pregnancy | MY SPECIAL DOCTOR

HEALTH: Beware of obesity when expecting a baby

24 February 20246 January 2024 by MinnieLuongo

Obesity is always dangerous, but it becomes even more so for mothers expecting a baby. This is emphasized by the World Health Organization (WHO), specifying that maternal obesity is not only a global health problem but is also associated with adverse outcomes, both for pregnant women and newborns.

The alarming data on obesity

Obesity is now officially identified as a global epidemic, that is, as one of the biggest health problems of the 21st century. Recent data from the WHO are alarming: since 1975, obesity worldwide has almost tripled to 13 percent, with an absolute 650 million obese individuals over the age of 18; 41 million children under the age of 5 who are overweight or obese; and more than 340 million children and adolescents between the ages of 5 and 19 living with obesity.

Maternal obesity

Obesity can impact the individual from the moment of conception: in fact, very frequent cases of pregnant women who are obese due to previous obesity or excessive weight gain during gestation. “Maternal obesity,” says Dr. Daniela Galliano, director of the IVI Center in Rome – constitutes a serious problem that is associated with both maternal and perinatal adverse outcomes: in fact, it increases abortion rates and obstetric and neonatal complications, resulting in lower birth rates of healthy babies.

In addition to the negative consequences of moods for the mother,”Obesity is a major risk factor for the onset of chronic diseases during their children’s lifetimes, especially in adolescence and adulthood, such as cardiovascular disease, metabolic syndrome, type 2 diabetes, osteoporosis, cancer, and neurodevelopmental delay. Finally, obesity-induced fetal programming of metabolic function may have an intergenerational effect and could, therefore, pass on obesity into the next generation.”

Conclusions on obesity

Therefore, it is essential to seek medical advice and, at the same time, change one’s eating behavior and lifestyle. How? With diets suggested by specialists (no to “do-it-yourself” diets, but early pregnancy diets followed by the doctor) and increased exercise, with the aim of reducing weight in women before conception of a child, and thus to break the vicious cycle of intergenerational obesity.

The brain of the pregnant woman

24 February 20246 January 2024 by Redazione My Special Doctor

The traditional biomedical conception of pregnancy examines the mother-child exchange in a unidirectional sense, from mother to child. Biological changes that medicine records go in the aforementioned direction: increased iron demand, increased circulating blood volume, and reduced insulin sensitivity are evaluated in relation to the increased metabolic demands resulting from the developmental needs of the fetus. Psychological models (from Bion to Winnicott) also emphasize the “nurturing” role of the mother toward the new being in formation.

A different point of view

Research in immunology and neurobiology changes this view, emphasizing the two-way exchange between mother and child. Not only does the mother condition the child’s development with her nutrition, emotions and lifestyle, but the child also marks the mother’s body and mind. Immunological research is older and more established, although many aspects are still obscure. We know that the pregnant woman’s immune system has to undergo a shift, a shift from the Th1 circuit to the Th2 circuit, which is functional for the continuation of the pregnancy, which could be disrupted by excessive activity of the Th1 circuit, prompted by the partial heterogenicity of the fetus, which is genetically different from the maternal organism. An ‘immune alteration that, in most cases, rebalances in the postpartum period and functions as a protective factor toward autoimmune diseases activated by Th1 circuit hyperresponsiveness, such as multiple sclerosis.

Woman changes

We now know that a woman’s brain also changes during pregnancy. Research by a group of neuroscientists at the University of Barcelona has shown that strategic cortical areas change, that this change predicts the quality of the mother’s attachment to the child, and that it persists well beyond the period of pregnancy1. The research examined, with MRI, the brains of 25 women monitored before, during and after the conclusion of pregnancy. The images, compared with those of a group of women of the same age without children, showed changes in the gray matter of the pregnant women in the brain circuitry that underlies the so-called “theory of mind” and that is the ability a person has to understand the thoughts and emotions of others.

This mental function underlies the construction of human relationships and thus sociality. The more pronounced the brain changes in this circuit were during pregnancy, the greater the mother’s degree of attachment to the infant was found to be at a follow-up 2 1/2 months after birth. Of note was the fact that after 2 years, some brain areas, such as the hippocampus, showed persistence of changes. Finally, very intriguing was the fact that the above changes were in terms of reducing the overall volume of gray matter. This reminds us that a reduction in gray matter is not always negative in itself. The phenomenon occurs at crucial passages of life, for example, during adolescence, where the structuring and stabilization of brain circuits is accompanied by an overall reduction in the volume of certain strategic areas, but to the benefit of greater stability and efficiency of the circuits. The mother’s brain becomes, so to speak, more refined, more willing to put ego and aggression on the back burner. He makes himself smaller to enjoy the love that comes from filial relationship.

By
Francesco Bottaccioli

HEALTH: MORE INFORMATION FOR THE PREGNANT WOMAN WITH MULTIPLE SCLEROSIS

24 February 20246 January 2024 by MinnieLuongo

As many as 114,000 people in Italy are affected by multiple sclerosis, a chronic progressive neurological disease. Women of childbearing age are the most affected and many of them want to have children, but there is still too much misinformation. A European survey reveals thisconducted by Wakefield Research with support from Teva Pharmaceuticals Europe and touchNeurology® in Germany, the Netherlands, Italy, Spain, and the United Kingdom among a sample of 1,000 women (200 in each of the 5 countries) aged 25 to 35 years diagnosed with relapsing Multiple Sclerosis in the past 5 years. Respondents were invited, via e-mail, to participate in the online survey that took place between August 10 and September 1, 2017.

Multiple sclerosis and pregnancy

Insufficient access to information and persistent misconceptions are potentially fueled by the lack of dialogue with the physician on pregnancy-related issues. In fact, it was found that more than one in three women, or 35 percent of the total number of women, do not talk about these issues with their neurologist/MS specialist, and 49 percent do not even talk about them with their primary care physician, despite the fact that these are issues close to their hearts. Instead, “a diagnosis of multiple sclerosis,” says Maria Pia Amato, Ordinaria of the Department of Neuroscience at the University of Florence, “can raise many questions in women about the issues of contraception and pregnancy. We know that for most women with this disease, the risk of pregnancy-related complications does not generally increase. Women with MS need access to quality information and support from trained health care providers. In the PRIMUS project, Professor Amato continued, we adopted a multidisciplinary approach with the participation of neurologists from MS Clinical Centers, gynecologists and psychologists. The multidisciplinary team, based on the evidence available in the literature and clinical experience, developed a consensus with respect to counseling the woman with MS facing a maternity project and the treatment choices to be evaluated before, during pregnancy and in the postpartum period.”

Conclusions

The “Toolkit on Multiple Sclerosis and Pregnancy,” can be downloaded in the English language version on the TouchNeurology website. The most developed themes concern the misconceptions that have emerged; at the same time, it is intended to stimulate a more in-depth dialogue between women and their physicians. In particular, here are the most clicked points:

– Information on Multiple Sclerosis and pregnancy issues for women with this condition

– Advice on pregnancy-related issues

– Guidance for physicians on survey results and dialogue with their patients.

Quitting smoking in pregnancy: why you should and why it is difficult

22 February 20246 January 2024 by rosanna.feroldi

Smoking is bad for you at every stage of life, but in pregnancy it hurts twice as much, because not only the woman but also the developing fetus suffers the deleterious consequences of smoking. To protect it, it is necessary to be able to quit in time.

Also thanks to good laws and numerous prevention initiatives, people in Italy today tend to smoke less and more consciously than 2-3 decades ago. However, compared to the past, more women smoke today, and on average they develop greater addiction and have a harder time quitting. So much so that they sometimes fail to break the smoking habit even during pregnancy, risking impairment and negatively affecting the development of the baby.

In a recent review published in the scientific journal Therapeutic Advances in Drug Safety, some American experts on the subject have summarized the reasons why all women wishing to engage in pregnancy should try to stop smoking before conception or, in the case of unplanned pregnancies, soon after (ideally, by the end of the 1st trimester).

In particular, there is evidence that the Smoking in pregnancy increases the risk of preterm delivery (i.e., before 37 weeks, with associated complications), low birth weight, premature rupture of membranes, placenta previa (i.e., placed in front of the baby’s head at the time of delivery, resulting in criticality during expulsion), and loss of the baby. In addition, smoking in pregnancy is a recognized risk factor for congenital anomalies of the cleft lip and palate (cleft lip-palate), cardiac, gastrointestinal, and neurological defects of the newborn.

A wide range of studies also indicate that even when in pregnancy it’s okay, exposure to secondhand smoke in the first months/years of life increases a child’s risk of going through acute respiratory diseases (virus and bacterial airway infections) and chronic (asthma, respiratory allergies, etc.), as well as to otitis, short stature, and metabolic and behavioral changes (hyperactivity).

The woman who succeeds in quitting smoking on time and not starting again after the birth of the child enables herself and the whole family to live healthier lives. Since, often, good will is not enough, to succeed it is advisable to seek medical advice and be directed in the use of one or more of the many supports, pharmacological and otherwise, available today (nicotine replacement therapy in gum, chewing tablets, nasal spray, patch, etc.; bupropion; varenicline; counseling and psychological support; auricular acupuncture, etc.). Ideally, also involving the partner, if a smoker, in the venture. Of course, it will not be easy, but it is definitely worth it.

Source: Scherman A et al. Smoking cessation in pregnancy: a continuing challenge in the United States. Ther Adv Drug Saf. 2018;9(8):457-474. doi:10.1177/2042098618775366

Nutrition in pregnancy: which foods to prefer and what to avoid

19 February 20246 January 2024 by clemente.ferrara

A woman in a state of
pregnancy
has a moral obligation to think not only of her own state of health but also, and primarily, of that of the infant she is carrying. In fact, there are many bad habits of mothers that can harm the health of the baby, even before it is born. Of all of them, the most famous and widespread are undoubtedly those of smoking and alcohol abuse, substances that can bring very serious damage to the fetus already during pregnancy, some of which are even irreversible, as well as promote the onset of some very dangerous diseases.

In addition to this, another factor to pay close attention to is nutrition. Poor nutrition, in fact, combined with uncontrolled weight gain of the expectant woman can certainly affect both the body weight of the fetus at the time of birth and its future health status. So which foods are to be preferred and which are to be avoided ?

Some dietary tips

During pregnancy, a woman’s diet must be especially careful and, above all, varied. A poor diet, for example, can lead to the onset of type 2 diabetes during the infant’s growth phase, as well as promote metabolic and cardiovascular complications. Having said that, however, it is necessary to point out that it is not necessary to upset one’s diet during a pregnancy, but it will be enough to follow a few small steps that will bring important benefits to the health of your little ones, as well as to that of the mothers. To ensure proper energy intake, which is necessary for the development of the fetus, it is advisable to take in between 2200 and 2900 KCAL daily calories, although the recommended weight change should be calculated according to the mother’s pre-pregnancy body mass index. It is very important the intake of nutrients such as calcium, phosphorus, magnesium, vitamin A and B that can be found in milk, the regular consumption of which is recommended.

Protein (high biological value) intake from meat, fish, eggs and cheese are also very important. Among the foods just mentioned, the one to be preferred is definitely fish (rather than meat) because of the nutrients contained within it such as polyunsaturated fatty acids, phosphorus, iodine and because of its higher digestibility.

As for restrictions to be observed, it is advisable to moderate the intake of beverages such as coffee, tea and caffeinated drinks, and eliminate alcoholic ones. You should also avoid raw meats, sausages, sweets, unpasteurized milk, improperly washed vegetables and fruits, and reduce salt use to prevent water retention problems.

Such a balanced diet minimizes the risk of chronic diseases and provides the child with all the basic nutrients he or she needs to grow and develop healthy and strong.

How is the Advocacy model expressed?

19 February 20246 January 2024 by Redazione My Special Doctor

We can imagine that among the advocacy activities conceived as social justice, the midwife/midwife is called upon to perform counseling, foster early mother/father and child attachment, promote breastfeeding, and support the parental role. The midwife can practice advocacy by spreading voluntary breastmilk donation and alleviating patient fears, or by helping caregivers reach informed decisions about their health status and the course of care to be followed, informing them of their rights and that the right of equity in care will be respected, but also implementing an advocacy campaign.

What is an advocacy campaign?

It is a series of targeted actions to influence politicians and the general population in support of a cause or problem that you want to change. An example of an advocacy campaign led by midwives could be to support women at different stages of pregnancy to help them adopt functional pregnancy lifestyles and prepare them for natural childbirth; further upstream is the need to ensure the quality and safety of care processes.

What are the steps involved in implementing an advocacy campaign?

The problem identification stage that needs to be addressed; it consists of framing i.e., selecting certain aspects of a perceived reality and making them more salient so as to promote a particular problem definition, causal interpretation, moral evaluation. For example, in a campaign to promote functional pregnancy lifestyles (e.g., counteracting smoking, use/abuse of anxiolytics or analgesics….) and preparation for childbirth.
The research phase i.e., collecting the necessary information to ensure that the causes and effects of the problem are understood; refers to the activities that are involved in identifying, describing, and quantifying the magnitude of a public health problem: characteristics with which it presents, its risk and protective factors, causal sequences, the effectiveness of the program for each level of prevention, barriers to effectiveness, and changes over time in all these factors.

The planning stage: When advocacy has been identified as the appropriate way to deal with a problem, there is a need to formulate a strategy, so goals, indicators, method, activities, and timeline must be established. Goals must always agree with public health goals. Advocacy goals through the strategic use of media can include an overlooked goal by making it become discussed or more discussed or by making it become differentially discussed; by introducing articulated facts and perspectives into the debate; or by introducing different voices in ways calculated to enhance the authenticity or power of an argument.
The action phase involves acting in coordination with all stakeholders in the campaign. This phase refers to the activities involved in implementing specific strategies, including fundraising, specifying tactics, formulating detailed timetables, and shifting the attention of staff in key organizations to the problem. Intermediate products of this stage include changes in attitudes, habits, resource locations, physical and social environments, and social rules that may influence the frequency or severity of public health problems.

The evaluation phase involves monitoring the actions and results of the entire cycle, for example, it involves deciding which actions are appropriate or reshaping the advocacy campaign so that it is done more effectively in the future.

These steps are conceptually sequential but, in practice, simultaneous. The work in each stage is continuously adjusted according to the results of the other stages. The work in each stage of this assembly line must be continually adjusted in light of changing circumstances and progress or setbacks in the other stages, so that even if the last stage is the most visible, its success depends on the previous stages. In addition, the application of this campaign has practical implications; for example, public health advocacy teams need members with complementary skills in distinct but well-coordinated roles.

A possible example of the application of a campaign of advocacy outreach with a public health-focused goal could be to consider issues related to dysfunctional lifestyle intake in pregnancy, especially with conditions such as diabetes, and those related to the high use of cesarean sections.

An advocacy campaign in this regard should be aimed at reducing the social burden of public health problems by changing the factors that foster these problems, both in the patient’s social and family context and in the care processes (counseling centers, hospital wards).

In this sense, one could work toward an integration of health services predisposed to the management of pregnancy: family doctor, counseling centers, hospital departments, which interconnected and functionally integrated could ensure better management of the care process, at all stages of pregnancy.

To date, these services appear to be poorly integrated, with phenomena of dilution of responsibilities, with no common actions to ensure the safety and quality of pregnancy; therefore, it seems essential to intervene for better management and integration of available resources within the National Health System.

Subsequently or concurrently with the integration of these services, it may be important to foster awareness campaigns toward the adoption of healthy lifestyles and early recognition of signs and symptoms related to diseases of particular clinical relevance, such as gestosis.

In particular, an appropriate awareness campaign for appropriate eating styles can be relevant to the health of not only the woman but also the unborn child by raising awareness of this, even after delivery. There are three actors in an advocacy campaign: allies, neutrals, and opponents

Allies, are represented by the people and organizations that support the campaign. Opinion leaders, media personalities, and group members are expected to contribute their technical expertise and material and financial resources to the advocacy campaign.

Neutrals, are represented by the people and organizations who have not yet formed an idea about the issue. Neutral parties are very important in the advocacy campaign because they can quickly become allies or opponents.

Opponents are the people or organizations that oppose an advocacy campaign.

Advocacy challenges often provoke negative reactions from people currently in power, or from people who follow other values.

Identifying opponents is as important as identifying allies. Understanding the reasoning of opponents and why they feel threatened by the proposed policy change is critical to making the advocacy campaign more effective. It is necessary to try to convince opponents to change their views, or at least neutralize their influence on the policy change you want to pursue.

How can the actions of an advocacy campaign be realized?

Public health advocacy, is effectively accomplished through media advocacy. It consists of the strategic use of new mass media to advance a public tactics initiative.

Media advocacy seeks to develop and shape new stories so that they represent support for public policy and ultimately influence those with the power to change or preserve laws, enshrine policies, and accumulate interventions that can influence the entire population. Customarily recognized as fundamental to the public health project, it is rarely taken seriously by the community itself, compared to the attention given to other disciplines.

The status of advocacy as a legitimized discipline remains neophyte: few, very few public health programs explicitly address advocacy. Comparatively, there are few manual texts and no journals devoted to this exploration.

However, like any public health initiative, effective advocacy requires careful strategic planning and an equally strategic use of modern information media to achieve.

An advocacy campaign consists of a series of targeted actions to influence politicians

and the general population in support of a cause or problem that you want to change

The steps planned for its implementation are:

identification phase
research phase
planning phase
stage of action
evaluation phase

In an advocacy campaign there are three actors:

Allies: they support the campaign
Neutrals: can become allies or opponents
Opponents: oppose the campaign

Through:

Websites.
Flyers.
Petitions.
Newsletter.
Negotiations.
Press conferences.
Strikes.
Pamphlets.
Press releases.

A case of an organization applying this advocacy model

The American Academy of Pediatrics (AAP) is a professional organization that includes more than 50,000 pediatricians. It has a long history of dedicated, efficient and effective public health advocacy and has developed staff and systems to support this issue.

The functions of the research phase are performed by internal researchers who collect data in certain survey areas (e.g., through annual user surveys on various topics) and by members and other consultants working in committees, working groups, and other bodies.

The work of the planning also includes extensive dissemination of information to AAP members, allied organizations, the public through dedicated units within the academy and networking by national organizations, sectors, and to members with other medical societies, community groups, and other relevant organizations.

Work in the action phase is conducted by GPA staff dedicated to government affairs, who lobby national organizations.

How do I know if I can be a midwife/advocate?

The attributes needed to be able to apply patient advocacy are:

experience;
knowledge;
power.

Through experience, midwives gain the knowledge that enables them to be more effective advocates within the health care team and organization.

The power to participate in and influence decision making comes from both: experience and knowledge. In a survey, the following were identified as important characteristics of the guarantor health worker for the patient: effective communication skills, theoretical-scientific knowledge, empathy, and respect for the family.

This supports previous studies that have also identified knowledge and empathy, along with assertiveness and communication skills as important attributes for advocacy to be realized. To achieve these attributes, midwives must be confident in their ability to understand the ethical dilemmas they face and must ensure that they are aware of basic ethical principles to support their contribution to discussions.

In addition to experience, knowledge and power, the specific qualities required to be “advocates” for patients are:

Strong communication skills;
Negotiating skills;
Perseverance;
Empathy;
Awareness of the needs of others;
Ability to read signals and evaluate timing;
Leadership skills;
Knowledge of basic health concepts;
Be system thinkers and have the ability to multitask both inside and outside the workplace.

Source: ” Mediserve‘s Intrapartum Care Models,” by Vittorio Artiola, Simona Novi, Salvatore Paribello, Ferdinando Pellegrino, Giuseppina Piacente, Andrea Vettori

Vegan diet in pregnancy and childhood ok, if well planned

18 February 20246 January 2024 by rosanna.feroldi

Chosen by more and more people, for themselves and their families, for ideological reasons or health beliefs; opposed by just as many, who consider it an unnecessary or even harmful food fad. The vegan diet, no doubt, causes debate, and in many cases, even doctors and nutritionists are far from in agreement as to whether or not it should be recommended or discouraged, either in general or in specific subgroups of people.

Raising the most doubts and heated disputes is the choice of some women not to betray vegan dietary dictates even during
pregnancy
and breastfeeding and to offer the same dietary style to their children from weaning. A behavior considered permissible by some and irresponsible by many others, in view of the risk of even serious nutritional deficits (and consequent health damage) resulting from not eating any food of animal origin. The question is, who is right?

To try to bring order to an area where opinions teem, but reliable scientific evidence is scarce, little known or incorrectly interpreted, a panel of Italian experts from the Scientific Society of Vegetarian Nutrition (SSVN) recently published a consensus document containing some important recommendations for structuring a healthy and balanced vegan diet that is also suitable for women during pregnancy/lactation and pediatric age.

The advice given by experts is as reasonable as ever, to the point of seeming almost obvious, but trivializing it and not following it carries serious risks. Therefore, if you choose to be vegan all the time, it is better to learn how to structure your daily diet with the support of an experienced nutritionist and, in the case of children, also the pediatrician.

A first aspect to consider is overall calorie and individual nutrient intake, which must be sufficient and balanced to individual needs. Contrary to what many people think, taking in “complete” protein is not a problem, if you get used to always combining grains and legumes and if you consume “pseudocereals” (such as quinoa, amaranth) and the countless plant-derived protein products (tofu, tempeh, natto, soy milk, seitan, etc.) available commercially.

In addition to protein, soy derivatives are also a good alternative source of calcium (essential for bone metabolism), which can also be taken in adequate amounts by eating cabbage, broccoli, turnip greens, oranges, figs, almonds, and other dried fruits often, and by drinking at least 2 liters a day of a water that is rich enough in it (300-350 mg/liter).

Calcium can only be utilized by the body in the presence of vitamin D, which is essentially absent in the vegan diet, but is produced by skin exposed to the sun: just exposing the face, arms and legs for 15 minutes a day without sunscreen (avoiding the hottest hours) is enough to obtain a sufficient amount. In the cold months, if necessary, supplements may also be used on medical advice.

Vegans should be aware that plant foods alone cannot provide the necessary supply of vitamin B12 (found exclusively in animal foods and yeasts). Especially during pregnancy/lactation and in childhood, it is, therefore, advisable to take dietary supplements containing this vitamin, which is essential for red blood cell synthesis and nervous system function. In contrast, omega-3 fatty acids, important for the nervous system and immune system, are provided by almonds, flaxseed and chia seeds and oil, and may be further supplemented with targeted preparations.

Iodine can be taken in sufficient quantities (about 100 mg/day in children; 150 mg/day in adults; and 200 mg/day in pregnancy) simply by using iodized salt instead of common table salt, while to better assimilate the iron found in vegetables (spinach, cabbage, broccoli, beans, lentils, etc.) it is necessary to combine these foods with a source of vitamin C (lemon or other citrus fruits, peppers, fresh or dried tomatoes, berries, kiwi, etc.). The vegan woman of childbearing age should, however, regularly monitor possible iron deficiency and, if present, resort to supplements, agreed with the doctor.

Source: Baroni L et al. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers. Nutrients 2019;11:5. doi:10.3390/nu11010005 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356233/)

Fainting in pregnancy not to be overlooked

16 February 20246 January 2024 by rosanna.feroldi

Fainting in pregnancy is an uncommon occurrence and is generally thought to be a benign, consequence-free phenomenon related to the effects of hormonal changes characteristic of gestation on the cardiovascular system. In order to facilitate blood flow to the placenta and fetus, in fact, pregnancy hormones induce increased heart rate and vasodilation, which can cause extemporaneous drops in blood pressure and/or a sudden and transient decrease in oxygen flow to the woman’s brain.

This type of fainting of a cardiovascular nature. (also called syncope), until now, has been considered a minor malaise in the young and overall healthy pregnant woman: an inconvenience that is certainly bothersome, but which passes on its own in a few minutes by lying down for a while in a quiet place, with legs slightly elevated, and taking some water and sugar and/or mineral salts.

New data, obtained as part of a research Canadian study involving 481,930 births in the province of Alberta between 2005 and 2014, indicate, however, that this is not always the case and that fainting in pregnancy deserves to be brought to the physician’s attention and possibly investigated with some targeted testing, as it could be a sign of maternal and/or fetal health problems. Especially, when it occurs in the 1st trimester.

Specifically, it was observed in the study that fainting occurs in about 1% of pregnant women and that in one-third of cases (32.3%) fainting occurs in the 1st trimester. In the latter case, women who have at least one syncope are more likely to give birth pre-term, that is, before 37 weeks of gestation, with all that this entails in terms of fragility and possible health complications for the baby in the first months of life.

In addition, among those born to mothers who had fainted at least once in the 1st trimester , congenital heart defects were more common , while the mothers themselves were at risk of experiencing cardiac arrhythmias and further episodes of syncope in the year after the baby’s birth. In-depth medical investigation and subsequent monitoring are even more important if the pregnant woman faints more than once: an occurrence that in the study occurred in 8% of women with syncope, accounting for about one in every 1,000 of those monitored. In fact, congenital abnormalities and low birth weight of the newborn were more frequently found in these cases.

Given this evidence, researchers believe that fainting in pregnancy should be considered an important warning sign and included among the risk factors for mother and baby, on par with preeclampsia (hypertension in pregnancy) and gestational diabetes.

The recommendation to undergo medical evaluation, on the other hand, should not lead to undue concern: in the majority of cases, fainting in pregnancy is indeed benign and free of sequelae; performing a few checkups is important to eliminate any doubts and/or detect early the few cases in which there might be problems deserving of treatment.

Source

Chatur S et al. Incidence of Syncope During Pregnancy: Temporal Trends and Outcomes. J Am Heart Assoc. 2019;8(10):e011608. doi:10.1161/JAHA.118.011608 (https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011608?url_ver=Z39.88-2003&rfr_id=oriridcrossref.org&rfr_dat=cr_pubpubmed)

Mood swings: do you suffer from them too?

12 February 20246 January 2024 by Redazione My Special Doctor

Seasonal changes, it is known, do not help to maintain mental and physical balance and can be affected on many fronts. Disorders digestion, difficulty sleeping, nervousness, mood swings, excessive responsiveness. Just to name a few of the most common annoyances. The problem can be particularly difficult to bear if, in addition to the change season, there are also other factors that can facilitate the mood swings, such as taking certain types of medications, being on pregnancy or early menopause, following an unhealthy diet, etc. Check here what elements can interfere with psychological balance in daily life and how do to try to reduce its impact and live more peacefully.

Pregnancy not to be medicalized: recommendations of gynecologists-obstetricians

12 February 20246 January 2024 by rosanna.feroldi

At a time when couple infertility is becoming increasingly common and where pregnancies, often late in life, are received almost as an exceptional occurrence rather than as a physiological function that most women are able to cope with without problems, it is quite common for everything related to conception, gestation, and delivery to receive somewhat excessive attention, both from the parents-to-be and from the physicians who have to accompany them on this journey.

However, unless clinical reasons are present to justify special precautions to ensure the well-being of the woman and the child, one should not overdo it with medical checks and interventions if one does not want to risk turning a natural event like pregnancy into a “disease,” taking away some of the pleasure and serenity that should accompany the experience of procreation and birth.

Aware of this trend toward medicalization and in keeping with the spirit of the “Choosing Wisely Italy – Doing More Doesn’t Mean Doing Better” initiative, the Association of Italian Hospital Obstetricians-Gynecologists (AOGOI) has developed “
5 Recommendations”
to support appropriate, safe and respectful obstetrical care for women, especially with regard to labor, cesarean section and umbilical cord clamping. The recommendations were presented at the National Congress of Gynecology and Obstetrics, held Oct. 27-30 in Naples, and include the following.

1) Do not clamp (i.e., cut and tie) the umbilical cord early,
but wait at least one minute after the infant’s expulsion to encourage the passage of blood from the placenta, strengthening the infant’s iron stores and reducing the risk of necrotizing colitis, a gastrointestinal illness that can prove fatal. Delayed cord cutting does not increase a woman’s risk of postpartum hemorrhage and reduces mortality in very preterm births (before 32 weeks).

2) Do not perform routine episiotomy
To facilitate the passage of the baby. According to AOGOI gynecologists, incision of the perineum in the final stage of labor is an overused procedure with no benefit to the woman, as it requires the application of painful stitches, is associated with the risk of infection, and hinders the resumption of sexual intercourse after delivery. For these reasons, episiotomy should be performed only when there is a real clinical need, such as expediting expulsion in cases of fetal distress.

3) Do not induce labor before 39 weeks.
The induction of labor involves the medicalization of an entirely physiological event and can cause adverse events, including an increased need for cesarean section delivery. For these reasons, induction of labor should also be performed only when conditions are present that jeopardize the continuation of the pregnancy and/or may pose a danger to the well-being and safety of the fetus or mother.

4) Do not schedule routine cesarean section in all women with previous cesarean section.
In contrast to the established trend, AOGOI gynecologists refute the “once a cesarean always a cesarean” rule as having no scientific basis. In contrast, available data indicate that women who have previously delivered by cesarean section and admitted to labor at a subsequent pregnancy have a lower mortality risk than women undergoing a second scheduled cesarean section (3 vs. 13 per 100 thousand). Therefore, the choice of the most appropriate and safe mode of delivery should be evaluated with each new pregnancy.

5) Do not force fasting or prohibit fluid intake for women in labor.
In physiological pregnancies (i.e., not associated with specific diseases or criticality), fluid intake is not contraindicated and does not increase the risk of complications if general anesthesia is used during delivery. Thus, there is no good reason to prevent the woman from drinking.

“As the World Health Organization (WHO) recalls,” stressed Elsa Viora, AOGOI President, “gestation and childbirth are experiences that should be lived with serenity and, in the presence of a physiological pregnancy, that is, without risk factors, should be medicalized as little as possible. Labor and delivery are, without a doubt, emotionally delicate circumstances in which, more than others, the woman needs to feel protected, reassured and respected. This is the commitment made on a daily basis by the health workers, gynecological doctors and midwives involved in the birth and delivery pathway, which is based on dialogue, trust and the empathic relationship built over time with the woman, which are necessary to arrive at informed and shared choices.”

Source: Association of Italian Hospital Obstetrician-Gynecologists (AOGOI)(www.aogoi.it/notiziario/il-congresso-20192-stop-ai-cesarei-di-routine-nelle-donne-con-pregresso-cesareo-ecco-la-carta-dell-appropriatezza-per-il-parto/)

Nutrition during pregnancy

8 February 20246 January 2024 by Alessia Giannino

During pregnancy , women must meet their own needs and those of their unborn child by following proper nutrition. The balanced diet will be able to ensure that the child has the nutrients useful for healthy development. The pregnant woman needs an increase in kcal based on her starting weight.

It is most important to consume foods such as fish, white and red meat, eggs, milk, legumes, pasta, bread and rice. In terms of vitamin and mineral intake, however, some requirements are increased during these months, especially those of calcium and iron. It is preferable to use extra virgin olive oil to season food, and as for water, it is recommended to drink at least one and a half liters a day. In addition, it is necessary to cook the eggs well, as they may transmit salmonella.

During pregnancy it is important to avoid: alcohol and hard liquor, nerve drinks, cold cuts and sausages, raw meat, shellfish and game, unpasteurized milk, sweeteners, and foods high in salt.

To reduce nausea upon waking, it is best to eat dry foods, such as crackers or rusks. Liquids such as water and milk are to be avoided and should be taken during the rest of the day.

Source: Handbook of Dietetics and Clinical Nutrition by Franco Contaldo et al.

Clinical recommendations in pregnancy in times of Corona-Virus

5 February 20246 January 2024 by Redazione My Special Doctor

In a recent article (Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? AOGS 2020; doi.org/10.1111/aogs.13836) discussed clinical recommendations in pregnancy during this time of the Corona-virus pandemic.

However, it is important to highlight how these recommendations refer to guidelines that evolve as more and more data become available and new experiences are gathered. The same Interim Guidance on the Management of COVID – 19 issued by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) includes recommendations for pregnant women based mainly on the experience of previous outbreaks.

A multidisciplinary approach would be needed for the management of these patients, enabling communication and sharing of expertise and responsibilities.

The important starting premise is that because pregnancy is a state of partial immune suppression, pregnant women may be more vulnerable to viral infections. It would therefore be desirable and advisable for them to adhere to appropriate social distancing as well as personal and social hygiene rules. Should you experience symptoms such as fever, sore throat, cough, fatigue, myalgia, shortness of breath you should promptly consult your doctor. If any woman has had contact with infected people or has traveled to an area with a high incidence of infection, she should be placed under observation and in isolation. Attention should always be paid, however, to mood and have the opportunity to offer professional psychological support if necessary, since anxiety and depression can develop during pregnancy.

In suspected cases, tests (with samples obtained from saliva, upper respiratory tract, lower respiratory tract, urine and feces) should be repeated to confirm the diagnosis. In addition, a noncontrast computed tomographic (CT) scan of the chest is the most useful investigation both to confirm or rule out viral pneumonia and because fetal radiation exposure is very low.

People diagnosed with infection should be admitted to an isolation ward, where adequate rest, hydration, nutritional support, water and electrolyte balance, and constant monitoring of vital signs and oxygen saturation can be ensured.

Pregnant patients can be given antiviral treatment; antibiotics are to be given only in the presence of a secondary bacterial infection. In contrast, the use of corticosteroids is not recommended.

Regarding the course of pregnancy, there is not enough information when the infection occurs in the first or second trimester. Instead, it would appear that if the infection occurs in the third trimester, there may be risk of premature rupture of membranes, preterm delivery, tachycardia, and fetal distress.

Regular monitoring of maternal vital signs, ultrasound examination and heart rate monitoring is necessary to assess fetal well-being. Based on obstetric history, gestational age, and fetal condition, a decision may be made to continue the pregnancy to term under close supervision. Conversely, in the face of severe infection, existing comorbidities such as preeclampsia, diabetes, heart disease, etc., it may be necessary to “tailor” the timing of delivery. If continuation of the pregnancy may pose a risk to the survival of the mother or the safety of the fetus, it is appropriate to proceed with delivery, even if prematurely. In particularly critical cases, to save the woman’s life, a decision may be made to terminate the pregnancy after, of course, careful discussion with the patient, family members, and the ethics committee.

As there is no evidence related to transplacental and vertical transmission ( Amniotic fluid, cord blood and neonatal throat swab in babies born to positive mothers are negative) there is no contraindication in stable patients to vaginal delivery. If a cesarean section is to be used, attention should be paid to the choice of anesthesia.

While, as mentioned above, transplacental transmission is unlikely, infection can occur with close contact between the infected mother and the infant. In these cases, therefore, it is first recommended that the umbilical cord be cut quickly and that the child be placed in isolation for at least two weeks and monitored for signs of infection.

Breastfeeding is discouraged, precisely to avoid direct contact, while breast milk draught is recommended, since breast milk samples tested negative for SARS-COV-2.

NUTRITION AND DIET	NATURE, SPORTS, PLACES	CULTIVATING HEALTH	MENOPAUSE	MOM IN SHAPE
TRADITIONAL CHINESE MEDICINE	HEART SURGERY	MEDICINES AND MEDICAL DEVICES	PARENTING	THE CULTURE OF HEALTH
HEALTH UTILITIES	GENERAL MEDICINE	NATURAL MEDICINE, THERMAL	MIND AND BRAIN	NEUROVEGETATIVE DYSTONIA
WAYS OF BEING	HEALTH AND SOCIETY	HEALTHCARE AND PATIENTS	SEXUALITY	OLDER AGE
CANCERS	EMERGENCIES

NUTRITION AND DIET	NATURE, SPORTS, PLACES
CULTIVATING HEALTH	MENOPAUSE
MOM IN SHAPE	TRADITIONAL CHINESE MEDICINE
HEART SURGERY	MEDICINES AND MEDICAL DEVICES
PARENTING	THE CULTURE OF HEALTH
HEALTH UTILITIES	GENERAL MEDICINE
NATURAL MEDICINE, THERMAL	MIND AND BRAIN
NEUROVEGETATIVE DYSTONIA	WAYS OF BEING
HEALTH AND SOCIETY	HEALTHCARE AND PATIENTS
SEXUALITY	OLDER AGE
CANCERS	EMERGENCIES

DIGESTIVE SYSTEM	RESPIRATORY SYSTEM	UROGENITAL SYSTEM	HEART AND CIRCULATION	SKIN
INFECTIOUS DISEASES	EYES	EARS, NOSE, AND THROAT	BONES AND LIGAMENTS	ENDOCRINE SYSTEM
NERVOUS SYSTEM

DIGESTIVE SYSTEM	RESPIRATORY SYSTEM
UROGENITAL SYSTEM	HEART AND CIRCULATION
SKIN	INFECTIOUS DISEASES
EYES	EARS, NOSE, AND THROAT
BONES AND LIGAMENTS	ENDOCRINE SYSTEM
NERVOUS SYSTEM

The alarming data on obesity

Maternal obesity

Conclusions on obesity

A different point of view

Woman changes

Multiple sclerosis and pregnancy

Conclusions

Some dietary tips

info portale

per i pazienti

per i dottori

your advertisingexclusively ONMY SPECIAL DOCTOR

complete the form and you will be contacted by one of our managers

your advertising
exclusively ON
MY SPECIAL DOCTOR