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If you have just found out that you are pregnant, you may want to read the previous articles. This is just a reminder that pregnancy is calculated from the first date of your last menstrual period (LMP) and not when you conceived. Losing weight this early is not uncommon, and in a few weeks things will begin to shift in the other direction.
Your baby is approximately an inch (2.54 centimeters) long by the end of this week and weighs less than an aspirin. At this point you are well into your first trimester and may be suffering from morning sickness. If morning sickness is so severe that you are constantly throwing up and not keeping anything down, consult your doctor about the possibility of having hyperemesis gravidarum. Talk with your partner about which prenatal appointments she would like you to attend with her. Begin making plans to attend certain or all of the appointments, and do not forget to mark them on your calendar.
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The Association is only able to accomplish our mission with the commitment of people like you. All recommendations have been updated and reorganized to clarify management considerations for women with pregestational or gestational diabetes in the prepregnancy period, during pregnancy, and in the intrapartum and postpartum periods.
1.All women of reproductive age with type 1 or type 2 diabetes should receive advice on reliable birth control, the importance of glycemic control prior to pregnancy, the impact of BMI on pregnancy outcomes, the need for folic acid and the need to stop potentially embryopathic drugs prior to pregnancy [Grade D, Level 4 (1)]. 4.Women with type 2 diabetes who are planning a pregnancy should switch from noninsulin antihyperglycemic agents to insulin for glycemic control [Grade D, Consensus]. 6.Women should be screened for chronic kidney disease prior to pregnancy (see Chronic Kidney Disease chapter, p.
9.Detemir [Grade C, Level 2 (24)] or glargine [Grade C, Level 3 (25)] may be used in women with pregestational diabetes as an alternative to NPH.
11.Women should receive adequate glucose during labour in order to meet their high-energy requirements [Grade D, Consensus]. 12.Women with pregestational diabetes should be carefully monitored postpartum as they have a high risk of hypoglycemia [Grade D, Consensus]. 15.All women should be encouraged to breastfeed since this may reduce offspring obesity, especially in the setting of maternal obesity [Grade C, Level 3 (28)].
17.If there is a high risk of GDM based on multiple clinical factors, screening should be offered at any stage in the pregnancy [Grade D, Consensus]. 21.Receive nutrition counselling from a registered dietitian during pregnancy [Grade C, Level 3 (37)] and postpartum [Grade D, Consensus]. 22.If women with GDM do not achieve glycemic targets within 2 weeks from nutritional therapy alone, insulin therapy should be initiated [Grade D, Consensus]. 23.Insulin therapy in the form of multiple injections should be used [Grade A, Level 1 (20)].
24.Rapid-acting bolus analogue insulin may be used over regular insulin for postprandial glucose control, although perinatal outcomes are similar [Grade B, Level 2 (38,39)].
27.Women should receive adequate glucose during labour in order to meet their high-energy requirements [Grade D, Consensus]. 29.Women should be screened with a 75 g OGTT between 6 weeks and 6 months postpartum to detect prediabetes and diabetes [Grade D, Consensus]. Epilepsy is a chronic disorder or group of disorders characterized by recurrent, unpredictable seizures. The National Institute of Neurological Disorder and Stroke (NINDS) estimates epilepsy affects 1% of the United States population (about 2.5 million people). There is also the added difficulty of nausea, which may cause medication to be thrown up before it can properly be absorbed into the body. The type of seizure you experience with your epilepsy can cause different degrees of complications. During a tonic-clonic seizure, there is a temporary interruption of breathing; although this interruption rarely affects the mother, it can lead to oxygen deprivation in your baby. A primary concern for expecting mothers with epilepsy is the effect the medication can have on the baby. However, there are more major birth defects such as spina bifida, cleft lip, neural tube defects, and heart abnormalities.
There are steps that should be taken if you are epileptic and want to ensure the healthiest pregnancy possible. When taking anticonvulsant medications you should speak with your doctor about taking folic acid. Taking folic acid before and during pregnancy can increase your baby’s health.  Anticonvulsant medications can interfere with the folic acid levels in the body, and low levels of folic acid can lead to neural tube defects. However, it is always important to consult your doctor before taking folic acid, as it can interact with some anticonvulsant medications, making them less effective and increasing your chances of having a seizure.
Labor and birth can put a tremendous amount of stress on the body affecting the health and well-being of the mother. It is important for the mother to get plenty of rest, remain stress free, and take her medications as prescribed by her doctor. A large number of women with epilepsy are encouraged to breastfeed, because of the numerous benefits of breast milk for the baby. In the United States, Down syndrome occurs in 1 of every 800 infants with many as 6,000 children born with Down syndrome each year. Down syndrome can be caused by one of three types of abnormal cell division involving chromosome 21.
Translocation Trisomy 21-Sometimes (in 3-4% of cases) part of chromosome 21 becomes attached (translocated) to another chromosome (usually the 13th, 14th or 15th chromosome) before or at conception.
For couples who have had one child with Down syndrome due to translocation trisomy 21, there may be an increased likelihood of Down syndrome in future pregnancies. The chance of passing the translocation depends on the sex of the parent who carries the rearranged chromosome 21. In all cases of Down syndrome, but especially in cases with translocation trisomy 21, it is important for the parents to have genetic counseling in order to determine their risk.
Generally, couples who have had one child with Down syndrome have a slightly increased risk (about 1%) of having a second child with Down syndrome. Parents who are carriers of the genetic translocation for Down syndrome have an increased risk depending on the type of translocation.
There is no evidence of a man with Down syndrome fathering a child. While the incidence of births of children with Down syndrome increases with maternal age, more children are born to women under the age of 35 due to higher fertility rates.

In the January issue of Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists released guidelines recommending screening for Down syndrome to all pregnant women during their first trimester. Diagnostic tests tend to be more expensive and have a degree of risk; screening tests are quick and easy to do. Quad Marker Screen – Maternal blood is tested for four substances that normally come from a baby’s blood, brain, spinal fluid and amniotic fluid. Triple Screen – During the 16th and 18th week of pregnancy a blood test can be performed which measures the quantities of three substances: Alpha-fetoprotein (AFP) which is produced by the fetus, human chorionic gonadotropin (hCG), and unconjugated estriol which is produced by the placenta. If the screening tests are positive or a high risk for Down syndrome exists, further testing might be needed. It is important to discuss the risks and benefits of testing thoroughly with your health care provider. The general health and quality of life for people with Down syndrome has improved drastically in recent years. Assemble a team of professionals –Find a team of health care providers, teachers, and therapists that you trust to work with you in providing the best care for your child. Seek out other families – Support from those who have had similar experiences with a Down syndrome child can be very beneficial.
Don’t believe the myths about Down syndrome – Immense strides have been made in recent years with people who have Down syndrome. It is not likely that the people around you can even tell that you are pregnant at this point.
The hair and nipple follicles are forming, and the eyelids and tongue have begun developing. Read our information on choosing a health care provider and what to expect at your first prenatal visit.
Seventy to eighty percent of all pregnant women experience some form of morning sickness, which is caused by the increased amount of hormones in your body. Many couples like to attend every appointment together, while others only attend major appointments like sonograms together. Your tax deductible contribution provides valuable education and more importantly support to women when they need it most.
Women with pregestational diabetes who also have PCOS may continue metformin for ovulation induction [Grade D, Consensus]. S129) [Grade D, Level 4, for type 1 diabetes (17) ; Grade D, Consensus, for type 2 diabetes].
If the initial screening is performed before 24 weeks of gestation and is negative, rescreen between 24 and 28 weeks of gestation. Recommendations for weight gain during pregnancy should be based on pregravid BMI [Grade D, Consensus]. Use of oral agents in pregnancy is off-label and should be discussed with the patient [Grade D, Consensus]. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. Poor glycated hemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies. Glycemic control during early pregnancy and fetal malformations in women with type 1 diabetes mellitus. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with pre-pregnancy diabetes. Glycaemic control is associated with preeclampsia but not with pregnancy-induced hypertension in women with type 1 diabetes mellitus. Strategies for reducing the frequency of preeclampsia in pregnancies with insulin-dependent diabetes mellitus.
Effect of pregnancy on microvascular complications in the Diabetes Control and Complications Trial.
Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study. Central nervous system and limb anomalies in case reports of first-trimester statin exposure. Microalbuminuria, preeclampsia, and preterm delivery in pregnancy women with type 1 diabetes: results from a nationwide Danish study.
Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy?
Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial.
Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Glycemic control and perinatal outcomes of pregnancies complicated by type 1 diabetes: influence of continuous subcutaneous insulin and lispro insulin. A comparison of lispro and regular insulin for the management of type 1 and type 2 diabetes in pregnancy.
Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome.
Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness.
Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. Recommendations for nutrition best practice in the management of gestational diabetes mellitus. Maternal metabolic control and perinatal outcome in women with gestational diabetes treated with regular or lispro insulin: comparison with non-diabetic pregnant women.
Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus. Prospective observational study to establish predictors of glyburide success in women with gestational diabetes mellitus.

Comparative placental transport of oral hypoglycemic agents in humans: a model of human placental drug transfer.
Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes.
Association of breast-feeding and early childhood overweight in children from mothers with gestational diabetes mellitus.
Lactation intensity and postpartum maternal glucose tolerance and insulin resistance in women with recent GDM: the SWIFT cohort. A seizure is a temporary physiological dysfunction of the brain, in which neurons will produce excessive electrical discharge. Anticonvulsant medications tend to work differently during pregnancy, and as a result your doctor might see the need to change your medication during pregnancy. Additionally your baby’s heart rate can slow for as long as 30 minutes after a tonic-clonic seizure.
Tonic-clonic seizures present the greatest risk during the last trimester, when the baby’s brain is larger and needs more oxygen. Epileptic women have a 4-6 % chance of having a baby born with a birth defect as a result of taking anticonvulsant drugs. You should consult your doctor about your anticonvulsant medication when trying to become pregnant. Studies have shown that taking folic acid during the first three months of pregnancy decreases the risk of spinal bifida.
Getting help from family and friends or using a postpartum doula are some ways to reduce stress.
It was first described in 1866 and is named after John Langdon Down, the doctor who first identified the syndrome.
It is estimated that about 85% of infants with Down syndrome survive one year and 50% of those will live longer than 50 years. An extra chromosome (chromosome 21) originates in the development of either the sperm or the egg.
While similar to simple trisomy 21, the difference is that the extra chromosome 21 is present in some, but not all cells, of the individual.
The carrier (the one having the translocated chromosome) will have 45 chromosomes instead of 46 but they will have all the genetic material of a person with 46 chromosomes.
If the father is the carrier, the risk is about 3 percent, with the mother as the carrier, the risk is about 12 percent.
Therefore, prenatal screening and genetic counseling are important. People with Down syndrome rarely reproduce. Screening tests do not provide conclusive answers, but rather, they provide an indication of the likelihood of the baby having Down syndrome. If the screening test is positive and a risk for Down syndrome exists, further testing may be recommended. However, screening tests have a greater chance of being wrong; there are “false-positive” (test indicates the baby has the condition when the baby really does not) and “false-negatives” (baby has the condition but the test indicates they do not). These screening tests do not provide conclusive answers but provide an indication of the likelihood of the baby having Down syndrome. In determining the results of the test, health care providers take into account the mother’s age, weight and ethnicity. If some or all of the characteristic Down syndrome features are present, the health care provider will order a chromosomal karyotype test to be done.
Your health care provider will help you decide if the benefits from the results could outweigh any risks from the procedure. Mental and physical developments are usually slower in people with Down syndrome than for those without the condition. However, children with Down syndrome would benefit from early medical assistance and developmental interventions beginning during infancy. Children with Down syndrome may benefit from speech therapy, physical therapy and occupational therapy. Many adult patients are healthier, live longer, and participate more actively in society due to early intervention and therapy. These support groups can be found through local hospitals, physicians, schools and the Internet. This week-by-week newsletter will keep you informed about what to expect for you and your developing baby during your pregnancy. You may have gained a couple of pounds, but you also may have lost weight if you are experiencing morning sickness.
Women with microalbuminuria or overt nephropathy are at increased risk for development of hypertension and preeclampsia [Grade A, Level 1 (17,18)] and should be followed closely for these conditions [Grade D, Consensus].
Because it is a chronic condition, many women want to know about epilepsy during pregnancy, and how it may affect their baby.
They may recommend changing your medication or lowering the dosage of your current medication. Your doctor will review your medical history in order to determine if a change in your anticonvulsant medication is needed.
According to the National Down Syndrome Society, there are more than 350,000 people living with Down syndrome in the United States.
When the egg and the sperm unite to form the fertilized egg, three (rather than two) chromosomes 21 are present. This is because the extra chromosome 21 material is located on a different chromosome (the translocated one). Fifteen to thirty percent of women with trisomy 21 are fertile and they have about a 50% risk of having a child with Down syndrome. Then, an ultrasound is used to look at the nuchal translucency region under the skin behind the baby’s neck.
Infants born with Down syndrome may be of average size, but grow slowly and remain smaller than other children of the same age. In cellular mosaicism, the mixture can be seen in different cells of the same type; while with tissue mosaicism, one set of cells may have normal chromosomes and another type may have trisomy 21. The carrier will not exhibit any of the symptoms of Down syndrome because they have the correct amount of genetic material.

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