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MOE104A: Complications During Pre-pregnancy and PregnancyPRE-PREGNANCY COMPLICATIONSWhat is lung disease?right000Lung disease refers to disorders that affect the lungs, the organs that allow us to breathe. Breathing problems caused by lung disease may prevent the body from getting enough oxygen. Examples of lung diseases are:Asthma, chronic bronchitis, and emphysemaInfections, such as influenza and pneumoniaLung cancerSarcoidosis (sar-KOY-doh-sis) and pulmonary fibrosisLung disease is a major concern for women. The number of U.S. women diagnosed with lung disease is on the rise. More women are also dying from lung disease.What types of lung disease are most common in women?Three of the most common lung diseases in women are asthma, chronic obstructive pulmonary disease (COPD), and lung cancer.AsthmaAsthma is a chronic (ongoing) disease of the airways in the lungs called bronchial tubes. Bronchial tubes carry air into and out of the lungs. In people with asthma, the walls of these airways become inflamed (swollen) and oversensitive. The airways overreact to things like smoke, air pollution, mold, and many chemical sprays. They also can be irritated by?allergens?(like pollen and dust mites) and by respiratory infections (like a cold). When the airways overreact, they get narrower. This limits the flow of air into and out of the lungs and causes trouble breathing. Asthma symptoms include?wheezing, coughing, and tightness in the chest.Women are more likely than men to have asthma and are more likely to die from it. The percentage of women, especially young women, with asthma is rising in the United States. Researchers are not sure why. Many experts think that air pollution and allergens play a role in this increase. Breathing tobacco smoke also is linked to an increased risk of asthma.Chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease (COPD) refers to chronic obstructive bronchitis and emphysema. These conditions often occur together. Both diseases limit airflow into and out of the lungs and make breathing difficult. COPD usually gets worse with time.A person with COPD has ongoing?inflammation?of the bronchial tubes, which carry air into and out of the lungs. This irritation causes the growth of cells that make mucus. The extra mucus leads to a lot of coughing. Over time, the irritation causes the walls of the airways to thicken and develop scars. The airways may become thickened enough to limit airflow to and from the lungs. If that happens, the condition is called chronic obstructive bronchitis.In emphysema, the lung tissue gets weak, and the walls of the air sacs (alveoli) break down. Normally, oxygen from the air goes into the blood through these air sac walls. In a person with emphysema, the ruined air sac walls means less oxygen can pass into the blood. This causes shortness of breath, coughing, and wheezing.More than twice as many women as men are now diagnosed with chronic bronchitis. The rate of emphysema among women has increased by 5 percent in recent years but has decreased among men. And more women have died from COPD than men every year since 2000. Researchers are trying to understand why. Cigarette smoking, a main cause of COPD, has increased among women. One theory is that cigarette smoke is more damaging to women than to men.Lung cancerLung cancer?is a disease in which abnormal (malignant) lung cells multiply and grow without control. These cancerous cells can invade nearby tissues, spread to other parts of the body, or both. The two major kinds of lung cancer are named for the way the cells look under a microscope. They are:Small cell lung cancer.?This kind of lung cancer tends to spread quickly.Non-small cell lung cancer.?This is a term for several types of lung cancers that act in a similar way. Most lung cancers are non-small cell. This kind of lung cancer tends to spread more slowly than small cell lung cancer.In the United States, more women now die from lung cancer than from any other type of cancer. Tobacco use is the major cause of lung cancer.Other lung diseasesLess common lung problems that affect women include:Pulmonary emboli.?These are blood clots that travel to the lungs from other parts of the body and plug up blood vessels in the lungs. Some factors that increase your risk include being pregnant, having recently given birth, and taking birth control pills or?menopausal hormone therapy. Pulmonary emboli can affect blood flow in the lungs and can reduce oxygen flow into the blood. Very large emboli can cause sudden death.Pulmonary hypertension.?This is high blood pressure in the arteries that bring blood to the lungs. It can affect blood flow in the lungs and can reduce oxygen flow into the blood.Sarcoidosis and pulmonary fibrosis.?These inflammatory diseases cause stiffening and scarring in the lungs.LAM (lymphangioleiomyomatosis)?(lim-FAN-jee-oh-LEE-oh-MEYE-oh-mah-TOH-sis). This is a rare lung disease that mostly affects women in their mid-30s and 40s. Muscle-like cells grow out of control in certain organs, including the lungs.Influenza (the flu) and pneumonia.?Flu is a respiratory infection that is caused by a virus and can damage the lungs. Usually, people recover well from the flu, but it can be dangerous and even deadly for some people. Those at greater risk include older people, young children, pregnant women, and people with certain health conditions like asthma. Pneumonia is a severe inflammation of the lungs that can be caused bybacteria,?viruses, and fungi. Fluid builds up in the lungs and may lower the amount of oxygen that the blood can get from air that's breathed in. People most at risk are older than 65 or younger than 2, or already have health problems. Vaccines are the best protection against flu and pneumonia.What causes lung disease?Smoking causes lung cancer and many other types of lung disease.?Experts don't know the causes of all types of lung disease, but they do know the causes of some. These include:Smoking.?Smoke from cigarettes, cigars, and pipes is the number one cause of lung disease. Don't start smoking, or quit if you already smoke. If you live or work with a smoker, avoid secondhand smoke. Ask smokers to smoke outdoors. Secondhand smoke is especially bad for babies and young children.Radon.?This colorless, odorless gas is present in many homes and is a recognized cause of lung cancer. You can check for radon with a kit bought at many hardware stores. Radon can be reduced in your home if you find out there are high levels.Asbestos.?This is natural mineral fiber that is used in insulation, fireproofing materials, car brakes, and other products. Asbestos can give off small fibers that are too small to be seen and can be inhaled. Asbestos harms lung cells, causing lung scarring and lung cancer. It can cause mesothelioma (MEZ-oh-THEE-lee-OH-muh), which is a cancer that forms in the tissue covering the lungs and many other organs of the body.Air pollution.?Recent studies suggest that some air pollutants like car exhaust may contribute to asthma, COPD, lung cancer, and other lung diseases.Some diseases that affect the lungs, like the flu, are caused by germs (bacteria, viruses, and fungi).Signs of lung diseaseEarly signs of lung disease are easy to overlook. Often, an early sign of lung disease is not having your usual level of energy.The signs and symptoms can differ by the type of lung disease. Common signs are:Trouble breathingShortness of breathFeeling like you're not getting enough airDecreased ability to exerciseA cough that won't go awayCoughing up blood or mucusPain or discomfort when breathing in or outMake sure to call your doctor if you have any of these symptoms.Symptoms of asthma?Asthma can be hard to diagnose. The signs of asthma can seem like the signs of?COPD,?pneumonia,?bronchitis, pulmonary embolism,?anxiety, and?heart mon symptoms of asthma are:CoughingWheezingChest tightnessShortness of breathTo diagnose asthma, the doctor asks about your symptoms and what seems to trigger them, reviews your health history, and does a physical exam.To confirm the diagnosis, the doctor may do other tests, such as:Spirometry?(speye-ROM-eh-tree). The doctor uses a medical machine called a spirometer. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out. The doctor may also give you medicines and then retest you to see if your results improve.Bronchoprovocation?(bron-KOH-prah-vuh-KAY-shun). Your lung function is tested using spirometry while more stress is put on the lungs. This may be during physical activity or after you breathe in increasing doses of a special chemical or cold air.Chest x-ray or EKG (electrocardiogram).?These tests can sometimes find out if another disease or a foreign object may be causing your symptoms.Other tests.?The doctor may want to test for other problems that might be causing the symptoms. These include stomach acid backing up into the throat, vocal cord problems, or?sleep apnea.TreatmentAsthma is a chronic disease. Medicines can be used to treat asthma, but they cannot cure it. You can help control your symptoms by working with your doctor to set up and then follow a personal asthma action plan. The plan will include possible medications and ways to avoid things that trigger your asthma.Following an asthma action planYour asthma action plan will show:The kinds of medicines you should takeWhen to take your medicinesHow to regularly monitor your asthmaWays to avoid what triggers your asthmaWhen to call your doctor or go to the emergency roomTaking medicinesAsthma medicines work by opening the lung airways. The medicines used to treat asthma fall into two groups: long-term control and quick relief.Long-term control medicines?are to be taken every day, usually over a long period of time. They help prevent symptoms from starting. Once symptoms occur, they do not give quick relief. These medicines include:Inhaled corticosteroids.?These are the preferred medicines for long-term asthma control. They relieve airway inflammation and swelling.Long-acting beta2-agonists.?These inhaled medicines are often added to low-dose inhaled corticosteroids to improve long-term asthma control.Leukotriene modifiers.?These pills help block the chain reaction that causes inflammation in the airways.Cromolyn and nedocromil.?These inhaled medicines can help keep airways from reacting in response to an asthma trigger.Theophylline.?This is a pill that helps open the airways.Quick-relief medicines?are used only when needed. These include short-acting inhaled beta2-agonists and short-acting bronchodilators, like albuterol and pirbuteral. Quick-relief medicines often relieve symptoms in minutes. They do this by quickly relaxing tightened muscles around the airways. They are taken when symptoms worsen to prevent a full-blown asthma attack and to stop attacks once they have started.Avoiding asthma triggersAvoid things that make your asthma worse. Common asthma triggers are tobacco smoke, animal dander, dust mites, air pollution, mold, and pollens. You can try "fragrance-free" products if your asthma is triggered by fragrances. Talk to your doctor about allergy shots if your asthma symptoms are linked to allergens that you cannot avoid. The shots may lessen or prevent the symptoms but will not cure the asthma. You can reduce your exposure to air pollution by limiting your outdoor activities on days when the air quality in your neighborhood is poor.PREGNANCY AND ASTHMAIf you have asthma and may become pregnant, talk to your doctor. Only in very severe cases might asthma be a reason to avoid becoming pregnant.If you have asthma and become pregnant, you and your doctor can discuss the safety of your medicines. Changes in the medicines can sometimes make good sense. It is very important to manage your asthma symptoms when you are pregnant. Asthma that gets out of control can harm your baby.You should also talk with your doctor about getting a flu shot. Flu can be very serious for anyone with asthma, but it's even more of a concern for pregnant women with asthma.Signs and Symptoms of chronic obstructive pulmonary disease (COPD)People with COPD have symptoms that develop very slowly over many years. As a result, many people ignore these symptoms until their disease has reached an advanced stage. COPD can be easily diagnosed and can be managed.The symptoms of COPD include:An ongoing cough that often produces large amounts of mucusShortness of breath, especially during physical activityWheezingChest tightnessIf you have some or all of these symptoms, make sure to talk to your doctor.To find out if you have COPD, the doctor will:Ask about your symptomsAsk about your medical history, including family historyAsk about your history of exposure to things that can cause COPD, such as tobacco smoke, air pollution, or chemicalsDo a physical exam, including using a stethoscope to listen for wheezing or other abnormal chest soundsThe main test to check for COPD is spirometry. For this test, you will be asked to take a deep breath and blow as hard as you can into a tube that is connected to a spirometer. This machine measures how much air you breathe out and how fast.Other tests can include:Chest x-ray or chest computed tomography (CT) scan.?These tests create pictures of the heart and lungs. The pictures can show signs of COPD. They can also show whether your symptoms are caused by another condition, such as heart failure.Arterial blood gas test.?This blood test measures the oxygen and carbon dioxide levels in your blood. It can help determine how severe the COPD is and whether?oxygen therapy?is needed.TREATMENT OF COPDDamage to the lungs cannot be repaired. The disease can be slowed by avoiding certain exposures, though. For smokers, the best approach is to stop smoking. You should also limit your exposure to smoke, dust, fumes, and irritating vapors at home and work. Also limit outdoor activities during air pollution alerts. Treatment can relieve symptoms. Common medicines are:Bronchodilators?to open up air passages in the lungsInhaled steroids?to relieve symptoms by reducing inflammation in the lungsAntibiotics?to clear up infections in the lungsFor patients with COPD, doctors may also recommend:Flu shots.?Influenza (flu) can cause serious problems for people with COPD.Pneumonia shots.?The pneumococcal (NOO-muh-kok-uhl) vaccine reduces the risk of some kinds of pneumonia.Pulmonary rehabilitation.?This treatment helps people cope physically and mentally with COPD. It can include exercise, training to manage the disease, diet advice, and counseling.Oxygen therapy.?The patient receives extra oxygen, either through a tube or mask.Surgery.?Sometimes surgery can help people with severe COPD feel better. Lung transplant surgery is becoming more common for people with severe emphysema. Another procedure called lung volume reduction surgery is also used to treat some patients with severe COPD of the emphysema type. In this surgery, the most damaged part of each lung is removed.LUNG CANCERSymptoms lung cancer?Usually there are no warning signs of early lung cancer. By the time most people with lung cancer have symptoms, the cancer has become more serious.Symptoms of lung cancer may include:A cough that doesn't go away or gets worseBreathing trouble, like shortness of breathCoughing up bloodChest painHoarseness or wheezingPneumonia that doesn't go away or that goes away and comes backIn addition, you may feel very tired, have a loss of appetite, or unexplained weight loss. If you have symptoms of lung cancer, it's important to talk to your doctor. The doctor will ask about your health history, smoking history, and exposure to harmful substances. He or she will also do a physical exam and may suggest some mon tests for diagnosis of lung cancer include:Chest x-rays.?Chest x-rays allow doctors to "see" abnormal growths in the puterized tomography scans (CT scans).?CT scans are more powerful than standard x-rays. The images can show subtle signs of cancer that don't show up on x-rays. This can increase the chances of finding the cancer before it spreads further.Sputum cytology.?A sample of mucus that you cough up is studied to see if it has cancer cells in it.Bronchoscopy.?Doctors pass a special tube called a bronchoscope through the nose or mouth and down into the lungs. They can see into the lungs and remove small bits of tissue to test.Fine-needle aspiration.?Doctors pass a needle through the chest wall into the lung to remove a small amount of tissue or fluid.Thoracotomy?(thohr-uh-KOT-oh-mee). Doctors cut open the chest and remove tissue from the lungs.If I smoke, should I get tested for lung cancer?Testing for cancer before a person has any symptoms is called screening. Screening may help find cancers early, when they may be easier to treat.Many studies show that screening smokers with x-rays or sputum cytology does not save lives. But recently a major study showed that CT scans of older people who smoke a lot (or used to smoke a lot) can save lives. You can learn more about the results of the study, which is called the?National Lung Screening Trial. Experts are still working to figure out who should get CT screening. There are risks and benefits to screening for lung cancer.For now, the U.S. Preventive Services Task Force (USPSTF) makes no recommendation either for or against routine screening for lung cancer. If you're concerned about your lung cancer risk, talk to your doctor about whether screening is right for you. Of course, the best way to reduce your risk of lung cancer is not to smoke.How is lung cancer treated?Sometimes lung cancer treatments are used to try to cure the cancer. Other times, treatments are used to stop the cancer from spreading and to relieve symptoms.Your specific treatment will depend on:The type of lung cancerWhere the cancer is and if it has spread to other parts of the bodyYour age and overall healthYour doctor may recommend one treatment or a combination of treatments.Surgery?is used to remove the lung tissue that has the cancerous tumor. Sometimes a large part of a lung or all of it is removed. When the cancer has not spread, surgery can cure the patient.Radiation therapy?uses a machine to aim high-energy x-rays at the tumor. This energy kills cancer cells. Radiation therapy can relieve pain and make a person feel better.Chemotherapy?uses medicine to kill cancer cells. Chemotherapy medicines can be given through a vein or taken as a pill.Targeted therapy?uses medicine to block the growth and spread of cancer cells. It can be given through a vein or taken as a pill.Can I lower my risk for lung disease?Things you can do to reduce your risk of lung diseases include:Stop smoking.?If you smoke, the most important thing you can do is stop. Talk to your doctor about the best way to quit. All kinds of smoking (cigarettes, cigars, pipes, and marijuana) can boost the chances of lung disease.Avoid secondhand smoke.?If you live or work with people who smoke cigarettes, pipes, or cigars, ask them to smoke outside. Non-smokers have the right to a smoke-free workplace.Test for radon.?Find out if there are high levels of the gas radon in your home or workplace. You can buy a radon test kit at most hardware stores. The U.S. Environmental Protection Agency offers information on?how to deal with radon.Avoid asbestos.?Exposure to asbestos can cause scarring of the lungs, lung cancer, and other serious lung disease. Asbestos can be a particular concern for those whose jobs put them in contact with it. This includes people who maintain buildings that have insulation or other materials that contain asbestos and people who repair car brakes or clutches. Employers of those who work with asbestos should offer training about asbestos safety and should regularly check levels of exposure. They also should provide ways to limit exposure, such as special breathing masks that filter asbestos dust from the air.Protect yourself from dust and chemical fumes.?Working in dusty conditions and with chemicals can increase your risk of lung disease. And the risk is not just from industrial chemicals. Many products used at home, like paints and solvents, can cause or aggravate lung disease. Read labels and carefully follow instructions for use. If possible, avoid using products that cause eye, nose, or throat irritation. If you can't avoid them, use them as little as possible and only in a well-ventilated area. Wear protective equipment such as a special mask. Make sure you know which type of equipment you need and how to wear it.Eat a healthy diet.?The National Cancer Institute notes that studies show that eating a lot of fruits or vegetables may help lower the risk of lung cancer. Of course, diet can't undo the damage caused by unhealthy behaviors like smoking.Ask your doctor if you should have a? HYPERLINK "" \l "ST" spirometry test.?Some groups recommend routine spirometry testing of at-risk people, such as people who are over 45 and smoke and those who are exposed to lung-damaging substances at work.Ask your doctor about protecting yourself from flu and pneumonia with vaccinations.See your doctor?if you have a cough that won't go away, trouble breathing, pain or discomfort in your chest, or any of the other symptoms described here.DEPRESSION What is depression?Life is full of ups and downs. But when the down times last for weeks or months at a time or keep you from your regular activities, you may be suffering from depression. Depression is a medical illness that involves the body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things.It is different from feeling "blue" or down for a few hours or a couple of days. It is not a condition that can be willed or wished away.What are the different types of depression?Different kinds of depression include:Major depressive disorder.?Also called major depression, this is a combination of symptoms that hurt a person's ability to work, sleep, study, eat, and enjoy hobbies.Dysthymic (diss-TIME-ic) disorder.?Also called dysthymia, this kind of depression lasts for a long time (two years or longer). The symptoms are less severe than major depression but can prevent you from living normally or feeling well.Some kinds of depression show slightly different symptoms than those described above. Some may start after a particular event. However, not all scientists agree on how to label and define these forms of depression. They include:Psychotic depression, which occurs when a severe depressive illness happens with some form of psychosis, such as a break with reality,?hallucinations, and?delusions.Postpartum depression, which is diagnosed if a new mother has a major depressive episode within one month after delivery.Seasonal affective disorder (SAD),?which is a depression during the winter months, when there is less natural sunlight.What causes depression?There is no single cause of depression. There are many reasons why a woman may become depressed:Genetics (family history)?– If a woman has a family history of depression, she may be more at risk of developing it herself. However, depression may also occur in women who don't have a family history of depression.Chemical imbalance?– The brains of people with depression look different than those who don't have depression. Also, the parts of the brain that manage your mood, thoughts, sleep, appetite, and behavior don't have the right balance of chemicals.Hormonal factors?– Menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause, and menopause may all cause a woman to develop depression.Stress?– Stressful life events such as trauma, loss of a loved one, a bad relationship, work responsibilities, caring for children and aging parents, abuse, and poverty may trigger depression in some people.Medical illness?– Dealing with serious medical illnesses like stroke, heart attack, or cancer can lead to depression.What are the signs of depression?Not all people with depression have the same symptoms. Some people might only have a few, and others a lot. How often symptoms occur, and how long they last, is different for each person. Symptoms of depression include:Feeling sad, anxious, or "empty"Feeling hopelessLoss of interest in hobbies and activities that you once enjoyedDecreased energyDifficulty staying focused, remembering, making decisionsSleeplessness, early morning awakening, or oversleeping and not wanting to get upNo desire to eat and weight loss or eating to "feel better" and weight gainThoughts of hurting yourselfThoughts of death or suicideEasily annoyed, bothered, or angeredConstant physical symptoms that do not get better with treatment, such as headaches, upset stomach, and pain that doesn't go awayI think I may have depression. How can I get help?Below are some people and places that can help you get treatment.Family doctorCounselors or social workersFamily service, social service agencies, or clergy personEmployee assistance programs (EAP)Psychologists and psychiatristsIf you are unsure where to go for help, check the Yellow Pages under?mental health, health, social services, suicide prevention, crisis intervention services, hotlines, hospitals,?or?physicians?for phone numbers and addresses.What if I have thoughts of hurting myself?Depression can make you think about hurting yourself or suicide. You may hurt yourself to:Take away emotional pain and distressAvoid, distract from, or hold back strong feelingsTry to feel betterStop a painful memory or thoughtPunish yourselfRelease or express anger that you're afraid to express to othersYet, hurting yourself does just that — it hurts you. If you are thinking about hurting or even killing yourself,?please ask for help!?Call 911, 800-273-TALK (8255) or 800-SUICIDE, or check in your phone book for the number of a suicide crisis center. The centers offer experts who can help callers talk through their problems and develop a plan of action. These hotlines can also tell you where to go for more help in person. You also can talk with a family member you trust, a clergy person, or a doctor. There is nothing wrong with asking for help — everyone needs help sometimes.You might feel like your pain is too overwhelming to cope with, but those times don't last forever. People do make it through suicidal thoughts. If you can't find someone to talk with, write down your thoughts. Try to remember and write down the things you are grateful for. List the people who are your friends and family, and care for you. Write about your hopes for the future. Read what you have written when you need to remind yourself that your life is IMPORTANT!How is depression found and treated?Most people with depression get better when they get treatment.The first step to getting the right treatment is to see a doctor. Certain medicines, and some medical conditions (such as viruses or a thyroid disorder), can cause the same symptoms as depression. Also, it is important to rule out depression that is associated with another mental illness called?bipolar disorder. A doctor can rule out these possibilities with a physical exam, asking questions, and/or lab tests, depending on the medical condition. If a medical condition and bipolar disorder can be ruled out, the doctor should conduct a psychological exam or send the person to a mental health professional.Once identified, depression almost always can be treated with:TherapyMedicine called?antidepressantsBoth therapy and medicineSome people with milder forms of depression do well with therapy alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with both treatments — therapy and antidepressants.Should I stop taking my antidepressant while I am pregnant?The decision whether or not to stay on medications is a hard one. You should talk with your doctor. Medication taken during pregnancy does reach the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness, difficulty feeding, and low blood sugar after delivery. However, moms who stop medications can be at high risk of their depression coming back. Talk to your doctor about the risks and benefits of taking antidepressants during pregnancy. Your doctor can help you decide what is best for you and your baby. In some cases, a woman and her doctor may decide to slowly lower her antidepressant dose during the last month of pregnancy. Doing so can help the newborn suffer from fewer withdrawal symptoms. After delivery, a woman can return to a full dose. This can help her feel better during the postpartum period, when risk of depression can be greater.Should I stop taking my antidepressant while breastfeeding?If you stopped taking your medication during pregnancy, you may need to begin taking it again after the baby is born. Be aware that because your medication can be passed into your breast milk, breastfeeding may pose some risk for a nursing infant.What are SSRIs?Selective serotonin reuptake inhibitors (SSRIs) are a kind of antidepressant for treating depression and anxiety disorders.However, a number of research studies show that certain antidepressants, such as some of the SSRIs (see box at right) have been used relatively safely during breastfeeding. You should discuss with your doctor whether breastfeeding is an option or whether you should plan to feed your baby formula. Although breastfeeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.Before taking medication for an anxiety disorder:Ask your doctor to tell you about the effects and side effects of the drug.Tell your doctor about any alternative therapies or over-the-counter medications you are using.Ask your doctor when and how the medication should be stopped. Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision.Work with your doctor to determine which medication is right for you and what dosage is best.Be aware that some medications are effective only if they are taken regularly and that symptoms may come back if the medication is stopped.Is it safe for young adults to take antidepressants?It may be safe for young people to be treated with antidepressants. However, drug companies who make antidepressants are required to post a "black box" warning label on the medication. A "black box" warning is the most serious type of warning on prescription drugs.It may be possible that antidepressants make children, adolescents, and young adults more likely to think about suicide or commit suicide. In 2007, the FDA said that makers of all antidepressant medications should extend the warning to include young adults up through age 24.The warning says that patients of all ages taking antidepressants should be watched closely, especially during the first weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. Families and caregivers should pay close attention to the patient, and report any changes in behavior to the patient's doctor. The latest information from the FDA on antidepressants can be found on their?website.How can I help myself if I am depressed?You may feel exhausted, helpless, and hopeless. It may be very hard to do anything to help yourself. But it is important to realize that these feelings are part of the depression and do not reflect real life. As you understand your depression and begin treatment, negative thinking will fade. In the meantime:Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Participate in religious, social, or other activities.Set realistic goals for yourself.Break up large tasks into small ones, set some priorities and do what you can as you can.Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.Be confident that positive thinking will replace negative thoughts as your depression responds to treatment.DIABETES MELLITUS What is diabetes?Diabetes means that your blood glucose (sugar) is too high. Your blood always has some glucose in it because the body uses glucose for energy; it's the fuel that keeps you going. But too much glucose in the blood is not good for your health.Your body changes most of the food you eat into glucose. Your blood takes the glucose to the cells throughout your body. The glucose needs insulin to get into the body's cells. Insulin is a hormone made in the pancreas, an organ near the stomach. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into body cells. If your body does not make enough insulin or the insulin does not work right, the glucose can't get into the cells, so it stays in the blood. This makes your blood glucose level high, causing you to have diabetes.If not controlled, diabetes can lead to blindness, heart disease, stroke, kidney failure, amputations (having a toe or foot removed, for example), and nerve damage. In women, diabetes can cause problems during pregnancy and make it more likely that your baby will be born with birth defects.What is pre-diabetes?Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. It also means you are at risk of getting type 2 diabetes and heart disease. There is good news though: You can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years.What are the different types of diabetes?The three main types of diabetes are:Type 1 diabetes?is commonly diagnosed in children and young adults, but it's a lifelong condition. If you have this type of diabetes, your body does not make insulin, so you must take insulin every day. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making healthy food choices, getting regular physical activity, taking aspirin daily (for many people), and controlling blood pressure and cholesterol levels.Type 2 diabetes?is the most common type of diabetes — about 9 out of 10 people with diabetes have type 2 diabetes. You can get type 2 diabetes at any age, even during childhood. In type 2 diabetes, your body makes insulin, but the insulin can't do its job, so glucose is not getting into the cells. Treatment includes taking medicine, making healthy food choices, getting regular physical activity, taking aspirin daily (for many people), and controlling blood pressure and cholesterol levels. If you have type 2 diabetes, your body generally produces less and less insulin over time. This means that you may need to increase your medications or start using insulin in order to keep your diabetes in good control.Gestational (jess-TAY-shun-ul) diabetes?occurs during pregnancy. This type of diabetes occurs in about 1 in 20 pregnancies. During pregnancy your body makes hormones that keep insulin from doing its job. To make up for this, your body makes extra insulin. But in some women this extra insulin is not enough, so they get gestational diabetes. Gestational diabetes usually goes away when the pregnancy is over. Women who have had gestational diabetes are very likely to develop type 2 diabetes later in life.Who gets diabetes?About 24 million Americans have diabetes, about half of whom are women. As many as one quarter do not know they have diabetes.Type 1 diabetes occurs at about the same rate in men and women, but it is more common in Caucasians than in other ethnic groups.Type 2 diabetes is more common in older people, mainly in people who are overweight. It is more common in African-Americans, Hispanic-Americans/Latinos, and American Indians.What causes diabetes?Type 1 and type 2 diabetes?—The exact causes of both types of diabetes are still not known. For both types, genetic factors make it possible for diabetes to develop. But something in the person's environment is also needed to trigger the onset of diabetes.? With type 1 diabetes, those environmental triggers are unknown. With type 2 diabetes, the exact cause is also unknown, but it is clear that excess weight helps trigger the disease. Most people who get type 2 diabetes are overweight.Gestational diabetes?— Changing hormones and weight gain are part of a healthy pregnancy, but these changes make it hard for your body to keep up with its need for insulin. When that happens, your body doesn't get the energy it needs from the foods you eat.Am I at risk for diabetes?The risk factors for type 1 diabetes are unknown. Things that can put you at risk for type 2 diabetes include:Age?— being older than 45Overweight or obesityFamily history?— having a mother, father, brother, or sister with diabetesRace/ethnicity?— your family background is African-American, American Indian/Alaska Native, Hispanic-American/Latino, Asian-American/Pacific Islander and Native HawaiianHaving a baby with a birth weight more than 9 poundsHaving diabetes during pregnancy (gestational diabetes)High blood pressure?— 140/90 mmHg or higher. Both numbers are important. If one or both numbers are usually high, you have high blood pressure.High cholesterol?— total cholesterol over 240 mg/dLInactivity?— exercising less than 3 times a weekAbnormal results in a prior diabetes testHaving other health conditions that are linked to problems using insulin, like?polycystic ovarian syndrome (PCOS)Having a history of?heart disease or strokeShould I be tested for diabetes?If you're at least 45 years old, you should get tested for diabetes, and then you should be tested again every 3 years. If you're 45 or older and overweight (Calculate your Body Mass Index) you may want to get tested more often. If you're younger than 45, overweight, and have one or more of the risk factors listed in?"Am I at Risk for Diabetes?"?you should get tested now. Ask your doctor for a blood glucose or A1c test. Your doctor will tell you if you have normal blood glucose (blood sugar), pre-diabetes, or diabetes.What are the signs of diabetes?Being very thirstyUrinating a lotFeeling very hungryFeeling very tiredLosing weight without tryingHaving sores that are slow to healHaving dry, itchy skinLosing feeling in or having tingling in the hands or feetHaving blurry visionHaving more infections than usualIf you have one or more of these signs, see your doctor.How can I take care of myself if I have diabetes?Many people with diabetes live healthy and full lives. By following your doctor's instructions and eating right, you can too. Here are the things you'll need to do to keep your diabetes in check:Follow your meal plan?— Eat lots of whole grain foods, fruits, and vegetables.Get moving?— Health benefits are gained by doing the following each week:2 hours and 30 minutes of moderate intensity aerobic physical activity????????????????or1 hour and 15 minutes of vigorous-intensity aerobic physical activity????????????????orA combination of moderate and vigorous-intensity aerobic physical activity????????????????andMuscle-strengthening activities on 3 daysTest your blood glucose?— Keep track of your blood glucose levels and talk to your doctor about ways to keep your levels on target. Many women report that their blood glucose levels go up or down around their period. If you're going through menopause, you might also notice your blood glucose levels going up and down.Take your diabetes medicine exactly as your doctor tells you.Talk to your doctor about other things you can do to take good care of yourself. Taking care of your diabetes can help prevent serious problems in your eyes, kidneys, nerves, gums and teeth, and blood vessels.How can I take care of myself if I have gestational diabetes?Taking care of yourself when you have gestational diabetes is very much like taking care of yourself when you have other types of diabetes. But it can be a little scary when you're pregnant and you also have a new condition to take care of. Don't worry. Many women who've had gestational diabetes have gone on to have healthy babies. Here are the things you'll need to do:Follow your meal plan?— You will meet with a dietitian or diabetes educator who will help you design a meal plan full of healthy foods for you and your baby. You will be advised to:Limit sweetsEat often — three small meals and one to three snacks every dayBe careful about the carbohydrates you eat —your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snackEat lots of whole grain foods, fruits, and vegetablesGet moving?— try to be active for at least 2 hours and 30 minutes each week. If you're already active, your doctor can help you make an exercise plan for your pregnancy. If you haven't been active in the past, talk to your doctor. Your doctor can suggest activities, such as swimming or walking, to help keep your blood glucose on track.Test your blood glucose?— Your doctor may ask you to use a small device called a blood glucose meter to check your blood glucose levels. You will be shown how to use the meter to check your blood glucose. Your diabetes team will tell you what your target blood glucose range is, how often you need to check your blood glucose, and what to do if it is not where it should be.The following chart shows blood glucose targets for most women with gestational diabetes. Talk with your health care team about whether these targets are right for you.Blood glucose targets for most women with gestational diabetesOn awakeningnot above 95 mg/dL1 hour after a mealnot above 140 mg/dL2 hours after a mealnot above 120 mg/dLEach time you check your blood glucose, write down the results in a record book.?Take the book with you when you visit your health care team. If your results are often out of range, your health care team will suggest ways you can reach your targets.Take your diabetes medicine exactly as your doctor tells you.?You may need to take insulin to keep your blood glucose at the right level. If so, your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby — it cannot move from your bloodstream to your baby's.Is there a cure for diabetes?There is no cure for diabetes at this time, but there is a great deal of research going on in hopes of finding cures for both type 1 and type 2 diabetes. Many different approaches to curing diabetes are being studied, and researchers are making progress.Is there anything I can do to prevent diabetes?Yes. The best way to prevent diabetes is to make some lifestyle changes:Maintain a healthy weight.?Being overweight raises your risk for diabetes.?Calculate your Body Mass Index (BMI)?to see if you're at a healthy weight. If you're overweight, start making small changes to your eating habits by adding more whole grain foods, fruits, and vegetables. Start exercising more, even if taking a short walk is all you can do for now. If you're not sure where to start, talk to your doctor. ?Even a relatively small amount of weight loss – 10 to 15 pounds – has been proven to delay or even prevent the onset of type 2 diabetes.Eat healthyEat lots of whole grains (such as whole wheat or rye bread, whole grain cereal, or brown rice), fruits, and vegetables.Choose foods low in fat and cholesterol. Read food labels. If you eat 2,000 calories per day, you should eat no more than 56 grams of fat each day.If you drink alcohol, limit it to no more than one or two drinks (one 12-ounce beer, one 5-ounce glass of wine, or one 1.5-ounce shot of hard liquor) a day.Get moving.?Health benefits are gained by doing the following each week:2 hours and 30 minutes of moderate intensity aerobic physical activity????????????????or1 hour and 15 minutes of vigorous-intensity aerobic physical activity????????????????orA combination of moderate and vigorous-intensity aerobic physical activity????????????????andMuscle-strengthening activities on 3 daysSome suggestions for fitting physical activity in:Take the stairs instead of the elevatorTake a brisk walk on your lunch breakPark at the far end of the parking lot and walkGet off the bus or subway a few stops early and walk the rest of the wayWalk or bicycle whenever you canSEXUALLY TRANSMITTED INFECTIONS (STI)What is a sexually transmitted infection (STI)?It is an infection passed from person to person through intimate sexual contact. STIs are also called sexually transmitted diseases, or STDs.How many people have STIs and who is infected?In the United States about 19 million new infections are thought to occur each year. These infections affect men and women of all backgrounds and economic levels. But almost half of new infections are among young people ages 15 to 24. Women are also severely affected by STIs. They have more frequent and more serious health problems from STIs than men. African-American women have especially high rates of infection.How do you get an STI?You can get an STI by having intimate sexual contact with someone who already has the infection. You can’t tell if a person is infected because many STIs have no symptoms. But STIs can still be passed from person to person even if there are no symptoms. STIs are spread during vaginal, anal, or oral sex or during genital touching. So it’s possible to get some STIs without having intercourse. Not all STIs are spread the same way.Can STIs cause health problems?Yes. Each STI causes different health problems. But overall, untreated STIs can cause cancer,?pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other parts of the body, organ damage, and even death.Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs makes it easier for you to get HIV if you are exposed.What are the symptoms of STIs?Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as?urinary tract infection?or?yeast infection. This is why screening for STIs is so important. The STIs listed here are among the most common or harmful to women.Symptoms of sexually transmitted infectionsSTISymptomsBacterial vaginosis (BV)Most women have no symptoms. Women with symptoms may have:Vaginal itchingPain when urinatingDischarge with a fishy odorChlamydiaMost women have no symptoms. Women with symptoms may have:Abnormal vaginal dischargeBurning when urinatingBleeding between periodsInfections that are not treated, even if there are no symptoms, can lead to:Lower abdominal painLow back painNauseaFeverPain during sexGenital herpesSome people may have no symptoms. During an “outbreak,” the symptoms are clear:Small red bumps, blisters, or open sores where the virus entered the body, such as on the penis, vagina, or mouthVaginal dischargeFeverHeadacheMuscle achesPain when urinatingItching, burning, or swollen glands in genital areaPain in legs, buttocks, or genital areaSymptoms may go away and then come back. Sores heal after 2 to 4 weeks.GonorrheaSymptoms are often mild, but most women have no symptoms. If symptoms are present, they most often appear within 10 days of becoming infected. Symptoms are:Pain or burning when urinatingYellowish and sometimes bloody vaginal dischargeBleeding between periodsPain during sexHeavy bleeding during periodsInfection that occurs in the throat, eye, or anus also might have symptoms in these parts of the body.Hepatitis BSome women have no symptoms. Women with symptoms may have:Low-grade feverHeadache and muscle achesTirednessLoss of appetiteUpset stomach or vomitingDiarrheaDark-colored urine and pale bowel movementsStomach painSkin and whites of eyes turning yellowHIV/AIDSSome women may have no symptoms for 10 years or more. About half of people with HIV get flu-like symptoms about 3 to 6 weeks after becoming infected. Symptoms people can have for months or even years before the onset of AIDS include:Fevers and night sweatsFeeling very tiredQuick weight lossHeadacheEnlarged lymph nodesDiarrhea, vomiting, and upset stomachMouth, genital, or anal soresDry coughRash or flaky skinShort-term memory lossWomen also might have these signs of HIV:Vaginal yeast infections and other vaginal infections, including STIsPelvic inflammatory disease?(PID) that does not get better with treatmentMenstrual cycle changesHuman papillomavirus (HPV)Some women have no symptoms. Women with symptoms may have:Visible warts in the genital area, including the thighs. Warts can be raised or flat, alone or in groups, small or large, and sometimes they are cauliflower-shaped.Growths on the?cervix?and?vagina?that are often invisible.Pubic lice(sometimes called "crabs")Symptoms include:Itching in the genital areaFinding lice or lice eggsSyphilisSyphilis progresses in stages. Symptoms of the primary stage are:A single, painless sore appearing 10 to 90 days after infection. It can appear in the genital area, mouth, or other parts of the body. The sore goes away on its own.If the infection is not treated, it moves to the secondary stage. This stage starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage are:Skin rash with rough, red or reddish-brown spots on the hands and feet that usually does not itch and clears on its ownFeverSore throat and swollen glandsPatchy hair lossHeadaches and muscle achesWeight lossTirednessIn the latent stage, symptoms go away, but can come back. Without treatment, the infection may or may not move to the late stage. In the late stage, symptoms are related to damage to internal organs, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Some people may die.Trichomoniasis(sometimes called "trich")Many women do not have symptoms. Symptoms usually appear 5 to 28 days after exposure and can include:Yellow, green, or gray vaginal discharge (often foamy) with a strong odorDiscomfort during sex and when urinatingItching or discomfort in the genital areaLower abdominal pain (rarely)How do you get tested for STIs?There is no one test for all STIs. Ask your doctor about getting tested for STIs. She or he can tell you what test(s) you might need and how it is done. Testing for STIs is also called STI screening. Testing (or screening) for STIs can involve:Pelvic and physical exam — Your doctor can look for signs of infection, such as warts, rashes, discharge.Blood sampleUrine sampleFluid or tissue sample —? A swab is used to collect a sample that can be looked at under a microscope or sent to a lab for testing.Who needs to get tested for STIs?If you are sexually active, talk to your doctor about STI screening. Which tests you might need and how often depend mainly on your sexual history and your partner’s. Talking to your doctor about your sex life might seem too personal to share. But being open and honest is the only way your doctor can help take care of you. Also, don’t assume you don’t need to be tested for STIs if you have sex only with women. Talk to your doctor to find out what tests make sense for you.How are STIs treated?The treatment depends on the type of STI. For some STIs, treatment may involve taking medicine or getting a shot. For other STIs that can’t be cured, like herpes, treatment can help to relieve the symptoms.Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will give you. But this is not true, and the safety of these products is not known.What can I do to keep from getting an STI?You can lower your risk of getting an STI with the following steps. The steps work best when used together. No single strategy can protect you from every single type of STI.Don’t have sex.?The surest way to keep from getting any STI is to practice abstinence. This means not having vaginal, oral, or anal sex. Keep in mind that some STIs, like genital herpes, can be spread without having intercourse.Be faithful.?Having a sexual relationship with one partner who has been tested for STIs and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.Use condoms correctly and every time you have sex.?Use condoms for all types of sexual contact, even if intercourse does not take place. Use condoms from the very start to the very end of each sex act, and with every sex partner. A male latex condom offers the best protection. You can use a male polyurethane condom if you or your partner has a latex allergy. For vaginal sex, use a male latex condom or a female condom if your partner won’t wear a condom. For anal sex, use a male latex condom. For oral sex, use a male latex condom. A?dental dam?might also offer some protection from some STIs.Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.?If you use one of these methods, be sure to also use a condom correctly?every timeyou have sex.Talk with your sex partner(s) about STIs and using condoms before having sex.?It’s up to you to set the ground rules and to make sure you are protected.Don’t assume you’re at low risk for STIs if you have sex only with women.?Some common STIs are spread easily by skin-to-skin contact. Also, most women who have sex with women have had sex with men, too. So a woman can get an STI from a male partner and then pass it to a female partner.Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had.?Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all health problems. Also, being open with your doctor and partner will help you protect your health and the health of others.Have a yearly pelvic exam.?Ask your doctor if you should be tested for STIs and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner an STI is found, the easier it is to treat.Avoid using drugs or drinking too much alcohol.?These activities may lead to risky sexual behavior, such as not wearing a condom.How do STIs affect pregnant women and their babies?STIs can cause many of the same health problems in pregnant women as women who are not pregnant. But having an STI also can threaten the pregnancy and unborn baby's health. Having an STI during pregnancy can cause early labor, a woman's water to break early, and infection in the?uterus?after the birth.Some STIs can be passed from a pregnant woman to the baby before and during the baby’s birth. Some STIs, like syphilis, cross the?placenta?and infect the baby while it is in the uterus. Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy and infect the baby during the birth process.The harmful effects to babies may include:Low birth weightEye infectionPneumoniaInfection in the baby’s bloodBrain damageLack of coordination in body movementsBlindnessDeafnessAcute?hepatitisMeningitisChronic liver diseaseCirrhosisStillbirthSome of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if needed. Other problems can be treated if the infection is found at birth.What can pregnant women do to prevent problems from STIs?Pregnant women should be screened at their first prenatal visit for STIs, including:ChlamydiaGonorrheaHepatitis BHIVSyphilisIn addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant.Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For women who have active genital herpes lesions at the onset of labor, a?cesarean delivery?(C-section) can lower the risk of passing the infection to the newborn. For women who are HIV positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the newborn to less than 2 percent. C-section is also an option for some women with HIV. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.Pregnant women also can?take steps?to lower their risk of getting an STI during pregnancy.Is there any research being done on STIs?Yes. Research on STIs is a public health priority. Research is focused on prevention, diagnosis, and treatment.With prevention, researchers are looking at strategies such as vaccines and topical microbicides (meye-KROH-buh-syds). One large study is testing a herpes vaccine for women. Topical microbicides could play a big role in protecting women from getting STIs. But so far, they have been difficult to design. They are gels or creams that would be put into the vagina to kill or stop the STI before it could infect someone. Researchers are also looking at the reasons some people are at higher risk of STIs, and ways to lower these risks.Early and fast diagnosis of STIs means treatment can start right away. Early treatment helps to limit the effects of an STI and keep it from spreading to others. Researchers are looking at quick, easy, and better ways to test for STIs, including vaginal swabs women can use to collect a sample for testing. They also are studying the reasons why many STIs have no symptoms, which can delay diagnosis.Research also is underway to develop new ways to treat STIs. For instance, more and more people are becoming infected with types of gonorrhea that do not respond well to drugs. So scientists are working to develop new antibiotics to treat these drug-resistant types. An example of treatment research success is the life-prolonging effects of new drugs used to treat PLICATIONS OF PREGNANCYComplications of pregnancy are health problems that occur during pregnancy. They can involve the mother's health, the baby's health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the?pregnancy. Keep in mind that whether a complication is common or rare, there are ways to manage problems that come up during pregnancy.Health problems before pregnancyBefore pregnancy, make sure to talk to your doctor about health problems you have now or have had in the past. If you are receiving treatment for a health problem, your doctor might want to change the way your health problem is managed. Some medicines used to treat health problems could be harmful if taken during pregnancy. At the same time, stopping medicines that you need could be more harmful than the risks posed should you become pregnant. Be assured that you are likely to have a normal, healthy baby when health problems are under control and you get good prenatal care.Health problems before pregnancyConditionHow it can affect pregnancyAsthmaPoorly controlled asthma may increase risk of preeclampsia, poor weight gain in the fetus,?preterm birth,?cesarean birth, and other complications. If pregnant women stop using asthma medicine, even mild asthma can become severe.DepressionDepression that persists during pregnancy can make it hard for a woman to care for herself and her unborn baby. Having depression before pregnancy also is a risk factor for?postpartum depression.DiabetesHigh?blood glucose (sugar) levels?during pregnancy can harm the fetus and worsen a woman's long-termdiabetes?complications. Doctors advise getting diabetes under control at least three to six months before trying to conceive.Eating disordersBody image changes during pregnancy can cause eating disorders to worsen. Eating disorders are linked to many pregnancy complications, including birth defects andpremature birth. Women with eating disorders also have higher rates of?postpartum depression.Epilepsy?and other seizure?disordersSeizures during pregnancy can harm the fetus, and increase the risk of?miscarriage?or?stillbirth. But using medicine to control seizures might cause birth defects. For most pregnant women with epilepsy, using medicine poses less risk to their own health and the health of their babies than stopping medicine.High blood pressureHaving chronic high blood pressure puts a pregnant woman and her baby at risk for problems. Women with high blood pressure have a higher risk of? HYPERLINK "" \l "preeclampsia" preeclampsiaand placental abruption (when the placenta separates from the wall of the uterus). The likelihood of?preterm birth?and?low birth weight?also is higher.HIVHIV can be passed from a woman to her baby during pregnancy or delivery. Yet this risk is less than 2 percent if a woman takes certain HIV medicines during pregnancy. Women who have HIV and want to become pregnant should talk to their doctors before trying to conceive. Good prenatal care will help protect a woman’s baby from HIV and keep her healthy.MigraineMigraine symptoms tend to improve during pregnancy. Some women have no migraine attacks during pregnancy. Certain medicines commonly used to treat headaches should not be used during pregnancy. A woman who has severe headaches should speak to her doctor about ways to relieve symptoms safely.Overweight and ObesityRecent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of a range of pregnancy complications, including preeclampsia?and?preterm delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies.Sexually transmitted infections?(STIs)Some STIs can cause early labor, a woman's water to break too early, and infection in the?uterus?after birth. Some STIs also can be passed from a woman to her baby during pregnancy or delivery. Some ways STIs can harm the baby include:?low birth weight, dangerous infections, brain damage, blindness, deafness, liver problems, or?stillbirth.Thyroid?diseaseUncontrolled hyperthyroidism (overactive thyroid) can be dangerous to the mother and cause health problems such as heart failure and poor weight gain in the fetus. Uncontrolled hypothyroidism (underactive thyroid) also threatens the mother's health and can cause birth defects.Uterine fibroidsUterine fibroids are not uncommon, but few cause symptoms that require treatment. Uterine fibroids rarely cause?miscarriage. Sometimes, fibroids can cause preterm?or breech birth.?Cesarean delivery?may be needed if a fibroid blocks the birth canal.Pregnancy related problemsSometimes pregnancy problems arise — even in healthy women. Some prenatal tests done during pregnancy can help prevent these problems or spot them early. Use this chart to learn about some common pregnancy complications. Call your doctor if you have any of the symptoms on this chart. If a problem is found, make sure to follow your doctor's advice about treatment. Doing so will boost your chances of having a safe delivery and a strong, healthy baby.Health problems during pregnancyProblemSymptomsTreatmentAnemia?– Lower than normal number of healthy red blood cellsFeel tired or weakLook paleFeel faintShortness of breathTreating the underlying cause of the anemia will help restore the number of healthy red blood cells. Women with pregnancy related anemia are helped by taking?iron?and folic acid supplements. Your doctor will check your iron levels throughout pregnancy to be sure anemia does not happen again.Depression?– Extreme sadness during pregnancy or after birth (postpartum)Intense sadnessHelplessness and irritabilityAppetite changesThoughts of harming self or babyWomen who are pregnant might be helped with one or a combination of treatment options, including:TherapySupport groupsMedicinesA mother's depression can affect her baby's development, so getting treatment is important for both mother and baby. Learn more about depression during and after pregnancy.Ectopic (ek-TOP-ihk) pregnancy?– When a fertilized egg implants outside of the uterus, usually in the?fallopian tubeAbdominal painShoulder painVaginal?bleedingFeeling dizzy or faintWith ectopic pregnancy, the egg cannot develop. Drugs or surgery is used to remove the ectopic tissue so your organs are not damaged.Fetal problems?– Unborn baby has a health issue, such as poor growth or heart problemsBaby moving less than normal (Learn how to count your baby's movements?on our Prenatal care and tests page.)Baby is smaller than normal for gestational ageSome problems have no symptoms, but are found with prenatal testsTreatment depends on results of tests to monitor baby's health. If a test suggests a problem, this does not always mean the baby is in trouble. It may only mean that the mother needs special care until the baby is delivered. This can include a wide variety of things, such as bed rest, depending on the mother's condition. Sometimes, the baby has to be delivered early.Gestational diabetes?– Too high blood sugar levels during pregnancyUsually, there are no symptoms. Sometimes, extreme thirst, hunger, or fatigueScreening test shows high blood sugar levelsMost women with pregnancy related diabetes can control their blood sugar levels by a following a healthy meal plan from their doctor. Some women also need?insulin?to keep blood sugar levels under control. Doing so is important because poorly controlled diabetes increases the risk of:PreeclampsiaEarly deliveryCesearean birthHaving a big baby, which can complicate deliveryBaby born with low blood sugar, breathing problems, and?jaundiceHigh blood pressure(pregnancy related)?– High blood pressure that starts after 20 weeks of pregnancy and goes away after birthHigh blood pressure without other signs and symptoms of preeclampsiaThe health of the mother and baby are closely watched to make sure high blood pressure is not preeclampsia.Hyperemesis gravidarum(HEYE-pur-EM-uh-suhss grav-uh-DAR-uhm) (HG)?– Severe, persistent nausea and vomiting during pregnancy — more extreme than "morning sickness"Nausea that does not go awayVomiting several times every dayWeight lossReduced appetiteDehydrationFeeling faint or faintingDry, bland foods and fluids together is the first line of treatment. Sometimes, medicines are prescribed to help nausea. Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit and feel nauseated throughout all three trimesters.Miscarriage?– Pregnancy loss from natural causes before 20 weeks. As many as 20 percent of pregnancies end in miscarriage. Often, miscarriage occurs before a woman even knows she is pregnantSigns of a miscarriage can include:Vaginal?spotting or bleeding*Cramping or abdominal painFluid or tissue passing from the vagina* Spotting early in pregnancy doesn't mean miscarriage is certain. Still, contact your doctor right away if you have any bleeding.In most cases, miscarriage cannot be prevented. Sometimes, a woman must undergo treatment to remove pregnancy tissue in the?uterus. Counseling can help with emotional healing. See our section on Pregnancy loss.Placenta previa?–?Placenta covers part or entire opening of cervix?inside of the?uterusPainless?vaginal bleeding during second or third trimesterFor some, no symptomsIf diagnosed after the 20th week of pregnancy, but with no bleeding, a woman will need to cut back on her activity level and increase bed rest. If bleeding is heavy, hospitalization may be needed until mother and baby are stable. If the bleeding stops or is light, continued bed rest is resumed until baby is ready for delivery. If bleeding doesn't stop or if?preterm labor?starts, baby will be delivered by?cesarean section.Placental abruption?–?Placenta separates from?uterine?wall before delivery, which can mean the fetus doesn't get enough oxygen.Vaginal?bleedingCramping, abdominal pain, and uterine tendernessWhen the separation is minor, bed rest for a few days usually stops the bleeding. Moderate cases may require complete bed rest. Severe cases (when more than half of the placenta separates) can require immediate medical attention and early delivery of the baby.Preeclampsia?(pree-ee-CLAMP-see-uh)?– A condition starting after 20 weeks of pregnancy that causes?high blood pressure?and problems with the kidneys and other organs. Also called toxemia.High blood pressureSwelling of hands and faceToo much protein in urineStomach painBlurred visionDizzinessHeadachesThe only cure is delivery, which may not be best for the baby. Labor will probably be induced if condition is mild and the woman is near term (37 to 40 weeks of pregnancy). If it is too early to deliver, the doctor will watch the health of the mother and her baby very closely. She may need medicines and bed rest at home or in the hospital to lower her blood pressure. Medicines also might be used to prevent the mother from having?seizures.Preterm labor?– Going into labor before 37 weeks of pregnancyIncreased?vaginal dischargePelvic pressure and crampingBack pain radiating to the abdomenContractionsMedicines can stop labor from progressing. Bed rest is often advised. Sometimes, a woman must deliver early. Giving birth before 37 weeks is called "preterm birth." Preterm birth is a major risk factor for future preterm births.Infections during pregnancyDuring pregnancy, your baby is protected from many illnesses, like the common cold or a passing stomach bug. But some infections can be harmful to your pregnancy, your baby, or both. This chart provides an overview of infections that can be harmful during pregnancy. Learn the symptoms and what you can do to keep healthy. Easy steps, such as hand washing, practicing safe sex, and avoiding certain foods, can help protect you from some infections.Infections during pregnancyInfectionSymptomsPrevention and treatmentBacterial vaginosis (BV)A?vaginal?infection that is caused by an overgrowth of bacteria normally found in the vagina.BV has been linked topreterm birth?and?low birth weight?babies.Grey or whitish discharge that has a foul, fishy odorBurning when passing urine or itchingSome women have no symptomsHow to prevent BV is unclear. BV is not passed through sexual contact, although it is linked with having a new or more than one sex partner.Women with symptoms should be tested for BV.Antibiotics?are used to treat BV.Cytomegalovirus?(SEYE-toh-MEG-uh-loh VEYE-ruhss) (CMV)A common virus that can cause disease in infants whose mothers are infected with CMV during pregnancy. CMV infection in infants can lead to hearing loss, vision loss, and other disabilities.Mild illness that may include fever, sore throat, fatigue, and swollen glandsSome women have no symptomsGood hygiene is the best way to keep from getting CMV.No treatment is currently available. But studies are looking at antiviral drugs for use in infants. Work to create a CMV vaccine also is underway.Group B strep?(GBS)Group B strep is a type of bacteria often found in the vagina?and rectum of healthy women. One in four women has it. GBS usually is not harmful to you, but can be deadly to your baby if passed during childbirth.No symptomsYou can keep from passing GBS to your baby by getting tested at 35 to 37 weeks. This simply involves swabbing the vagina and rectum and does not hurt.If you have GBS, an?antibiotic?given to you during labor will protect your baby from infection. Make sure to tell the labor and delivery staff that you are a group B strep carrier when you check into the hospital.Hepatitis B virus?(HBV)A viral infection that can be passed to baby during birth. Newborns that get infected have a 90 percent chance of developing lifelong infection. This can lead to liver damage and liver cancer. A vaccine can keep newborns from getting HBV. But 1 in 5 newborns of mothers who are HBV positive don’t get the vaccine at the hospital before leaving.There may be no symptoms. Or symptoms can include:Nausea, vomiting, and diarrheaDark urine and pale bowel movementsWhites of eyes or skin looks yellowLab tests can find out if the mother is a carrier of hepatitis B.You can protect your baby for life from HBV with the hepatitis B vaccine, which is a series of three shots:First dose of hepatitis B vaccine plus HBIG shot given to baby at birthSecond dose of hepatitis B vaccine given to baby at 1-2 months oldThird dose of hepatitis B vaccine given to baby at 6 months old (but not before 24 weeks old)Influenza (flu)Flu is a common viral infection that is more likely to cause severe illness in pregnant women than in women who are not pregnant. Pregnant woman with flu also have a greater chance for serious problems for their unborn baby, including premature labor and delivery.Fever (sometimes) or feeling feverish/chillsCoughSore throatRunny or stuffy noseMuscle or body achesHeadachesFeeling tiredVomiting and diarrhea (sometimes)Getting a flu shot is the first and most important step in protecting against flu. The flu shot given during pregnancy is safe and has been shown to protect both the mother and her baby (up to 6 months old) from flu. (The nasal spray vaccine should not be given to women who are pregnant.)If you get sick with flu-like symptoms call your doctor right away. If needed, the doctor will prescribe an antiviral medicine that treats the flu.Listeriosis?(lih-steer-ee-OH-suhss)An infection with the harmful bacteria called listeria. It is found in some refrigerated and ready-to-eat foods. Infection can cause?early delivery?or miscarriage.Fever, muscle aches, chillsSometimes diarrhea or nauseaIf progresses, severe headache and stiff neckAvoid foods that can harbor listeria.Antibiotics?are used to treat listeriosis.Learn more from our???Pregnancy food don'ts – Print-and-go guide?(PDF, 126 KB).Parvovirus B19 (fifth disease)Most pregnant women who are infected with this virus do not have serious problems. But there is a small chance the virus can infect the fetus. This raises the risk of?miscarriage during the first 20 weeks of pregnancy. Fifth disease can cause severe?anemia?in women who have red blood cell disorders like?sickle cell disease or immune system problems.Low-grade feverTirednessRash on face, trunk, and limbsPainful and swollen jointsNo specific treatment, except for?blood transfusions?that might be needed for people who have problems with their immune systems or with red blood cell disorders. There is no vaccine to help prevent infection with this virus.Sexually transmitted infection?(STI)An infection that is passed through sexual contact. Many STIs can be passed to the baby in the womb or during birth. Some effects include?stillbirth,?low birth weight, and life-threatening infections. STIs also can cause a woman's water to break too early or?preterm labor.Symptoms depend on the STI. Often, a woman has no symptoms, which is why screening for STIs during pregnancy is so important.For more information, see our?Sexually transmitted infections fact sheet.STIs can be prevented by practicing safe sex. A woman can keep from passing an STI to her baby by being screened early in pregnancy.Treatments vary depending on the STI. Many STIs are treated easily with antibiotics.Toxoplasmosis?(TOK-soh-plaz-MOH-suhss)This infection is caused by a parasite, which is found in cat feces, soil, and raw or undercooked meat. If passed to an unborn baby, the infection can cause hearing loss, blindness, or intellectual disabilities.Mild flu-like symptoms, or possibly no symptoms.You can lower your risk by:Washing hands with soap after touching soil or raw meatWashing produce before eatingCooking meat completelyWashing cooking utensils with hot, soapy waterNot cleaning cats' litter boxesMedicines are used to treat a pregnant woman and her unborn baby. Sometimes, the baby is treated with medicine after birth.Urinary tract infection(UTI)Bacterial infection in urinary tract. If untreated, it can spread to the kidneys, which can cause?preterm labor.Pain or burning when urinatingFrequent urinationPelvis, back, stomach, or side painShaking, chills, fever, sweatsUTIs are treated with?antibiotics.Yeast infectionAn infection caused by an overgrowth of bacteria normally found in the vagina. Yeast infections are more common during pregnancy than in other times of a woman's life. They do not threaten the health of your baby. But they can be uncomfortable and difficult to treat in pregnancy.Extreme itchiness in and around the vaginaBurning, redness, and swelling of the vagina and the?vulvaPain when passing urine or during sexA thick, white vaginal discharge that looks like cottage cheese and does not have a bad smellVaginal creams and suppositories are used to treat yeast infection during pregnancy.When to call the doctor or midwifeWhen you are pregnant don't wait to call your doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem.Call your doctor or midwife as soon as you can if you:Are bleeding or leaking fluid from the vaginaHave sudden or severe swelling in the face, hands, or fingersGet severe or long-lasting headachesHave discomfort, pain, or cramping in the lower abdomenHave a fever or chillsAre vomiting or have persistent nauseaFeel discomfort, pain, or burning with urinationHave problems seeing or blurred visionFeel dizzySuspect your baby is moving less than normal after 28 weeks of pregnancy (If you count less than 10 movements within two hours. Learn how to?count your baby's movements?on our Prenatal care and tests page.)Have thoughts of harming yourself or your baby ................
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