DOCSLIB.ORG

Pregnancy and Childbirth with Neuromuscular Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pregnancy and Childbirth with Neuromuscular Disease Pregnancy and Childbirth with Neuromuscular Disease by Margaret Wahl, Amy Labbe and Miriam Davidson aving a baby can be the most thrilling and rewarding experience of a woman’s Hlife, yet it also can be fraught with fear and uncertainty. This is especially true for women with neuromuscular disease. This special MDA report takes a look at the issues that arise for expectant mothers with muscle disease and finds that, with proper care and planning, these women are usually — although not always — able to have successful pregnancies and give birth to healthy children. The report contains information from the July-September 2010 issue of MDA’s Quest magazine, as well as additional information not found in the print magazine. Contents include: Caution, Preparation and Teamwork Lead to the Best Pregnancy Outcomes in Women with Neuromuscular Diseases. 2 Disease-Specific Complications (chart). 7 Good Advice from Women Who’ve Been There. ..11 Medication Complications for Pregnant Women with Neuromuscular Disease (chart). 17 Personal Stories Diagnosis Later in Life. 3 Baby Born with Challenges. 4 Scared and Worried. 6 Achieving All Her Goals . 9 Worth the Effort . 10 The Nurse Called It ‘Fred’s Ataxia’. 12 A Turn of Fate. 15 Surprise Pregnancies. 16 In addition, listen to a podcast of an interview with neurologist Emma Ciafaloni and obstetrician Eva Pressman by going to quest.mda.org/podcasts. 1 Caution, Preparation and Teamwork Lead to the Best Pregnancy Outcomes in Women with Neuromuscular Diseases hen Emma Ciafaloni was prepar- veyed reported worsen- Wing to become a neuromuscular ing of FSHD symptoms disease specialist in the 1990s, and that for the most part did even when she directed the MDA not resolve after child- neuromuscular disease clinic at Duke birth. The most common University in the early 2000s, she was problems were, in order struck by the lack of information she of frequency: worsening could offer patients who wanted to of generalized weakness, become pregnant. frequent falling, difficulty “I really have an interest in women carrying the newborn and neuromuscular diseases, in what due to worsening shoul- we can do better for them in dealing der weakness, worsening with their neuromuscular disease and or new-onset pain, and also with pregnancy,” says Ciafaloni, difficulty carrying the now at the University of Rochester newborn due to worsen- Medical Center, where she sees patients ing of leg weakness. An echocardiogram to evaluate heart function prior to becoming pregnant can help with decision making. in the MDA clinic and has received Despite some child- MDA research support. birth complications and possible per- First, some red flags: “I’m very interested in how to best manent worsening of their FSHD, 90 care for patients. I’m not the one who’s percent of the women said they would Cardiac involvement going to discover the treatment for choose pregnancy again. Cardiac involvement can occur in many FSHD [facioscapulohumeral muscular Eva Pressman, director of maternal- neuromuscular diseases and, if it’s dystrophy] or myotonic dystrophy, but fetal medicine at the University of severe, can be a major problem for I’m very interested in good standards Rochester, collaborated with Ciafaloni women considering pregnancy. of care.” and others on the FSHD study. “The Pregnancy leads to a significant Ciafaloni’s interest ultimately led her important thing about our study was increase in cardiac output, as well as a to collaborate with several colleagues that the outcomes were really good,” 50-percent increase in blood volume, in the departments of neurology and she says. “It’s important for patients so the heart does “much, much more obstetrics and gynecology to conduct to know that just because they have an work,” says Pressman. “And if you go a study of pregnancy in women with underlying disorder, that doesn’t mean into the pregnancy with a heart that’s FSHD. The results were published in that pregnancy is contraindicated. With functioning less than optimally, it will 2006 in the journal Neurology. appropriate monitoring and going into clearly deteriorate over the course of The researchers administered ques- the pregnancy with your eyes open as the pregnancy. That can lead to heart tionnaires to, and reviewed the medical to what the risks might be, I think most failure in the mother and endanger both records of, 38 women with FSHD. On patients can be quite successful.” the mother and the fetus, depending the whole, pregnancy outcomes were But not all neuromuscular disorders, on when in the pregnancy those issues good in this group, although the rates let alone all women or all babies, are occur. The most common time for heart of operative deliveries (Caesareans the same. And even with conditions problems is the end of the second and forceps deliveries) and babies with like FSHD, where the odds of having a trimester or the beginning of the third low birth weights were higher than the successful outcome appear to be good, trimester.” national average. there are steps women can take to Pressman strongly recommends About one in four of the women sur- improve them. that patients who are at risk for cardiac 2 dysfunction have echocardiograms existing impairment can become more before pregnancy to evaluate their problematic. heart function and “really consider not “We see women who have reason- becoming pregnant if they have signifi- able respiratory function prior to preg- cant cardiac dysfunction.” nancy that deteriorate as the pregnancy And if they’re already pregnant and progresses,” Pressman says. They want to continue the pregnancy despite generally recover to their pre-pregnancy their heart problem? “Then you do the level after delivery, she notes, but they best you can,” Pressman says. “You may require extra support (such as can manage some of it with medica- noninvasive assisted ventilation) during tions, you can keep their fluid status the pregnancy. at an optimal level, and we can usually Says Pressman, “We often end up get them through to the point where delivering a little bit early, because the the baby is viable. But often we deliver respiratory impairment only gets worse these patients early, to minimize the towards the end of pregnancy, and stress on the heart.” sometimes the safest thing is to not be pregnant anymore.” Immunosuppressant medications that aren’t Weak respiratory muscles corticosteroids can pose some problems. See Weakness of the respiratory muscles Unstable autoimmune disease “Medication Complications for Pregnant Women with Neuromuscular Disease” on page 17. can also be a problem for pregnant It’s critical that women with autoim- women with muscle disease. As the mune disease are medically stable and they try to get pregnant, says Hannah pregnancy progresses, the work of on a stable regimen of medications Briemberg, a neurologist and assistant breathing becomes harder, so any for at least six to 12 months before professor in the neuromuscular dis- Diagnosis the natural way and almost lost her,” Rivera recalled. “I had to Late in Life have an emergency C-section [Caesarean], and she had to be resuscitated.” During her second pregnancy at age 33, Rivera’s still-undi- Kathy Rivera, 58 agnosed CMT noticeably worsened. Her legs were so sore when Tucson, Ariz. she woke up that she couldn’t get out of bed. “We put the bed type 2 Charcot- next to the wall so I could climb up the wall to get to a standing Marie-Tooth disease position. I thought, ‘I’m not having any more kids.’” As with her first pregnancy, Rivera had high blood sugar. Her ike many people son was born healthy via a planned C-section. with Charcot- L Rivera’s symptoms continued to worsen, and it was her Marie-Tooth (CMT), Kathy Rivera, her husband, Tom, and their two daughter who convinced her to see a neurologist. “My 6-year-old Kathy Rivera didn’t children, in 1985 said to me, ‘Mom, why don’t you pick up your feet?’” realize she had a neuro- Today, Rivera wears braces on both legs and no longer muscular disease until relatively late in life. Called “clumsy” as a works. She loved her job as a bakery manager at Safeway, but child, she wore special shoes to keep her feet facing forward, but her doctor advised her to quit. In recent years, Rivera has devel- didn’t receive an official diagnosis of CMT until age 36. oped nerve compression requiring surgery in both wrists (likely Rivera received almost no medical care growing up, which related to CMT) and spinal cord inflammation (which may or partially explains the late diagnosis. She moved a lot, spent time may not be related to CMT). in foster care and was raised primarily by an uncle. Her symp- Rivera believes her now-adult daughter may have CMT too, toms were shrugged off as “growing pains.” although she’s never been tested. Her daughter decided not to Rivera married and had her first child, a healthy girl, at age have children, but instead adopted a little girl. In an ironic twist, 27. For reasons probably unrelated to CMT, Rivera had high Rivera’s adopted grandchild has muscle problems and is being blood sugar during the pregnancy and, during the birth, her tested at the MDA clinic in Tucson for possible neuromuscular cervix (entrance to the uterus) didn’t open. “I tried to give birth disease — receiving the care and attention that Rivera never did. 3 Baby Born with from muscle weakness). She almost didn’t survive her first night Challenges and had to be rushed to a hospital that had a neonatal intensive care unit, where she spent six weeks before her parents could Liz Trumpy, 39 take her home.
Load more

Recommended publications
  • Childbirth Education Booklet
    Childbirth Education Contents Normal Discomforts of Pregnancy 2 Call Your Doctor 4 Late Pregnancy 5 Labor: Stage 1 6 Labor: Stages 2 & 3 8 Breastfeeding in the Hospital 9 Breathing Techniques 10 Birth Plans 10 Labor Positions 11 How Your Partner and Doula Can Help 13 Packing for the Hospital 15 Normal Discomforts of Pregnancy Fatigue Backache • Listen to your body, take naps, get extra rest • Maintain correct posture • Do pelvic tilt exercises while standing and on hands Stuffy Nose and knees • Warm compresses to nose • While on all fours, crawl forwards and backwards, • Cool mist humidifier in your home or rock, and do pelvic tilts bedroom at night • When picking up something lift with your legs to protect your back Shortness of Breath • Don’t stay that way, slow down and catch your breath • For prolonged standing, elevate 1 foot on a step stool • Sleep propped up with pillows or in recliner • Receive back massages • Maintain correct posture Dribble Urine • Moderate intensity exercising (walking, stationary • Do Kegel exercises – at least 50 a day bike, swim, flexibility moves) (do 10 every time you wash your hands) • How can you tell if you are dribbling urine or your Heartburn/Nausea water broke? Call your OB or midwife, and remember • Don’t eat 3 big meals a day, eat 5-6 smaller meals this acronym: • Drink 8 cups of water a day COAT. C=color, O=odor, A=amount, T=time. • Have dry crackers/cereal to nibble on–keep in purse and at bedside • Don’t let stomach become empty • Eat well balanced diet–vitamin B may help to decrease • Avoid
    [Show full text]
  • The Effects of Alcohol in Newborns Efeitos Do Álcool No Recém-Nascido
    REVIEW The effects of alcohol in newborns Efeitos do álcool no recém-nascido Maria dos Anjos Mesquita* ABSTRACT alcoólicas leva a prejuízos individuais, para a sua família e para The purpose of this article was to present a review of the effects toda a sociedade. Apesar disso, a dificuldade do seu diagnóstico e of alcohol consumption by pregnant mothers on their newborn. a inexperiência dos profissionais de saúde faz com que o espectro Definitions, prevalence, pathophysiology, clinical features, diagnostic dessas lesões seja pouco lembrado e até desconhecido. As lesões criteria, follow-up, treatment and prevention were discussed. A causadas pela ação do álcool no concepto são totalmente prevenidas search was performed in Medline, LILACS, and SciELO databases se a gestante não consumir bebidas alcoólicas durante a gestação. using the following terms: “fetus”, “newborn”, “pregnant woman”, Assim, é fundamental a detecção das mulheres consumidoras “alcohol”, “alcoholism”, “fetal alcohol syndrome”, and “alcohol- de álcool durante a gravidez e o desenvolvimento de programas related disorders”. Portuguese and English articles published from específicos de alerta sobre as consequências do álcool durante a 2000 to 2009 were reviewed. The effects of alcohol consumed by gestação e amamentação. pregnant women on newborns are extremely serious and occur frequently; it is a major issue in Public Health worldwide. Fetal alcohol Descritores: Bebidas alcoólicas/efeitos adversos; Feto; Recém-nascido; spectrum disorders cause harm to individuals, their families, and the Síndrome alcoólica fetal; Transtornos relacionados ao uso de álcool entire society. Nevertheless, diagnostic difficulties and inexperience of healthcare professionals result in such damage, being remembered rarely or even remaining uncovered.
    [Show full text]
  • Local Control of Human Umbilical Vessel Tone
    LOCAL CONTROL OF HUMAN UMBILICAL VESSEL TONE. Thesis submitted to the University of London for the degree of Doctor of Philosophy in the Faculty of Science. by Anita-Jane Sexton B.Sc. (Hons.) Department of Anatomy and Developmental Biology University College London. ProQuest Number: 10017796 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10017796 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT This thesis examines the influence of the vascular endothelium on the local control of human feto-placental vascular tone and how these influences may vary with gestation. Electron microscopic studies have revealed that human umbilical vessels are devoid of nerves throughout gestation. Structural changes in the arterial and venous wall could be detected throughout gestation. The presence of a subpopulation of endothelial cells containing nitric oxide synthase (NOS)-like immunoreactivity was identified only in late pregnancy. The umbilical artery and vein, from both early and late pregnancy, did not relax to acetylcholine (ACh), adenosine 5-triphosphate (ATP), substance P (SP) and calcium ionophore A23187, known to be endothelium-dependent vasodilators, but did relax to sodium nitroprusside (SNP).
    [Show full text]
  • Care During Pregnancy and Delivery ACCESSIBLE, QUALITY HEALTH CARE DURING PREGNANCY and DELIVERY
    Care during Pregnancy and Delivery ACCESSIBLE, QUALITY HEALTH CARE DURING PREGNANCY AND DELIVERY Why It’s Important Having a healthy pregnancy and access to quality birth facilities are the best ways to promote a healthy birth and have a thriving newborn. Getting early and regular prenatal care is vital. Prenatal care is the health care that women receive during their entire pregnancy. Prenatal care is more than doctor’s visits and ultrasounds; it is an opportunity to improve the overall well-being and health of the mom which directly affects the health of her baby. Prenatal visits give parents a chance to ask questions, discuss concerns, treat complications in a timely manner, and ensure that mom and baby are safe during pregnancy and delivery. Receiving quality prenatal care can have positive effects long after birth for both the mother and baby. When it is time for the mother to give birth, having access to safe, high quality birth facilities is critical. Early prenatal care, starting in the 1st trimester, is crucial to the health of mothers and babies. But more important than just initiating early prenatal care is receiving adequate prenatal care, having the appropriate number of prenatal care visits at the appropriate intervals throughout the pregnancy. Babies of mothers who do not get prenatal care are three times more likely to be born low birth weight and five times more likely to die than those born to mothers who do get care.1 In 2017 in Minnesota, only 77.1 percent of women received prenatal care within their first trimester of pregnancy.
    [Show full text]
  • Surgical Challenges in Complex Primary Total Hip Arthroplasty
    A Review Paper Surgical Challenges in Complex Primary Total Hip Arthroplasty Sathappan S. Sathappan, MD, Eric J. Strauss, MD, Daniel Ginat, BS, Vidyadhar Upasani, BS, and Paul E. Di Cesare, MD should be assessed, the Thomas test should be used to Abstract determine presence of flexion contracture, and limb-length Complex primary total hip arthroplasty (THA) is defined as discrepancy should be documented with the patient in the primary THA in patients with compromised bony or soft-tissue supine and upright positions (with use of blocks for stand- states, including but not limited to dysplastic hip, ankylosed hip, prior hip fracture, protrusio acetabuli, certain neuromus- ing, allowing the extent of limb-length correction to be 3 cular conditions, skeletal dysplasia, and previous bony proce- estimated). dures about the hip. Intraoperatively, provisions must be made Standard anteroposterior (AP) and lateral x-rays of the for the possible use of modular implants and/or bone grafts. In hips should reveal underlying hip pathology and facili- this article, we review the principles of preoperative, intraop- tate surgical planning and component templating (Figure erative, and postoperative management of patients requiring a 4 complex primary THA. 1). Special imaging modalities, including computed tomography (CT) of the hip, may be useful in complex .S. surgeons annually perform more than 150,000 hip arthroplasty. CT provides 3-dimensional information total hip arthroplasties (THAs), 90% of which about anterior and posterior column deficiencies, socket are primary procedures.1 Improved surgical size, and thickness of the anterior and posterior walls and technique and instrumentation have expanded allows visualization of the external iliac vessels to ensure Uthe clinical indications for THA to include patients who previously would not have been considered eligible for this procedure.
    [Show full text]
  • Tonic and Rhythmic Spinal Activity Underlying Locomotion
    Send Orders for Reprints to [email protected] Current Pharmaceutical Design, 2017, 23, 1-11 1 REVIEW ARTICLE Tonic and Rhythmic Spinal Activity Underlying Locomotion Yury P. Ivanenkoa,*, Victor S. Gurfinkelb, Victor A. Selionovc, Irina A. Solopovac, Francesca Sylos-Labinid, Pierre A Guertine and Francesco Lacquanitia,d,f aLaboratory of Neuromotor Physiology, Santa Lucia Foundation, 00179 Rome, Italy; bBiomedical Engineering Department, Oregon Health and Science University, Portland, Oregon, USA; cLaboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow 127994, Russia; dCentre of Space Bio-medicine, University of Rome Tor Vergata, 00133 Rome, Italy, City, Country; eDepartment of Psychiatry and Neurosciences, Laval University, Québec City, Canada G1V 4G2; fDepartment of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy Abstract: In recent years, many researches put significant efforts into understanding and assessing the functional state of the spinal locomotor circuits in humans. Various techniques have been developed to stimulate the spinal A R T I C L E H I S T O R Y cord circuitries, which may include both diffuse and quite specific tuning effects. Overall, the findings indicate that tonic and rhythmic spinal activity control are not separate phenomena but are closely integrated to properly initiate and sustain stepping. The spinal cord does not simply transmit information to and from the brain. Its Received: November 2, 2016 Accepted: January 20, 2017 physiologic state determines reflex, postural and locomotor control and, therefore, may affect the recovery of the locomotor function in individuals with spinal cord and brain injuries. This review summarizes studies that exam- ine the rhythmogenesis capacity of cervical and lumbosacral neuronal circuitries in humans and its importance in DOI: 10.2174/1381612823666170125 developing central pattern generator-modulating therapies.
    [Show full text]
  • Cerebral Palsy
    Cerebral Palsy Cerebral palsy encompasses a group of non-progressive and non-contagious motor conditions that cause physical disability in various facets of body movement. Cerebral palsy is one of the most common crippling conditions of childhood, dating to events and brain injury before, during or soon after birth. Cerebral palsy is a debilitating condition in which the developing brain is irreversibly damaged, resulting in loss of motor function and sometimes also cognitive function. Despite the large increase in medical intervention during pregnancy and childbirth, the incidence of cerebral palsy has remained relatively stable for the last 60 years. In Australia, a baby is born with cerebral palsy about every 15 hours, equivalent to 1 in 400 births. Presently, there is no cure for cerebral palsy. Classification Cerebral palsy is divided into four major classifications to describe different movement impairments. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed. In most cases of cerebral palsy, the exact cause is unknown. Suggested possible causes include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, preterm birth, infection, and trauma. Spastic cerebral palsy leads to increased muscle tone and inability for muscles to relax (hypertonic). The brain injury usually stems from upper motor neuron in the brain. Spastic cerebral palsy is classified depending on the region of the body affected; these include: spastic hemiplegia; one side being affected, spastic monoplegia; a single limb being affected, spastic triplegia; three limbs being affected, spastic quadriplegia; all four limbs more or less equally affected.
    [Show full text]
  • Back-To-Basics: the Intricacies of Muscle Contraction
    Back-to- MIOTA Basics: The CONFERENCE OCTOBER 11, Intricacies 2019 CHERI RAMIREZ, MS, of Muscle OTRL Contraction OBJECTIVES: 1.Review the anatomical structure of a skeletal muscle. 2.Review and understand the process and relationship between skeletal muscle contraction with the vital components of the nervous system, endocrine system, and skeletal system. 3.Review the basic similarities and differences between skeletal muscle tissue, smooth muscle tissue, and cardiac muscle tissue. 4.Review the names, locations, origins, and insertions of the skeletal muscles found in the human body. 5.Apply the information learned to enhance clinical practice and understanding of the intricacies and complexity of the skeletal muscle system. 6.Apply the information learned to further educate clients on the importance of skeletal muscle movement, posture, and coordination in the process of rehabilitation, healing, and functional return. 1. Epithelial Four Basic Tissue Categories 2. Muscle 3. Nervous 4. Connective A. Loose Connective B. Bone C. Cartilage D. Blood Introduction There are 3 types of muscle tissue in the muscular system: . Skeletal muscle: Attached to bones of skeleton. Voluntary. Striated. Tubular shape. Cardiac muscle: Makes up most of the wall of the heart. Involuntary. Striated with intercalated discs. Branched shape. Smooth muscle: Found in walls of internal organs and walls of vascular system. Involuntary. Non-striated. Spindle shape. 4 Structure of a Skeletal Muscle Skeletal Muscles: Skeletal muscles are composed of: • Skeletal muscle tissue • Nervous tissue • Blood • Connective tissues 5 Connective Tissue Coverings Connective tissue coverings over skeletal muscles: .Fascia .Tendons .Aponeuroses 6 Fascia: Definition: Layers of dense connective tissue that separates muscle from adjacent muscles, by surrounding each muscle belly.
    [Show full text]
  • 1 Human Resting Muscle Tone
    Human Resting Muscle Tone (HRMT): Narrative Introduction and Modern Concepts Alfonse T. Masi, MD, DR.P.H. * Professor of Medicine and Epidemiology University of Illinois College of Medicine at Peoria One Illini Drive, Peoria, IL 61656, USA Tel: +1 309 671 8428 Fax: +1 309 671 8513 Email: [email protected] John Charles Hannon, DC Certified Feldenkrais Practitioner 1141 Pacific Suite B San Luis Obispo, CA 93401, USA Tel: +1 805 542 9925 Fax: +1 805 541 2391 Email: [email protected] Key Words: passive tone or tonus; viscoelastic; skeletal muscle; fascia; myofascial, biotensegrity *Correspondence to: Dr. AT Masi 1 Abstract Human resting muscle studies have been performed to establish (myofascial) tone (HRMT) is the passive normal frequency distributions of degrees of tonus or tension of skeletal muscle that myofascial tone. Clinical experience derives from its intrinsic (EMG-silent) indicates that persons with certain molecular viscoelastic properties. The word symptomatic musculoskeletal conditions tone has been used to convey varying may have palpably increased resting muscle clinical and physiological features that have firmness or hardness (EMG-silent), such as led to confusion and controversy. HRMT is that of the upper trapezius in tension-type the vital low-level, passive tension, and headache, and the lumbodorsal extensors resistance to stretch that contributes (hartspann) in degenerative lumbar disc importantly to maintaining postural stability disease and ankylosing spondylitis. in balanced equilibrium positions. In contrast, co-contraction of muscle is an In summary, resting skeletal muscle tone is active neuromotor control that provides an intrinsic viscoelastic tension exhibited greater levels of tonus for increased within the body’s kinematic chains.
    [Show full text]
  • Rule 17, Exhibit 1
    RULE 17, EXHIBIT 1 Low Back Pain Medical Treatment Guidelines Revised: February 3, 2014 Effective: March 30, 2014 Adopted: March 24, 1993 Effective: April 30, 1993 Revised: March 11, 1994 Effective: April 30, 1994 Revised: January 9, 1995 Effective: March 2, 1995 Revised: January 8, 1998 Effective: March 15, 1998 Revised: October 4, 2001 Effective: December 1, 2001 Revised: September 29, 2005 Effective: January 1, 2006 Revised: April 26, 2007 Effective: July 1, 2007 Presented by: State of Colorado Department of Labor and Employment DIVISION OF WORKERS' COMPENSATION TABLE OF CONTENTS SECTION DESCRIPTION PAGE A. INTRODUCTION .............................................................................................................................. 1 B. GENERAL GUIDELINE PRINCIPLES ............................................................................................ 2 1. APPLICATION OF GUIDELINES ....................................................................................... 2 2. EDUCATION ....................................................................................................................... 2 3. INFORMED DECISION MAKING ....................................................................................... 2 4. TREATMENT PARAMATER DURATION ........................................................................... 2 5. ACTIVE INTERVENTIONS ................................................................................................. 2 6. ACTIVE THERAPEUTIC EXERCISE PROGRAM .............................................................
    [Show full text]
  • 14. Management of Diabetes in Pregnancy: Standards of Medical
    Diabetes Care Volume 42, Supplement 1, January 2019 S165 14. Management of Diabetes in American Diabetes Association Pregnancy: Standards of Medical Care in Diabetesd2019 Diabetes Care 2019;42(Suppl. 1):S165–S172 | https://doi.org/10.2337/dc19-S014 14. 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. In general, specific risks of uncontrolled diabetes in pregnancy include spontaneous abortion, fetal anomalies, preeclampsia, fetal demise, macrosomia, neonatal hypoglycemia, and neonatal hyperbilirubinemia, among others.
    [Show full text]
  • If You Are Pregnant: INFORMATION on FETAL DEVELOPMENT, ABORTION and ALTERNATIVES August 2019
    If You Are Pregnant: INFORMATION ON FETAL DEVELOPMENT, ABORTION AND ALTERNATIVES August 2019 IF YOU ARE PREGNANT: INFORMATION ON FETAL DEVELOPMENT, ABORTION AND ALTERNATIVES If You Are Pregnant: Information on Fetal Development, Abortion and Alternatives Resources used by the Minnesota Department of Health for this publication are Human Embryology and Developmental Biology, Fifth Edition, 2014; Larsen’s Human Embryology, Fifth Edition, 2014; The Developing Human, 10th Edition, 2016; and In the Womb, 2006. The photographs in this booklet are credited to Lennart Nilsson/TT Images and are used by permission; except for week 38 copyright Minnesota Department of Health. The illustrations found throughout this booklet were created by Peg Gerrity, Houston, Texas. Copyright: http://www.peggerrity.com. Minnesota Department of Health Division of Child and Family Health PO Box 64882 St. Paul, MN 55164-0882 651-201-3580 Women's Right to Know (https://www.health.state.mn.us/people/wrtk/index.html) Upon request, this material will be made available in an alternative format such as large print, Braille or audio recording. Printed on recycled paper. 2 IF YOU ARE PREGNANT: INFORMATION ON FETAL DEVELOPMENT, ABORTION AND ALTERNATIVES Contents If You Are Pregnant: INFORMATION ON FETAL DEVELOPMENT, ABORTION AND ALTERNATIVES............................................................................................................................. 1 Introduction ...............................................................................................................................
    [Show full text]