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listlengths 384
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Leddy\tet\tal,\t2009\n).\nAnorexia\n\tand\tbulimia\tare\tassociated\twith\tincreased\trisk\tof\tmiscarriage,\tbirth\tdefects,\thyperemesis,\nIUGR,\tand\tmicronutrient\tdeficiencies,\tas\twell\tas\tpostpartum\tdepression\tand\timpaired\tinfant\nbonding.\tFor\tthose\twith\tbinge\teating,\texcessive\tweight\tgain,\tmacrosomia,\tand\tincreased\tcesarean
|
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rates\tare\tseen.\tThose\tthat\tpurge\tmay\thave\tcaries\tor\tfractured\tteeth\tsevere\tenough\tthat\tthey\tcannot\nchew\tmeat.\nThe\teffect\n\tof\tpregnancy\ton\tthe\tindividual\twith\tan\teating\tdisorder\tvaries,\tbut\t70%\tmay\tshow\nimprovement,\tespecially\twith\tpurging\tbehaviors\t(\nHarris,\t2010\n).\tHowever,\tpregnancy\tdoes\tnot\tcure
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] |
Harris,\t2010\n).\tHowever,\tpregnancy\tdoes\tnot\tcure\nthe\teating\tdisorder\tand\tsymptoms\toften\tare\texacerbated\tafter\tdelivery.\tIn\tfact,\tin\tsome\tcases\tthe\nnewborn\tis\tseen\tas\t“too\tfat,”\tto\tthe\tpoint\tof\trestricting\tfood,\tadministering\tsuppositories\tor\tenemas,\nor\tinducing\tvomiting.\n\tA\tteam\tapproach\tto\ttreating\tthe\tmom\tis\thelpful\tin\tthose\tcases.
|
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] |
A\tteam\tapproach\tto\ttreating\tthe\tmom\tis\thelpful\tin\tthose\tcases.\nFor\tthe\twoman\twith\tan\teating\tdisorder,\tpregnancy\tmay\tbe\tparticularly\tfrightening\tbecause\tof\tthe\nloss\tof\tcontrol\tand\tdisturbed\tbody\timage.\tAnorexia\tcan\tbe\tdiagnosed\tduring\tpregnancy.\tSubstance
|
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abuse,\tas\twell\tas\tthe\tuse\tof\tlaxatives\tor\tdiet\tpills,\tmay\tbe\tcoping\tmechanisms.\tInsulin\thas\tbeen\tused\nas\ta\tpurging\tmechanism.\tWomen\tmay\tfear\n\tbeing\tweighed\tand\tmay\tneed\treassurance\tthat\tthe\tnausea\nand\tvomiting\tof\tpregnancy\tis\tnot\tnecessarily\ta\tresurgence\tof\tpurging.\tFatigue,\tirritability,\tand
|
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] |
depression\tmay\tbe\tdue\tto\tstarvation.\tThese\tpregnant\twomen\tshould\tbe\ttreated\twith\tparticular\tcare,\nincluding\tfocusing\ton\thealthy\teating\tfor\toptimal\tfetal\tgrowth\tand\tdevelopment\t(see\t\nChapter\t21\n).\nEdema\tand\tleg\tcramps\nMild\tphysiologic\tedema\tis\n\tusually\tpresent\tin\tthe\tthird\ttrimester\tand\tshould\tnot\tbe\tconfused\twith\tthe
|
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] |
pathologic,\tgeneralized\tedema\tassociated\twith\tpreeclampsia.\tNormal\tedema\tin\tthe\tlower\textremities\nis\tcaused\tby\tthe\tpressure\tof\tthe\tenlarging\tuterus\ton\tthe\tvena\tcava,\tobstructing\tthe\treturn\tof\tblood\nflow\tto\tthe\theart.\tWhen\ta\twoman\treclines\ton\ther\tside,\tthe\tmechanical\teffect\tis\tremoved,\tand\nextravascular\tfluid\tis\tmobilized\tand
|
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extravascular\tfluid\tis\tmobilized\tand\n\teventually\teliminated\tby\tincreased\turine\toutput.\tNo\tdietary\nintervention\tis\trequired,\tassuming\ther\tprotein\tintake\tis\tadequate.\tIf,\thowever,\ther\turine\tis\tdark\nand/or\tshe\thas\tswelling\tin\ther\thands,\tincreased\tfluid\tintake\tis\trecommended\tand\texcessive\tsalt\nconsumption\tshould\tbe\treduced.
|
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0.0792555958032608,
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] |
consumption\tshould\tbe\treduced.\nIncreased\tfluid\tintake\talso\tis\trecommended\tfor\tleg\tcramps.\tWomen\tshould\tbe\tadvised\tto\tstretch\nwith\ttheir\ttoes\tpointing\n\tback\ttoward\ttheir\tbodies\trather\tthan\taway\tfrom\tthem.\tMassage\tand\theat\napplication\tmay\thelp\ttreat\tthe\tcramp.\tOptimal\tcalcium\tintake\tmay\treduce\tthe\tprevalence\tof\tleg
|
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] |
cramps.\tThe\tliterature\tis\tconflicting\tabout\tthe\tbenefit\tof\tmagnesium\tsupplementation\tfor\tprevention\nor\ttreatment\tof\tpregnancy-related\tleg\tcramps\t(\nZhou\tet\tal,\t2015\n).\tCaution\tis\tadvised\tagainst\tlarge\nintakes\tof\tsupplements.\nHeartburn\nGastric\tesophageal\treflux\tis\tcommon\tduring\tthe\tlatter\tpart\tof\tpregnancy\tand\toften\toccurs\tat\tnight.
|
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] |
The\tpressure\tof\tthe\tenlarged\tuterus\ton\tthe\tintestines\tand\tstomach,\talong\twith\tthe\trelaxation\tof\tthe\nesophageal\tsphincter\tdue\tto\thormonal\tchanges,\tmay\tresult\tin\tregurgitation\tof\tstomach\tcontents\tinto\nthe\tesophagus.\tRelief\tmeasures\tmay\tinclude\teating\tsmaller\tmeals,\tlimiting\tfluids\twith\tmeals,\tlimiting
|
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] |
caffeine,\tchocolate,\tmint,\tcarbonated\tbeverages,\ttomatoes,\tcitrus,\tfat,\tand\tspicy\tfoods,\tas\twell\tas\nchewing\tgum,\twalking,\tand\tstaying\tupright\tfor\tat\tleast\t3\thours\tafter\ta\tmeal,\tbut\tinterventions\thave\nnot\tbeen\tevaluated\tfor\teffectiveness\t(\nKaiser\tand\tCampbell,\t2014\n).\tUsing\tmore\tpillows\tat\tnight\talso\nmay\thelp\t(see\t\nChapter\t26\n).
|
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] |
).\tUsing\tmore\tpillows\tat\tnight\talso\nmay\thelp\t(see\t\nChapter\t26\n).\nAlthough\theartburn\tmedicines\tcan\tbe\tused,\tthey\tare\tnot\tbenign\tand\tuse\n\tshould\tbe\tlimited.\tTaking\nexcessive\tcalcium\tcarbonate\tcan\tcause\tlife-threatening\tmilk-alkali\tsyndrome\t(hypercalcemia,\trenal
|
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] |
sufficiency,\tand\tmetabolic\talkalosis).\tHypercalcemia-induced\tpancreatitis\thas\talso\tbeen\tdocumented\n(\nTrezevant\tet\tal,\t2017\n).\tThe\tUL\tof\t2500\tmg\tof\telemental\tcalcium\t(food\tplus\tsupplements)\tshould\tbe\nobserved.\tIf\ta\tcouple\tof\tcalcium\tcarbonate\ttablets\t(two\tregular\tstrength\tTums\n\tcontain\t400\tmg
|
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] |
contain\t400\tmg\ncalcium;\ttwo\tultrastrength\ttablets\tprovide\t800\tmg)\tdo\tnot\tresolve\tthe\theartburn,\tswitching\tto\tthose\ncontaining\tmagnesium\tmay\tbe\tbeneficial.\tHowever,\tprolonged\tuse\tof\thigh-dose\tmagnesium-\ncontaining\tantacids\tis\tassociated\twith\toffspring\tkidney\tstones,\thypotonia,\tand\trespiratory\tdistress\n(\nBustos\tet\tal,\t2017
|
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(\nBustos\tet\tal,\t2017\n).\tAntacids\tcontaining\tbicarbonate\tmay\tcause\tmaternal\tand\tfetal\tmetabolic\nacidosis,\n\tas\twell\tas\tfluid\toverload\tand\tare\tnot\trecommended\tin\tpregnancy.\tProton\tpump\tinhibitors\nmay\treduce\tthe\tbioavailability\tof\tmany\tnutrients,\tincluding\tvitamins\tC,\tB\n12\n,\tcalcium,\tmagnesium,\tand
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] |
12\n,\tcalcium,\tmagnesium,\tand\nnonheme\tiron.\tThe\tuse\tof\tantacids\talso\tpotentially\tcan\tincrease\tthe\trisk\tof\tfood\tallergies\tby\timpeding\ngastric\tprotein\tdigestion,\tbut\twhether\tthat\ttranslates\tinto\ta\thigher\trisk\tof\tfood\tallergy\tor\tasthma\tfor\nthe\n\tchild\tis\tunclear.\tSome\therbal\tmedicines,\tincluding\taloe\tvera\tjuice,\tare\tpromoted\tfor\ttreatment\tof
|
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] |
heartburn.\tHowever,\tcaution\tis\tadvised\tbecause\tanimal\tresearch\tdemonstrates\tsome\tpreparations\tof\naloe\tcontain\tlatex\twhich\tmight\tinduce\tabortion\tand/or\tstimulate\tmenstruation\t(\nZielinski\tet\tal,\t2015\n).\nHypertension\nHypertension\tobserved\tduring\tpregnancy\tmay\tbe\tpreexisting\tor\tobserved\tfor\tthe\tfirst\n\ttime.\tElevated
|
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time.\tElevated\nblood\tpressure\tthat\tis\tfirst\tdiagnosed\tin\tpregnancy\tmay\tbe\trelatively\tbenign.\tHowever,\ta\trise\tin\nblood\tpressure,\taccompanied\tby\tother\tchanges\tlisted\tin\tthis\tchapter,\tcan\tbe\ta\tsign\tof\t\npreeclampsia\n,\na\tprogressive,\tsystemic\tproblem\taffecting\t3%\tto\t8%\tof\tpregnancies\tworldwide\tand\tthe\tleading\tcause
|
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of\tmaternal\tand\tneonatal\tmorbidity\tand\tmortality\t(\nMyers,\t2017\n).\tAlthough\tdelivery\tresolves\n\tthe\nproblem\tfor\tmost,\tsome\twomen\tdevelop\thypertension\tafter\tdelivery.\nChronic\thypertension\tpredates\tpregnancy\tand\tis\tassociated\twith\tfetal\tgrowth\trestriction.\nAvoidance\tof\tsevere\thypertension\tis\ta\tgoal,\tbut\tthe\toptimal\tblood\tpressure\tduring\tpregnancy\tfor
|
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] |
someone\twith\tpreexisting\thypertension\tis\tunclear\t(see\t\nChapter\t32\n).\tAppropriate\tweight\tgain,\ta\nmodified\tDietary\tApproaches\tto\tStop\tHypertension\n\t(DASH)\tdiet\t(see\t\nAppendix\t17\n),\tand\tregular\naerobic\texercise\tfor\tthose\twithout\tcomplications\tare\trecommended.\tAlthough\texcessive\tsodium
|
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] |
should\tbe\treduced,\tACOG\thas\tpreviously\trecommended\tthat\tintake\tshould\tnot\tbe\tless\tthan\t2300\nmg/day\t(\nACOG,\t2013c\n).\tCalcium\tsupplementation\tfor\tthose\twith\tlow\tcalcium\tintakes\tmay\tbe\thelpful.\nSome\tantihypertensive\tmedications\tcan\tbe\tused\tduring\tpregnancy\tbut\tmay\tneed\n\tto\tbe\tmodified\nduring\tbreastfeeding.\nGestational\thypertension
|
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] |
to\tbe\tmodified\nduring\tbreastfeeding.\nGestational\thypertension\n\tis\tdefined\tas\televated\tblood\tpressure\tthat\tappears\tafter\t20\tweeks\tof\ngestation,\tbut\twithout\tproteinuria\tor\tother\tfindings.\tSome\twomen\t(up\tto\t50%)\tgo\ton\tto\tdevelop
|
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] |
preeclampsia,\twhile\tothers\tmay\thave\tno\trisk\texcept\tthe\televated\tblood\tpressure\t(\nACOG,\t2019\n).\tThey\nare\ttreated\tthe\tsame\tas\tthose\twith\tchronic\thypertension\tand\tmonitored\tfor\n\tworsening\tof\tsymptoms.\nGestational\thypertension\tmay\tpredict\tincreased\trisk\tfor\tfuture\thypertension.\tOptimal\tpericonceptual
|
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nutrition\tis\timportant,\tincluding\tfocus\ton\tfolate,\tsodium,\tcalcium,\tpotassium,\tiron,\tcopper,\tand\tzinc\nintakes\t(\nTande\tet\tal,\t2013\n).\nSome\twomen\twho\tdevelop\thypertension\tduring\tpregnancy\tgo\ton\tto\tdevelop\tpreeclampsia.\tRisk\nfactors\tinclude\twomen\twho\tare\tprimiparous\tand\tobese,\n\tbut\tother\trisk\tfactors\tinclude\ta\tpersonal\tor
|
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but\tother\trisk\tfactors\tinclude\ta\tpersonal\tor\nfamily\thistory\tof\tpreeclampsia,\tchronic\thypertension,\tdiabetes\t(type\t1,\ttype\t2,\tor\tGDM),\tchronic\nrenal\tdisease,\thistory\tof\tthrombophilia,\tsystemic\tlupus\terythematosus,\tantiphospholipid\tantibody\nsyndrome,\tobstructive\tsleep\tapnea,\tmultifetal\tpregnancy,\tIVF\t(especially\tfollowing\toocyte\tdonation\n[
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] |
[\nMyers,\t2017\n]),\tand\tmaternal\tage\tof\tat\tleast\t35\tyears\t(\nACOG,\t2019\n).\tHowever,\tthe\tpresence\tof\tthese\nrisk\tfactors\tdoesn’t\tnecessarily\tguarantee\tthat\tan\tindividual\twill\tdevelop\tpreeclampsia.\tFor\texample,\nwhile\twomen\twho\tare\tobese\tare\ttwice\tas\tlikely\tto\tdevelop\tpreeclampsia\tcompared\twith\twomen\twith
|
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] |
a\tlower\tBMI,\tonly\tone\tin\tten\twomen\twith\tobesity\tdevelop\tpreeclampsia\t(\nMyers,\t2017\n).\tIn\taddition,\nmost\tcases\tof\tpreeclampsia\toccur\tin\thealthy,\tnulliparous\twomen\twith\tno\n\tapparent\trisk\tfactors\n(\nACOG,\t2019\n).\tPaternal\tfactors\talso\tlikely\tplay\ta\trole.\tRisk\tincreases\twith\tadvanced\tpaternal\tage,
|
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paternal\tobesity,\tand\tfamily\thistory\tof\tearly-onset\tCVD.\tPaternal\tgenes\talso\tmay\tbe\timportant—\nincreased\trisk\tfor\tpreeclampsia\tis\tseen\tif\tthe\tman\thas\tfathered\ta\tpreeclamptic\tpregnancy\tor\tif\the\nwas\tborn\tof\ta\tpreeclamptic\tpregnancy\t(\nDekker\tet\tal,\t2011\n).\tMaternal\tsmoking\treduces\n\tthe\trisk\tby\n35%\t(\nACOG,\t2013c
|
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] |
).\tMaternal\tsmoking\treduces\n\tthe\trisk\tby\n35%\t(\nACOG,\t2013c\n),\tbut\tif\tpreeclampsia\toccurs,\tthe\tseverity\tincreases\t(Trogstad\tet\tal,\t2011).\tRisk\tof\nrecurrence\tin\ta\tsubsequent\tpregnancy\tis\t25%\t(\nMyers,\t2017\n).\tRisk\tof\tpreeclampsia\tis\tless\tlikely\tin\nsubsequent\tpregnancies\twith\tthe\tsame\tpartner\tthan\twhen\tthe\tmother\tis\tpregnant\twith\ta\tnew\npartner.
|
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] |
partner.\nPreeclampsia\tinvolves\tdysfunction\tof\tmultiple\torgan\tsystems.\tIt\tis\tdynamic,\tprogressive,\n\tand\tonce\nevident,\tis\tnot\treversible.\tDelivery\tis\tneeded\tbecause\tit\tis\tpotentially\tfatal\tfor\tmother\tand\tbaby.\nGrowth\trestriction\tis\tcommon\tand\tbabies\tare\toften\talso\tpremature\tin\tan\teffort\tto\tavoid\tthe\tmother
|
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progressing\tto\tsevere\tpreeclampsia,\teclampsia\t(new\tonset\tgrand\tmal\tseizures),\tor\t\nHELLP\nsyndrome\n\t(hemolysis,\televated\tliver\tenzymes,\tand\tlow\tplatelets),\tall\tof\twhich\thave\thigh\trates\tof\nmaternal\n\tmorbidity\tand\tmortality\t(\nACOG,\t2019\n).\tThose\twomen\twith\tsuperimposed\tpreeclampsia\tonto
|
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0.04981375113129616,
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0.04516717046499252,
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0.08221317082643509,
0.028369490057229996,
0.07442677766084671,
0.023012952879071236
] |
ACOG,\t2019\n).\tThose\twomen\twith\tsuperimposed\tpreeclampsia\tonto\nchronic\thypertension\t(13%\tto\t40%\tof\twomen)\thave\tmuch\tworse\tconsequences\t(\nACOG,\t2013c\n).\nWomen\twith\tpreeclampsia\tthat\tdevelops\tnear\tterm\thave\tdouble\tthe\trisk\tof\tCVD\tlater\tin\tlife,\tbut\tthe\nrisk\tof\tCVD\tis\tnearly\t10-fold\tfor\tthose\twho\tmust\tbe\tdelivered\tat\tless\tthan\t34\tweeks\tof\tgestation
|
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] |
because\tof\tpreeclampsia\t(\nRoberts\tand\tBell,\t2013\n).\nPreeclampsia\thas\thistorically\tbeen\tdefined\tby\televated\tblood\tpressure\tand\tproteinuria,\tbut\nguidelines\tnow\trecommend\tnot\twaiting\tfor\tthe\tproteinuria\tto\tappear.\t\nBox\t14.4\n\tsummarizes\ndiagnostic\tcriteria\tdesigned\tto\tfacilitate\tearlier\tdiagnosis\tand\ttherefore\tearlier\ttreatment.\nBOX\t14.4
|
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] |
BOX\t14.4\nPreeclampsia\tDiagnostic\tCriteria\nElevated\tblood\tpressure\nConfirmed\t≥160\tor\t≥110\tfor\tanyone\t(confirmed\n\tover\ta\tfew\tminutes)\tor\t≥140\tor\t≥90\nafter\t20\tweeks\tof\tgestation\t(confirmed\tover\t4\thours)\tif\tpreviously\tnormal\nAND\nProteinuria\n≥300\tmg/24-hour\turine\tcollection,\tan\textrapolated\tamount\tfrom\ta\ttimed\tcollection,
|
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] |
protein/creatinine\tratio\t≥0.3,\tor\tdipstick\treading\tof\t2+\tif\tno\tother\tquantitative\tmethods\nare\tavailable\nOR\nElevated\tblood\tpressure\nConfirmed\t≥160\tor\t≥110\tfor\tanyone\t(confirmed\n\tover\ta\tfew\tminutes)\tor\t≥140\tor\t≥90\nafter\t20\tweeks\tof\tgestation\t(confirmed\tover\t4\thours)\tif\tpreviously\tnormal\nAND\nNew\tonset\tof\tany\tof\tthe\tfollowing:
|
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] |
AND\nNew\tonset\tof\tany\tof\tthe\tfollowing:\nThrombocytopenia:\tplatelets\t<100,000/microliter\nRenal\tinsufficiency:\tserum\tcreatinine\t>1.1\tmg/dL\tor\tdoubling\tof\tserum\tcreatinine\nconcentration\tin\tabsence\tof\tother\trenal\tdisease\nImpaired\tliver\tfunction:\televated\tliver\ttransaminases\tto\ttwice\n\tnormal\tblood\nconcentrations\nPulmonary\tedema
|
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] |
normal\tblood\nconcentrations\nPulmonary\tedema\nCerebral\tor\tvisual\tsymptoms\nAdapted\tfrom\tAmerican\tCollege\tof\tObstetricians\tand\tGynecologists\t(ACOG):\tACOG\tPractice\tBulletin\tNo.\n202:\tGestational\tHypertension\tand\tPreeclampsia,\tObstet\tGynecol\t133:e1,\t2019.\nThe\tcauses\tof\tpreeclampsia\tare\tunder\tintense\tinvestigation.\tIt\tappears\tto\tbe\ta\ttwo-stage\tprocess,
|
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] |
with\ta\tpoorly\tperfused\tplacenta\n\t(from\tfailed\tremodeling\tof\tthe\tmaternal\tspiral\tarteries)\tbeing\tthe\nroot\tcause\t(\nACOG,\t2013c\n).\tReduced\tperfusion\tand\tincreased\tvelocity\tof\tblood\tperfusing\tthe\nintervillous\tspaces\talters\tplacental\tfunction\tand\tleads\tto\tmaternal\tdisease\tthrough\toxidative\tand
|
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endoplasmic\treticulum\tstress\tand\tinflammation,\tas\twell\tas\tmodified\tendothelial\tfunction\tand\nangiogenesis.\tThe\tsecond\tstage,\tcalled\t\nmaternal\tsyndrome,\n\tis\ta\tcascade\tof\tevents,\tbut\twhat\tlinks\tthe\nhypoxic\tplacenta\tand\tthe\tmaternal\tsyndrome\tis\tunclear\tand\tpossibly\tinvolves\toxidative\tstress.\tThe
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hypertension\tand\tproteinuria\tare\tonly\ta\tsmall\tpart\tof\tthe\tsyndrome\tand\treduced\tperfusion\tof\tany\norgan\tin\tthe\tbody\tcan\tlead\tto\themorrhage\tand\tnecrosis.\tNot\tall\twomen\twith\tinadequate\tplacental\nperfusion\tdevelop\tpreeclampsia.\tA\twoman’s\tunderlying\tdisease\n\t(e.g.,\tdiabetes,\thypertension),
|
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] |
(e.g.,\tdiabetes,\thypertension),\nlifestyle\t(e.g.,\tobesity,\tactivity,\tsleep),\tgenetics,\tand\tenvironmental\tconditions\t(e.g.,\tair\tpollution)\tmay\naffect\tthe\tmaternal\tresponse\t(\nRoberts\tand\tBell,\t2013\n).\tThe\tinflammatory\tresponse\tis\taccentuated\tin\npreeclampsia.\tPredictive\ttests\tare\tbeing\tstudied\tbut\tare\tnot\tready\tfor\tclinical\tuse\t(\nACOG,\t2019\n).\tIt\tis
|
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] |
ACOG,\t2019\n).\tIt\tis\nnow\tthought\tthat\tpreeclampsia\tis\tactually\ta\tsyndrome\n\tof\tmany\tdiseases\twith\tsubsets\tof\npathophysiology\tand\tvaried\tcontributions\tof\tmaternal\tand\tplacental\tfactors\t(\nRoberts\tand\tBell,\t2013\n).\nPrevention\tof\tpreeclampsia\thas\tnot\tyet\tbeen\teffective,\talthough\tdaily\tlow-dose\taspirin\tmay\tbe\nbeneficial\t(\nACOG,\t2019
|
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] |
beneficial\t(\nACOG,\t2019\n).\tAlthough\tpreviously\trecommended,\tvitamin\tC\tand\tE\tsupplements\tdo\tnot\nprevent\toccurrence\tof\tpreeclampsia\tor\tadverse\toutcomes\tand\tmay\tbe\tassociated\n\twith\tincreased\trisk\nof\tgestational\thypertension\tand\tLBW.\tCalcium\tsupplementation\tmay\thelp\treduce\tsymptom\tseverity\tif
|
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] |
a\tmother’s\tbaseline\tcalcium\tintake\thas\tbeen\tless\tthan\t600\tmg/day\t(\nACOG,\t2013c\n).\tThere\tis\ninsufficient\tevidence\tto\tdemonstrate\teffectiveness\tof\tfish\toil,\tgarlic,\tvitamin\tD\tor\tfolic\tacid\nsupplementation,\tnor\tof\tsodium\trestriction\t(\nACOG,\t2019\n).\tAvoiding\texcessive\tweight\tgain\tand\ttightly
|
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ACOG,\t2019\n).\tAvoiding\texcessive\tweight\tgain\tand\ttightly\ncontrolling\tdiabetes\tmay\thelp.\tProtein\tand\tcalorie\trestriction\tfor\twomen\twith\tobesity\tdoes\tnot\nreduce\tthe\trisk\tof\teither\tgestational\thypertension\tor\tpreeclampsia\tand\tmay\tincrease\tthe\trisk\tof\nIUGR.\tBed\trest\tdoes\tnot\tappear\tto\treduce\trisk.\tDiuretics\tare\tnot\trecommended.\tModerate\texercise
|
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] |
(30\tminutes/day)\tis\trecommended\tas\tduring\tnormal\tpregnancy,\tbut\tit\tis\tunclear\twhether\tit\tcan\thelp\nreverse\tthe\n\tendothelial\tdysfunction\tand\tprevent\tadverse\tpregnancy\toutcomes.\tObesity,\tleptin,\ninsulin,\tand\tfree\tfatty\tacids\tappear\tto\taffect\tvarious\tstages\tof\tpreeclampsia.\tEndothelial\tcell\tdisorder
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carbon\tmonoxide,\tand\tthe\teffect\tof\tstatins\tare\tall\tbeing\tstudied.\nFor\tthose\twomen\twith\ta\thistory\tof\tpreeclampsia,\tweight\tloss,\tincreased\tphysical\tactivity,\tsmoking\ncessation,\tand\toptimization\tof\tblood\tglucose\tlevels\tand\tnutrient\tintakes\tpreconceptually\tare\nrecommended.\tDuring\tpregnancy,\thelping\twomen\tmaintain\ta\n\tnormal\trate\tof\tweight\tgain,\twith
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normal\trate\tof\tweight\tgain,\twith\noptimal\tcalcium\tintake\tand\tfruits\tand\tvegetables\t(antioxidants),\tmay\tbe\tbeneficial.\tEncourage\nnotifying\tthe\tmedical\tprovider\timmediately\tif\tthere\tis\ta\tsudden\tonset\tof\tface\tor\thand\tswelling,\npersistent\theadaches,\tseeing\tspots\tor\tchanges\tin\teyesight,\tpain\tin\tthe\tupper\tright\tquadrant\tor
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] |
stomach,\tnausea\tand\tvomiting\tin\tthe\tsecond\thalf\tof\tpregnancy,\trapid\tweight\tgain,\n\tor\tdifficulty\nbreathing.\nAlthough\tdelivery\tresolves\tthe\tpreeclampsia\tfor\tmost,\ta\tsubset\tof\twomen\thave\ta\tworsening\tof\npreeclampsia\tafter\tdelivery\tand\tothers\tmay\tfirst\tdevelop\tpreeclampsia\tpostpartum,\tincluding\tHELLP
|
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] |
syndrome.\tPain\tmedications\tmay\thave\tto\tbe\tmodified.\tBlood\tpressure\tmay\tbe\tlabile\tfor\tmonths\tbut\nusually\tnormalizes\tby\t1\tyear\tpostpartum.\tPostpartum\thypertension\tmay\tpredict\tfuture\n\tchronic\nhypertension\t(\nACOG,\t2013c\n).\nNausea\tand\tvomiting,\thyperemesis\tgravidarum,\tand\tptyalism\nMorning\tsickness,\t\nnausea\tand\tvomiting\tin\tpregnancy\t(NVP)
|
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] |
Morning\tsickness,\t\nnausea\tand\tvomiting\tin\tpregnancy\t(NVP)\n,\taffects\t50%\tto\t90%\tof\tall\tpregnant\nwomen\tduring\tthe\tfirst\ttrimester\tand\tusually\tresolves\tby\t20\tto\t22\tweeks\tof\tgestation,\talthough\tup\tto\n10%\tof\twomen\tsuffer\twith\tit\tuntil\tdelivery\t(\nBustos\tet\tal,\t2017\n).\tThe\tcause\tof\tNVP\tis\tunclear\tbut\tlikely
|
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] |
Bustos\tet\tal,\t2017\n).\tThe\tcause\tof\tNVP\tis\tunclear\tbut\tlikely\nincludes\ta\tgenetic\tpredisposition,\tcombined\twith\tchanges\tin\thuman\tchorionic\tgonadotropin\t(hCG),\nestrogen,\tand\tprogesterone\tlevels.\tRecently\tan\tincrease\tin\tthe\thalf-life\tof\tendokinin\tB,\ta\ttachykinin\nproduced\tby\tthe\tplacenta\tto\tincrease\tblood\tflow,\thas\talso\tbeen\tproposed\tas\ta\tcause\t(
|
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Lowry\tand\nWoods,\t2018\n)\tbecause\tit\talso\tstimulates\tthe\tNK1R\treceptor\tin\tthe\tbrain,\tcausing\tnausea\tand\nvomiting\tin\tsome\n\twomen.\tNVP\tmay\tbe\tmediated\tthrough\tthe\tvestibuloocular\treflex\tpathway\tand\nthose\twith\ta\thistory\tof\tmotion\tsickness\tor\tmigraines\tare\tat\tincreased\trisk.\tThose\tpregnant\twith\ta
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female\tfetus,\tmultiple\tfetuses,\tor\ta\tmolar\tpregnancy\t(sperm\tfertilizes\tan\tempty\tegg,\tresulting\tin\tno\nembryo\tbut\ta\tplacenta\tthat\tdevelops\tinto\tan\tabnormal\tmass\tof\tcells)\tare\tmore\tlikely\tto\tsuffer\twith\neither\tNVP\tor\thyperemesis\n\tgravidarum,\tas\tare\tthose\twith\thyperthyroid\tdisorders,\tGI\tdisorders,
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] |
gravidarum,\tas\tare\tthose\twith\thyperthyroid\tdisorders,\tGI\tdisorders,\npreexisting\tdiabetes,\tor\ta\tpsychiatric\tillness.\tMaternal\tage\tmore\tthan\t30\tyears\tand\tsmoking\tare\nprotective,\tbut\tpaternal\tsmoking\tincreases\trisk\t(\nFejzo\tet\tal,\t2012\n).\tNVP\tis\tassociated\twith\tmore
|
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] |
Fejzo\tet\tal,\t2012\n).\tNVP\tis\tassociated\twith\tmore\nfavorable\tpregnancy\toutcomes,\tincluding\tfewer\tbirth\tdefects;\treduced\trisk\tof\tmiscarriage,\tpreterm\ndelivery,\tor\tstillbirth;\tand\tgreater\n\tbirth\tweight.\nTreatment\tfor\tNVP\tinvolves\tmanaging\tthe\tsymptoms.\tMotion,\tspecific\todors,\tloud\tnoises,\tbright\tor
|
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] |
flickering\tlights,\tand\tadverse\tclimate\tconditions\tmay\ttrigger\tthe\tnausea.\tFortunately,\tmost\twomen\nwith\tNVP\tare\tfunctional,\table\tto\twork,\tdo\tnot\tlose\tweight,\tand\tare\thelped\tby\tsimple\tdietary\nmeasures.\tMany\tdietary\tand\tlifestyle\trecommendations\thave\tnot\tbeen\tevaluated\tin\tthe\tliterature\n(\nKaiser\tand\tCampbell,\t2014
|
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] |
(\nKaiser\tand\tCampbell,\t2014\n).\tAlthough\tthe\tquality\tof\tthe\tevidence\tis\tlow,\tit\tappears\tthat\tginger\npreparations\t(tablets,\tsyrup,\tcapsules,\tor\tginger\tbiscuits)\tare\tmore\teffective\tthan\tplacebos\tin\nreducing\tthe\tseverity\tof\tsymptoms\t(\nO’Donnell\tet\tal,\t2016\n),\tpossibly\tby\tmultiple\tmechanisms\t(\nMarx\tet\nal,\t2017
|
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] |
),\tpossibly\tby\tmultiple\tmechanisms\t(\nMarx\tet\nal,\t2017\n).\tHowever,\twhile\tginger\treduces\tthe\tnausea,\tit\tmay\tnot\treduce\tthe\tepisodes\tof\temesis\tand\ndoes\tnot\twork\tfor\tmany\tpeople,\tespecially\n\tthose\twith\thyperemesis\t(\nDean\tand\tO’Hara,\t2015\n).\tGinger\nsupplements\tcan\tbe\toffered\tas\ta\tfirst\tline\ttherapy\t(250\tmg\tcapsules\t4x/day)\t(\nACOG,\t2018b\n)\tbut
|
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] |
ACOG,\t2018b\n)\tbut\nshould\tnot\tbe\tused\tfor\twomen\ton\tanticoagulation\ttherapy\tbecause\tof\tthe\tincreased\trisk\tof\tbleeding\nwith\tplatelet\tfunction\tinhibition\t(\nBustos\tet\tal,\t2017\n).\tGinger\thas\talso\tbeen\treported\tto\tincrease\nsymptoms\tfor\tsome,\tincluding\theartburn\tand\tthroat\tburning\n\tduring\tvomiting\t(\nDean\tand\tO’Hara,
|
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] |
2015\n).\tIf\tthe\tsymptoms\tare\talready\tsevere,\tginger\tis\tunlikely\tto\tbe\thelpful\tand\ttherefore\tdelays\tmore\neffective\ttreatment.\nAcupressure\tof\tthe\tP6\tpoint\tof\tthe\twrist\tmay\thave\tlimited\tbenefit\tbut\tneither\tacupuncture\tnor\nelectrical\tnerve\tstimulation\tappear\tto\tbe\teffective\t(\nACOG,\t2018b\n).\tNoise\treduction\tand\thypnosis\talso
|
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ACOG,\t2018b\n).\tNoise\treduction\tand\thypnosis\talso\ncan\tbe\thelpful.\tIf\tnot\ttolerated,\tstopping\n\tthe\tprenatal\tvitamins\tmay\thelp,\tbut\twomen\tshould\tcontinue\nthe\tsupplemental\tfolic\tacid\tif\tpossible,\tand\toften\ttaking\tthe\tprenatal\tvitamins\tbefore\tbed\tor\twith\tfood
|
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] |
during\tthe\tlargest\tmeal\tof\tthe\tday\tis\ttolerated.\tOthers\trecommend\tadding\tsupplemental\tthiamin\t(at\nleast\t5\tmg/day)\tto\tlower\tthe\trisk\tof\tWernicke’s\tencephalopathy\t(\nFejzo\tet\tal,\t2016\n).\tVarious\nantinausea\tmedications\tare\talso\tavailable,\twith\n\tdifferent\tmodes\tof\taction\tand\trisk\tlevels.\tVitamin\tB\n6\n,\nin\tcombination\twith\tdoxylamine,\tis\toften\tused\t(
|
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] |
6\n,\nin\tcombination\twith\tdoxylamine,\tis\toften\tused\t(\nACOG,\t2018b\n).\tWhether\tthe\tvitamin\tB\n6\n\talone\tis\neffective\tas\twell\tas\twhat\tform\tof\tthe\tB\n6\n\tis\tbest\tare\tboth\tunclear\tbut\tit\tappears\tthat\tthe\tmetabolites\npyridoxine\tand\tpyridoxal\tmay\tfunction\tas\tprodrugs\t(\nMatok\tet\tal,\t2014\n).\tMarijuana,\twhile\tit\tis
|
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Matok\tet\tal,\t2014\n).\tMarijuana,\twhile\tit\tis\npromoted\tby\tsome\tto\thelp\twith\tNVP,\tis\tnot\trecommended\n\t(\nACOG,\t2018b\n).\tIn\tfact,\tcannabinoid\nhyperemesis\tsyndrome,\tpotentially\tfatal,\thas\tbeen\tdocumented\t(\nNourbakhsh\tet\tal,\t2018\n).\nSmall,\tfrequent\tsnacks\tof\tcarbohydrate\tfoods,\tincluding\tcrackers\tor\tdry\tcereal,\treduce\tnausea\tfor
|
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some,\twhereas\tprotein\tfoods\tmay\thelp\tothers\t(\nErick,\t2014\n).\tSome\twomen\tcrave\tpotato\tchips.\tSome\ndo\tnot\ttolerate\todors\tand\tare\tbothered\tby\thot\tfoods,\tpreferring\tfoods\tthat\tare\n\tcold\tor\tat\troom\ntemperature.\tSmelling\tlemons\tmay\thelp\tblock\tnoxious\todors.\tAvoiding\thunger\tby\teating\tmore
|
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] |
frequently\toften\thelps,\tas\tdoes\tseparating\tdry\tfoods\tfrom\tliquids.\tAvoiding\thighly\tspiced\tfoods\tor\nbitter\tfoods\tis\thelpful\tfor\tsome,\tbut\tfor\tothers\ttaste\tsensitivity\tdecreases\tand\tstrong\tflavors\tare\ncraved.\tWomen\tshould\tavoid\todors\tor\tsituations\tthat\ttrigger\tsymptoms\tand\tshould\teat\twhatever\nreduces
|
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] |
reduces\n\tthe\tnausea\tsensation.\tUnfortunately,\tthere\tis\tno\tcure-all.\tHowever,\treminding\tthe\tmother\nthat\tthis\tis\ta\tgood\tsign\tfor\tthe\tpregnancy\t(i.e.,\tthe\tbody\tis\tresponding\tas\tit\tshould),\tand\tthat\tit\t\nwill\nend,\toften\treassures\ther\tand\tlowers\tthe\tworry\tand\tstress,\tthus\thelping\twith\tthe\tnausea.
|
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] |
When\tearly\tpregnancy\tis\tcharacterized\tby\texcessive\tvomiting\t(severity\tis\toften\testimated\tby\tthe\nPUQE\tscore:\t\np\nregnancy-\nu\nnique\t\nq\nuantification\tof\t\ne\nmesis)\tand\tweight\tloss\t(often\tat\tleast\t5%\nprepregnant\tweight),\tusually\twith\tdehydration,\telectrolyte\timbalances\tcan\toccur.\tHere,\t“morning\nsickness”\tbecomes\t\nhyperemesis\tgravidarum\t(HG)
|
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sickness”\tbecomes\t\nhyperemesis\tgravidarum\t(HG)\n.\tThe\tprevalence\tof\tHG\tis\t0.3%\tto\t3%\tof\npregnancies\t(\nACOG,\t2018b\n)\tand\tis\tthe\tmost\tfrequent\tcause\tof\thospital\tadmissions\tearly\tin\npregnancy,\tincreasing\tboth\tworry\tand\tthe\teconomic\tburden.\tRisk\n\tfactors\tare\tthe\tsame\tas\tthose\twith\nNVP.\tRecurrence\trate\tin\ta\tsubsequent\tpregnancy\tis\t15%\tto\t81%\t(
|
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0.11681094765663147,
0.0841846689581871,
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0.000473794003482908
] |
NVP.\tRecurrence\trate\tin\ta\tsubsequent\tpregnancy\tis\t15%\tto\t81%\t(\nGrooten\tet\tal,\t2016\n),\twith\thigher\nestimates\tfrom\tsurveys\tin\twhich\tsymptoms\tare\treported\trather\tthan\tthose\tjust\tlooking\tat\thospital\nadmissions.\tEarly\ttreatment\tof\tNVP,\tincluding\teven\tpreemptive,\tis\tthought\tto\thelp\tprevent\nprogression\tto\tHG\t(\nACOG,\t2018b\n).
|
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] |
progression\tto\tHG\t(\nACOG,\t2018b\n).\nFetal\tcomplications\tof\tHG\tvary\tbut\tinclude\tpoor\n\tfetal\tgrowth\tand\tpreterm\tdelivery.\tThere\tis\tan\nincreased\trisk\tof\tfetal\tloss\twith\tgestational\tmalnutrition,\tas\thigh\tas\t37%\tspontaneous\tfetal\tloss\trate\namong\twomen\twith\tsignificant\tweight\tloss\tand\tWernicke’s\tencephalopathy\t(\nChiossi\tet\tal,\t2006\n).
|
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] |
Chiossi\tet\tal,\t2006\n).\nWhile\tdocumented\tcongenital\tanomalies\tare\trare,\tchondrodysplasia\tpunctata\tresulting\tfrom\nmaternal\tvitamin\tK\tdeficiency\thas\tbeen\tdocumented\t(\nErick,\t2014\n).\tResearch\thas\tshown\tthese\nexposed\tchildren\thave\ta\t3.28-fold\tincrease\tin\tthe\todds\tof\treceiving\ta\tneurodevelopmental\tdiagnosis,
|
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0.05815082788467407,
0.0605313815176487,
0.02595798671245575,
0.09737810492515564,
0.018345098942518234
] |
including\tattention\tor\tsensory\tdisorders\tand\tspeech,\tlanguage,\tand\tlearning\tdelays,\tespecially\tif\tthe\nHG\tstarted\tbefore\t5\tweeks\tof\tgestation\t(\nFejzo\tet\tal,\t2015\n).\tLower\tinsulin\tsensitivity\tin\tchildren\nexposed\tto\tHG\thas\talso\tbeen\tseen\t(\nAbramowitz\tet\tal,\t2017\n).\tMaternal\tcomplications\n\tinclude\textreme
|
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] |
Abramowitz\tet\tal,\t2017\n).\tMaternal\tcomplications\n\tinclude\textreme\nfatigue,\tdehydration,\tand\tmalnutrition.\tHG\tis\tassociated\twith\tguilt\tand\ta\tloss\tof\tself,\toften\twith\ta\nsense\tof\tdying,\tas\twell\tas\twith\tsocial\tisolation.\tIt\tis\tassociated\twith\tincreased\tdepression\tand/or
|
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] |
anxiety\tbut\tthe\tdirection\tof\tthe\trelationship\tis\tcontroversial\tand\tstigmatizing\tthe\tmother\tis\tnot\nhelpful\t(\nDean\tet\tal,\t2018\n).\tOther\tcomplications\tmay\tinclude\tsplenic\tavulsion\t(spleen\n\tis\ttorn\tfrom\tits\nnormal\tlocation,\tresulting\tin\tan\temergency\tsituation\tdue\tto\texcessive\tbleeding),\tesophageal\trupture,
|
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] |
diaphragmatic\ttears,\tpneumothorax,\tValsalva\tretinopathy,\thypocalcemia,\tliver\tdysfunction,\tacute\nrenal\tfailure,\trhabdomyolysis,\tcentral\tpontine\tmyelinolysis,\tand\tdelirium,\tas\twell\tas\tmaternal\nposttraumatic\tstress\tsyndrome\tand\thigh\trisk\tof\tpregnancy\ttermination\twhen\tmanagement\tof\n\tHG\nfails\t(\nErick,\t2014\n;\t\nFejzo\tet\tal,\t2012\n;\t\nDean\tet\tal,\t2018\n;
|
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] |
HG\nfails\t(\nErick,\t2014\n;\t\nFejzo\tet\tal,\t2012\n;\t\nDean\tet\tal,\t2018\n;\t\nACOG\t2018b\n;\t\nAbramowitz\tet\tal,\t2017\n).\nMaternal\tdeaths\tassociated\twith\tHG\thave\tbeen\treported\t(\nFejzo\tet\tal,\t2016\n).\tDifficulty\tproducing\nbreastmilk\tand\tbonding\talso\tmay\thave\tto\tbe\taddressed.
|
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] |
breastmilk\tand\tbonding\talso\tmay\thave\tto\tbe\taddressed.\nHospitalization\tfor\tnutrition\tsupport\tand\thydration\tusually\tis\tindicated\tfor\tHG.\tManagement\tgoals\ninclude\tappropriate\tweight\tgain\tfor\tpregnancy,\tcorrection\n\tof\tfluid\tand\telectrolyte\tdeficits,\tavoidance
|
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] |
of\tfluid\tand\telectrolyte\tdeficits,\tavoidance\nof\tketosis,\tcontrol\tof\tHG\tsymptoms,\tand\tachievement\tof\tnitrogen,\tvitamin,\tand\tmineral\tbalance.\nBecause\tpregnancy\tis\ta\tcondition\tof\taccelerated\tstarvation,\trefeeding\tsyndrome\tis\tseen\toften,\nespecially\twith\tthe\tprovision\tof\tsimple\tdextrose-containing\tintravenous\tfluids.\tPhosphorus,
|
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] |
magnesium,\tand\tpotassium\tmust\tbe\tevaluated\tdaily\tbecause\tlow\tlevels\n\tmay\tresult\tin\tcardiac\nirregularities\tand\trespiratory\tfailure\t(see\t\nChapter\t12\n).\tAnother\tpotentially\tserious\tcomplication\tis\nWernicke’s\tencephalopathy,\twith\tat\tleast\t63\tcases\tbeing\treported\tworldwide\t(\nDi\tGangi\tet\tal,\t2012\n).\tIt
|
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0.04257525876164436,
0.05091230571269989,
0.04744161665439606,
0.0007653211359865963
] |
Di\tGangi\tet\tal,\t2012\n).\tIt\nis\tthought\tto\tbe\tcaused\tby\tthiamin\tdepletion\tand,\tbecause\tthere\tis\tlittle\tstorage\tin\tthe\tbody\t(\nFrank,\n2015\n),\ta\tdeficiency\tcan\tdevelop\tin\tas\tlittle\tas\t2\tweeks\tof\tvomiting\t(\nSelitsky\tet\tal,\t2006\n).\tThere\tis\tno\nconsensus\ton\tearly\tdiagnosis,\ttreatment,\tor\tprevention.\tThe\tclassic\ttriad\tof\tnystagmus\tand
|
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] |
ophthalmoplegia,\tmental\tstatus\tchanges,\tand\tataxia\thas\tbeen\tfound\tin\tonly\t16%\tof\tknown\tHG\tcases.\nWomen\tin\t60%\tof\tcases\tdisplayed\tocular\tsymptoms,\t83%\thad\tcerebellar\tchanges,\tand\t52%\thad\nmemory\timpairment\t(\nDi\tGangi\tet\tal,\t2012\n).\tSymptoms\tare\toften\tvague\tand\tnonspecific,\tincluding\nheadaches,
|
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).\tSymptoms\tare\toften\tvague\tand\tnonspecific,\tincluding\nheadaches,\n\tfatigue,\tabdominal\tdiscomfort,\tirritability,\tand\tinability\tto\tconcentrate.\tIf\tnot\ttreated\nquickly,\tWernicke’s\tencephalopathy\tcan\tprogress\tto\tKorsakoff\tsyndrome,\twith\tchronic\tmaternal\nmemory\timpairment\t(\nKloss\tet\tal,\t2018
|
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] |
memory\timpairment\t(\nKloss\tet\tal,\t2018\n).\tThiamin\tblood\tlevels\tare\tnot\tuseful\tfor\tdiagnosis.\tInstead,\nthiamin\tis\tgiven\tintravenously,\tand\ta\tpresumptive\tdiagnosis\tis\tmade\tif\tthe\tpatient\tresponds.\tACOG\nrecommends\tgiving\n\t100\tmg\tIV\tthiamin\twith\tthe\tinitial\trehydration\tfluid,\tfollowed\tby\t100\tmg/day\tfor
|
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the\tnext\t2\tto\t3\tdays,\tfollowed\tby\tIV\tmultivitamins\t(\nACOG,\t2018b\n).\tCorrecting\tdeficiencies\tof\tniacin\nand\tmagnesium\talso\tmay\tbe\thelpful.
|
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] |
In\tHG,\tearly\tenteral\ttube\tfeeding\tdoes\tnot\tconsistently\timprove\tbirthweight\t(\nGrooten\tet\tal,\t2017\n).\nWomen\twith\tsevere\temesis\tand\tretching\thave\toften\tdislodged\ttubes\tand\tare\tsometimes\n\treluctant\tfor\nreplacement.\tDuring\thospitalization,\tfrequent\tnursing\tchecks\ton\ttube\tplacement\tadd\tto\tsleep\ndeprivation\tissues,\twhich\thave\tnot\tbeen\tfully\tappreciated\t(
|
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] |
deprivation\tissues,\twhich\thave\tnot\tbeen\tfully\tappreciated\t(\nErick,\t2014\n).\tWhen\tenteral\tnutrition\tis\tnot\ntolerated\tand\toral\tintake\tis\tnot\tsufficient,\tparenteral\tnutrition\tshould\tbe\tconsidered\t(see\t\nChapter\n11\n).\tHistorically,\tproblems\twith\tinfections,\tas\twell\tas\thyperglycemia,\thepatic\tdysfunction,\n\tand\nrespiratory\tcompromise\thave\tall\tbeen\tseen\t(
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] |
and\nrespiratory\tcompromise\thave\tall\tbeen\tseen\t(\nWorthington\tet\tal,\t2017\n).\tHowever,\twith\tcareful\nmanagement,\tincluding\tavoiding\toverfeeding,\tadequate\tglucose\tcontrol,\tand\tmeticulous\tvenous\naccess\tcare,\tthese\tproblems\tcan\tbe\tminimized\tor\teliminated.\tParenteral\tnutrition\thas\tsafely\tbeen
|
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employed\tduring\tpregnancy\tfor\tHG,\tas\twell\tas\tGI\tdisorders\tsuch\tas\tshort\tbowel\tsyndrome\tand\nCrohn’s\tdisease\t(\nMogensen\tand\tErick,\t2017\n).\nWomen\thistorically\thave\tbeen\treassured\tthat\teven\twith\tHG\tthe\tfetus\tis\tprotected,\tusing\tadequate\nbirth\tweight\tas\tevidence.\tHowever,\tgiven\tthe\tresults\tof\tthe\tDutch\tfamine\tstudies,\tit\tis\tknown\tthat
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] |
birth\tweight\tdoes\tnot\tnecessarily\tpredict\tlong-term\thealth\tand\tthat\tthere\tare\tconsequences\tof\tearly\nmalnutrition,\teven\tif\tlater\tresolved\t(\nErick,\t2014\n;\t\nRoseboom\tet\tal,\t2011\n).\tHG\tmerits\tearly\tand\naggressive\n\tattention\tand\ttreatment.\nSome\twomen\tdevelop\t\nptyalism\tgravidarum\n,\tor\texcess\tsaliva.\tIt\toften\thas\tan\tabrupt\tonset\t2\tto\t3
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Lowry\tand\tWoods,\t2018\n).\nSalivary\toutput\tcan\tbe\tsubstantial,\tup\tto\t1.5\tto\t2.0\t1iters/day,\tand\tcan\tbe\ta\tsource\tof\tlost\telectrolytes\nas\twell\tas\tdehydration\t(\nThaxter\tNesbeth\tet\tal,\t2016\n)\tbecause\tthe\tsaliva\tis\toften\tspit\tinto\ta\tcup\tor\npaper\ttissue.\tIt\tmay\tinterfere\twith\tswallowing\tand\tcause\tdistended\tcheek\tpouches\tand\tswollen
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] |
salivary\tglands.\tBecause\tthe\tsaliva\tis\texcessively\tthick\tand\tthe\ttongue\tis\toften\tenlarged\tand\tcoated,\nptyalism\toften\tinterferes\twith\tspeech.\tIt\tmay\tincrease\tthe\tnausea\tand\tvomiting\tand\toften\tadversely\naffects\tthe\tsense\tof\ttaste.\tIt\tinterferes\twith\tsleep\tand\tis\tassociated\twith\tincreased\tdepression.
|
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] |
However,\tptyalism\tdoes\tnot\tappear\tdangerous\tfor\tthe\tfetus.\tAntihistamines\tmay\tbe\thelpful,\tas\tmay\nchewing\tgum\tor\tsucking\ton\thard\tcandy,\tthroat\tlozenges,\tlemon\tdrops,\tor\tice.\tPtyalism\tceases\tat\ndelivery\n\tbut\tmay\tend\tafter\tthe\tfirst\ttrimester\tfor\tsome\tpeople\t(\nThaxter\tNesbeth\tet\tal,\t2016\n).\nOral\thealth
|
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] |
Thaxter\tNesbeth\tet\tal,\t2016\n).\nOral\thealth\nGood\toral\thealth\tis\timportant\tthroughout\tone’s\tlifetime,\tincluding\tduring\tpregnancy\t(see\t\nChapter\n24\n).\tPregnant\twomen\tcan\treceive\tdental\tcare\twhile\tpregnant,\twith\tsome\tqualifications.\tThe\tNational\nMaternal\tand\tChild\tOral\tHealth\tResource\tCenter\tprovides\tguidance.\tAlthough\tperiodontal\tinfection\nis
|
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is\n\tassociated\twith\tpreterm\tbirth\tand\tLBW,\ttreatment\tdoes\tnot\tappear\tto\tlower\tthat\trisk.\tHowever,\noptimal\tmaternal\toral\thygiene\tmay\tlower\tthe\tamount\tof\t\nStreptococcus\tmutans\n\ttransmitted\tto\tthe\ninfant\tthrough\tsharing\tspoons\tor\tlicking\tpacifiers,\tthus\tlowering\tor\tdelaying\tthe\trisk\tof\tchildhood\ncaries.
|
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] |
caries.\nDuring\tpregnancy,\tincreased\tinflammatory\tresponse\tto\tdental\tplaque\tcauses\tgingivae\tto\tswell\tand\nbleed\n\tmore\teasily.\tRinsing\twith\tsalt\twater\t(1\ttsp\tsalt\tin\t1\tcup\twarm\twater)\tcan\thelp\tsoothe\tthe\nirritation.\tErosion\tof\tenamel\tmay\toccur\twith\tincreased\texposure\tto\tgastric\tacid\tfrom\tvomiting\tor
|
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] |
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