PREGNANCY, DRUGS IN
P
a n d t i r e d n e s s , s o m e w o m e n e x p e r i e n c e
c e r t a i n
c o m m o n ,
m
i n o r
h e a l t h
p r o b -
l e m s . A l t h o u g h t h e s e c o n d i t i o n s m a y b e
u n c o m f o r t a b l e
o r
t r o u b l e s o m e ,
t h e y
u s u a l l y d i s a p p e a r a f t e r d e l i v e r y .
D u r i n g
p r e g n a n c y ,
f o o d
p a s s e s
t h r o u g h t h e i n t e s t i n e m
o r e s l o w l y t h a n
n o r m a l . T h i s e n a b l e s m
o r e n u t r i e n t s t o
b e a b s o r b e d f o r t h e b a b y , b u t a l s o t e n d s
t o
c a u s e c o n s t i p a t i o n .
P ic a
( c r a v i n g t o
e a t
s u b s t a n c e s
o t h e r
t h a n
f o o d s )
i s
a n o t h e r
c o m
m o n
c o n d i t i o n .
I n
l a t e
p r e g n a n c y , t h e g r o w i n g f e t u s p u t s p r e s -
s u r e o n t h e i n t e r n a l o r g a n s ; t h i s p r e s s u r e
m a y
r e s u l t
i n
h a e m o rrh o id s ,
h e a rt b u rn
( d u e t o a c i d r e f l u x ) , s w o l l e n a n k l e s , a n d
v a ric o s e v e in s .
O t h e r c o m
m o n d i s o r d e r s
d u r i n g
p r e g n a n c y
i n c l u d e
u rin a ry tra ct
in fe c tio n s ,
s t r e s s i n c o n t i n e n c e
( s e e
in c o n -
tin e n c e , u r in a r y ) ,
a n d v a g i n a l
c a n d id ia s is .
C o m p l i c a t i o n s o f p r e g n a n c y a n d d i s -
o r d e r s t h a t a f f e c t i t i n c l u d e
a n te p a rtu m
h a e m o rrh a g e
;
d ia b e t ic p re g n a n c y
;
m is c a r -
ria g e ; p o ly h y d ra m n io s ; p re - e c la m p s ia ; p r e -
m a tu rity ;
a n d
R h e s u s in c o m p a tib ility .
( S e e
a l s o
c h ild b irt h ; fe ta l h e a rt m o n it o rin g ; p r e g -
n a n c y
,
m u lt ip le .
)
p re g n a n c y , d ru g s in
C e r t a i n
d r u g s
t a k e n d u r i n g
p r e g n a n c y
,
s u c h a s
t h a lid o m id e
a n d
is o t re t in o in ,
m a y
p a s s
f r o m
t h e
m o t h e r
t o
t h e
f e t u s
t h r o u g h
t h e
p la c e n ta .
T h e y
m a y
i n t e r -
f e r e w i t h f e t a l d e v e l o p m e n t , l e a d i n g t o
b irt h d e fe c ts .
R e l a t i v e l y f e w
d r u g s h a v e
b e e n p r o v e d t o c a u s e h a r m t o a d e v e l -
o p i n g
b a b y ,
b u t
n o
d r u g
s h o u l d
b e
c o n s i d e r e d
c o m p l e t e l y
s a f e ,
e s p e c i a l l y
i n
e a r l y
p r e g n a n c y .
P r e g n a n t
w o m e n
s h o u l d s e e k m e d i c a l a d v i c e b e f o r e t a k -
i n g
a n y
d r u g ,
i n c l u d i n g
o v e r - t h e -
c o u n t e r
p r e p a r a t i o n s .
H o w e v e r ,
i f t h e
b e n e f i t s o f a d r u g t o t h e m o t h e r o u t -
w e i g h t h e r i s k s t o t h e f e t u s , t h e
d r u g
m a y b e r e c o m m e n d e d .
P r o b l e m s
m a y
a l s o
b e
c a u s e d
i n
a
d e v e l o p i n g b a b y i f a p r e g n a n t w o m a n
d r i n k s
a lc o h o l,
s m o k e s
t o b a c c o
( s e e
s m o k in g
) , o r t a k e s d r u g s o f a b u s e . T h e
b a b i e s o f w o m
e n w h o u s e
h e ro in
d u r i n g
p r e g n a n c y
t e n d
t o
h a v e
a
l o w
b i r t h -
w e i g h t
a n d
a
h i g h e r
d e a t h
r a t e
t h a n
n o r m a l l y e x p e c t e d d u r i n g t h e f i r s t f e w
w e e k s
o f l i f e .
B a b i e s
o f w o m
e n w h o
a b u s e
d r u g s i n t r a v e n o u s l y a r e a t h i g h
r i s k o f
H IV
i n f e c t i o n .
p re g n a n c y , fa ls e
A n u n c o m
m o n p s y c h o l o g i c a l d i s o r d e r ,
w h i c h i s a l s o k n o w n a s p s e u d o c y e s i s . I n
f a l s e p r e g n a n c y , a w o m a n h a s m a n y o f
t h e p h y s i c a l s i g n s o f p r e g n a n c y , i n c l u d i n g
m o rn in g s ic k n e s s
,
a m e n o rrh o e a
( a b s e n c e o f
p e r i o d s ) ,
e n l a r g e d
b r e a s t s ,
a n d
a b d o -
m i n a l s w e l l i n g , b u t i s n o t p r e g n a n t . T h e
w o m a n i s c o n v i n c e d t h a t s h e i s p r e g -
n a n t . T r e a t m e n t f o r f a l s e p r e g n a n c y m a y
i n v o l v e
c o u n s e llin g
o r
p s y c h o th e ra p y .
( S e e
a l s o
c o n v e rs io n d is o r d e r
. )
p re g n a n c y , m u ltip le
M
o r e t h a n o n e
f e t u s
i n t h e u t e r u s . M
u l -
t i p l e
p r e g n a n c y
c a n
o c c u r
i f t w o
o r
m
o r e o v a
( e g g s ; s e e
o v u m
)
a r e f e r t i l -
i z e d a t t h e s a m e t i m
e o r i f a s i n g l e e g g
d i v i d e s e a r l y i n d e v e l o p m e n t .
CAUSES AND INCIDENCE
T w in s
a r e
t h e
m o s t
c o m
m
o n
t y p e
o f
m u l t i p l e p r e g n a n c y a n d o c c u r i n a b o u t
1
i n
8 0
p r e g n a n c i e s ;
t r i p l e t s o c c u r i n
a b o u t
1
i n
8 , 0 0 0 , a n d q u a d r u p l e t s i n
a b o u t
1
i n
5 0 0 , 0 0 0 .
M
u l t i p l e
p r e g -
n a n c i e s a r e m
o r e c o m
m
o n i n w o m e n
w h o a r e t r e a t e d w i t h
f e rtility d ru g s ,
o r i f
a n u m b e r o f f e r t i l i z e d o v a a r e i m p l a n t e d
i n t h e u t e r u s d u r i n g
in v itro f e rt iliz a t io n
.
EFFECTS OF HORMONES DURING PREGNANCY
A pregnant woman undergoes many changes that enable her to maintain the
pregnancy, nourish the baby, and prepare for breast-feeding. These adaptations
are brought about by increased levels of the female sex hormones oestrogen and
progesterone, and by the action of two other hormones, human chorionic gonado-
trophin (HCG) and human placental lactogen (HPL), produced only by the placenta.
Hormone
Effect
Progesterone
Decreases the excitability of smooth muscle, thereby helping to prevent
uterine contractions and premature labour.
Causes constipation and oesophageal acid reflux as a result of its effects
on smooth muscle.
Increases body temperature.
Affects mood.
Increases breathing rate.
Human placental
lactogen (HPL)
Increases energy production necessary for fetal development.
Causes enlargement of breasts and development of milk glands.
Induces temporary diabetes mellitus (gestational diabetes) in susceptible
women as a result of its effects on metabolism.
Human chorionic
gonadotrophin
(HCG)
Increases energy production necessary for fetal development.
Induces gestational diabetes in susceptible women.
Oestrogens
Are important for the developmentofthe reproductive system and breasts.
Stimulate growth ofthe uterine muscle to enable the powerful contractions
of labour.
Increase vaginal secretions.
Increase the size ofthe nipples and help the development of milk glands
in the breasts.
Increase the production of protein, which is essential for healthy growth of
the woman and fetus.
Alter collagen and other substances to allow body tissues to soften and
stretch in preparation for labour.
Relax ligaments and joints.
May cause sciatica and backache, and may also contribute to the
formation of varicose veins as a result of their effects on body tissue.
Melanocyte-
stimulating
hormone
Stimulates pigmentation (in combination with oestrogens), particularly of
the nipples. May also produce chloasma (darkening ofthe facial skin).
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