Every couple’s goal during pregnancy is to make sure they bring a healthy child into the world and raise it with love after birth. But there can be lots of hurdles and questions involved, from drinking during pregnancy and unsuspected genetic disorders to postpartum depression. Doctors can help, and when in doubt , they say, just ask.
passing the test
For parents falling into certain groups, genetic testing might be merited to help identify risk for certain disorders.
genetic screening
“What most women do is conceive spontaneously and then elect to have some sort of screening test or diagnostic test done after they’ve conceived to see if the fetus is affected,” says Dr. Diana Gray, professor of obstetrics and gynecology and radiology at Washington University School of Medicine.
The American College of Obstetricians and Gynecologists recommends offering all pregnant women screening for chromosomal disorders, Gray says. Chorionic villus sampling (CVS) is the definitive test, but it carries some risk because it requires either drawing amniotic fluid or taking small samples of the placenta very early in pregnancies. Those tests have a small risk of miscarriage.
Dr. Stephen Braddock, director of the division of medical genetics and a professor of pediatrics at Saint Louis University School of Medicine, strongly recommends couples speak with a genetic counselor when considering pre-natal testing so they understand what tests will and won’t show. A counselor takes an extensive medical history of the couple and their ancestors and looks for signs of risk potential—disorders like autism and cystic fibrosis, for instance. “If we find tidbits of that in their history, we can educate the family about the risks and what to do next,” Braddock says.
ethnicity matters
Some ethnic populations are at higher risk for certain disorders and should be proactive about screening, the physicians stress. Ashkenazi Jews and French-Canadians, for example, are more susceptible to Tay-Sachs disease, a fatal genetic disorder that progressively destroys the nervous system, while African-Americans have a higher chance of sickle cell anemia.
Because of the blending of cultures today, most people don’t know all of their ethnic backgrounds, Braddock says. Therefore, expanded, pan-ethnic carrier panels are appropriate. “Reviewing them with a genetic counselor or physician is advisable,” he says.
The newest diagnostic is called the cell-free fetal DNA test, Gray explains. Fetal cells and DNA circulate in maternal blood during pregnancies. “The vast majority of that is going to be maternal, but a small proportion—somewhere in the range of 10 to 20 percent, is going to be fetal. So if the results show an oversupply of chromosome 21, that is highly suggestive of Down syndrome.
be patient
DNA testing shouldn’t be done until after 10 weeks of pregnancy, the physicians explain. “Most of the DNA is coming from the placenta, which, before then, is so small that there aren’t sufficient quantities of cells and DNA in maternal circulation to have it be a reproducible test,” Gray says.
“Some women want the test just for assurance reasons,” she points out. “The vast majority of the time, you’re going to give them reassuring test results, because these conditions are rare. Even in a 40-year-old woman, which is sort of the end of what we consider normal reproductive life, the risk for a chromosome disorder like Down syndrome is no greater than 2 percent.”
The reality is that even with no family history, every baby has a 3 to 5 percent risk of birth defects. “Many such issues occur sporadically and without known risk factors,” Braddock concludes.
the baby blues
Having a baby should be a joyous and carefree time, but postpartum depression can throw a wrench into the wonders of new parenthood.
why now?
“There are dramatic changes in hormones when someone gives birth,” says Dr. Sarah Shores of Signature Medical Group’s Allied Associates in OB/GYN.
Other issues can exacerbate the hormone swing, including a traumatic delivery, any type of complication or high-risk pregnancy, a pre-term baby, or multiple babies, Shores says. Additionally, women with pre-delivery issues like high blood pressure or pre-term labor might spend one to three months in the hospital before giving birth.
“That is very depressing,” Shores says. “It’s not easy to lie in bed for months. And then they give birth, and they think, ‘It’s all over.’ But it’s not, because now you have a baby to take care of, you’re exhausted, your hormones are wreaking havoc, and it brings a lot of anxiety.”
depression or decompression?
“Eighty percent of women will have baby blues,” says Shellie Fidell, a psychotherapist affiliated with Missouri Baptist Hospital. “It tends to be something that does not require treatment—it lifts on its own.”
Postpartum depression, however, is more serious. It can include mood swings, excessive crying, not bonding with the baby, withdrawing from friends and family, insomnia or excessive sleep, and panic attacks. “You are not interested in your baby, you are not interested in things you used to enjoy, your appetite has changed, your sleep pattern is not only disrupted by the baby, but you can’t sleep when the baby is sleeping,” describes Fidell. “That’s a big red flag.”
no judgment
Fidell encourages women to ask for help and says medical professionals will not stigmatize them as ‘bad mothers,’ a common fear with new moms who react this way. “The fear of being judged is the biggest obstacle,” she says. “There is an intense shame and guilt connected with this.”
So how do new mothers know when to ask for help? “Anytime you or someone around you feels there is a problem, that’s probably a signal that you need to give your doctor a call,” Shores advises. The doctor will discuss symptoms, sometimes run tests to make sure nothing else is involved, like thyroid issues, and perform a depression screening. Treatment can involve counseling, seeing a psychiatrist or psychologist, and starting medications, typically mood stabilizing drugs like Zoloft, Lexapro or Prozac, she says.
Patients need to be reassured they are not alone and this is not unusual. “There are some things going on here,” says Fidell. “Usually it’s a combination of biological, psychological and social.” Starting in January 2016, Fidell, in conjunction with Missouri Baptist, will offer two classes that address postpartum issues: Preparing for the Fourth Trimester: Postpartum Adjustment and Beyond is a single session for expecting couples to help them determine whether they are at risk and to create a plan so things go more smoothly after birth. Fourth Trimester: Baby Blues and Beyond is a four-week class for after the baby is born. For more information about the classes, visit mobapbaby.org or call 313.996.LIFE to register.
drinking during pregnancy
A generation ago, it wasn’t uncommon for an OB/G YN to prescribe a nightcap to help their pregnant patients relax. Now, order a drink in a restaurant while pregnant and you’re likely to be refused service. So what’s correct? Is an occasional glass of wine good for mom and baby, or is total abstinence recommended?
alcohol forbidden … mostly
“I strictly forbid any alcohol use during pregnancy,” says Dr. Jodie Rai of Women’s Healthcare Consultants. “There is no known safe amount, time or alcohol content. However, there does appear to be increasing risk with increasing amounts of use, and no proven risk for women who drink a small amount once or twice a week.” Rai defines small as 4 ounces of wine, half a pint of beer or 1 ounce of hard liquor.
“Some doctors find it easier to say no alcohol any time, because it’s safe—you can’t make a mistake,” says Dr. Teresa Knight with Women’s Health Specialists of St. Louis. “But in general, a social drink with a meal is certainly not something that would make me panic during pregnancy. The risk is that saying one drink is fine leaves the size and alcohol content up to interpretation.” Patients ask her “every single day” if it’s safe to drink while pregnant. She focuses on why they ask.
“Are (they) people who have some underlying addiction or some reason why they feel they need alcohol? It really becomes a longer conversation of ‘Why are you asking this question,’ and ‘What are the real risks?’ and then recognizing that culturally, it may not be acceptable,” she says. “I’ve had patients who were very comfortable drinking wine during pregnancy go to restaurants and be refused alcohol.”
quantity & timing
This does not mean drinking is without risk, by any means. With increasing alcohol use, Rai states, babies can develop a spectrum of disorders. And there even is evidence that drinking before and during early pregnancy can increase the risk of miscarriage in the first trimester, she says. “Developing babies have the same blood alcohol concentration as the mother, but they lack the ability to process or metabolize alcohol,” Rai says. “The effects on the baby include learning disabilities, hyperactivity, attention disorders, speech and language delays, low IQ, poor reasoning and poor judgment.”
Knight maintains that timing is everything, when it comes to moderate drinking and pregnancy. “When the organs are forming in the fetus, if there is an excessive amount of alcohol at that time, it can cause fetal alcohol syndrome,” she says. That condition, at its most extreme, can result in impaired brain development and developmental delays.
moderation is key
Both doctors stress moderation. “There has never been any data to show that there would be poor outcomes with having a little glass of wine with friends, or a glass of the wine at the end of the day or on special occasions,” Knight says. “It’s continual alcohol exposure, or high doses of exposure, that we worry about.”
While one small glass of wine shouldn’t cause a problem, prudence is important. That said, no one actually knows where the safety line is. “We just don’t know,” Rai says. “If it’s not been proven to cause harm to drink a small amount once or twice a week, it’s also not been proven to be safe either. There are simply very limited statistics available on drinking during pregnancy.”
