The Bad Effects of Rubella (German Measles) During Pregnancy

There are different type of measles caused by various viruses. Most do not cause problems during pregnancy. The type that has the most severe effects during pregnancy is caused by rubella virus and is known as German measles. Since 1969, when a vaccine for rubella became available, preschool and young  school-age children have been vaccinated. It has been estimated that about 75-80% of the population is protected against rubella by the time they reach childbearing age because they have been exposed to the disease, have had it, or have been vaccinated. Once infected with rubella virus, you are immune for life, even if the infection doesn’t actually make you ill.

It is fortunate that so few people are now susceptible to rubella, because the virus can cause birth defects and long-term disorders in babies who are exposed to the virus while their mothers were pregnant. The risk depends on when infection occurred during the first month, about 50% of the babies will be affected. By the third month, the risk is lowered to about 10%. The most common problems include cataracts (an eye problem that can cause blindness), heart defects, and deafness-together called congenital rubella syndrome. Other disorders, such as diabetes, can develop later in life.

As a routine part of prenatal care, each pregnant woman is tested for antibodies to show whether she is immune to rubella. If there are sings that a women is not immune but may have been exposed to rubella or if she develops symptoms (fever, rash swollen lymph glands), she will be tested again. If the diagnosis of rubella infection during pregnancy is confirmed, a type of immunoglobulin may be given. If the women has been exposed to rubella but has not developed the disease, the immunoglobulin may prevent her from becoming ill. It will not prevent the fetus from being affected, however.

Because rubella can give such a severe impact on the fetus and because nothing can be done during pregnancy to protect the fetus, it is best that a women receive the rubella vaccine before she becomes pregnant. A woman who has not had rubella or the vaccine could be vaccinated just after delivery, before she becomes pregnant again. Although the vaccine does not cause congenital rubella syndrome, the virus in the vaccine may be able to infect the fetus. Therefore, it is best to wait 3 month after receiving the vaccine during early pregnancy, however, the risk that the baby will have a problem is very low.

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Planning for Pregnancy

Pregnancy is a major event. When it is planned in advance, a woman can make decisions that will benefit both her health and that of her baby. Good general health before pregnancy can help you cope with the stress of pregnancy, labor, and delivery. It can also help ensure that neither you nor your baby is exposed to things that could be harmful.

Many women do not know they are pregnant until 5, 6, or even 8 weeks. About 2 weeks after a woman’s menstrual cycle, an egg can be fertilized by a man’s sperm; it then moves to a woman’s uterus and becomes attached there to grow. These early weeks are some of the most significant ones for the baby, because it is during this time that the baby’s body and internal organs are formed. Certain substances for example, alcohol, cigarettes, and drugs-may interfere with that growth, whereas a healthy life style may help promote it. Preconception, or pre pregnancy, care can guide you in planning for a healthy pregnancy.

Preconception care:

Becoming a parent is a major commitment filled with challenges, rewards, and choices. By making some plans and adjustments now, you will promote a healthy pregnancy later. Some aspects of pregnancy are part of the natural process over which you have no control. However you can control one of the most important factors in determining your health and that of your baby-your life style. Planning for pregnancy in advance can help prepare you for the experience ahead and help promote a healthy life style for your future.

A Preconception Visit: Pregnancy-planning

You may wish to arrange a special visit with your doctor to discuss your plans for pregnancy. As part of your preconception visit, you will be asked questions about your medical history, any past pregnancies, and your life style. The answers to (preconception care inventory such as family history, Genetic history, Medical history, Current medication, Nutrition, Environmental factors, Obstetric history, Counseling) these questions should be honest and open. This information may be discussed during a preconception visit. They will let your doctor know whether you may need special care duringpregnancy, and they will be treated as confidential information.

Some women have medical conditions that require special attention or care during pregnancy. The condition may be an illness that was present before pregnancy or it may arise during pregnancy.

Because pregnancy puts special demands on a woman’s body, a health problem that is normally under control can change while you are pregnant. Certain medical conditions, such as hypertension and diabetes, should be brought under control before you become pregnant and may require more frequent visits to your doctor or other special attention. Changes in your life style may also be in order, and your doctor may be able to offer suggestions for improving it.

If you’ve had a problem in a previous pregnancy, that doesn’t necessarily mean that the problem will recur or that you shouldn’t try again. Some problems develop a pattern of repeating, but most do not. If a problem is apt to be repeated you should be aware in advance that you may need special attention before and during your pregnancy.

If you have a family history of birth defects, your doctor may suggest that you see a genetic counselor. Genetic counseling can also help identify a pattern of inherited disorders, if one exists.

Your preconception visit is a time for you to ask questions, too. Don’t hesitate to ask for advice or discuss any concerns you might have. Your doctor is there to provide information and guidelines.

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A Healthy Life Style during Pregnancy

Many of the choices you make in your daily life affect your fetus. This is true of the things you do-exercise, rest, and works-as well as the things you don’t do-expose your fetus to drugs, alcohol, cigarettes, or other risks. Some women may need to change their life style during pregnancy. This change may not be easy, but your doctor and the health care team can give you information and support. Even better is the daily support of your family and friends, and especially your partner. Together, you can construct a healthy life style that will benefit you and your baby.

Exercise during Pregnancy

Regular exercise during pregnancy can lead to a better appearance and posture, enhance your feeling of well-being, and lessen some of the discomforts of pregnancy, such as backache and tiredness. The goal of exercise during pregnancy should be to reach or keep a level of fitness that is safe.

What you can do in sports and exercise during pregnancy depends on your own health and, in part, on how active you were before you become pregnant. This is not a good time to take up a new, strenuous sport, but if you were active before your pregnancy, you should be able to continue, within reason. Caution should be the rule.

Here are some general guidelines for following a safe and healthy exercise program geared to the special needs of pregnancy:  

1.  Regular exercise (at least three times per week) is better than spurts of heavy exercise followed by long periods of no activity.

2.Brisk exercise should not be performed in hot, humid weather of when you have an illness with a fever, such as a cold of flu.

3. Avoid jerky, bouncy, or high-impact motions. Activities that require jumping, jarring motions, or rapid changes in direction may cause pain. Exercise on a wooden floor or a tightly carpeted surface to reduce shock and provide a sure footing. Wear a good fitting supportive bra to help protect your breasts.

4. Avoid deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches. During pregnancy, these exercises may injure the tissue that connect your leg and back joints.

5. Avoid exercises that require lying with your back on the floor for more than a few minutes after 20 weeks of pregnancy.

6. Always begin with a 5-minute period of slow walking or stationary cycling with low resistance to warm up your muscles. Intense exercise should not last longer than 15 minutes.

7. Heavy exercise should be followed by a 5-10-minute period of gradually slower actively that ends with gentle stretching in place. To reduce the risk of injuring the tissue connecting your joints, do not stretch as far as you possibly can.

8. The extra weight you are carrying will make you work harder as you exercise at a slower pace. Measure your heart rate at a peak times of activity. Do not exceed your target heart rate and limits established with your doctor’s advice.

9. Get up slowly and gradually from the floor to avoid dizziness or fainting. Once you are standing, walk in place for a brief period.

10. Drink water often before and after exercise to prevent dehydration. Take a break in your workout to drink more water if needed.

11.  Women who did not regularly exercise before becoming pregnant should begin with physical activity of very low intensity and higher levels of activity very gradually.

·  Stop your activity and consult your doctor if any unusual symptoms appear, such as the following:

-Pain

-Bleeding

-Dizziness

-Shortness of breath

-Palpitations (irregular heartbeat)

-Faintness

-Tachycardia (rapid heartbeat)

-Back pain

-Pubic pain

-Difficulty walking

Almost any form of exercise is safe if it is done in moderation. Some exercises offer aerobic conditioning of the heart and lungs; others relieve stress and tone muscles. Pregnancy causes many changes in your body, some of which have an effect on your ability to exercise. These changes can interfere with activities that require good balance, so you may wish to modify your form of exercise during pregnancy.

1. Walking is always good exercise. If you were not active before you become pregnant, walking is a good way to begin an exercise program.

2. Swimming can be continued if you were used to swimming before pregnancy. Swimming is excellent for your body because it uses many different muscles while the water supports your weight. However, it is best not to dive in the later months of pregnancy. Scuba diving is not recommended during pregnancy.

3. Jogging can be done in moderation if you were used to jogging before you become pregnant. Avoid becoming overheated, stop if you are feeling uncomfortable or unusually tired, and drink water to replace what you lose through sweating. 

4.Tennis is generally safe if you were used to playing tennis before pregnancy, but be aware of your change in balance and how it affects rapid movements.

5. Golf and bowling are fine for recreation bit don’t really strengthen the heart and lungs. With either of these sports, you may have to adjust to your change of balance.

6. Snow skiing, water skiing, and surfing pose some risk. You can hit the ground or water with great force, and taking a fall at such fast speeds could harm you or your fetus. Before you decide to participate, you should talk with your doctor.

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Pregnancy Related Disability for Employees

Having a disability means that you are not able to work because of physical problems that could interfere with your ability to perform your usual duties. Only you and your doctor can decide whether your pregnancy is partially or totally disabling. A disability may fall into any of three categories:

1. Disability of the pregnancy itself. Some women suffer side effects such as nausea, vomiting, indigestion problems, dizziness, and swollen legs and ankles during pregnancy. Your doctor should re-evaluate these minor problems at regular intervals.

2. Disability related to complications. More serious complications, such as infection, bleeding, or early rupture of the amniotic sac, may cause disability. Also, medical conditions you had before becoming pregnant, such as heart disease, diabetes, or high blood pressure, may be disabling during pregnancy.

3. Disability related to job exposure. Some disabilities may be job related linked with such factors as exposure to high levels of toxic substances.

If your doctor decides that your pregnancy is disabling, you may request a letter to verify to your employer that you are eligible for disability benefits. Likewise, if your doctor says you are able to keep working.

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How Reproduction Occurs??

A general understanding of the reproductive process, particularly fertilization and ovulation, will help as you prepare for pregnancy. Knowing how your body works will help you identify the time in your menstrual cycle when you are most fertile.

The Menstrual Cycle

A women’s fertility revolves around her menstrual cycle. Each month her ovaries produce an egg. The uterus is prepared for pregnancy by development of a thick lining in which the egg will grow if it is fertilized. If the egg isn't fertilized, the lining is shed during the menstrual period and the cycle begins again.

The changes that take place in the menstrual cycle are caused by hormones-substances normally produced by the body to control certain functions:

* Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are produced by the pituitary gland (a small organ located at the base of the brain) and cause eggs to mature and be released.

* Estrogen and progesterone are produced by the ovaries and prepare the lining of the uterus to nourish a fertilized egg.

* Human chorionic gonadoratropin ( Hcg) is produced by cells that eventually form the placenta once the fertilized egg has developed and attached to the uterine wall.

Days 1-5 of the menstrual cycle are called menstruation, during which the endometrium (lining of the uterus) breaks down and is shed through the vagina during your monthly menstrual period. This shedding is triggered by a drop in the levels of the hormones oestrogen and progesterone, which occurs when an egg is not fertilized.

The drop in estrogen and progesterone signals the pituitary to send a surge of the hormone FSH to the ovaries. During days 1-13 of the menstrual cycle, FSH stimulates follicles in the ovaries to produce oestrogen. Follicles are structures that produce the egg inside the ovary. Each month one follicle is the source of the egg for that cycle. The oestrogen made by the follicle causes the endometium to begin to thicken and develop. Cervical mucus becomes thinner and clearer during this phase.

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Balanced Diet and Weight for Pregnancy

A balanced diet is a basic part of good health at all times in your life. The foods you eat are the main source of the nutrients for your fetus, the term used to refer to the baby while it is growing inside you during pregnancy. As the fetus grows and places new demands on your body you will need more of most nutrients than you did in the past. A good pregnancy diet is the best to ensure that you and your baby start out with the nutrients you both needs.

 Your body functions best when it is well fueled with a balanced diet. To choose that diet you should be aware of what nutrients your body requires, how much of each nutrient you need, and which foods are good sources. Healthy eating practices are not just for pregnancy, but for the best of your life. An appropriate healthy diet can easily be modified during pregnancy to provide the extra calories you need. Nutrition is general and the extra needs of pregnancy.

Special Diets:

Your doctor may detect needs in your diet that should be met before you become pregnant. The factors listed below can affect how your body uses nutrients. If any of these factors apply to you, consult your doctor, because you may need to change your diet.

Do you take medication (prescription or over-the-counter) regularly?

Do you follow a strict vegetarian diet?

Do you run long distance or perform strenuous exercise on a regular basis?

Do you fast?

Do you follow a reducing diet?

Do you have history of anemia?

Phenylketonuria is an inherited condition that keeps the body from processing an essential amino acid found in foods that contain protein. As a result, the levels of this amino acid build up in the mother’s body and can cause birth defects and mental retardation in the fetus. If you were treated for phenylketouria probably as a child, you still have the disorder, even if there are no signs of it. However, by following a special diet before pregnancy you can help keep this condition from affecting your body during pregnancy, even though there is still a small chance that the baby will inherit the disorder. Before trying to become pregnant, you should consult a doctor and be following a special diet if you have phenylketouria.

Weight :

Every woman would like to maintain an ideal weight for her height. If you are planning to have a baby, however, it’s important that you not be excessively underweight or overweight before pregnancy. Under weight women tend to have smaller babies. This is not an advantage, however, because smaller babies have more problems during labor and in the nursery. In general, being overweight is a health hazard. During pregnancy, being overweight is linked to having high blood pressure or diabetes. Extreme obesity puts a strain on the heart that becomes an added burden during pregnancy. Women who are overweight are also more prone to discomforts during pregnancy. It is not a good idea to be on a weight-loss diet while you are pregnant or trying to become pregnant, however. This type of diet could deny you and your baby the nutrients you both need. The best way to plan for your pregnancy is to try to reach an ideal weight before you become pregnant. You will be more comfortable during pregnancy, and the extra weight you gain will be easier to lose later.

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The benefits of Exercise during Pregnancy

Good health at any time in your life depends not only on proper diet but also on getting enough exercise. What you can do in sports and exercise during pregnancy depends on your health and, in part, on how active you are before you become pregnant.

When beginning a program, decide whether you want to improve your heart and lung function, the tome of your body muscles, or both. Then, select exercise that will enable you to meet your goals. If you are not used to being active, you should begin an exercise program gradually.

Exercise to improve your heart and lung function can be measured by keeping track of your heart rate. When you know how your heart rate responds to exercise, you can find out how hard to exercise. You should exercise so that your heart beats at your target heart rate, because this is the level gives you the best workout.

Every time you exercise, you should begin with a 5-to 10-minute period of light activity, such as brisk walking, as a warm-up before each session. One your body warmed up. Exercise for 20-30 minutes at your target heart rate. After this 20-30 minute period, you should have a cool-down period of 5-10 minutes. During this period, you gradually reduce your activity, allowing your heart rate to return to a near-normal level.

A program for toning muscles usually requires exercise at least three times a week. It does not have to be done daily-some people’s muscles cannot withstand hard exercise every day. Every other day is fine. But it is important that you maintain your routine throughout the year. If you stop for 6-8 weeks, you will need to start again at a lower level of exertion, as if you are just beginning a muscle-toning program.

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Rh Immunoglobulin

If you are Rh negative and your partner is Rh positive, sensitization (producing antibodies against the fetus) and hemolytic disease can be prevented by injections with blood product called Rh immunoglobulin (RhIg). It will prevent antibodies from forming, but it is not helpful if you have been sensitized and the antibodies already exist in your blood.

Sensitization can occur any time fetal blood mixes with the mother's blood. This could happen during pregnancy as well as after and abortion, miscarriage, ectopic pregnancy, or amniocentesis. Rhig will usually be given after these events to prevent sensitization and the risk of hemolytic disease in a future pregnancy. The protection from RhIg seems to last only about 12 weeks, so the treatment must be repeated at any event that could result in the mother's Rh-negative blood mixing with that of her fetus.

If a women with Rh-negative blood has not been sensitized, her doctor may recommend that she receive RhIg near near 28 weeks of pregnancy. This takes care of the small number of women who can become sensitized during the last 3 months of pregnancy. If her baby has Rh-positive blood, the mother should be given another does shortly after she gives birth. This treatment keeps the mother from developing antibodies to the Rh-positive cells from her baby that she may have been exposed to during labor and delivery, removing the risk to a fetus in a subsequent pregnancy. Sensitization could occur in the next pregnancy as well, however, so repeat doses of RhIg are given with each pregnancy and birth of an Rh-positive child.

RhIg is safe for a pregnant woman. The only known side effects are soreness where the drug was injected or a slight fever. Both are temporary reactions. RhIg is prepared in a way that kills most viruses and bacteria that might have been in the blood if was made form

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Blood Group Incompatibility

Everyone's blood is one of four major types: A, B, AB or O. Blood types are determined by the types of antigens on the blood cells. Antigens are proteins found on the surfaces of blood cells that can type B has only B antigens, type AB has both A and B antigens, and type O has neither A nor B antigens. There are other antigens, referred to as minor, that can make blood types even more specific. One of the most common of these minor antigens is the Rh factor.

As a part of your prenatal care, you will have blood tests to find out your blood type. If the mother's blood lacks the Rh antigen (Rh negative), and father's blood contains it (Rh positive), the fetus can acquire the antigen from its father. This can result in the mother's blood being incompatible with the blood of the fetus.

Normally, during pregnancy a small amount of the fetus's blood mixes with the mother's blood. When the fetus's blood is different allergic to the fetus by making antibodies to the antigens in the fetus's blood. This process is called sensitization. If the antibodies the mother produces cross the placenta into the fetus's bloodstream, the mother's antibodies attack the fetus's blood, breaking down its red blood cells and causing anemia. This is a serious condition called erythroblastosis fetalis, also known as hemolytic or Rh disease. It can become severe enough to cause serious illness or even death in the fetus or newborn.

One of the main causes of this disease-sensitization to the Rh factor- acan usualy be prevented. One antibodies are formed, they do not go away. Therefore, the best course is to prevent the mother from becoming sensitized, and thus forming antibodies, in the first place. To so this, your doctor will prescribe Rh immunoglobulin (RhIg) injections if you are unsensitzed.

If you have already become sensitized, your fetus is at risk. As your pregnancy progresses, your doctor will measure the levels of antibodies in your blood. If the levels become high, special tests may be done to check your fetus's health.

If the fetus is anemic, it will need a blood transfusion. After 18 weeks of pregnancy, these transfusions can be given during pregnancy while the fetus is still in the uterus. If the fetus is old enough to be delivered, your doctor may decide on early delivery, and the baby can be treated in a special-care nursery.

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Lung Disorders During Pregnancy

Pregnancy causes a number of changes in a woman's breathing patterns. Due to the growing uterus, the shape of the chest cavity is changed. It is quite common for a pregnant woman to feel short of breath (for hints on ways to feel more comfortable when you are short of breath. There are certain lung disorders, however, that may cause changes beyond this common shortness of breath.

Asthma, a lung disorder that causes wheezing and breathing problems, is one of the more common problems. It has not been shown to worsen or improve during pregnancy, but it could pose problems it the fetus does not get enough oxygen. Most women with asthma can go safely through a pregnancy, continuing to use their inhalers or prescribed medicines to help them breathe and supply the fetus with enough oxygen. Most of the medicines used for asthma are sage during pregnancy, except those containing iodine or tetracycline. Therefore, your doctor needs to know which medicines you take. Women with severe asthma must have their problem carefully controlled and be watched closely, because their asthma attacks will probably continue during pregnancy.

Pneumonia is an infection in the lungs that may be more serious in pregnancy than it is at other times. It may result in the mother and fetus getting less oxygen, and so it should be diagnosed and treated promptly. A chest X-ray is usually and important step in finding pneumonia. The technician who takes the X-ray may place a lead apron on your abdomen to shield the fetus, This type of X-ray has not been shown to cause any harm to the fetus. A pregnant woman with pneumonia is often hospitalized to receive antibiotics, many of which are sate for the mother and fetus.

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Heart Disease During Pregnancy

Women who have heart disease during their reproductive years may have either rheumatic heart disease or congenital heart disease. Because of advances in preventing rheumatic heart disease, it is a less common problem in pregnancy. Women with congenital heart disease are born with an anatomic defect in the heart. The nature and severity of this defect determine whether they may be at risk of having problems during pregnancy.

Ideally, heart disease should be diagnosed before conception. Once the condition is diagnosed, all possible steps can be taken to correct it. Counselling also can be provided about the impact of the disease on the pregnancy and vice versa. If you have serious cardiac disease, your doctor will work in a team approach with cardiologist to manage your care throughout the pregnancy.

Pregnancy increases the work the heart has to do, and labor and delivery place added stress on the heart. The amount of blood the heart pumps increases by up to 40% during pregnancy. Physical activity may need to be limited so that the demand on the heart is lessened. Your doctor will prescribe a routine of rest and possibly medications.

During labor, contractions increase the heart's work load, as do the pain and anxiety that go along with them. In spite of this, when obstetric conditions permit, vaginal delivery is preferred over cesarean birth because it causes less stress to the heart. Anesthesia may be given during labor to reduce pain and anxiety.

Women with heart disease are more likely to deliver prematurely, and their babies are often smaller than they should be. The babies of mothers who have congenital heart disease have a 4-5% chance of having the disease as well, although it may not be serious or life-threatening. New techniques for diagnosing heart disease in the fetus have improved the accuracy of this diagnosis and make it possible to plan for special care.

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