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Pregnancy's hidden perils

July 7, 2016

 

You’re pregnant.

 

You’re excited.

 

You’re terrified.

 

You’re wondering just what the next 9 months is going to bring. What will you have to deal with…..

 

You might have to deal with the overwhelming urge to empty the contents of your stomach at random inopportune times – even when your stomach is already empty – bliss.

 

You will almost certainly have to deal with the realisation that your breasts have taken on a sentient existence of their own. I mean, seriously – that can be the only explanation for the fact that they have grown to the extent that they have and respond to the mewling of your newborn without any conscious input from yourself.

 

Or perhaps you may have the joy of dealing with your amazing capacity to forget what you were saying even as the words were coming out of your mouth. That incredibly weird physical symptom that you really wanted to ask your obstetrician about – gone – even as you sit there in front of him (or her) desperately wondering what the hell is going on with the organ between your ears that used to function so perfectly.

 

Perhaps the most challenging problem to deal with is the fact that people will want to enthusiastically discuss the act of child birth itself. The veil of secrecy that once hung over the labour ward has now been lifted for all its glory to be seen. A well-meaning cousin will tell you the most intimate details of their birth experience even when it’s just WAAAYYYYY too much information. There are TV shows with well-placed blur blobs to disguise “those” bits but unfortunately no blur blob is going to mute the appropriate howls of pain that punctuate the soundtrack. Some friends and family will also want to give you their version of “advice” for your pregnancy. Your sister in law will stare at your growing belly and exclaim that you’re very small. Half an hour later your mother will be more than happy to give the impression that your unborn baby has gigantism and is sure to match the dimensions of a Mack truck when it comes time to exit your body.

 

All of these things that you have to deal with are OUT THERE. You can see them coming. Heck, you can slap them if they get up too close and personal. But there are perils that no-one really talks about. Lurking in the shadows with potentially devastating effects for you and your baby. THESE are the microscopic trespassers that can turn your world upside down. There are many microbes (“germs” if you like) that can affect your pregnancy. I’m going to touch on just three. Listeria, Toxoplasmosis and CMV (cytomegalovirus).

 

Listeria. If you get infected with Listeria the outcomes for pregnant women can be devastating – miscarriage, preterm birth, stillbirth. Yes – it can kill your baby but it is RARE. In the 15 years that I have been in training for and practising in O&G I have seen one (that’s right – 1) case of Listeria in pregnancy. More babies die from SIDS each year than Listeria. More babies die from GBS (Group B Streptococcus) each year (that’s the bacteria that we check for with a vaginal swab at about 36 weeks). Some people might say that there is a Listeria hysteria – but part of the reason for Listeria being so rare is because the population has been educated again and again and again about Listeria and the foods to avoid. We all know about soft cheeses, pate and processed meat but there are lists upon lists of foods to avoid. You might find yourself thinking that you need to drink the purest of spring water and cruskits for the duration of your pregnancy. I found the list HERE to be one of the more useful ones as it gives reasoning behind avoiding the foods mentioned.

 

Toxoplasmosis – this is a parasite. It lives in cats and can be transmitted to pregnant women either via cat poop directly or via other animal’s flesh (which have been exposed to and ingested the cat poop). Hence, the way to avoid toxo infection is to avoid changing litter trays (particularly of kittens who excrete more of the parasite), avoid gardening without gloves (where cats poop on the ground) and making sure that meat is well cooked (to kill the toxo within it). Can toxo be a problem during pregnancy? Yes – again, rarely – but any disease that can potentially cause mental retardation, seizures, blindness and death in your baby is best to be avoided.

 

Cytomegalovirus – cyto what? Okay – let’s call it CMV for short. CMV is probably one of the lesser known of our microscopic buddies that can well and truly crash the pregnancy party. Diagnosis and treatment of CMV during pregnancy is difficult as most infections are asymptomatic – you don’t even know you’ve been infected.  However, if the baby is infected at birth then the risk of long term problems is relatively high at 10 to 20%. The most common issue is hearing loss, which can be severe. Other issues include eye problems, hydrocephalus (water on the brain) and other neurological abnormalities. It is estimated that 0.6 to 0.7% of births in Australia are affected by CMV

 

The problem with CMV is that it is VERY common in the general community. Young children are the most common source of infection and child care centres are a breeding ground for transmission of CMV. Frequent prolonged contact with young children is a major risk factor. Essentially, the best way to avoid exposure is to avoid close contact with young children (under 3 years) and if you do have contact with them then wash your hands thoroughly with soap and water. Also, avoid sharing toothbrushes, towels and bedding with young children. From a social, practical and logistical point of view this is not going to be easily accomplished. Some small studies have shown that these avoidance behaviours are probably effective in reducing transmission but no large studies in the general population have been done to date. Essentially - good hygiene is a must.

 

                                                             CMV Avoidance

 

 

It’s important that you don’t walk away from this blog thinking that there are microscopic disasters waiting around every corner. The three infections that I have mentioned can be devastating to your pregnancy but in general are relatively uncommon. If basic hygiene and common sense eating patterns are followed the risk of you developing one of these infections during pregnancy is low. Hopefully, the most repugnant thing you will be exposed to during your pregnancy is your Great Uncle Harold trying to rub your swollen belly.

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