Pregnancy and Valvular Heart Disease

Valvular heart disease is defined as a condition of heart disease in which involves in one or more of the problems of valves of the heart. Heart valve problems may be congenital or acquired later in the patient life.

Women who have the valvular heart diseases and would like to get pregnancy
Women who have the valvular heart diseases and would like to get pregnancy are advised to talk to their doctor for the potential risks during pregnancy to the mother and the developing fetus. In a study of "Management of Valvular Heart Disease in Pregnancy" by Patrick T. O'Gara, M.D., F.A.C.C.; Albert E. Raizner, M.D., F.A.C.C. posted in Medsnew today, researcher wrote that the management of women with valvular heart disease should ideally begin before conception. A careful cardiac examination and assessment of functional capacity are needed to determine the likelihood that patients will tolerate the increased hemodynamic burden of pregnancy, labor, and delivery, and the risk of complications during gestation.
A. Your heart and pregnancy
During pregnancy, the blood volume increases by 30 to 50 percent as it is necessary to nourish your growing baby as the result it increases the pressure in the heart as it also require to pump 30%-50% each minutes. Women who have Valvular Heart Disease and want to get pregnant may be associated with risk of Hemodynamic burden that can lead to disability and death.

B. Hemodynamic burden
Therefore, women who have Valvular Heart Disease and would like to get pregnant should have a careful cardiac assessment to determine the risks of increased hemodynamic burden of pregnancy, labor, delivery, and complications in a 40 weeks gestation. As the diseases are associated with the non-pregnancy causes of disability and death of pregnant women in approximately less than 4% of all pregnancies.

C. Diagnosis
After careful recording the personal medical history and physical exam, tests include
1. 12-lead electrocardiogram
12-lead ECG is a types of electrocardiogram in which 12 different electrical signals are recorded at the same time and suggested to use for women with Valvular Heart Disease during pregnancy diagnosis.

2. Trans-thoracic echocardiogram
Trans-thoracic echocardiogram also known as cardiac ultrasound, with the use of echocardiography transducer (or probe) which is placed on the chest wall to produce images of the heart to assess the health of the heart of women with Valvular Heart Disease during pregnancy.

3. Doppler study
Doppler study is another type of an ultrasound used to sound waves produce images for you doctor to check for the blood flow of the arteries and veins.

4. Exercise test
In a study of Exercise in Cardiovascular Disease - "Exercise Testing in Nonatherosclerotic Heart Disease, Hypertrophic Cardiomyopathy, Valvular Heart Disease, and Arrhythmias by Anthony P. Morise, MD, the author stated that the application of exercise testing is often combined with cardiac imaging. This is reflected in recently available appropriate use criteria for myocardial perfusion imaging and stress echocardiography..... In the latest version of the ACC/AHA guidelines for exercise testing published in 2002, ⁴ HCM is listed as a relative contraindication. However, in the ACC/European Society of Cardiology (ESC) expert consensus document on hypertrophic cardiomyopathy published in 2003, an abnormal exercise systolic blood pressure response is listed as a risk factor for sudden cardiac death in HCM.
Prenatal care of Women who have the disease during pregnancy also are looked after by the joint team of cardiologist and obstetrician. It is suggested of those with mild disease, prenatal visits should be scheduled every month, while in the moderate or severe cases, prenatal visits should be scheduled every 2 weeks until 28 to 30 weeks and weekly thereafter until delivery.

D. Treatments
D.1. Guidelines for Management of Patients With Valvular Heart Disease
According to the ACC/AHA Practice Guidelines for Management of Patients With Valvular Heart Disease" These guidelines follow the format established in previous American College of Cardiology/American Heart Association (ACC/AHA) guidelines for classifying indications for diagnostic and therapeutic procedures:
Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective
Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
IIa. Weight of evidence/opinion is in favor of usefulness/efficacy
IIb. Usefulness/efficacy is less well established by evidence/opinion.
Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful and in some cases may be harmful.
If you would like to read the entire guideline click the Source.

D, 2. Medication
1. Warfarin
Since women with the disease are associated with higher risks of thromboembolism as result of hypercoagulability. Warfarin is one of most recommended medication.

2. Depending to the diagnosis, other treatments may be included
a. Asymptomatic patients
If you are disganosis with Valvular Heart Disease but experience no symptoms, there will no treatment.

b. Pulmonary edema
If you are experience pulmonary congestion or edama, as result of the failure of the heart to remove fluid from the lung circulation, Diuretics medication may be taken orally, depending to the diagnosis.
c. Surgery
If a woman is diagnosis with severity of stenosis with is an abnormal narrowing in a blood vessel of the heart, sugery may be requried.
d. Other treatments depending to diagnosis accordingly
d.1. Infective endocarditis is an inflammation of the inner tissue of the heart may be treated with high dose of antibiotics.
d.2. Coagulation can be treated with anticoagulant to prevents and stops blood from clotting such as warfarin
d.3. Etc.

Women who have the valvular heart diseases during pregnancy
A. Causes
Valvular Heart Disease during pregnancy, in most case, is caused by rheumatic heart disease as a result of rheumatic fever caused by inflammatory disease after Streptococcus pyogenes infection, that can lead to Believed to be caused by antibody cross-reactivity problem of the heart, joints, skin, and brain.

B. Symptoms
Valvular heart diseases during pregnancy symptoms include
1. Palpitations
2.Chest pain
3. Hemoptysis
4. Thromboembolism
5. Opening snap
6. Right-sided heart failure
7. Pulmonary hypertension
8. Heart sounds
9. Etc.

C. Diagnosis
1. Chest X-ray
Chest X ray is used to produced image od the organs inside the chest, including the lung, heart, etc. In patient with Valvular heart disease, X chest X ray may show left atrial enlargement.

2. Echocardiography (ECG)
After chest X ray and abnomality is found in your heart, your doctor may order the Echocardiography to confirm the severity of the abnomality. Echocardiography is a sonogram of the heart.

3. Other test may be similar the diagnosis of prepregnancy of Valvular Heart Disease, depending to the first 2 diagnosis.

D. Treatments

1. Asymptomatic patients
If you are disganosis with Valvular Heart Disease but experience no symptoms, there will no treatment.

2. Pulmonary edema
If you are experience pulmonary congestion or edama, as result of the failure of the heart to remove fluid from the lung circulation, Diuretics medication may be taken, depending to the diagnosis.

3. Surgery
If a woman is diagnosis with severity of stenosis with is an abnormal narrowing in a blood vessel of the heart, sugery may be requried.

4. Other treatments depending to diagnosis accordingly
a. Infective endocarditis is an inflammation of the inner tissue of the heart may be treated with high dose of antibiotics.
b. Coagulation can be treated with anticoagulant to prevents and stops blood from clotting such as warfarin.

c. Etc.

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Periodontal (Gum) Disease in Pregnancy

Gum diseases is a type of periodontal disease that can affect a woman pregnancy outcome, including preterm pregnancy and low weight baby. According to the study of Periodontal Disease and Pregnancy Outcomes by Dolapo A. Babalola and Folashade Omole posted in the Journals of pregancy, researcher found that It is vitally important for women of reproductive age including pregnant women to practice good dental hygiene which involves making regular dentist visits that include the removal of calculus or tartar, brushing and flossing regularly, and using mouthwash. This is because pregnancy causes hormonal changes that increase the risk of developing gum disease, and because your oral health can affect the health of the developing baby. In an effort to sustain a normal pregnancy, it is necessary to balance the mother's nutritional, hormonal, and immunological systems.

Causes of gum diseases during pregnancy
Gum diseases mostly caused by infection that can affect the fetus include
1. Hormone
The change of hormone during pregnancy can cause gum bleeding as a result of fluctuation of hormones that make your gums more sensitive to the bacteria.

2. Mouth Infection
Mouth Inflammation caused by thrush, a candida mouth infection that occurs most often in during pregnancy can increase the risk of gum diseases, including bleeding.

3. Symptoms of pregnancy
Certain symptoms in pregnancy can promote gum diseases such as morning sickness, rinse our mouth with water, etc.

4. Pregnancy tumors
Pregnancy tumor such as pyogenic granuloma can increase the risk of as a result of the response to plaque building up that can lead to inflammation.

5. Genetic susceptibility
Some pregnant women are more prone to gum disease than others.

6. Smoking
See avoid smoking in prevention

7. Etc.

Symptoms
1. Swollen gum
2. Bleeding while brushing, flossing, or eating hard food
3. Tender gums
4. Tooth sensitive
5. Loose or separating teeth
6. Persistent bad breath
7. Etc.

Prevention
Healthy habits and good oral hygiene are always the best way in preventing gum disease.
1. Reduce in take of sugar or sugar related products, including candy bars, snack bars, sugar related drinks, etc.

2. Quit Smoking
Smoking can increase the risk of gym diseases as a result of Calculus, Deep pockets between your teeth and gums and Loss of the bone and tissue that support your teeth. In a study of "Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort." by Thomson WM, Broadbent JM, Welch D, Beck JD, Poulton R. researcher found that Complete data were available for 810 individuals of whom 48.9% had ever smoked (31.5% were current smokers). Compared with never-smokers, long-term smokers (and other age-32 smokers) had very high odds ratios (ORs of 7.1 and 5.7, respectively) for having 1 +sites with 5 +mm AL, and were more likely to be incident cases after age 26 (ORs of 5.2 and 3.2, respectively). Two-thirds of new cases after age 26 were attributable to smoking. There were no significant differences in periodontal health between never-smokers and those who had quit smoking after age 26. and concluded that Current and long-term smoking in young adults is detrimental to periodontal health, but smoking cessation may be associated with a relatively rapid improvement in the periodontium.

3. Dental Examinations
women who are pregnant with gum disease may be experience no symptom at all. It is for the pregnant and the fetus benefits that they have at least on dental examination during pregnancy.

4. Good hygiene such as tooth brushing, mouth cleansing, and flossing is always the best way to prevent periodontal disease.

5. Etc.

Treatments
Treatments of Periodontal Disease During Pregnancy depending to the diagnosis, your dentist will provide you with all information, The aim od this article is to make sure that you understand that treatments are beneficial to you and you baby with no hazardous to you or your pregnancy.
1. According to the study of "Treatment of Periodontal Disease During Pregnancy: A Randomized Controlled Trial" by Newnham, John P. FRANZCOG; Newnham, Ian A. FRACDS(Perio); Ball, Colleen M. RN; Wright, Michelle AssocDDentHyg; Pennell, Craig E. FRANZCOG; Swain, Jonathan MDSc(Perio); Doherty, Dorota A. PhD, posted in Obstetrics & Gynecology, researchers found that the evidence provided by the present study does not support the hypothesis that treatment of periodontal disease during pregnancy in this population prevents preterm birth, fetal growth restriction, or preeclampsia. Periodontal treatment was not hazardous to the women or their pregnancies.

2. Another study of "Treatment of Periodontal Disease and the Risk of Preterm Birth" by Bryan S. Michalowicz, D.D.S., James S. Hodges, Ph.D., Anthony J. DiAngelis, D.M.D., M.P.H., Virginia R. Lupo, M.D., M.P.H., M. John Novak, B.D.S., Ph.D., James E. Ferguson, M.D., William Buchanan, D.M.D., M.Md.Sc., James Bofill, M.D., Panos N. Papapanou, D.D.S., Ph.D., Dennis A. Mitchell, D.D.S., M.P.H., Stephen Matseoane, M.D., and Pat A. Tschida, Ph.D. for the OPT posted in New England Journal of medicine, researchers found that treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. (ClinicalTrials.gov number, NCT00066131.)

3. In another study of "Exploring the relationship between periodontal disease and pregnancy complication" by Yiorgos A. Bobetsis, DDS, PhD, Silvana P. Barros, DDS, PhD and Steven Offenbacher, DDS, PhD, MMSc posted in the Jouenal of American Dental association, ARTICLES JADA Continuing Education, researchers found that It is important to note that all of the studies to date that have involved treating periodontal disease in pregnant women (usually in the second trimester of pregnancy) suggest that periodontal treatment is safe for both the mother and the child. Therefore, treatments can be provided safely during pregnancy to improve the oral health of the mother. What we do not yet know is whether this treatment also significantly improves the pregnancy’s outcome. Nor can we tell pregnant women that treating their gingival condition will improve their pregnancy or neonatal outcomes. We will have to wait for the results of the multicenter trials sponsored by the National Institute of Dental and Craniofacial Research that are in progress before we have an opportunity to answer this critical question.

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Genetic Birth Defects in Pregnancy

Birth defects is defined as a condition in which the baby was born with structural or functional abnormalities that can lead to physical or mental disability.
Genetic disease is a inherited disease, passing down from generation to generation, caused by abnormal mutation of a gene or a group of genes or or chromosomal defects, of which can lead to birth defects.

Types of genetic diseases
Genetic diseases can be classified as the below
A. Chromosomal abnormalities
The diseases can be caused by genetic passing through from the parent or an error in cell division. Chromosomal abnormalities can be divided into two basic groups, numerical and structural anomalies.
A.1. Numerical anomalies
Numerical anomalies is a condition of missing either a chromosome from a pair or has more than two chromosomes of a pair. In other words, it has more or fewer chromosomes than the normal number. Types of numerical anomalies include
a. Down syndrome (trisomy 21)
It is a genetic disease caused by the the presence of all or part of an extra 21st chromosome genetic material and most common cause of birth defects in the US, according to the statistic 1 in 800 born with Down syndrome each year. As of today, there are no treatment for children with diseases.

b. Turner syndrome -
Turner syndrome is a type of chromosome abnormalities with the absence of part or all sex chromosomes, leaving a single X chromosome, or 45 total in new born girl. According to the statistic, 1 in 2500 babies in US are born with Tuner syndrome.

A.2. Structural anomalies
It is a result of structural problem of the chromosomes themselves and can be classified as below 1. Deletion mutation
It is a result of missing part of a chromosome or DNA code. many researchers believe that it may be the result of errors in the process of chromosome cross over during the early stage of egg fertilization.
a. Cri du chat
It is due to the deletion of part of the short arm of chromosome 5.
Currently, there is no treatment for the disease.
b. Muscular dystrophy
It is a result of weaken muscles that affect the movement of the new born as a result of the defects of muscles protein that cause the death of the cell and tissue of the muscles. Currently, there is no cure for the disease and most infant born with muscular dystrophy are died at a young age.

2. Inversion
It is a genetic disorder caused by inversion of the part of broken DNA reattachment. If the inversion of the part of DNA is small, it may not cause any problem to the newborns as in most cases, happened to part of the chromosome 9,

3. Translocation
It is a rearrangement of parts between nonhomologous chromosomes.
a. Balanced translocation - the DNA is equally exchanged between chromosomes and none is lost or added. A parent with a balanced translocation is healthy, but he/she may be at risk for passing unbalanced chromosomes in a pregnancy.
b. Robertsonian translocation
It is a case of a centric fusion, as a result of chromosomal rearrangement occurs in the five 13, 14, 15, 21, and 22. chromosome pairs, causing only 45 chromosomes in each of their cells.

4. Rings:
It is a result of a parts of a chromosome has broken off and formed a ring. Many researchers believe that ring chromosome abnormality may be caused by genetic damage of a mutagens. The disease may only cause symptoms if it happens to a region of repetitive DNA sequences at the end of a chromosome,

5. Etc.

B. Single gene defects
It is a result of single gene defect out of 40-60,000 genes presented in the human body leading to the leads to alternation of the DNA code as a result of an defect amino acid sequence in the proteins. Types of Single gene defects include
1. Dominant
As a result of only one abnormal gene from either parent. Researchers found that the risk of the disease increased by a 50% for a baby born with parent with the disorder, including Huntington's disease, Marfan syndrome, etc.

2. Recessive
As a result of both parents are diagnosed with the disease. Bay born with above parent has a 25% inherited the mutation gene, including cystic fibrosis, sickle cell disease, Tay Sachs disease, etc.

C. X-Chromosome abnormality
Women who carry the mutated genes of the X chromosome have 50% risk in giving birth to a X-link related birth defects. Types of disorder is depended to the degrees of expression of the mutation. In X chromosome abnormality, men are affected and women are carriers.
a. Duchenne muscular dystrophy
It is a mutations in the dystrophin gene of the X chromosome that cause rapid muscle desperation.
b. Hemophilia
a bleeding disorder caused by low levels, or absence of, a blood protein. Patients with haemophilia may suffer severe and frequent bleeds, depending to the severity of the disease.

D. Multifactorial problems
It is a type of genes mutation involved many factors, including the environment in the causation of birth defection, including cleft lip or cleft palate, neural tube defects, etc.

E. Teratogenic problems
It is type of mutation gene abnormality caused by exposure to certain chemicals, radiation, alcohol, heavy chemicals, certain medication, etc.

Diagnosis
1. Blood test
a. Maternal Blood Screen
It is a blood test for the levels of proteins, human chorionic gonadotropin (hCG) and pregnancy associated plasma protein A (PAPP-A). If the protein levels are either too high or low, it may be a indication of a chromosomal mutation in the fetus.
b. Maternal Serum Screen
It is a blood test used to identify the risk of birth defect of the fetus at 15 to 20 weeks of pregnancy by screening the trisomy 18 for any abnormality.

2. Ultra sound
Ultrasound allows your doctor to visualize the fetus and around structures and to assess the abnormality the fetus.

3. Chorionic villus sampling
It is a type of of prenatal diagnosis to determine chromosomal or genetic disorders of the fetus with a test of a sample of the placental tissue before 15 weeks. In a sudy of Instruments for chorionic villus sampling for prenatal diagnosis, by Zarko Alfirevic, Peter von Dadelszen, researchers suggested that chorion can be removed through the abdomen or through the cervix using fine needles, plastic or metal tubes or biopsy forceps. The woman's risk of miscarriage increases if several attempts are needed to get chorion, or the gestational sac is damaged. The review found some evidence that small forceps may be more effective and less painful than aspiration cannulae for transcervical CVS. There were no trials found on transabdominal CVS.

4. Amniocentesis (withdrawing a sample of the amniotic fluid).
Amniocentesis is a test of abnormalities of the fetus by withdrawing a sample of amniotic fluid from a woman uterus and examining it in the laboratory.

5. Etc.

Counseling
According to the Centers for Disease Control and Prevention (CDC), approximately 3% of babies born in the United States will have a birth defect. Family who is at higher risk or previous birth defect incidence and have a family history of birth defect, abnormality of the gene is identified in any test or the pregnant mother is over the age 35 are beneficial for birth defect counseling.
According to the American pregnancy association, genetic counseling includes
1. Do you have a history of diabetes, hypertension, cancer, or twins?
2. Are there any diseases that seem to run in your family?
3. Is there a history of genetic disease like cystic fibrosis, hemophilia, or muscular dystrophy?
4. Is there anyone with mental retardation or any kind of birth defect?
5 Have any of your sisters, cousins, or other relatives had problems with their pregnancies?
6. Are your parents alive, and are they healthy?
7. What is your ethnic background?
8. Is there any reason that you suspect that your baby may be born with a birth defect or other medical problem?
The aim of the evaluation is to determine the risk of your baby will get from the disease and provide available options with the family, depending to the data collection, including families risk, interpretation of information, inheritance patterns analysis, risks of recurrence, etc.

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Skin Change in Pregnancy

Skin change is a change of skin color and appearance. Skin change in pregnancy is very common as a result of hormonal change such as new glow on your face or pinkish, reddish streaks on your stomach, etc., and not be mistaken as skin diseases, but they can cause some discomfort if you are worry about the appearance of skin change in your face. Most of skin change will disappear after childbirth but some of them will be less noticeable but not completely disappear.

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Why skin change in pregnancy
Approximate 90% of women experience some kinds of skin change in pregnancy, it is caused by the elevation of the estrogen levels effecting the change in veins and the melanocyte-stimulating hormone (MSH) effecting on melanocytes, the skin cells that contain the black pigment.

Types of skin change
Most common types of skin change in pregnancy include
1. Stretch Marks
Stretch marks are a form of scarring on the skin with pinkish or reddish streaks running down your abdomen and/or breasts as a result of tearing of the dermis due to the enlarged abdomen and breast overtime in pregnancy. Stretch marks may fade in color after childbirth but not completely disappear. In a study of Prophylaxis of Striae gravidarum with a topical formulation. A double blind trial. by Mallol J, Belda MA, Costa D, Noval A, Sola M., researchers found that a daily application of a cream (Trofolastin) containing Gotu Kola extract, vitamin E, and collagen hydrolysates was associated with fewer stretch marks during pregnancy.

2. Darkening of Freckles, Moles
It is the result of increased hormones cause changes in the skin pigmentation. The darken area will only lighten and not disappear after childbirth.

3. Melasma
Also known as Mask of pregnancy when appears in pregnant women, it is a tan or dark skin discoloration as a result of the stimulation of melanocytes in melanin pigments production by elevating of estrogen and progesterone. Usually, the mark of pregnancy will disappear over a period of several months after giving birth. Hydroquinone (HQ), the over-the-counter medicine of topical depigmenting agents inhibits tyrosinase, an enzyme involved in the production of melanin.

4. Skin Itchy
Dryness and itching abdomen and breast is a result of the growth of the fetus, making the skin of your belly and breast stretches and tightens in the later stage of pregnancy. It may cause discomfort as a result of hormonal change during pregnancy. They will go away a few months after childbirth. In this case, experts recommend not to hot showers and baths but shower and bath with mild soap and and rinse it off well and towel off lightly.
Some women,1 in 100% may develop intrahepatic cholestasis of pregnancy in the third trimester.
If you are experience severe itching, accompanied with the symptoms of darker urine, lighter stools, fatigue, increased nausea, decrease in appetite, itching that increases in the evening, Itching to the palms of the hands and soles of the feet, without presence of a rash, etc., please check with your doctor immediately, intrahepatic cholestasis if left untreated, it can increase the risk of fetal distress, meconium ingestion, meconium aspiration syndrome, stillbirth, etc. In this case, prescribed ursodeoxycholic acid can be helpful.
If the itching is intense and spreads to your arms and legs with the presence of hives-like rash and bumps on your abdomen, you may develop pruritic urticarial papules and plagues (PUPP) that affects about one in two hundred pregnancies and mostly to the mother who are carrying large babies, twins, and triplets, PUPP will go away after a few months after giving birth. (Some studies reveal that this condition is more frequent in women carrying boys). We will discuss the subject of PUPP more in next article.

5. Pimple and Acne
Pimple and Acne may be elevated as a result of oil glands secreting more oil as we mentioned above. Some women may be experience the pimple and acne breakouts but it is normal in pregnancy, especially for women already have the problems before pregnancy.
Experts do not recommend any oral medication in pregnancy but only mild soap or cleanser twice a day. In case of breakouts, topical prescription antibiotic creams containing erythromycin or clindamycin, may be used with the permission of your doctor.

6. Skin Tags
Skin tags are very small, rapid growth of skin due to hormonal change in pregnancy. It is mostly occurred in the skin rubbing against clothing such as under a bra, or skin rubbing together. The symptom usually disappears after childbirth.


7. Pregnancy Glow
Pregnancy Glow a common occurrence of women in the pregnancy as a result the increased blood volume circulating in the body, leading to oily ski, including to your face as a result of
hormonal change. Experts do not recommend the use of any medication in pregnancy but only oil free cleanser

8. Varicose Veins
Varicose veins are swollen veins that may bulge near the surface of the skin and usually appear on the legs during pregnancy, as a result of increasing blood flow to the fetus in pregnancy that affects the function of leaflet valves in preventing the blood from flowing backwards, causing varicose veins. Women who are overweight and/or have a family history of the diseases are at risk to develop varicose veins in pregnancy.
Since it will gone away a few months after giving birth, most experts do not recommend any treatments, unless there is blood clot infection or it has become unbearable pain. If you have developed blood clot in the leg in pregnancy, check with your doctor. Clot that do go away in a few months few months should be treated, otherwise, it may affect the lung, causing unnecessary consequences.

9. Spider Veins
Spider veins appear most in the Caucasian women in pregnancy. They are small dilated blood vessels near the surface of the skin, including face, neck, upper chest and arms, as a result of increasing blood flow due to hormonal change in pregnancy. Since they will be disminished a few months after giving birth, most experts do not recommend any treatment, unless they are absolutely necessary. On the other hand, in nutritional perspective, intake of Vitamin C can help to manufacture collagen, the protein and main component of connective tissue which can enhance the functions of the cartilage, bone, blood vessels, the gut, and intervertebral disc, etc.

10. Etc.

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Postpartum Thyroid Disease

Postpartum thyroid disease is defined as a condition of women who deliver babies have postpartum thyroiditis, with hyperthyroidism, hypothyroidism, or both, within one year after delivery as the thyroid pland has become abnormal in production of thyroid hormones. If you need more information abount postpartum depression, please follow the link. Due to hornomal change expected after giving birth, most postpartum thyroid diseases are overlook by your doctor. It is for your own benefit, if you are experiencing symptoms of thyroidism, you should see your doctor. According to statistic, approximately 10 percent of women may suffer thyroid disease after childbirth.
In most cases, postpartum thyroid disease (transient thyroidism) may be temporary, as it will disappear after a short period of time

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Postpartum depression and postpartum thyroid disease
According to the study of Postpartum thyroid disease is not associated with postpartum depression by American thyroid association, study of 641 women with no thyroid disease. They were evaluated at the time of delivery and 1, 3, 6, 9, and 12 months after delivery, researchers found that 56 women (11 percent) had postpartum thyroid disease. Sixty-one women (10 percent) had a high score on the Beck Depression Inventory. Eleven (2 percent) were confirmed by a psychiatrist to have postpartum depression and 50 (8 percent) had lesser psychological disturbances (depressive disorder, anxiety). Researchers concluded that Women with postpartum thyroid disease do not have an increased risk of depression.

Most common types of Postartum thyroid diseases
1. Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones.
2. Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones.
You will be direct to the article of hyperthyroidism in pregnancy and hypothyroidism in pregnancy. because of the similar of the subjects.

Please disreagrd the sections of "The importance to have hyperthyroidism under controlled in pregnancy" and "The importance to have hypothyroidism under controlled in pregnancy"

Please note
A. Hyperthoyrouidism
1. If your are not breast feeding with hyperthyroidism after child birth
a. Radioactive form of iodine may be used as it is the most effective treatment to cure hyperthyroidism as as a result of killing thyroid cells which have absorbed the radioctive iodine. Please note that the cells in the thyroid gland are the only cells in our body with the ability to absorb iodine, therefore the radioactive iodine will not damage other cells in the body.
b. Risks and side effects
b.1. Causing hypothyroidism as a result of radioactive iodine has killed more of the thyroid cells than expected
b.2. Mild case of hyoerthyroidism as a result od radioactive iodine has killed less thyroid cells as expect.
This risk can be disovled if the righ amount is used
b.3 Nausea
b.4. Swollen salivary glands
b.5. Mentallic taste.
As the glands have absorbed some of the radioactive iodine.
b.6. Etc.

Precautions: Following radioactive iodine therapy, you will need to take certain precautions to prevent radiation exposure to others, specially to elder and baby. As you doctors will give you a precised details.

2. If you are breast feeding your baby
1. You may consider stop it while you are in hyperthyroid treatment with radioactive iodine. Your doctor will tell you the time that is necessary for the radioactive iodine completely withdrawn from your body, before you can proceed with breast feeding your baby again.
2. If you choose not to stop, then the treatments will be the same with either medication or surgery.

B. Hypothyroidism
A Woman who is hypothyroid and on thyroid hormone replacement, with the follow up of thyroid hormone measurment to make sure that her thyroid hormone in the aceptable can be breast feeding her baby, because the amounts of medication cross over cause no harm to the baby health.
According to the article of "Breastfeeding and Thyroid Disease, Questions and Answers Can You Nurse Your Baby When Hypothyroid, Taking Thyroid Drugs Like Synthroid, or With Hyperthyroidism or Graves' Disease and Taking Antithyroid Drugs Like Tapazole or PTU" by Mary Shomon, the author wrote
" ....I (Mary Shomon) was not becoming engorged in between nursings, and after more visits to the lactation consultants and doula, the theory was that I didn't have a sufficient enough milk supply, and Julia didn't have a very strong sucking reflex. After trying many methods of increasing milk supply recommended by the various resources I called on -- everything from herbs like fenugreek, a nursing vacation, and nursing every 2 hours -- Julia continued to lose weight. At the three-week point, the pediatrician insisted that I add supplemental formula for Julia. Julia immediate began gaining weight.
Insuffient milk production by the mother may be a problem with postpartum hypothyroidism.
I will direct you to me previous article "Tips to help your New Born to Gain Weight - The Easy Way, if you are breastfeeding and have hypothyroidism" with a slight change to the tittle.

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Goiter in Pregnancy

Goiter is defined as a condition of the enlargement of the thyroid gland that can lead to swelling the lower part of the neck, causing abnormal functioning in production of thyroid hormone in most cases.

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Goiter and pregnancy
Since goiter is associated with either hypothyroidism or hyperthyroidism, it is for the pregnant women to talk to their doctor immediately and treat accordingly to the result of diagnosis to prevent the complications caused by the diseases. In some cases, they can cause difficulty of breathing if the swelling are growth large enough to block the airway or the cells of the thyroid gland have become malignant.

Types of goiter
Types of goiter are differentiated according to underlined symptoms
1. Hypothyroidism (please read hypothyroidism in pregnancy)
It happens in most cases as a result of the necessity of producing more thyroid hormones, causing swelling of thyroid tissue.
2. Toxic multinodular goiter
Toxic multinodular goieter is a form of hyperthyroidism as result of a small nodules in the thyroid gland have produced too much hormones (please read hyperthyroidism in pregnancy)
3. Malignancy
It is important for pregnant women to rule out the enlargement of thyroid gland are caused by cancerous cells.(Please read thyroid cancer for general information)
4. Iodine and Selenium deficiency
In Most cases, it is dueiodine and Selenium deficiency and happens mostly in the under developed world population.

Classification of goiter
The classification depend on the growth and size of the swelling of the thyroid gland
A. Growth patterns.
1. Uninodular (struma uninodosa)
Either inactive or a toxic nodule
2. Multinodular (struma nodosa)
Either inactive or toxic multinodular goiter
3. Diffuse (struma diffuse)
Enlargement of with the whole thyroid gland

B. Sizes
1. Class I
Found only by palpation, otherwise, it is completely hidden.
2. Class II
It can be easily seen.
3. Class III -
The lumps or swelling has become very large that can lead to pain behind the sternum and compression marks

The patterns and sizes will be become necessary to classify the stage and grade of the tumor if diagnosis later indicated that the swelling is caused by malignant of the cells of thyroid gland ( Please read thyroid cancer for general information)

Symptoms of Goiter
In some women, the swelling of thyroid gland has caused no symptoms, if the swelling is not associated with hormonal abnormalities. On the other hands, symptoms are depended to the association specific diseases.
In general, most symptoms are enlargement of thyroid gland without going into specific underlined diseases
1. Difficulty breathing and swallowing
As result of the enlargement has growth large enough to interfere with breathing and eating.
2. Hoarse voice
As a result of enlargement has interfered with voice box.
3. lump on the front of the neck
Caused by swelling of the thyroid gland
4. Sore throat
5. Etc.

Causes and risk factors
Depending to the types of goiter as mentioned above.


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Hypothyroidism in Pregnancy

Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones.

Hypothyroidism solution
Treat hypothyroidism naturally with
effective natural therapy

Hypothyroidism during pregnancy
According to statistic, approximately 2% of all pregnancies suffer from some degrees of hypothyroidism and another 2 out of 1,000 pregnancies will be complicated by clinical hypothyroidism. If you have hypothyroidism during pregnancy, you may need to have your thyroid hormone checked every 4-6 weeks, if necessary, medication is also adjusted to make sure that your thyroid within the acceptable range.

The importance to have hypothyroidism under controlled in pregnancy
Thyroid hormones over or under the normal range can be harmful to your baby. In fact, in the first few months of pregnancy, your thyroids hormone is very important for the development of the fetus' brain. Hypothyroidism in pregnancy can lead to insufficient hormones, causing severe cognitive, neurological and developmental abnormalities. In serve cases, it can lead can lead
to impaired brain development in the baby, miscarriage, stillbirth, lower birth weight, etc.

Symptoms
1. Weight gain
Weight gain more than average of a pregnancy
2. Constipation
While diarrhea is a symptoms of hyperthyroidism, constipation is a symptom of hypothyroidism.
3. Fatigue
4. Facial Problems
Your face looks swollen or puffy
5. Muscle cramps
6. Confusion,
7. Hair loss in your eyebrows
8. Etc.

Diagnosis and tests
Blood test is always important as soon as pregnancy is confirmed, especially for women with family and personal history of hypothyroidism. Test for thyroid stimulating hormone, if confirmed, certain medication, including levothyroxine, may be given to prevent the elevation of the disease and is adjusted to high dose if needed.


Causes and risk factors
1. Autoimmune disease
Hypothyroidism caused by autoimmune disease as a result of the cells of immune system mistakenly attacks the thyroid gland. The disease can start suddenly or over a long time including Hashimoto’s thyroiditis and atrophic thyroiditis.

2. Removal of thyroid gland
Surgical removal of the thyroid gland can cause low levels of thyroid hormones.

3. Radiation
Certain diseases including Graves’ disease, nodular goiter,or thyroid cancer are usually treated with radioactive iodine (I-131) with an aim to destroy the thyroid gland cause of diseases can lead to low levels of thyroid hormones.

4. Birth defect
Some baby was born with partly formed thyroid gland

5. Inflammation
Inflammation of thyroid gland may cause hypothyroidism.

6. Medication
Certain medication such as amiodarone, lithium, interferon alpha, can increase the risk of hypothyroidism.

7. Genetic factor
Gene passing through from one generation to generation. Sometime, it may skip.

8. Smoking
According to the World health organization, smoking is reported to be responsible for both decreasing secretion of thyroid hormone and blocking its action, thus exacerbating the symptoms of hypothyroidism.

9. Medical conditions
Medical condition such as Addison's disease, Myasthenia gravis,Polycystic ovarian syndrome,
Anorexia or bulimia are associated to the higher risk of hypothyroidism.

10. Etc.

Preventions
A. How to
1. Quit Smoking
2. Eating healthy
Eating healthy by providing your body before and during pregnancy is the best way to prevent all kins of diseases, including hyperthyroidism. For more information of over 100 healthy foods
3. Meditation or Yoga
Mediation and yoga can help a woman to calm and relax, thus reducing or lessening the risk of the disease caused by stress related
4. Limit intake of saturated fats and fats
As they can increase the risk of heart diseases and stroke.
5. Limit intake of alcohol
6. Moderate exercise to enhance the normal production of certain hormones.
7. Etc.

B. Nutritional supplements
1. L-tyrosine
The benefits of L-tyrosine, a nonessential amino acid is its function in assisting the making of thyroid hormones from the body. Since it promotes more thyroid hormone production, women with hyperthyroidism should avoid intake of L-tyrosine.

2. Omega 3 essential fatty acids
In a study of Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases

Artemis P. Simopoulos, MD, FACN, reseacher found that the clinical condition and biochemical factors of patients with arthritis, but the clinical intervention studies in other autoimmune conditions have given conflicting results, most likely due to lack of an adequate number of subjects in some and not taking into consideration the background diet or genetic variation. There is a clear need for more carefully designed and controlled clinical trials in the therapeutic application of omega-3 fatty acids to human autoimmune and inflammatory conditions.

3. Iodine
Women with deficiency of Iodine are at risk of developing hypothyroidism. According toThe Lancet, Volume 372, Issue 9633, Page 88, 12 July 2008, Iodine deficiency—way to go yet, indicated that acccording to WHO, in 2007, nearly 2 billion individuals had insufficient iodine intake, a third being of school age. Iodine deficiency can have serious consequences, causing abnormal neuronal development, mental retardation, congenital abnormalities, spontaneous abortion and miscarriage, congenital hypothyroidism, and infertility.

4. Selenium
According to an article of Selenium Critical to General Health and Thyroid Function
by Mary J. Shomon, the author wrote that selenium is a component of the enzyme that helps convert T4 to T3 peripherally, so deficiencies of selenium may impair thyroid function and promote hypothyroidism.

5. Zinc and copper
According to an article of Role of Zinc and Copper in Effective Thyroid Function posted in unarchive, indicated that
a. Copper plays an important role in thyroid metabolism, especially in hormone production and absorption. Copper stimulates the production of the thyroxine hormone (T4), and prevents over-absorption of T4 in the blood cells by controlling the body's calcium levels (Calcium is required for the stabilization of cell membranes and reduces cell permeability).
b. ust as copper is important for thyroid function, zinc too is needed to prevent thyroid problems. Zinc is involved in the process that converts inactive hormone T4 into active hormone T3. An excess of inactive thyroid hormones in the body can lead to an under active thyroid gland. An Italian study showed that patients suffering with hypothyroidism gained improved thyroid function by supplementing their diet with extra zinc.


6. Vitamin D
According to an article of Vitamin D and Hypothyroidism posted in the progressive health, the author wrote that Several articles published over 20 years ago showed that patients with hypothyroidism have low levels of Vitamin D, which may lead to some of the bone problems related to hypothyroidism. People with hypothyroidism may have low levels of Vitamin D due to poor absorption of Vitamin D from the intestine or the body may not activate the Vitamin D properly.

7. Etc.

Treatments
Thyroxine (T4) replacement
a. The aim of treatment is to bring your T4 and TSH back to normal levels with the synthesis thyroxine pills which similar to the natural T4 made by the thyroid gland.
b. Risks and side effects
b.1. If over doses
It can cause hyperthyroidism
b.2 Symptoms of hyperthyroidism
Including insomnia, greater appetite, nervousness, tremble, etc.
b.2. If under dose
Symptoms of hypothyroidism.
C. Follow up to make sure that T4 is within the acceptable range. If necessary, doses can be adjusted

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