March, 2013 browsing by month


An Acne Treatment That Requires a Waiver

Thursday, March 28th, 2013

I don’t blame you if you’re desperately trying to find a cure for your acne. Acne is embarrassing and unsightly, and severe forms of it can even cause lifelong scars. Any woman in her right mind would feel the urge to do whatever she could to get that clear complexion you see in the magazines. Unfortunately, one type of effective acne treatment can cause serious birth defects, and it should be ruled out for any woman hoping to conceive even just within the year. Isotretinoin is a medication that can cure the severe type of nodular acne that cannot be cured otherwise. It is usually sold under the brand name Accutane, and women who start taking it actually need to sign a waiver stating that they won’t get pregnant during the prescribed amount of time.

Avoid any type of medication with isotretinoin if you’re hoping to become pregnant someday soon. While your complexion might become clearer, your baby would be born with eye and ear defects, or even cleft palate or serious heart defects. Worse yet, women who take this type of medication soon before their pregnancy often have miscarriages or stillbirths.

Essentially, if you are of childbearing age, seek an alternative to isotretinoin. The risks are too great, and your being on the medication will limit your options if you become pregnant even accidentally. The birth defects are permanent and very serious. While acne is frustrating, it is nothing compared to the lifelong problems that your child might have from a heart defect or the serious and expensive surgery that would be required for a cleft palate.

If you are in your reproductive years and are sexually active, talk to your doctor about the alternatives if he or she prescribes a medication like Accutane with the active ingredient isotretinoin. Though some may not be quite as effective, they are worth a shot to avoid birth complications. Only if you are absolutely sure you won’t be having any children in the next few years should you take the pill; even then, pregnancies can still occur. However, people are famous for changing their mind frequently about starting a family, so don’t make a hasty decision of requesting Accutane.  Keep your options open as much as possible and look at the whole picture when it comes to using an acne medication that has the capability of causing birth defects.
– Yvonne S. Thornton, M. D., M. P. H.

A Brief History of the Dangers of Thalidomide in Pregnancy

Monday, March 25th, 2013

In the early 1950’s, a medication called thalidomide was prescribed to pregnant women who were suffering from severe morning sickness and pain. It was considered a sufficient and safe sedative for the problem. However, in the early 60’s, doctors started noticing rare birth defects in babies who were born to mothers on the medication. The birth defects were obvious and common, so experts took a second look at the drug and considered it more critically. As it turns out, their research showed that thalidomide did in fact cause the defects, and current research still supports that finding.

Decades ago, doctors didn’t even know that a medicine taken during pregnancy could actually affect a growing baby. They thought that as long as the drug didn’t kill the mother, the baby would be safe. This was obviously untrue, and thalidomide birth defects proved it. There is a famous photo from 1972 in which a young victim of gestational thalidomide intake is handing Princess Anne a bouquet of flowers with her foot because she was born without any arms at all.

As soon as the finding was discovered, doctors stopped using the medication to treat pregnant women for their ailments. However, it was not completely taken off the market, and some physicians still use it to treat conditions such as Hansen’s Disease. However, you should absolutely not take the medication while you are pregnant under any circumstances. It is one of those medications that will almost infallibly cause a birth defect in your child. If you take thalidomide regularly for a condition, speak with your doctor about a plan for pregnancy before you even start trying to conceive. Your body might need time to cleanse itself of the chemicals, so stopping when you find out you’re pregnant might even be too late.

Your baby bump will become your number one priority in life, so learning about which medications are safe and which are not can help you give your baby the healthiest gestation possible. As long as you follow your doctor’s orders and be careful of which medications you take, be they prescribed, herbal and over-the-counter, more likely than not, you’ll be holding a happy and healthy bundle of joy in no time.
 – Yvonne S. Thornton, M. D., M. P. H.

Cocaine Use During Pregnancy

Monday, March 18th, 2013

When most women find out they are pregnant, they become total health nuts. Everything they eat and everything they do is centered around the proper development of their child. Unfortunately, some women suffer from problems with addiction and cannot jump into a healthy lifestyle so easily. Women who are addicted to cocaine when they find out they’re pregnant have a long way to go. The best option is to never start in the first place. However, if you find yourself using regularly and hoping to have a healthy pregnancy at the same time, here is why you need to quit immediately.

Studies show that cocaine use during pregnancy causes low birth weight, preterm birth, and babies who are born too small for their gestational age. These problems can all create developmental disabilities that last a lifetime. Basically, having a baby too early cuts off some of the most important stages of his or her development, so it’s really important that you try your best to bring a baby to full term by staying healthy.
When you use cocaine while pregnant, you are restricting the flow of oxygen and blood to your baby. Basically, you are suffocating your child. When your child cannot receive oxygen and nutrients in utero, development is slowed down, which is why these babies are usually born too small. They did not grow sufficiently because of the restricted flow.  Also, the effect of cocaine on the placenta (the organ that nourishes the baby) often causes it to abruptly separate from its foundation, i.e. your womb, thus resulting in a medical condition known as “placental abruption”.  This is life-threatening to both the fetus and the mother.  There is no longer any support (or oxygen) for the baby because the placenta has separated from its bed.  Along with severe pain in the mother, massive bleeding may occur behind the placenta where it is hidden but still deadly or can be seen as hemorrhage causing exsanguination of the mother.  The baby dies and often the mother dies unless there is an immediate cesarean delivery.  Often, cocaine-using pregnant women never make it to the hospital in time.  Several pregnant celebrities have been whisked off to the hospital for emergency cesareans.  I just wonder whether or not they had been using cocaine before  they had pain and started bleeding.

If you are struggling with a cocaine addiction and have found out that you’re pregnant, get help immediately. If you wait any longer, you will only make your baby’s problems worse. Find a support group or a rehab center where you can find ways to cope with the addiction and discontinue your cocaine use. For women who use cocaine recreationally, I hope the results of this study serve as a warning sign against using it at all. Not only is it bad for your own body, but if you conceive at any point during your use, you could ruin your baby’s entire life. Give your baby a fighting chance and say no to cocaine during pregnancy.

 – Yvonne S. Thornton, M. D., M. P. H.

Your High Blood Pressure Meds May Have to Wait

Thursday, March 14th, 2013

The importance of being healthy before going into a pregnancy cannot be stressed enough.  While it’s true, many women find out they’re pregnant and immediately alter their lifestyles to something healthier, this is not always immediately possible.  In fact, there are some ailments that can’t be medically treated once you get pregnant because of the dangers to the baby.  High blood pressure, in some cases, is one of these issues.

According to the New England Journal of Medicine, doctors studied more than 29,000 infants in Tennessee who were born within the years of 1985-2000.  209 of those babies were exposed to ACE (angiotensin-converting enzyme) inhibitors during the first trimester and 202 more were exposed to other medications also prescribed for hypertension.  Upon birth, they found that the infants exposed to ACE inhibitors were more likely to develop congenital defects.  These included malformations in their cardiovascular systems and central nervous systems, as well as kidney abnormalities.  These findings have led them to believe that exposure to ACE inhibitors during the first trimester is not safe for developing babies and should be avoided.  Luckily, exposure to antihypertensive medications not classified as ACE inhibitors did not seem to increase the risk of defects.

This is why it’s so important to get medical issues like high blood pressure under control before deciding to get pregnant.   Preconceptionally, there are other things you can try besides medication. Try to exercise, lose that extra weight around your waistline and eat a healthy diet.  In this diet, you should restrict your intake of sodium, if at all possible.  However, if you find yourself pregnant and still struggling with hypertension, your obstetrician or perinatologist will prescribe antihypertensive medications that are safe for pregnancy.  Continued high blood pressure during pregnancy is not good for you or the baby.  You may suffer a stroke or develop kidney compromise and the baby may be born very small or not survive the pregnancy.

So, although high blood pressure may have an adverse effect on your pregnancy, and some medications may be harmful to the health of your fetus, taking the right medication to control it can make all the difference in the world.

– Yvonne S. Thornton, M. D., M. P. H.


The Implications of a Prolonged Pregnancy

Thursday, March 7th, 2013

You’ve waited nine long and painful months. Your ankles are swollen, your mood swings are drastic, and your belly feels like it’s about ready to burst. When your due date comes and goes without those telltale contractions, it’s impossible for you not to get a little upset.

However, your doctor or midwife most likely gave you the midpoint of your due month, i. e., 40 weeks (280 days of gestation).  Actually, your baby is considered mature between 38 weeks and 42 weeks (266 days to 294 days of gestation).  A prolonged pregnancy is any pregnancy that lasts beyond 294 days or 42 weeks.  I know you didn’t want to hear that, but that’s the truth.  I did my post-doctoral thesis at Columbia on postterm pregnancies and we had mothers pregnant up to 44 weeks.  While it seems like a really long time, it’s actually more common than you might think. No one actually knows why a pregnancy is prolonged.   There are many theories, but no one has found the reason for a pregnancy going beyond 42 weeks, except in cases of anencephaly.

There is nothing abnormal about a pregnancy going beyond 40 weeks, even to 42 weeks. The best way to ensure that your pregnancy lasts the normal 38 to 42 weeks is to stay healthy and active. Maintaining a healthy weight and avoiding harmful chemicals such as caffeine and alcohol will help you ensure that your pregnancy is as normal as possible.  If that doesn’t work though, thanks to advances in modern technology and medicine, there are a few different options for women with prolonged pregnancies. After a pregnancy reaches the midpoint of term, i.e., 40 weeks, your obstetrician may want to test the baby for its well being with electronic fetal surveillance.  Changes occur after 41 weeks that may jeopardize the baby’s health if not closely monitored.  If mom’s perception of fetal movement is normal, i.e. at least four kicks in one hour, and the testing is normal, it is best to wait for Mother Nature to bring on labor naturally.  However, if your physician or midwife has evidence that your baby may be in jeopardy, he or she will choose to induce your labor.

Stillbirth is a concern at any time during the pregnancy, but especially after 42 weeks. The amniotic fluid around the baby peaks at  34 weeks and decreases as the pregnancy progresses to term.  That is the reason for monitoring and assessment of the fluid when the pregnancy has passed 40 weeks.  The American College of Obstetricians and Gynecologists still defines postterm (prolonged) pregnancy as one extending beyond 42 weeks——not 40 weeks and not 41 weeks.  Babies also gain weight in utero with each passing week, so the longer baby is in “the oven” the bigger it will become (but not by much) until it reaches a critical size and then its weight begins to decline.  A mother need not worry about delivering a Butterball turkey, if she continues to normally gain ½ to one pound per week.  Few babies born after their due date experience any real issues,

Much of pregnancy is up to chance. Once you conceive, the pregnancy is really on “automatic pilot”.  From the time of conception to the time of delivery, the outcome of your pregnancy depends on your particular body and the way the hormones are interacting. The word, “obstetrics” means to “stand by”.  Therefore, inducing labor in normal pregnancy before 42 weeks violates our very creed.  That’s the fun of being pregnant.  It’s up to Mother Nature.  Some women may deliver at 38 weeks (which is normal for a term pregnancy), while others may deliver at 42 weeks (which is also normal).  Both of my children were delivered beyond 42 weeks and both are Ivy-league graduates and totally healthy.

Try not to fret or force your doctor or midwife into inducing labor, which may not have been in the cards (or the best interest of your baby), only for you to end up with a cesarean birth rather than a natural one.

 – Yvonne S. Thornton, M. D., M. P. H.

Conception and Congestion

Monday, March 4th, 2013

You probably thought you knew all there was to know about pregnancy. You’ve read all the books, talked to your obstetrician, visited every website, and browsed every forum. At this point, you probably feel like a pregnancy expert. Believe it or not, there are probably still some symptoms you don’t even know about.

Many of my patients come to me complaining about harmless but bothersome conditions during their pregnancy wondering if their issue is out of the ordinary. One common complaint is congestion. It is more worrisome than other symptoms because most women who experience it think they might be coming down with a cold, which they worry might harm their baby. Luckily, congestion is completely normal, and it makes sense when you consider the cause.

Your blood volume increases during pregnancy and many of your blood vessels expand to accommodate it. Since there are tiny capillaries and vessels in your nose, their expansion causes a drastic change in the nose’s structure. The stuffiness you’re feeling during pregnancy is not a result of mucus. Instead, it’s the larger blood vessels blocking air from flowing in and out normally.

Studies show that two-thirds of all women report severe stuffiness during their pregnancy, so it is not at all uncommon. Usually, it is mild enough to not cause any serious problems, but let your doctor know right away if it seems to be affecting your ability to breathe normally. It could also affect your ability to exercise, so bring that up with your physician as well.

Congestion is one of those weird pregnancy symptoms that your doctor didn’t warn you about. It is harmless, which is why people usually don’t even report it. It is still common, inconvenient, and uncomfortable though. There is no treatment to alleviate the congestion safely, but cigarettes can exacerbate the problem, so make sure you quit if the symptom is a problem. In fact, you should quit either way.

While congestion is completely harmless, it’s okay if you still want to bring it up with your doctor if you’re concerned. As a physician, believe me when I say that there are no silly questions during pregnancy. I actually like to see women who really pay attention to their bodies, because they are the ones who take care of themselves and their growing baby best.

– Yvonne S. Thornton, M. D., M. P. H.