Adequate information entails intake of routine drugs by pregnant women, avoidance of over-the-counter drugs early appointment, among others, will help in guiding against unnecessary risk during pregnancy and delivery. Omolara Akintoye writes.
WOMEN should be fully involved in decisions about their care and treatment during pregnancy and therefore need to be given the knowledge to make informed decisions. Where appropriate, a woman’s partner and family should be involved and informed and their views and values respected. Good communication is crucial at every step in pregnancy. In an interview with a gynaecologist, Dr. Fola Korede, he explained that apart from being physically matured to be able to carry the pregnancy, such a woman also needs a health professional who will give adequate information on the following:
Information on where antenatal care will be offered and by whom, including choice of providers where available and information about antenatal screening.
Information about routine drugs.
Lifestyle advice including:
Food hygiene and safe eating in pregnancy.
Advice about avoidance of alcohol and illicit drugs in pregnancy.
Medication advice (review of safety of any current medication in pregnancy and avoidance of over-the-counter (OTC) medication which may not be used in pregnancy).
She is expected to register in a certified government hospital or private hospital where she will be given information about : The development of the baby during pregnancy; the choice of attending antenatal classes; advice about exercise; Information and choice regarding the place of birth; information about breast-feeding, among others.
Speaking further, Korede warned that pregnant women should be encouraged to have a normal, balanced, healthy diet. “Because of the dangers of toxoplasmosis and listeriosis, women should avoid uncooked meat or fish, raw or partially cooked eggs, milk that has not been pasteurised and unwashed fruit or vegetables. (Fruit and vegetables should be washed). Women should be cautioned to avoid many herbal preparations and teas; their use and safety in pregnancy have not been studied, he warned.
Supplements such as folic acid, Vitamin D and other nutritional supplements should be taken during pregnancy.
All women intending to become pregnant, and those who are, should be advised to take folic acid up to 12 weeks of gestation to reduce incidence of foetal neural tube defects (NTDs). According to Korede, adequate vitamin D stores during pregnancy and breast-feeding are important for the health of both mother and baby. All women should be advised to take vitamin D supplements
“Iron should not be offered routinely as it has no benefit to either mother or baby and may cause constipation and other side-effects. Women should be given dietary advice, encouraging dietary intake of iron,” he said.
He also pointed out that women should guide against over-the-counter medication and complementary therapies, as few products have been shown to be definitely safe during pregnancy.
Women, he explained, who exercise regularly should be advised to continue to do so. “Those who are inactive should start a gentle programme of regular exercise. Moderate exercise has not been shown to cause any harm but the patient should be warned of the dangers of highly energetic and contact sports that would risk damage to the abdomen, falls or excessive joint stress,” he said.
Sexual intercourse in the words of Korede has not been shown to cause any harm during pregnancy. “It may be advisable to avoid it if there is risk of preterm rupture of membranes or if there is placenta praevia, although evidence is limited,” he said.
High levels of alcohol consumption during pregnancy according to him may result in the foetal alcohol syndrome (FAS). There are various components including growth restriction, general learning disability, facial anomalies and behavioural problems. “It is not known how much alcohol is safe to drink in pregnancy. Current advice from Nigerian Medical Association (NMA) is that women should not drink alcohol at all in the first three months of pregnancy. (This is because of the increased risk of miscarriage.) For the rest of pregnancy, women are advised ideally not to drink at all; however, if they do, to restrict it to its barest minimum,” he said.
Smoking in pregnancy is associated with a large number of adverse effects in pregnancy including intrauterine growth restriction and low birth weight, miscarriage and stillbirth, premature delivery, placental problems, among others. He therefore warned that women should quit smoking early even before they become pregnant.
Avoid drug misuse: The number of women misusing drugs has increased considerably in the past few decades and many are in their child-bearing years. Though pregnancy may act as a catalyst for change and present a “window of opportunity”, drug misusers may not use general health services until late into pregnancy and this increases the health risks for both the mother and child.
Early symptoms of pregnancy such as nausea and vomiting are generally resolved by 12-20 weeks of gestation.
Heartburn may be alleviated by taking small meals and raising the head of the bed. It may need antacids.
Constipation is another common symptom in early pregnancy. Women should be advised on diet to combat this (fluids and increasing dietary fibre).