Dr. Sunanda Kane discusses women with Crohn’s disease who want to get pregnant, issues around the time of birth, and breast feeding. Also discusses taking medications for Crohn’s disease during pregnancy and questions surrounding the chance of passing along Crohn’s disease to the baby.
A study found that, for healthy pregnancies, inducing labor after full term (39 weeks) rather than waiting for natural labor doesn’t increase the risk of major complications for newborns.
Being inside the womb for a full 39 weeks is important for a baby’s development. A baby’s brain nearly doubles in size during the last few weeks of pregnancy. The lungs and liver are still developing too.
Once a woman has reached full term, her doctor may suggest inducing labor for different medical, or non-medical, reasons. Sometimes the mother will request an induced labor if she’s uncomfortable in her final weeks.
Prior research has shown that inducing labor before 39 weeks of pregnancy puts the baby at risk of serious health problems. Researchers wanted to find out if inducing labor at full term also puts a baby at risk of serious health problems. They also wondered if it increases a woman’s chance of needing a surgery called a cesarean section, or C-section.
The team enrolled 6,000 pregnant women in the study. Participants were randomly assigned to two groups. Half of the women waited to have a natural labor. The other half were induced at 39 weeks.
The two groups of babies had similar survival rates and chances of serious health problems, such as needing help with breathing, having a seizure, or getting an infection. Inducing labor also reduced the mothers’ chance of a C-section and lowered their blood pressure.
“Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when,” says study leader Dr. William Grobman of Northwestern University.
When you’re in the second stage of labor, called delivery, you are mere minutes to a couple of hours away from meeting your newborn.
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International Fetal Alcohol Spectrum Disorders (FASD) Awareness Day, recognized every year on Sept. 9th, is an important reminder prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States. Almost 40 years have passed since it was recognized drinking during pregnancy can result in a wide range of disabilities for children, of which fetal alcohol syndrome (FAS) is the most severe. Still, 1 in 13 pregnant women report drinking in the past 30 days. Of those, about 1 in 6 report binge drinking during that time.
The disabilities associated with FASD can persist throughout life and place heavy emotional and financial burdens on individuals, their families, and society. Alcohol use during pregnancy can cause physical, behavioral, and intellectual disabilities. Often, a person with an FASD has a mix of these problems. It is recommended women who are pregnant or might be pregnant not drink alcohol. Fetal alcohol spectrum disorders are completely preventable if a developing baby is not exposed to alcohol before birth.
What We Know
- Women who are pregnant or who might be pregnant should be aware that any level of alcohol use could harm their babies.
- All types of alcohol can be harmful, including all wine and beer.
- The baby’s brain, body, and organs are developing throughout pregnancy and can be affected by alcohol at any time.
- Alcohol use during pregnancy can also increase the risk of miscarriage, stillbirth, preterm (early) birth, and sudden infant death syndrome (SIDS).
Cause and Prevention
FASDs are caused by a woman drinking alcohol during pregnancy. Alcohol in the mother’s blood passes to the baby through the umbilical cord. When a woman drinks alcohol, so does her baby.
There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer.
To prevent FASDs, a woman should not drink alcohol while she is pregnant, or when she might get pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks. In the United States, nearly half of pregnancies are unplanned.
If a woman is drinking alcohol during pregnancy, it is never too late to stop drinking. Because brain growth takes place throughout pregnancy, the sooner a woman stops drinking the safer it will be for her and her baby. Resources are available here.
FASDs are completely preventable if a woman does not drink alcohol during pregnancy—so why take the risk?
Signs and Symptoms
FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways and can range from mild to severe.
A person with an FASD might have:
- Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
- Small head size
- Shorter-than-average height
- Low body weight
- Poor coordination
- Hyperactive behavior
- Difficulty with attention
- Poor memory
- Difficulty in school (especially with math)
- Learning disabilities
- Speech and language delays
- Intellectual disability or low IQ
- Poor reasoning and judgment skills
- Sleep and sucking problems as a baby
- Vision or hearing problems
- Problems with the heart, kidneys, or bones
Types of FASDs
Different terms are used to describe FASDs, depending on the type of symptoms.
Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.
Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.
Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.
The term FASDs is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now.
Diagnosing FAS can be hard because there is no medical test, like a blood test, for it. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.
To diagnose FAS, doctors look for:
- Abnormal facial features (e.g., smooth ridge between nose and upper lip)
- Lower-than-average height, weight, or both
- Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
- Prenatal alcohol exposure; although confirmation is not required to make a diagnosis
FASDs last a lifetime. There is no cure for FASDs, but research shows early intervention treatment services can improve a child’s development.
There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.
Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential. These include:
- Diagnosis before 6 years of age
- Loving, nurturing, and stable home environment during the school years
- Absence of violence
- Involvement in special education and social services
What Can Be Done to Prevent Fetal Alcohol Spectrum Disorders
- Talk with their healthcare providers about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.
- Stop drinking alcohol if they are trying to get pregnant or could get pregnant.
- Ask their respective partners, families, and friends to support their choice not to drink during pregnancy or while trying to get pregnant.
- Ask their healthcare providers or other trusted people about resources for help if they cannot stop drinking on their own.
Healthcare providers can
- Screen all adult patients for alcohol use at least yearly.
- Advise women not to drink at all if there is any chance they could be pregnant.
- Counsel, refer, and follow up with patients who need more help.
- Use the correct billing codes so that alcohol screening and counseling is reimbursable.
If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from the National Organization on Fetal Alcohol Syndrome (NOFAS).
At the same time as you ask the doctor for a referral to a specialist, call your state’s early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.
Where to call for a free evaluation from the state depends on your child’s age:
If your child is younger than 3 years old, Call your state or territory’s early intervention program and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”
If your child is 3 years old or older, contact your local public school system. Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
Research to understand how alcohol exposure during pregnancy interferes with fetal development and how FASD can be identified and prevented is ongoing. Scientists continue to make tremendous strides, providing important new insights into the nature of FASD and potential intervention and treatment strategies.
The message is simple, not just on Sept. 9, but every day. There is no known safe level of drinking while pregnant. Women who are, who may be, or who are trying to become pregnant, should not drink alcohol.
If you or pregnant, may become pregnant, or are a new parent wondering about the effects of alcohol on your child, find a caring physician who can advise you using the first of its kind social ecosystem for HealthCare. At HealthLynked, your can connect with providers in new and unique ways to collaborate on your wellness and the health of your family.
Ready to get Lynked? Got to HealthLynked.com to sign up for Free, and start taking control of your health today?
Streissguth, A.P., Bookstein, F.L., Barr, H.M., Sampson, P.D., O’Malley, K., & Young, J.K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics, 5(4), 228-238.
Streissguth, A.P., Barr, H.M., Kogan, J. & Bookstein, F. L., Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Final report to the Centers for Disease Control and Prevention (CDC). Seattle: University of Washington, Fetal Alcohol & Drug Unit; August 1996. Tech. Rep. No. 96-06.
Labor is a journey – and it’s different for every mom-to-be. Here’s how it might unfold for you.
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14 possible causes for irregular periods
What causes irregular periods?
Your menstrual cycle is counted from the first day of your last period to the start of your next period. Your period is considered irregular if it’s longer than 38 days or if the duration varies.
Irregular periods can have several causes, from hormonal imbalances to other underlying conditions, and should be evaluated by your doctor. Here’s a look at the possible causes and their symptoms.
Pregnancy can cause you to miss your period or experience spotting. Other symptoms of early pregnancy may include:
- morning sickness
- sensitivity to smells
- breast tingling or tenderness
If you miss a period or notice changes in your period and you’ve had sex, you can take a pregnancy test at home or see your doctor to find out if you’re pregnant.
If you may be pregnant and experience sharp, stabbing pain in the pelvis or abdomen that lasts more than a few minutes, see your doctor right away to rule out ectopic pregnancy or miscarriage.
2. Hormonal birth control
Hormonal birth control pills and hormone-containing intrauterine devices (IUDs) can cause irregular bleeding.
Birth control pills may cause spotting between periods and result in much lighter periods.
An IUD may cause heavy bleeding.
Prolactin is a hormone that’s responsible for breast milk production. Prolactin suppresses your reproductive hormones resulting in very light periods or no period at all while you’re breastfeeding.
Your periods should return shortly after you stop breastfeeding. Read on to learn more the effects of breastfeeding on your period.
Perimenopause is the transition phase before you enter menopause. It usually begins in your 40s, but can occur earlier.
You may experience signs and symptoms lasting from 4 to 8 years, beginning with changes to your menstrual cycle. Fluctuating estrogen levels during this time can cause your menstrual cycles to get longer or shorter.
Other signs and symptoms of perimenopause include:
- hot flashes
- night sweats
- mood changes
- difficulty sleeping
- vaginal dryness
5. Polycystic ovary syndrome (PCOS)
Irregular periods are the most common sign of PCOS. If you have PCOS, you may miss periods and have heavy bleeding when you do get your period.
PCOS can also cause:
- excess facial and body hair
- male-pattern baldness
- weight gain or obesity
6. Thyroid problems
An underactive thyroid may cause longer, heavier periods.
A 2015 study found that 44 percent of participants with menstrual irregularities also had thyroid disorders.
Hypothyroidism, or underactive thyroid, can cause longer, heavier periods and increased cramping. You may also experience fatigue, sensitivity to cold, and weight gain.
High levels of thyroid hormones, which is seen in hyperthyroidism, can cause shorter, lighter periods. You may also experience:
- sudden weight loss
- anxiety and nervousness
- heart palpitations
Swelling at the base of your neck is another common sign of a thyroid disorder.
7. Uterine fibroids
Fibroids are muscular tumors that develop in the wall of the uterus. Most fibroids are noncancerous and can range in size from as small as an apple seed to the size of a grapefruit.
Fibroids can cause your periods to be very painful and heavy enough to cause anemia. You may also experience:
- pelvic pain or pressure
- low back pain
- pain in your legs
- pain during sex
Most fibroids don’t require treatment and symptoms can be managed with over-the-counter (OTC) pain medications and an iron supplement if you develop anemia.
Endometriosis affects 1 in 10 women of reproductive age. This is a condition in which the tissue that normally lines your uterus grows outside the uterus.
Endometriosis causes very painful, even debilitating menstrual cramps. Endometriosis also causes heavy bleeding, prolonged periods, and bleeding between periods.
Other symptoms may include:
- gastrointestinal pain
- painful bowel movements
- pain during and after intercourse
Exploratory surgery is the only way to diagnose endometriosis. There’s currently no cure for the condition, but symptoms can be managed with medication or hormone therapy.
9. Being overweight
Obesity is known to cause menstrual irregularity. Research shows that being overweight impacts hormone and insulin levels, which can interfere with your menstrual cycle.
Rapid weight gain can also cause menstrual irregularities. Weight gain and irregular periods are common signs of PCOS and hypothyroidism, and should be evaluated by your doctor.
10. Extreme weight loss and eating disorders
Excessive or rapid weight loss can cause your period to stop. Not consuming enough calories can interfere with the production of the hormones needed for ovulation.
You’re considered underweight if you have a body mass index lower than 18.5. Along with stopped periods, you may also experience fatigue, headaches, and hair loss.
See your doctor if:
- you’re underweight
- have lost a lot of weight without trying
- you have an eating disorder
11. Excessive exercise
Intense or excessive exercise has been shown to interfere with the hormones responsible for menstruation.
Female athletes and women who participate in intensive training and physical activities, such as ballet dancers, often develop amenorrhea, which is missed or stopped periods.
Cutting back on your training and increasing your calorie count can help restore your periods.
Research shows that stress can interfere with your menstrual cycle by temporarily interfering with the part of the brain that controls the hormones that regulate your cycle. Your periods should return to normal after your stress decreases. Try these 16 techniques to relieve your stress.
Certain medications can interfere with your menstrual cycle, including:
- hormone replacement therapy
- blood thinners
- thyroid medications
- epilepsy drugs
- chemotherapy drugs
- aspirin and ibuprofen
Speak to your doctor about changing your medication.
14. Cervical and endometrial cancer
Cervical and endometrial cancers can cause changes to your menstrual cycle, along with bleeding between periods or heavy periods. Bleeding during or after intercourse and unusual discharge are other signs and symptoms of these cancers.
Remember that these symptoms are more commonly caused by other issues. Speak to your doctor if you’re concerned.
When to call your healthcare provider
There are several possible causes of irregular periods, many of which require medical treatment. Make an appointment to see your doctor if:
- your periods stop for more than 3 months and you’re not pregnant
- your periods become irregular suddenly
- you have a period that lasts longer than 7 days
- you need more than one pad or tampon every hour or two
- you develop severe pain during your period
- your periods are less than 21 days or more than 35 days apart
- you experience spotting between periods
- you experience other symptoms, such as unusual discharge or fever
Your doctor will ask about your medical history and want to know about:
- any stress or emotional issues you’re experiencing
- any changes to your weight
- your sexual history
- how much you exercise
Medical tests may also be used to help diagnose the cause of your irregular bleeding, including:
- a pelvic examination
- blood tests
- abdominal ultrasound
- pelvic and transvaginal ultrasound
- CT scan
Treatment depends on what’s causing your irregular periods and may require treating an underlying medical condition. Your doctor may recommend one or more of the following treatments:
- oral contraceptives
- hormonal IUDs
- thyroid medication
- weight loss or weight gain
- vitamin D supplements
Stress reduction techniques may also help, including:
- deep breathing
- cutting back on work and other demands
How to track your period
Tracking your period is a good idea even when your period is regular. You can track your period on a calendar or in a notebook, or use one of the many period tracking apps available.
Begin tracking your period by marking the first day of your period on a calendar. Within a few months you’ll begin to see if your periods are regular or different each month.
Keep track of the following:
- PMS symptoms, such as headaches, cramps, bloating, breast tenderness, and moods
- when your bleeding begins and whether or not it was earlier or later than expected
- how heavy your bleeding was, including how many pads or tampons you used
- symptoms during your period, such as cramping, back pain, and other symptoms and how bad they were
- how long your period lasted and whether or not it was longer or shorter than your last period
Irregular periods can be caused by a number of things, some of them serious. Your doctor can help you determine the cause and help you get your cycle back on track. Eating a balanced diet, getting regular exercise, and avoiding stress can also help.