What Is Postpartum Depression? What Is Postnatal Depression?

Postnatal depression (PND), also known as Postpartum depression (PPD) is a type of depression that affects some women after having a baby. Typically, it develops within four to six weeks from giving birth, but can sometimes take several months to appear. Often, there is no clear reason for the depression. Some men also develop postnatal depression. The patient may experience fatigue, sadness, reduced libido, episodes of crying, irritability, anxiety, and irregular sleeping patterns.

Experts are aware of some risk factors linked to postnatal depression. However, nobody is completely sure what causes it. Doctors say that PND is effectively treatable, either with support groups and counseling, or such help combined with medication.
Parents need to be reassured that postnatal depression in absolutely no way means that the person does not love their baby - it is an clinical illness. Postpartum depression is not a character weakness. It is important that people with signs and symptoms see their doctor immediately.

Even though doctors and the general public are much more aware of postpartum depression today, a considerable number of women suffer in silence. A recent study carried out by 4Children, a UK charity, found that half of all women across the UK with postpartum depression do not see a healthcare professional about their problem. (Link to article)
Researchers from the Eastern Virginia Medical School, Norfolk, Va., found that approximately 10% of fathers experience postpartum or prenatal depression. They added that the highest rates are three to six months after childbirth. (Link to article)

Postpartum depression is a treatable condition

What are the signs and symptoms of postnatal depression?

Signs and symptoms have different meanings, although they are often incorrectly used interchangeably. A symptom is something the patient experiences and describes, such as a headache, while a sign is something everybody, including doctors and nurses can detect, such as a rash.
Postpartum depression can affect mothers in several different ways. Below are some common signs and symptoms:

• A feeling of being overwhelmed
• A feeling of being trapped
• A feeling that it is impossible to cope
• A low mood that lasts for longer than a week
• A sensation of being rejected
• Crying a lot
• Feeling guilty
• Frequent irritability
• Headaches, stomachaches, blurred vision - signs of tension
• Lack of appetite
• Loss of libido
• Panic attacks
• Persistent fatigue
• Problems concentrating or focusing on things
• Reduced motivation
• Sleeping problems
• The mother lacks interest in herself
• A feeling of inadequacy
• Unexplained lack of interest in the new baby
• Lack of desire to meet up or stay in touch with friends

Postpartum depression has nothing to do with baby blues, which affects many women for a few days after giving birth. If the woman's ability to go about her day-to-day life is significantly undermined, it is more likely she has postnatal depression.

For several possible reasons, a significant proportion of mothers with postnatal depression do not tell people how they feel. Partners, family and friends who are able to pick up on the signs of PND at an early stage should encourage her to get medical help as soon as possible.
Scary thoughts - some mothers may have thoughts about harming their child. Experts say this happens in about half of all patients with PND. The mother may also think about ending her life or harming herself. The mother and/or baby are very rarely harmed. However, having these thoughts are frightening and distressing.

What are the causes of postpartum depression?

Experts believe postpartum depression does not have just one cause, but is probably the result of multiple factors. However, the cause(s) of PND is still an enigma - nobody is sure.

Depression is usually caused by either emotional and stressful events, or some biological factor which leads to an imbalance of brain chemicals (neurotransmitters), or both.

The following potentially stressful events that may occur during pregnancy, childbirth or/and shortly afterwards, could be contributory factors:

• Depression develops during pregnancy
• Excessive worry about the baby and the responsibilities of being a parent
• Complicated or difficult labor and childbirth
• A Brazilian study published in The Lancet found that psychological violence by the pregnant woman's partner can raise the risk of her developing postpartum depression, regardless of whether or not there was any physical violence.(Link to article)
• Lack of family support
• Worries about relationships
• Financial difficulties
• Loneliness, not having close friends and family around
• A history of mental health problems, such as depression, or a previous postpartum depression
• Health consequences following childbirth, such as urinary incontinence, anemia, changes in blood pressure, and alterations in metabolism. A Dutch study found that complications around the time of childbirth can raise the risk of postnatal depression. (Link to article)
• Hormonal changes - after giving birth, estrogen and progesterone (hormones) levels may drop considerably, as may other hormones produced by the thyroid gland
• Lack of sleep - newborn babies can cry a lot at night and deprive parents of a lot of sleep
• An unplanned or unwanted pregnancy
• A UK study found that certain genes may have a positive or negative effect on postpartum depression risk, depending on a person's environment (Link to article)

A person with a family history of depression has a higher risk of developing it themselves. However, nobody knows why this occurs in detail.

Women who have bipolar disorder have a higher risk of developing postpartum depression compared to other mothers.

Researchers at South London and Maudsley NHS Foundation Trust, England, found that postpartum depression is not just confined to after the birth of the baby, but can start during the pregnancy itself. (Link to article)

How is postpartum depression diagnosed?

Postpartum depression is considered a subtype of major depression by DSM (Diagnostic and Statistical Manual of Mental Disorders). DSM is the standard classification of mental disorders used by doctors and psychologists in the USA - it is published by the American Psychiatric Association.

The DSM says that the signs and symptoms of major depression must have developed within four weeks of the baby being born (many experts say this period is too short).

A GP (general practitioner, primary care physician) and other health care professionals may ask the patient to complete a depression-screening questionnaire, The aim here is to rule out baby blues.

The doctor may also order some diagnostic tests, such as blood tests, to determine whether there are any hormonal problems, such as those caused by an underactive thyroid gland, or anemia.

According to the NHS (National Health Service), UK, a GP will probably ask the patient two questions:

• Have you been bothered by feeling down, depressed or hopeless during the past month
• Have you been bothered by taking little or no pleasure in taking part in activities that would usually make you happy?

A patient who answers "Yes" to both questions is much more likely to have postpartum depression.

The doctor may then ask the patient whether she feels she needs or wants help. Whether the doctor asks this will usually depend on how the first two questions were answered.
The NHS says that many mothers with no partner or close relative to help out with baby care might not want to answer openly, because they fear they will be diagnosed with postpartum depression and will have the baby taken away from them. UK authorities stress that this is most unlikely to happen. A baby is only taken away in very exceptional situations. Even in very severe cases where the mother has to be hospitalized in a mental health clinic, in the UK and most developed nations, she will usually have her baby next to her.
In most countries, a GP is trained to diagnose and treat postpartum depression. The doctor will probably try to determine what the signs and symptoms are so that the severity of the depression can be assessed (so that the best course of treatment can be decided upon).

The doctor will ask if the patient has:

• Sleeping problems
• Problems making decisions and concentrating
• Self-confidence problems
• Changes in appetite - this could be lack of appetite or eating more than usual (comfort eating)
• Anxiety
• Fatigue, listlessness, reluctance to be involved in any physical activity
• Been feeling guilty
• Been self-critical
• Been having suicidal thoughts

A patient who answer "yes" to three of the questions above probably has mild depression. In cases of mild depression, the mother is still able to go about her normal activities. The more "yes" answers there are, the higher the severity of depression, to "moderate" and finally "severe" depression.

A mother with moderate depression will find normal activities hard to do - but with the right help will probably cope. If she has severe depression she will not be able to function at all and will need extensive help from a dedicated mental health team.

What are the treatment options for postpartum depression?

Mothers who wonder whether they might have postpartum depression symptoms should get in touch with their doctor. In the UK and many other countries which offer universal healthcare, talking to a health visitor or midwife is also recommended.

Although postpartum depression is treatable and curable, recovery may sometimes take several months, and in some cases even longer.

The mother's most important step on the road to treatment and recovery is to acknowledge the problem. Family, partner and close friends' support can have a major impact on a faster recovery.

Experts say it is better for the mother to express how she feels to people she can trust, rather than bottling everything up inside. There is a risk partners and sometimes other loved ones may feel shut out, which can complicate things.

Self-help groups are useful because not only will the mother have access to useful data, she will also meet other mothers who share similar problems and symptoms. This may help her feel less isolated.

Drugs

In moderate or severe postpartum depression the doctor may prescribe an antidepressant. These are supposed to help balance the chemicals in the brain that affect mood. Antidepressants may help with irritability, hopelessness, a feeling of not being able to cope, concentration, and sleeplessness. These medications tend to have good results and help the mother cope better and bond with her baby.

Antidepressant may take a few weeks to kick in. Patients who despair at experiencing no immediate results need to be reminded about this. Depending on how patients respond, the doctor may alter the medication's dosage.

According to the NHS, between 50% and 70% of patients respond well to antidepressants within a few weeks. However, they do not work for everybody.

Antidepressant can be passed onto babies through breast milk. Nobody knows what the long-term risks are for the baby. According to some small studies, TCAs (tricyclic antidepressants), such as imipramine and nortriptyline are most likely the safest to take while breastfeeding a baby. If the mother has a history of heart disease, epilepsy, or severe depression with frequent suicidal thoughts she should not be prescribed TCAs.

Those who cannot take TCAs may be prescribed an SSRI (selective serotonin reuptake inhibitor), such as paroxetine or sertraline. The amount of paroxetine or sertraline that eventually gets into breast milk is minimal.

The mother should discuss feeding options with her doctor so that selecting the right treatment, which may include an antidepressant, is an informed choice decision.

Breastfeeding, apart from its nutritional benefits for the baby, also helps mother and child bond, and boosts the patient's confidence in being a good mother.

Tranquilizers may be prescribed in cases of postnatal psychosis, where the mother may have hallucinations, suicidal thoughts and irrational behavior. However, in such cases the medications should be used for a short time. Tranquilizers may cause loss of balance, memory loss, lightheadedness, drowsiness and confusion. Patients on tranquilizers may have impaired driving skills.

Talking therapies

Studies have found that CBT (cognitive behavioral therapy) has a success rate of between 50% to 70% for patients with moderate postpartum depression - a similar rate to medication. For those with severe depression, where motivation is low, talking therapies alone are much less effective.

Most studies agree that the best results come from a combination of talking therapies with medication, also known as counseling and drugs.

Examples of talking therapies may include:

• Cognitive therapy - this type of therapy is based on the principle that a person's thoughts can trigger depression. The patient is shown (taught) how her thoughts can have a harmful impact on her state of mind. The aim is to alter the patients thought patterns so that they become more positive.
• Cognitive behavioural therapy (CBT) - this is a combination of behavioral therapy and cognitive therapy. The patient is shown how to change the way she thinks, behaves and feels.
• Other therapies - these may include problem-solving therapy, interpersonal therapy, etc.

Severe postpartum depression - the patient may be referred to a team of specialists, including psychiatrists, psychologists, occupational therapists, and specialized nurses. If the doctor(s) feels that the patient is at risk of harming herself or her child, she may be hospitalized in a mental health clinic. In some cases, the baby may be cared for by the partner or family member while the mother is being treated.

In the UK, if the mother has nobody to help out, the team will usually find her a mother-and-baby mental health clinic so that the two can remain together. Initially, the baby may sleep in a separate room. As the mother improves, mother and baby spend more time together.

Electroconvulsive therapy (ECT) - if the mother's symptoms are very severe, she might benefit from electroconvulsive therapy. However, this is always a treatment of last resort - when all other options, such as medication, talking therapies, have failed.

ECT is applied under general anesthetic, plus drugs to relax the muscles. ECT is usually very effective in cases of very severe depression.

However, sometimes the improvements may be short-lived. There may be some side effects, such as headaches, and memory loss (usually short term, but not always). Memory is monitored closely after each ECT session. If doctors detect any sizeable memory loss, the treatment is stopped.

Preventing postpartum depression

The more a doctor knows during or even before a pregnancy about the patient's medical and family history, the higher the chances are of preventing postpartum depression. The GP should be told about any previous episodes of depression or mental illness.

A study carried out at the School of Physiotherapy at the University of Melbourne, Victoria, Australia, found that a physical therapy exercise and health education program effectively reduced the risk of developing postpartum depression. (Link to article)

An article published in Methods of Information in Medicine reported on a Spanish study that found that 80% percent of cases of postnatal depression can be predicted by a new method involving artificial neuronal networks and a series of risk factors. (Link to article)

According to the National Health Service, the following may help:

• Stay physical fit. Do regular exercise
• Eat a well balanced, healthy diet
• Rest - get at least 7 to 8 hours good quality sleep each night
• Blood sugar - eat frequently, don't let your blood glucose levels drop too much by not eating for long periods
• Make lists - organize yourself so you are not rushing around and becoming frustrated at not achieving much. Try not to do too much; prioritize
• Be open - talk to close friends, partners, and family members about how you feel, and things you are worried about
• Get in touch with local help groups
• Remember that postpartum depression affects millions of women every year. It is not your fault

A UK study found that properly trained health visitors can have a considerable impact in preventing the development of postpartum depression. (Link to article)

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Traditional Causes Of Death In Pregnant, Postpartum Women Outpaced By Homici...

Violent deaths are outpacing traditional causes of maternal mortality, such as hemorrhage and preeclampsia, and conflicts with intimate partner are often a factor, researchers report.
"We found that the mortality rate from homicide and suicide were more common than what we think of as traditional causes of maternal mortality," said Dr. Christie L. Palladino, an obstetrician-gynecologist and educational researcher at Georgia Health Sciences University. "It's not what you want to read, but it's the reality."

The analysis of the Centers for Disease Control and Prevention's National Violent Death Reporting System, a surveillance system from 17 states, found 94 pregnancy-associated suicides and 139 homicides from 2003-07. Overall, 64.4 percent of pregnancy-associated violent deaths - classified by the CDC as death during pregnancy and the following year - occurred during pregnancy. The mortality rate was 4.9 per 100,000 live births.
The findings, published in the journal Obstetrics & Gynecology, are a wakeup call for health care providers and families alike about the need for mental health awareness and treatment at a time typically associated with great joy, said Palladino who is working to enhance training of obstetrician-gynecologists in depression diagnosis and treatment.

"We have a lot of studies looking at the effects of pregnancy on the baby but often we don't focus so much on outcomes for moms, and the most disastrous of those for both mom and baby would be suicide," Palladino said. She noted that homicide and suicide are both potentially preventable. "The more we look into ways to prevent suicide, ways to effectively manage women with mental health diagnoses during pregnancy and postpartum, the more we can take steps to prevent these deaths," she said.

Among the suicides, 45.7 percent occurred during pregnancy and problems with current or former partners appeared to contribute to more than half. Older, Caucasian women were at greatest risk. Among homicides, 77.7 percent occurred during pregnancy and more than half the women were age 24 or younger and unmarried. Nearly half were black, even though black women accounted for less than 20 percent of the live births, and 45 percent were associated with violence from a current or former partner.

In follow-up, Palladino is surveying practicing physicians about their practice patterns in treating depression during pregnancy. She and her colleagues also want to learn more about precipitating circumstances such as substance abuse, stress and mental illness and treatment. Studies already indicate that intervention lowers the recurrence risk of intimate partner violence in pregnancy and postpartum.

It was her early experience as an obstetrician-gynecologist who felt ill-prepared to treat depression in pregnant women that got her interested in the topic. A 2003 report in The British Journal of Psychiatry identifying suicide as the leading cause of maternal death in Great Britain sealed the deal. "Unfortunately what we found paralleled the Great Britain findings," Palladino said.

The good news is that evidence-based guidelines for depression treatment during pregnancy or postpartum have been developed by The American College of Obstetricians and Gynecologists and The American Psychiatric Association, she said. The bad news is that women and their providers might be hesitant to seek or provide care because mental illness and pregnancy seem counterintuitive.

Collateral materials such as police, coroner and medical examiner reports also were examined as part of the CDC database to provide greater context for the cause of death. While the overall pregnancy-associated violent death rate was stable over the four-year study period, those numbers could be underreported because the pregnancy or postpartum status was marked "unknown" in the majority of female deaths in the CDC database, the researchers noted. Pregnancy or postpartum status also could be missed because autopsies might not include a pregnancy exam, might miss postpartum signs or might fail to report pregnancy status on death certificates.

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Preeclampsia: Early Detection And Immediate Treatment

A blood test can help to assess whether a pregnant woman who suffers from pregnancy induced hypertension, so-called preeclampsia, is at risk for an imminent delivery. This knowledge can be used to determine the due date as well as avoid complications for mother and child. This was now reported by a team of scientists at Charité Universitätsmedizin Berlin in the American Journal of Obstetrics & Gynecology. The assay was put to the test in collaboration with Universitätsklinik Leipzig and five other European research centers.
Preeclampsia is the most common of the dangerous pregnancy complications.

It is characterized by elevated blood pressure, protein in the urine and accumulation of excess fluid beneath the skin. If not treated in time, preeclampsia may progress to eclampsia, characterized by tonic-clonic seizures which can possibly result in maternal and infant death.

Dr. Stefan Verlohren from the Klinik für Geburtsmedizin and his team examined a total of 630 pregnant women. 388 of those were having a normal pregnancy whereas 164 suffered from preeclampsia. The scientists closely observed the remaining time of pregnancy in patients with preeclampsia. In cases where the concentration of two certain placenta-derived growth factors, so-called sFlt-1 and PlGF, exceeded a certain value the duration of pregnancy was significantly shorter. In patients with especially high test results delivery resulted within 48 hours.

"With this test we can assess the severity of preeclampsia and give a short-term prognosis of the disease course", explains Dr: Verlohren. Further studies will have to evaluate the test´s validity in women who have an elevated risk of developing preeclampsia.

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Daughters Of Women Given Diethylstilbestrol During Pregnancy At Greater Risk...

A large study of the daughters of women who had been given DES, the first synthetic form of estrogen, during pregnancy has found that exposure to the drug while in the womb (in utero) is associated with many reproductive problems and an increased risk of certain cancers and pre-cancerous conditions. The results of this analysis, conducted by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and collaborators across the country, were published Oct. 6, 2011, in the New England Journal of Medicine.
Beginning in 1940, diethylstilbestrol, known as DES, was used clinically to prevent certain complications of pregnancy. In the 1950s, clinical studies showed DES was ineffective for this purpose. In the late 1960s, an unusual occurrence of a rare cancer of the vagina among young women, called clear cell adenocarcinoma (CCA), was observed and subsequently linked to their exposure to DES while in the womb.
In 1971, the U.S. Food and Drug Administration notified physicians that DES should not be prescribed to pregnant women. However, between 5 million and 10 million pregnant women and babies had been exposed to the drug. It was manufactured under many different product names, and came in various forms, including pills, creams and vaginal suppositories.
"Our study carefully documents elevated risk for DES-exposed daughters for a host of medical problems - many of them also quite common in the general population," said study author Robert N. Hoover, M.D., director of the Epidemiology and Biostatistics Program in NCI's Division of Cancer Epidemiology and Genetics. "Without the sentinel finding of a very rare cancer in young women, and without the sustained follow-up of those who were exposed, we would not know the full extent of harm caused by DES exposure in the womb."
In this study, which included over 6,500 women (4,600 exposed and 1,900 unexposed), the researchers found that the daughters with exposure to DES while in the womb had an increased risk of 12 medical conditions, including a twofold higher risk of infertility and a fivefold increased risk of having a preterm delivery.
This study is also the first to estimate the cumulative proportion of all DES-exposed women who developed these conditions because of their exposure. Of all DES-exposed women, 1 in 5 will experience some level of infertility because of their exposure. And of all those exposed women who are successful in having at least one birth, 1 in 3 will have a preterm delivery due to DES.
Although DES-exposed daughters have about 40 times the risk of developing CCA than unexposed women, CCA is still a rare disease, occurring in 1 in 1,000 DES-exposed daughters. While the first women diagnosed with this condition in the late 1960s were adolescents and young adults at the time of their diagnosis, the research now shows that the risk for DES-exposed daughters continues through at least age 40. In addition, these women are more than twice as likely to develop pre-cancerous cells in the cervix or vagina (called cervical intraepithelial neoplasia) and have an 80 percent higher chance of developing breast cancer after age 40. According to the results of this study, by age 55, 1 in 25 DES-exposed daughters will develop abnormal cellular changes in the cervix or vagina, and 1 in 50 will develop breast cancer due to their DES exposure.
This study was the first to assess risk based on the presence of vaginal epithelial changes as a biomarker of timing and dose of DES exposure. Exposed daughters with higher total dose of DES and younger age of the embryo at first exposure had evidence of these changes in the lining of the vagina. Women with these changes were at even greater risk for 9 of the 12 conditions compared to exposed women who did not have the biomarker.
This study did not evaluate sons with DES exposure in the womb, but previous reports have indicated an increased risk for certain testicular abnormalities, including undescended testicles or the development of cysts in the epididymis, tightly coiled tubes connected to the testicles. As DES-exposed sons grow older, more data will be available to assess their cancer risk. So far, research has shown no decreased fertility for these men, even with testicular abnormalities.
The women in this study were followed as part of the NCI's DES Follow-up Study, which began in 1992. NCI researchers will continue to study DES-exposed daughters as they move into menopausal years. The cancer risks for exposed daughters, as well as sons, are continually being studied to determine if they differ from an unexposed population. In addition, researchers are studying possible health effects on the grandchildren of mothers who took DES during pregnancy, because some of the genetic changes caused by DES exposure in the womb may be inherited.

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Want to Have a Baby? See Your Dentist

For some women who are having trouble getting pregnant, the problem could be gum disease. A new study from Australia involving more than 3,500 pregnant women, found that those who had gum disease took about two months longer to conceive than the average among women who didn't have gum disease. The delay was even longer - more than a year - among non-Caucasian women, the researcher from the University of Western Australian reported at the European Society of Human Reproduction and Embryology meeting in July. Gum disease causes inflammation that can pass into the blood stream and has been linked to heart disease, type 2 diabetes, respiratory and kidney disease and pregnancy problems including miscarriage and premature birth, the study noted. The investigator reported that the effect of gum disease on fertility is equal to the negative influence of obesity. Bottom line: when considering pregnancy stop smoking, avoid alcohol, maintain a healthy weight, take folic acid supplements and see your dentist.

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Mother With Two Wombs Has Twins, Defying One In Five Million Chance

A mother has given birth to two babies, delivered from two separate uteruses, at Morton Plant Hospital in Clearwater, Florida in the US. Fraternal twins, Nathan and Natalie Barbosa, born on 15 September, are doing well, and delighting their parents Andreea Barbosa, 24, of Clearwater, and husband, Miguel Barbosa, who also have a two-year-old daughter.
Andreea Barbosa has uterus didelphys, or double uterus, a rare condition where the double uterus has two separate cervices, and often a double vagina as well.
It is thought to affect about 1 in 2,000 women worldwide, and there have only been 100 known cases of women with the condition being pregnant in both uteruses at the same time. The most recent known case before the Barbosa's was of a woman in India who gave birth in July.

The condition can cause infertility, miscarriage and premature birth. But Barbosa's twins were delivered by cesarean section at 36 weeks: Nathan was delivered first, weighing in at 5 lbs 8 oz (2.50 kg), then his sister Natalie, at 5 lbs 10 oz (2.55 kg), was born two minutes later.

Their mother told the press she was "shocked" when she found out she was pregnant in each uterus.

"But my husband and I are just so happy that they are here and healthy," she said.
Barbosa's doctor said her patient was aware of the risks of such a pregnancy. Patricia St. John, MD, OB/GYN at Morton Plant Hospital, said they were "thrilled" to be guiding the family through this "unique" pregnancy and delivery.

"Because we were aware of her condition, we were able to take special precautions to ensure that both mother and babies would be healthy," she added.
Uterus didelphys will have developed in Barbosa when she herself was a fetus in her mother's womb. There are two tubes that normally fuse together to form the uterus in the female fetus, but when this joining fails, they develop into two separate cavities.
The symptoms usually manifest as unusual pain before or during a period, and abnormal bleeding during a period. The condition is sometimes never diagnosed, and women can go through pregnancy and childbirth without knowing they have two wombs.

In 2006, an even rarer event occured in the UK when a mother with a double uterus had triplets: two babies from one uterus and another from the second uterus. Hannah Kersey, 23, from Northam in Devon, gave birth to identical twins Ruby and Tilly, and their fraternal twin sister, Grace. The odds of that happening are thought to be about 25 million to one.
Written by Catharine Paddock PhD

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Pregnant Women Reminded to Get Flu Vaccine

 Pregnant women should get a flu shot to protect themselves and even their newborn from the flu, experts say.

Pregnancy increases the risk of serious complications of flu, such as bacterial pneumonia and dehydration, according to the March of Dimes.
Not only does getting vaccinated offer protection from the flu for moms-to-be, the vaccine can also confer protection to the baby once it's born, said Dr. Alan Fleischman, March of Dimes medical director.
"The flu vaccine has been shown to be safe and effective. As an added bonus, during pregnancy, mothers pass on their immunity, protecting babies in those early months of life," said Fleischman in a March of Dimes news release. "We urge all pregnant women, and women who expect to become pregnant, to get their influenza immunization because the flu poses a serious risk of illness and even death during pregnancy."
During pregnancy, normal changes to women's immune system, heart and lungs make them more vulnerable to the dangerous complications of the flu. One out of every 20 deaths in 2009 from H1N1 was a pregnant woman.
Despite this increased risk, only half of all expectant mothers received the vaccination during last year's flu season, according to the U.S. Centers for Disease Control and Prevention.
Pregnant women can take additional steps to protect themselves from the flu by:

• Staying home when ill and avoiding contact with other people who are sick
• Coughing or sneezing into a tissue or your arm, not your hands
• Avoiding touching your eyes, nose and mouth.
• Washing your hands with soap and water often.
• Using hand sanitizers at work or in public places.
• Thoroughly washing dishes and utensils.
• Avoiding sharing dishes, utensils, drinking glasses or toothbrushes.

The March of Dimes noted that anyone who lives with a pregnant woman or has regular close contact with one should also be immunized. The group also advised that any expectant mothers who experience flu-like symptoms seek medical attention right away.
-- Mary Elizabeth Dallas

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Vitamins and Supplements During Pregnancy

When a woman is pregnant it's essential that she take extra vitamins. The fetus will need a great deal of vitamins and minerals from the mother's body and if those vitamins aren't replaced the mother could develop serious health problems and the baby could also suffer in the long run. If you were going to get all the extra vitamins and minerals that you need during pregnancy from eating alone you'd need to be eating 24 hours a day.

Pregnant women are usually prescribed pre-natal vitamins that have super high levels of certain vitamins that are crucial for the woman's health and the fetus' health. A woman that isn't on pre-natal vitamins should take extra vitamins and supplements to make sure that she is getting the nutrients her body needs to support the fetus. The vitamins that especially important during pregnancy are:

Vitamin A & Beta Carotene (700 mcg) –Vitamin A is essential for growing bones and keeping bones and teeth strong.

Vitamin D (5 mcg) Vitamin D is a "helping vitamin" that helps your body process calcium. Vitamin D also helps keeps bones and teeth strong.

Vitamin E (15 mg)-Vitamin E is essential to keep your red blood cells working properly and to help muscle growth in the fetus.

Vitamin C (80 - 85 mg) - Vitamin C will help boost your immune system and keep you strong and healthy during the pregnancy.

Thiamin/B1 (1.4 mg) Thiamin helps support the nervous system and will give you energy.

Riboflavin/B2 (1.4 mg) Riboflavin helps keep your skin clear and healthy and will help the development of the fetus' eyes.

Niacin/B3 (18 mg) Niacin will help manage your hormones and keep you calm.

Pyridoxine/B6 (1.9 mg) Works to create new red blood cells and will help fight off morning sickness.

Folic Acid/Folate (600 mcg) - Folic Acid is critical to the healthy development of the fetus. It helps
maintain the placenta and it prevents several birth defects.

Calcium (1,000 - 1,300 mg)-Calcium is needed by you and the fetus for strong bones, healthy teeth,
and strong red blood cells.

Iron (27 mg) –It's essential that you take an iron supplement during pregnancy. Iron will help prevent anemia, which is one of the most common problems women face during pregnancy. It will also help prevent low birth weight in the fetus and premature delivery.

Protein (60 mg) –Protein will give you energy. It will also help stimulate the production of amino acids.

Zinc (11-12 mg) –Zinc will help your immune system stay strong and healthy and it will also help
your body produce insulin and other enzymes that you need in order to keep your body and the fetus
healthy.

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Pregnancy Outcomes Help To Predict Women's Long-Term Health

"A woman's pregnancy outcome can be an indicator of future health conditions," stated George R. Saade, M.D., president of the Society for Maternal-Fetal Medicine and professor of obstetrics and gynecology at The University of Texas Medical Branch in Galveston, Texas. Saade gave a compelling presentation to SMFM members on the links between pregnancy outcomes and women's long-term health. He emphasized the importance of greater physician collaboration in reviewing patients' health records, particularly in noting pregnancy outcomes as these can be important indicators of future health problems.

Saade noted that there are multiple studies on the association between hypertensive disorders in pregnancy and long-term maternal outcomes including a study in Norway of 15,065 women who were analyzed. "Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors" (Magnussen EB, Vatten LJ, Smith GD, Romundstad PR; Obstet Gynecol 2009), provides incontrovertible evidence that women with pregnancy-related hypertension are at higher risk for hypertension and metabolic abnormalities later in life. Other studies have shown that preterm birth, stillbirth, and fetal growth restriction are also associated with long term maternal cardiovascular, as well as metabolic disorders including insulin resistance and type 2 diabetes.

"Pregnancy represents a unique opportunity to identify women who may be at increased risk of chronic diseases later in life," stated Saade. "For patients with pregnancy complications, the care should not stop at delivery or shortly thereafter. It may be time to change the paradigm from short term prenatal care to maternal care," Saade continued, "It would be appropriate for the obstetrician to identify mothers who may be at risk for long term diseases to ensure that these women receive the preventive care needed starting in the postpartum period rather than waiting until they reach the age for routine check-ups in the general population." He stated that the preventive measures need not be drastic but should include periodic assessment for primary and preventive care.

Complications from hypertension, diabetes and hyperlipidemias are clearly prevented with early therapy rather than waiting until these abnormalities are discovered at the time of routine check-up. Pregnancy weight gain appears to be an important factor in the association between adverse pregnancy outcomes and long term maternal health. Failure to lose weight in the postpartum period is associated with long term obesity and its consequences. Pregnancy and the postpartum period offer a unique opportunity to promote healthy lifestyles for the mother and her family, such as healthy diet and plenty of exercise. Breastfeeding is a frequently overlooked prevention strategy. In addition to its beneficial effect in the infant, breastfeeding increases the likelihood the mother will return to her pre-pregnancy weight and improves her metabolic profile. Unfortunately, preventive care may not be available to most women because their health care coverage is limited to pregnancy and the 6 weeks postpartum period. Continuing coverage for patients with pregnancy complications is an important step in the right direction for preventing chronic diseases in women.
"One of the limitations is that pregnancy complications are not always on the mind of general practitioners when they are caring for a woman later in life," explained Saade. "It would be very advantageous for all physicians who see female patients to review their patients' pregnancy history." Other simple measures that may be started following a complicated pregnancy include regular visits to check blood pressure and metabolic profiles, including lipid and glucose tolerance testing.

Not all women with adverse pregnancy outcomes will have cardiovascular or metabolic abnormalities later in life, Saade explained. In the future, biomarkers may be identified that can be used to target those women who may benefit most from regular follow up and intervention.

Inflammatory biomarkers, particularly high sensitivity C reactive protein (hsCRP) may be such a test. Men and women with elevated hsCRP are at increased risk for coronary artery disease. Women who develop preeclampsia or have a history of eclampsia have been known to have elevated hsCRP - an indication that they are at increased risk for coronary artery disease.

"This information puts obstetricians in a position of holding a primary role in the prevention of chronic diseases by identifying women at the greatest risk," Saade concluded. "We have the opportunity to successfully identify markers that will impact our patients for the remainder of their lives. No longer is our role confined to a single condition - a single pregnancy. We now have the capability and resources to identify and prevent chronic diseases in mothers and their offspring."

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Article adapted by Medical News Today from original press release. Visit our  women's health / gynecology section for the latest news on this subject.

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