Healthy babies are worth the effort

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics

Emory University School of Medicine

Grady Memorial Hospital, Atlanta, Georgia

November 6, 2009

In the past decade, one of the most important emphases in the field of obstetrics and gynecology is attention to pre-pregnancy measures that can ensure the healthiest possible baby.  What are some of the steps a woman considering pregnancy, the family around her and her physicians and nurse practitioners and nurse midwives can consider?

Here are the things a woman can do to have a healthy baby:

●    Plan your pregnancy and your activities once pregnant to ensure that everything you do leading up to and during your pregnancy sustains your developing child’s brain.

●    Get the vaccine against H1N1 flu right away.

●  If there is any possibility that you are pregnant, write down the first day of your last menstrual cycle  to help your doctor to determine you due date accurately and then here are several recommendations for a healthy baby:

1.   Stop drinking any alcoholic beverages!! Fetal alcohol syndrome is the leading known preventable cause of mental retardation. There is no safe level of alcohol intake for a pregnant woman. If you have a relative who is pregnant, definitely do not offer her a beer or a drink.

2.   Go immediately to a pharmacy and get prenatal vitamins, the most important of which is folic acid (folate). Folic acid, 0.4 mg daily, should be taken throughout the reproductive years. Why bother? Because, folic acid prevents a number of neural tube defects including spina bifida. Stop smoking, if you are smoking.

3.   Eat healthy foods…fruits, vegetables and 3 glasses of milk a day to ensure a total of 1500 mg of calcium a day. Remember you are eating for two people. Pregnancy is definitely not the time to lose weight.

4.   Avoid risk of exposure to sexually transmitted infection. Use condoms if at any risk for an infection.

5.   If you want to have children, do all you can for their good health. 

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MISSING PILLS

What can a woman do if she misses combined oral contraceptives (COCs)?

For 30-35 µg ethinylestradiol pills:

Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late

• She should take an active (hormonal) pill as soon as possible * and then continue taking pills daily, 1 each day.
• She does not need any additional contraceptive protection.

Missed 3 or more active (hormonal) pills or if she starts a pack 3 or more days late

• She should take an active (hormonal) pill as soon as possible* and then continue taking pills daily, 1 each day.
• She should also use condoms or abstain from sex until she has taken active (hormonal) pills for 7 days in a row.
• If she missed the pills in the third week, she should finish the active (hormonal) pills in her current pack and start a new pack the next day.  She should not take the 7 inactive pills.
• If she missed the pills in the first week and had unprotected sex, she may wish to consider the use of emergency contraception.

For 20 µg or less ethinylestradiol pills:

• If the woman misses 1 active (hormonal) pill or starts a pack 1 day late, she should follow the guidance above for “Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late.”
• If the woman misses 2 or more active (hormonal) pills or if she starts a pack 2 or more days late, she should follow the guidance above for “Missed 3 or more active (hormonal) pills or if she starts a pack 3 or more days late.”

For both 30-35 µg and 20 µg or less ethinylestradiol pills:

Missed any inactive (nonhormonal) pills

• She should discard the missed inactive (nonhormonal) pill(s) and then continue taking pills daily, 1 each day.

*    If a woman misses more than 1 active (hormonal) pill, she can take the first missed pill and then either continue taking the rest of the missed pills or discard them to stay on schedule.

http://www.who.int/reproductive-health/publications/

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Flu is here!!!

What are the latest numbers and what are the most important implications for WOMEN?

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics at the Emory University

Grady Memorial Hospital, Atlanta, Georgia

December 11, 2009

H1N1 flu has claimed an estimated 10 000 lives in the United States, more than double the estimated death toll in November, the Centers for Disease Control and Prevention (CDC) said on Thursday.

The H1N1 virus has infected about 50 million people, or one in six Americans, as of November 14.

The fatalities include about 1 100 children and 7 500 younger adults, who continue to be the most vulnerable to the H1N1 virus, said Thomas Frieden, director of the government CDC.

“That’s much higher than in a usual flu season,” Frieden said.

The death figure over the last seven months had more than doubled from the estimated 3 900 deaths in mid November, which was a six- month total.

 Two weeks ago Frieden said that there have been more than 20,000 hospitalizations. The symptoms of H1N1 include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting.

What does H1N1 flu mean to women?

1.   As the primary caretakers for the health of children (mothers take children for 90% of pediatric visits), mothers should continue to line up for those limited supplies of the H1N1 vaccine.  If a father can be the person who lines up for this shot, wonderful. GO DADS! As you are most likely know, H1N1 flu is worse for children than for audits. The vaccine against H1N1 flu is safe.  It is effective. It saves lives. But this H1N1 flu is even worse for pregnant women.

2.   If considering pregnancy, women should definitely get the H1N1 vaccine in advance. Pregnant women are 6 to 7 times more likely to die from H1N1 flu than others who become infected with the H1N1 flu virus

3.   If pregnant and not already protected by the H1N1 vaccine, women should go immediately for the vaccine.  Pregnant women are the very highest priority group of individuals to receive the vaccine

4.  If it appears that a pregnant woman has become infected with H1N1 flu and she has not received the H1N1 flu vaccine, she should be treated with the antiviral antibiotic called TAMIFLU. Speed is important and testing to confirm that a pregnant woman’s symptoms are due to H1N1 flu NOT necessary and is not recommended prior to treating that woman with Tamiflu.  TESTING FOR THE SPECIFIC STRAIN OF FLU CAUSING A WOMAN’S SYMPTOMS IS NOT NECESSARY BEFORE A PREGNANT WOMAN RECEIVES TAMIFLU.  If your doctor says he or she needs to test you before providing Tamiflu, go to a different doctor immediately.

Tamiflu (oseltamivir) is an antiviral drug that slows the spread of influenza (flu) virus between cells in the body. Tamiflu and is taken orally in capsules or a suspension. It has been used to treat and prevent Influenza A and Influenza B infection in over 50 million people since 1999. As of October 2009, only 39 out of over 10,000 samples of 2009 pandemic H1N1 (swine) flu tested worldwide have shown resistance to Tamiflu. Take home messages: Tamiflu is EFFECTIVE and it must be taken very quickly.  Tamiflu is in somewhat short supply now but if a pregnant woman develops flu-like symptoms she or her family must look quickly for a source of Tamiflu.

5.   Preventive measures to help avoid getting sick include: washing hands frequently and thoroughly; covering coughs and sneezes; and folks staying home from work or school if sick.

6.  For many, many reproductive age women now is not the best time to try to become pregnant.  Less than 1/4^th of pregnant women have received the vaccine against H1N1 flu and the vaccine against seasonal flu does not protect against H1N1 flu. Since half of all pregnancies in the United States are unplanned, now is a time for women to use contraceptives very, very carefully.

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