and I know that makes pregnancy complicated—but how complicated?”

As someone who’s lived with cystic fibrosis (CF) for her whole life, you’re already used to the challenges that the condition comes with—but you’re also used to working hard at overcoming them. And though the challenges do increase somewhat with pregnancy, there are plenty of things that you and your doctors can do to help make your pregnancy safe and successful.

The first challenge may be gaining enough weight, so working closely with your doctors to ensure that the numbers on the scale keep climbing will be important (a nutritionist may be a helpful addition to your pregnancy team). To keep a closer eye on your weight and your baby’s growth—as well as on all aspects of your pregnancy—you’ll have more frequent prenatal visits than the average mom-to-be (on the plus side, that means more chances to hear your baby’s heartbeat—and more opportunities to ask questions). Your activity may be limited, and because you’ll be at higher risk for premature delivery, additional precautions will be taken to reduce the risk and help ensure that your baby stays safely put until term. It’s also possible that periodic hospitalization may be necessary.