Pregnancy health dilemmas solved by our GP

Our family GP answers your questions on everything from chickenpox to SPD

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What do your aches and pains in pregnancy mean?

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If you catch chickenpox in pregnancy, is it dangerous for your unborn baby?

Q: Can a couple of drinks a week really harm my baby? I’ve been having no more than this for the 18 weeks of my pregnancy and would like to continue, but obviously not at risk to my child. Can you advise?

A: Heavy or binge drinking in pregnancy is dangerous for a baby, but there’s a lot of debate about drinking very small amounts of alcohol, which is where it gets confusing. As far as large amounts are concerned, these can cause severe and permanent defects, including the condition known as foetal alcohol syndrome. Around 20 units a week (20 small glasses of wine, or 10 pints or ordinary lager) can reduce a baby’s IQ by several points. Even 15 units a week can lower a baby’s birth weight and cause miscarriage.

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However, there’s no hard and fast evidence that very low intakes of alcohol, such as 4 units a week, can harm a baby. Suggestions that it might increase the risk of miscarriage remain to be proven, and the Royal College of Obstetricians and Gynaecologists has not yet warned women to avoid alcohol all together.

I certainly didn’t forbid myself the odd celebratory drink in my pregnancies, and for the moment I don’t think other pregnant women should either. Although other countries (like the USA) are more radical, and advocate no alcohol in pregnancy, 2 units a week is probably safe in the light of present knowledge. By the time you are 18 weeks pregnant almost all of your baby’s organs are formed anyway, so you have much less to worry about.

Q: My 5 year old son picked up chickenpox at school and I am 17 weeks pregnant with my 3rd child. Can the virus be passed on to my baby? How do I avoid getting it? And how harmful would it be if the baby contracted it?

A: Although chickenpox is usually mild for school-age and preschool children, it can be serious for adults and particularly dangerous for an unborn baby, because the virus can be passed on from the mother. The main worries for the baby are poor growth, and eye and nervous system problems.

Premature labour is another possibility. Having said that, most women who develop chickenpox in pregnancy go on to have completely normal babies. And your risk of catching it isn’t that high anyway, because 9 out of 10 women have immunity to it. But discuss it with your midwife without delay, just to be sure. You should do this for your own sake as well as your unborn child, as chickenpox in pregnancy is sometimes pretty bad for the mum too.

If you’re unsure whether you’ve had chickenpox in the past, you’ll need a blood test to check if you have had any protective antibodies against the chickenpox virus (also called VZV or varicella zoster). Please don’t panic: even amongst people who don’t think they’ve had chickenpox, the vast majority still have the antibodies against it. If you’re one of the few without antibody protection, you may be offered a jab of immune globulin to protect you and your baby temporarily.

Unfortunitely you can’t really avoid being exposed to chickenpox if your young son has it, as it’s contagious from around a day before the rash appears.

Q: I have just found out that I’m rhesus negative, and will need injections of immunoglobulin at 28 weeks, 34 weeks and after delivery. I’m worried about receiving blood from a donor, and don’t understand why this is more dangerous for my next child than for the baby I’m expecting?

A: Some blood cells from a baby always reach the mum’s circulation during pregnancy. If your rhesus negative and the baby you’re carrying is rhesus positive, then you can produce antibodies against your baby’s blood. This causes the condition known as haemolytic disease of the newborn (HDN), which makes a baby anaemic and jaundiced and can be fatal.

HDN doesn’t affect the first pregnancy because the antibodies you make initially are of the type called IgM, and they’re too big to get through the placenta. But your immune system soon switches to make IgM antibodies, which are smaller and can reach your baby. That’s why prevention methods are offered during the first pregnancy. The idea is to give a woman two (or sometimes more) injections of anti-D immune globulin. This combines with the cells in your bloodstream that came from your baby, and stops your immune system from making antibodies against your baby’s blood cells.

I understand your worries about donated blood, but blood products are carefully screened during manufacture and it’s not clear if it’s possible to catch infections such as CJD from immune globulin. Anti-D has been used in the UK since 1969, without problems, though on rare occasions there can be an allergic reaction. Before anti-D, HDN used to kill about one baby in every 2,000, so I wouldn’t hesitate to have it myself.

Q: I’m 28 weeks pregnant with my first baby and have been told I have Group B Strep. Could you explain what this is, and how it will affect me and my baby.

A: Group B Strep (GBS) is a common kind of bacteria, with about 1 in 4 or 5 women carrying it in their vagina – usually without it causing any harm at all to them. Unfortunately it can pass to the baby during birth, and a few babies are susceptible to it. About 1% of babies in the UK get ill from GBS. Symptoms can include fever, poor feeding, breathing problems, low blood pressure and even pneumonia and meningitis. Fast treatment is essential and it’s best to prevent a baby catching GBS from her mum.

GBS is hard to eradicate with antibiotics, even if a woman takes several courses of treatment. However it’s possible to treat it with antibiotics by injection during labour. That’s what happens if by any chance your baby might be at higher risk of GBS – for instance if she is premature, or your membranes ruptured early, or you’ve already had one baby become ill from GBS.

The reason that GBS is diagnosed at about 28 weeks is because you and the team looking after you need to know whether you carry it before you go into labour or your waters break. It’s no good waiting till labour, because tests for GBS take 24 – 48 hours. So talk to your midwife and agree on a birth plan. (See www.gbss.org.uk for more information).

Q: I am 27 weeks pregnant and have symphysis pubis dysfunction (SPD). I have had dummy contractions every hour for the last 4 weeks. The hospital didn’t seem concerned, but could they be linked to the SPD?

A: Symphysis pubis dysfunction refers to the pain some women get in pregnancy when the symphysis pubis – the small joint at the front of the pelvis – softens under the influence of pregnancy hormones like relaxin. There’s a reason for this softening. It’s to make labour easier by helping the baby’s head fit through your pelvis.

Rest assured that, although it’s uncomfortable, it has no serious consequences. Neither does SPD have anything to do with contractions, other than the fact that they both occur in pregnancy from the second trimester onwards.

Braxton-Hicks differ from genuine contractions in that they’re not painful and they have no lasting effect on the muscle of the womb. If you start getting pain, or feel your contractions even more often, get in touch with the hospital. It’s just possible that you’re getting more than your share of Braxton-Hicks because you’re not resting enough, so that the uterus responds with muscle twitching. Try putting your feet up every day, and don’t stand about for long periods.

Q: I’m 28 weeks pregnant and since about 11 weeks I have had stomach pains. The midwife keeps telling me it’s not the baby. Any ideas what they could be?

A: It can be hard to tell what tummy ache means in pregnancy, as the abdominal organs are all gradually moved aside by the growing baby.

The important thing is that your baby is developing well, and you should by now be feeling plenty of movements. If your midwife is happy, then it’s unlikely to be anything serious. I expect she will also have checked you don’t have a urine infection. This is common in pregnancy and can cause abdominal pain.

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Many women get muscular pain in pregnancy, especially above the groin on both sides. Another possibility in much the same place is ligament pain, or a condition such as IBS that you can get any time. None is serious, but see your GP is you haven’t already.

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