Pregnancy-Related Conditions As Disabilities Under the ADA
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Gestational Diabetes Insipidus, HELLP Syndrome and Eclampsia in a Twin Pregnancy: a Case Report
Journal of Perinatology (2010) 30, 144–145 r 2010 Nature Publishing Group All rights reserved. 0743-8346/10 $32 www.nature.com/jp PERINATAL/NEONATAL CASE PRESENTATION Gestational diabetes insipidus, HELLP syndrome and eclampsia in a twin pregnancy: a case report JL Woelk, RA Dombroski and PR Brezina Department of Obstetrics and Gynecology, East Carolina University, Greenville, NC, USA alanine aminotransferase, 65 U lÀ1; and lactate dehydrogenase, We report a case of eclampsia in a twin pregnancy complicated by HELLP 390 U lÀ1. A 24-h urine collection was begun to quantify proteinuria. syndrome and diabetes insipidus. This confluence of disease processes During the first night of hospitalization, the patient developed suggests that a modification of common magnesium sulfate treatment marked polyuria and polydipsia. Urine output increased to 1500 cc hÀ1 protocols may be appropriate in a certain subset of patients. by the early morning totaling 12 l for the entire night. Repeat Journal of Perinatology (2010) 30, 144–145; doi:10.1038/jp.2009.115 electrolytes were unchanged. The endocrinology service was then Keywords: diabetes insipidus ; eclampsia ; HELLP syndrome ; twin consulted for the management of presumptive DI. Therapy with the pregnancy ; magnesium sulfate administration of dDAVP (1-deamino-8-D-arginine vasopressin) orally twice daily was initiated. Serum osmolality was increased at 296 mOsm kgÀ1, and urine osmolality was decreased to 71 mOsm kgÀ1 Introduction with a specific gravity of 1.000. The 24-h urine results showed a total The association between diabetes insipidus (DI) and liver protein of 780 mg. The patient denied the previously reported dysfunction in a preeclamptic patient has been established in headaches, blurry vision and right upper quadrant pain, and her blood multiple case reports.1 This case is an important example that pressures remained 140 to 155 mmHg (systolic) and 80 to 95 mmHg illustrates how the pathophysiology of DI and the pharmacokinetics (diastolic), consistent with a diagnosis of mild preeclampsia. -
“Morning Sickness”
“Morning sickness” “Morning sickness”, which often occurs throughout the day, is a condition characterized by nausea, indigestion, and periodic vomiting during the first trimester of pregnancy. The condition varies from mild stomach upset to severe vomiting requiring hospitalization. Despite many years of study, the cause of these symptoms is unknown. Many women worry that failure to eat a full array of foods will somehow harm the fetus, but there is no cause for concern. In the era when intravenous nourishment was impossible, women with severe vomiting were treated with fluids only. Their babies were healthy and of normal birth weight. “Morning sickness” typically passes as the first trimester ends. In the meantime, the following suggestions can help: Separate solid food from liquids. Do not drink and eat simultaneously. Eat small amounts of food throughout the day. Bland foods such as bread or crackers work well. Wear acupressure bands at the pericardium 6 position of each wrist. This site is located three fingerbreadths above the wrist. Get plenty of rest and avoid stress. Avoid spicy and fatty foods. Try small dose of vitamin B6 (10-50mg three times a day). Add half a Unisom Nighttime Sleep Reliever to the B6 to concoct Benedectin, one the safest drugs for morning sickness ever developed. While the actual drug is not available in the US, experts on medications in pregnancy condone its use. If prenatal vitamins make you sick, take folic acid only (in a dose of 800 ug/day) until you feel better. Try antacids such as TUMS EX (which also contains calcium). -
Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text
Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text Welcome to the module Hypertensive Disorders of Pregnancy and Gestational Diabetes. In this module, we will be discussing hypertensive Slide 1 disorders of pregnancy, including pregnancy induced hypertension and preeclampsia. We will also discuss Gestational Diabetes as well as nutrition solutions related to these issues Slide 2 We will begin by discussing hypertensive disorders in pregnancy. There are at least 5 distinct categories of hypertension and related disorders that occur during pregnancy. These categories are: preeclampsia/eclampsia, chronic hypertension, preeclampsia Slide 3 superimposed upon chronic hypertension, gestational hypertension and transient hypertension. Each of these will be discussed individually throughout the module, with recommendations based on best practices provided. Blood pressure is the force of blood on the walls of the arteries. Systolic blood pressure is measured when the ventricles are contracting while diastolic pressure is measured when the ventricles are relaxed. Normal Slide 4 blood pressure is typically 120/80 mm Hg.The general definition of high blood pressure in adults is a systolic BP > 140 mg HG or a diastolic blood pressure > 90 mm Hg. These criteria should be used for women throughout pregnancy. Chronic hypertension often exists prior to pregnancy and continues throughout pregnancy. It may not be noticed until the second trimester of pregnancy if prenatal care is delayed or if women have suffered from prolonged nausea and vomiting or morning sickness. If hypertension is Slide 5 diagnosed in early pregnancy and persists past 6 weeks postpartum, it would be considered to be a chronic health condition. -
Role of Maternal Age and Pregnancy History in Risk of Miscarriage
RESEARCH Role of maternal age and pregnancy history in risk of BMJ: first published as 10.1136/bmj.l869 on 20 March 2019. Downloaded from miscarriage: prospective register based study Maria C Magnus,1,2,3 Allen J Wilcox,1,4 Nils-Halvdan Morken,1,5,6 Clarice R Weinberg,7 Siri E Håberg1 1Centre for Fertility and Health, ABSTRACT Miscarriage and other pregnancy complications might Norwegian Institute of Public OBJECTIVES share underlying causes, which could be biological Health, PO Box 222 Skøyen, To estimate the burden of miscarriage in the conditions or unmeasured common risk factors. N-0213 Oslo, Norway Norwegian population and to evaluate the 2MRC Integrative Epidemiology associations with maternal age and pregnancy history. Unit at the University of Bristol, Introduction Bristol, UK DESIGN 3 Miscarriage is a common outcome of pregnancy, Department of Population Prospective register based study. Health Sciences, Bristol Medical with most studies reporting 12% to 15% loss among School, Bristol, UK SETTING recognised pregnancies by 20 weeks of gestation.1-4 4Epidemiology Branch, National Medical Birth Register of Norway, the Norwegian Quantifying the full burden of miscarriage is Institute of Environmental Patient Register, and the induced abortion register. challenging because rates of pregnancy loss are Health Sciences, Durham, NC, USA PARTICIPANTS high around the time that pregnancies are clinically 5Department of Clinical Science, All Norwegian women that were pregnant between recognised. As a result, the total rate of recognised University of Bergen, Bergen, 2009-13. loss is sensitive to how early women recognise their Norway pregnancies. There are also differences across countries 6 MAIN OUTCOME MEASURE Department of Obstetrics and studies in distinguishing between miscarriage and and Gynecology, Haukeland Risk of miscarriage according to the woman’s age and University Hospital, Bergen, pregnancy history estimated by logistic regression. -
What You Need to Know About Morning Sickness What Is Morning Sickness? Morning Sickness Is Nausea And/Or Vomiting That Many Pregnant Women Experience
What You Need to Know About Morning Sickness What is morning sickness? Morning sickness is nausea and/or vomiting that many pregnant women experience. The term “morning sickness” is common, but it’s not correct, because many women have nausea and vomiting all day. The most important thing to know about nausea you may experience during your pregnancy is it’s normal. According to the American Pregnancy Association, more than 50% of pregnant women have nausea and/or vomiting. Although it’s most common during the first trimester, it’s possible to feel sick throughout the entire nine months of your pregnancy. For some women, feeling nauseous and/or throwing up are among the first symptoms of pregnancy. Most women start having nausea and/or vomiting around the sixth week of their first trimester. And some women notice their symptoms disappear around the 12th week of pregnancy or their second trimester. In general, nausea when pregnant isn’t harmful to you or the baby. However, if you can’t keep water or food down for long periods, then it can be dangerous, and you should talk to your provider about it. Common symptoms • Nausea • Vomiting • Feeling sick • Not being able to handle specific odors or foods Extreme morning sickness: Hyperemesis gravidarum Estimates are that 3% of pregnant women have hyperemesis gravidarum. This extreme nausea, vomiting and weight loss during pregnancy can be harmful to you and the baby, so you should talk to your doctor right away. If you’re not able to keep food or water down, then you could become malnourished and dehydrated. -
Gestational Diabetes Insipidus (GDI) Associated with Pre-Eclampsia
MOJ Women’s Health Case Report Open Access Gestational diabetes insipidus (GDI) associated with pre-eclampsia Abstract Volume 5 Issue 6 - 2017 Gestational diabetes insipidus (GDI) is a rare complication of pregnancy, usually developing in the third trimester and remitting spontaneously 4-6weeks post-partum. Afsoon Razavi, Muhammad Umair, Zehra It is mainly caused by excessive vasopressinase activity, an enzyme expressed by Tekin, Issac Sachmechi placental trophoblasts which metabolizes arginine vasopressin (AVP). The treatment Department of medicine, Icahn School of Medicine at Mount requires desmopressin. A 38year old G3P0A2 women with no significant medical Sinai/NYC Health+ Hospital/Queens, USA history was admitted to obstetrical service on 36th week of gestation due to significant malaise, anorexia, nausea, vomiting, polyuria, nocturia, and polydipsia, worsening Correspondence: Afsoon Razavi, MD, Department of in the 2weeks prior to presentation. Physical examination demonstrated decreased Medicine, Icahn School of Medicine at Mount Sinai/NYC skin turgor, hyperactive tendon reflexes and no pedal edema, and her blood pressure Health+Hospital/Queens, Diabetes center, 4th floor, Suit P-432, Pavilion building, Queens hospital center, 82-68 164th street, was 170/100mmHg, heart rate 67beats/min and weight 60kg (BMI 23.1kg/m2). Her Jamaica, New York, 11432, USA, Tel +8183843165, laboratory results a month prior to admission showed normal basic metabolic panel Email [email protected] and liver function tests. On admission she found to have urine osmolality112mOsmol/ kg (350-1000); serum osmolality 308mOsmol/kg (278-295); Urinalysis revealed Received: July 25, 2017 | Published: August 16, 2017 specific gravity less than 1005 with proteinuria. serum sodium 151mmol/L (135-145); potassium 4.1mmol/L (3.5-5.0); Cl 128mmol/L, urea 2.2 mmol/L (2.5-6.7), creatinine 1.4mg/dL, Bilirubin 1.3mg/dL, AST 1270 U/L, alkaline phosphatase, 717U/L, uric acid 10.1mg/dL and INR 1.1. -
Pregnancy: Morning Sickness
Managing Morning Sickness: After Your Visit Your Kaiser Permanente Care Instructions For many women, the toughest part of early pregnancy is morning sickness. Morning sickness can range from mild nausea to severe nausea with bouts of vomiting. Symptoms may be worse in the morning, although they can strike at any time of the day or night. If you have nausea, vomiting, or both, look for safe measures that can bring you relief. You can take simple steps at home to manage morning sickness. These steps include changing what and when you eat and avoiding certain foods and smells. Some women find that acupuncture and acupressure wristbands also help. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. How can you care for yourself at home? • Keep food in your stomach, but not too much at once. Your nausea may be worse if your stomach is empty. Eat five or six small meals a day instead of three large meals. • For morning nausea, eat a small snack, such as a couple of crackers or dry biscuits, before rising. Allow a few minutes for your stomach to settle before you get out of bed slowly. • Drink plenty of fluids, enough so that your urine is light yellow or clear like water. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink. -
Morning Sickness”
WHAT TO DO ABOUT “MORNING SICKNESS” For many pregnant women, “morning sickness” doesn’t just happen in the morning but comes and goes all day long. For most women this passes after the first trimester, but for 10-20% of pregnant women this unpleasantness lasts the whole nine months. Nausea and some vomiting are normal and are the body’s reaction to the surge of hormones that go with a healthy pregnancy. Although you can feel terrible, these symptoms are associated with a positive pregnancy outcome. One study found that women who threw up during their pregnancy were less likely to suffer miscarriages or stillbirths than women who didn’t. How To Best Manage Nausea and Vomiting Get plenty of fresh air! One theory is that high hormonal levels enhance your sense of smell making background odors you hardly noticed before more potent, making you feel queasy. It is often certain smells (a co-worker’s perfume, stale coffee, the fast- food restaurant you drive by) more than foods you eat that turn your stomach. Pay attention to odors that set you off and avoid them. Keep windows open as much as possible in your house. Get plenty of rest! Drink fluids between meals. Take your prenatal vitamins. Many women don’t eat well balanced meals in their first trimester which makes the nutrition supplement very important at this time. Be sure to take your vitamins with some food - you’ll be able to tolerate them better - and vitamins need food to do their jobs. Eat what you want when you want it. -
Standards of Medical Care in Diabetes—2018
Diabetes Care Volume 41, Supplement 1, January 2018 S137 13. Management of Diabetes American Diabetes Association in Pregnancy: Standards of Medical Care in Diabetesd2018 Diabetes Care 2018;41(Suppl. 1):S137–S143 | https://doi.org/10.2337/dc18-S013 13. MANAGEMENT OF DIABETES IN PREGNANCY The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. DIABETES IN PREGNANCY The prevalence of diabetes in pregnancy has been increasing in the U.S. The majority is gestational diabetes mellitus (GDM) with the remainder primarily preexisting type 1 diabetes and type 2 diabetes. The rise in GDM and type 2 diabetes in parallel with obesity both in the U.S. and worldwide is of particular concern. Both type 1 diabetes and type 2 diabetes in pregnancy confer significantly greater maternal and fetal risk than GDM, with some differences according to type of diabetes as outlined below. In general, specific risks of uncontrolled diabetes in pregnancy include spontaneous abortion, fetal anomalies, preeclampsia, fetal demise, macrosomia, neonatal hy- poglycemia, and neonatal hyperbilirubinemia, among others. -
Managing Morning Sickness | Nutrition Education Materials Online (NEMO)
My Nutrition Managing morning sickness About morning sickness • Nausea and vomiting is very common during pregnancy. For most people, it starts in the first 12 weeks of pregnancy and eases by 20 weeks. • Morning sickness may affect you at any time of the day, not only in the morning. This can make it hard to follow a balanced diet. • There are some medications that can help manage morning sickness and allow you to eat well. These include vitamin supplements (vitamin B6) and ginger tablets. It is important to discuss these with your doctor, especially if morning sickness is making it difficult to eat or drink. Tips to manage morning sickness • Eat small, frequent meals – skipping meals can make nausea worse. • It is important to stay hydrated by sippingMy fluids between meals. Drinking fluids with NutritionMy meals may fill you up and make it difficult to eat. Nutrition • Avoid drinks that are too cold. Caffeine-containing drinks like tea, coffee, softdrinks and energy drinks should also be avoided. • Choose a time when you feel well to eat. This may be 20 to 30 minutes after taking anti-nausea medication. • Choose room temperature or cold foods without strong smells. Remember to avoid foods that are high risk of Listeria in pregnancy. These include deli meats, smoked seafood, soft cheeses and leftovers that are cold or more than 24 hours old. • Iron supplements or iron in your pregnancy multivitamin may upset your stomach. Speak with your Doctor or Dietitian about this before changing your supplement. • Avoid smoking. This can make nausea worse and is harmful for you and your baby’s health. -
Screening for Gestational Diabetes Mellitus: a Systematic Review to Update the 2014 U.S
Evidence Synthesis Number 204 Screening for Gestational Diabetes Mellitus: A Systematic Review to Update the 2014 U.S. Preventive Services Task Force Recommendation Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA-290-2015-00009-I Prepared by: Pacific Northwest Evidence-Based Practice Center Oregon Health & Science University Mail Code: BICC 3181 SW Sam Jackson Park Road Portland, OR 97239 www.ohsu.edu/epc University of Alberta Evidence-Based Practice Center 4-474 Edmonton Clinic Health Academy 11405 – 87 Avenue Edmonton, Alberta, Canada T6G 1C9 Investigators: Jennifer Pillay, MSc Lois Donovan, MD Samantha Guitard, MSc Bernadette Zakher, MD Christina Korownyk, MD Michelle Gates, PhD Allison Gates, PhD Ben Vandermeer, MSc Christina Bougatsos, MPH Roger Chou, MD Lisa Hartling, PhD AHRQ Publication No. 21-05273-EF-1 February 2021 This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) and the University of Alberta EPC under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. -
Am I at Risk for Gestational Diabetes?
Am I at risk for gestational diabetes? U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH Eunice Kennedy Shriver National Institute of Child Health and Human Development What is gestational diabetes? Gestational diabetes (pronounced jess-TAY-shun-ul die-uh-BEET-eez) is a type of high blood sugar that only pregnant women get. In fact, the word “gestational” means pregnant. If a woman gets high blood sugar when she’s pregnant, but she never had high blood sugar before, she has gestational diabetes. Between 2 percent and 10 percent of U.S. pregnancies are affected by the condition every year,1 making it one of the top health concerns related to pregnancy. If not treated, gestational diabetes can cause problems for mothers and babies, some of them serious. But there is good news. Most of the time, gestational diabetes goes away after the baby is born. The changes in your body that cause gestational diabetes normally occur only when you are pregnant. After the baby is born, your body goes back to normal and the condition goes away. Gestational diabetes is treatable, and the best outcomes result from careful management and control of blood sugar levels. The best way to control gestational diabetes is to find out you have it early and start treatment quickly. Treating gestational diabetes—even if you don’t have any symptoms or your symptoms are mild— greatly reduces health problems for mother and baby. Why do some women get gestational diabetes? Usually, the body breaks down much of the food you eat into a type of sugar, called glucose (pronounced GLOO-kos).