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Dr. Andrew Rynne

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Pregnant. Receiving progesterone shots. What precaution and cure should be taken?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6011 Questions

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Posted on Mon, 28 Jan 2013 in Pregnancy
Question: Early pregnancy question:
My wife is approx 7 weeks pregnant. The pregnancy ix being carried in China. She has been receiving progesterone shots and is getting progesterone pills twice a day. At week 6 + we had the opportunity to get an ultrasound test. The baby according to the doctor seem to be ok/healthy. A heart bit was heard. However we were not told the bit rate.

As the health care is quite questionable here I'd like to know the critical steps we ought to take to ensure the mom as we as the baby are safe and healthy.
I want to know:
1) when to consult a doctor for follow-ups? I understand week 6 was a critical moment to go through, as it was critical to hear a heart bit which we did.
2) next visit at week 11. I was told that we should actually get a follow-up to week 10. Which is right? What should be done at that time? Another ultrasound?
3) what are the other follow-up stages?
4) how do we know if the fetus was correctly created (I.e right amount of chromosomes)?
5) when can we run a genetic test and should we be looking for?
6) how do we ensure and when our baby has a healthy and normal brain?
7) how do we ensure our baby will not have any birth deflects?
8) my wife's mother has depression condition (not sure exactly what it is) how died this impact the baby's genetic map? On my side none of this has been reported. What is the risk for the baby to carry my wife's mother gene? What is the risk for the baby to be negatively impacted ?
doctor
Answered by Dr. Aarti Abraham 1 hour later
Hello
Thanks for your query.
I will briefly detail the various stages of antenatal care , which should ideally be gone through :

1. Pre conceptional care is important. Ideally, all women planning a pregnancy should consume folic acid for 3 months prior to conceiving.

2. The first visit is generally before 11 - 12 weeks. An early visit, at 6 - 7 weeks, as you did, is highly recommended, as it provides pregnancy dating. At this visit, the complete history is detailed - medical history, habits like smoking etc, any family history, age, BMI, blood pressure, height and weight, thorough check up of all bodily systems. ALso a dating ultrasound is done.

3. Further visits are recommended every month till 28 weeks, every 15 days till 36 weeks and then every week until term ( 40 weeks ).
At each visit , the weight, B.P. and growth of pregnancy clinically is documented. Further tests are

First visit - Complete blood count, blood grouping and Rhesus factor typing, complete urine analysis, early glucose challenge test, thalassemia screening, viral markers such as HIV, Hepatitis B and syphilis, testing for rubella antibodies , Chlamydia and other sexually transmitted diseases, thyroid screening, vitamin D levels and dating ultrasound.

Since you are specifically interested in the genetic testing, a double marker test is recommended at 12 weeks.

Between 16 - 18 weeks, triple test for genetic screen and by 18 - 20 weeks, quadruple marker for genetic screen plus targetted ultrasound to screen for fetal anomalies can be performed.
Folic acid supplementation in the first trimester and iron and calcium supplementation from second trimester onwards is recommended. In endemic areas, vaccination against tetanus is recommended.

4. At 24 - 28 weeks, a repeat complete blood count, glucose challenge test, repeat TSH is done.

5. Ultrasound is repeated in the third trimester. Between 28 - 36 weeks, meticulous assessment of pregnancy growth by clinical examination is done. Also, various additional tests or ultrasounds maybe done at the discretion of the obstetrician, depending on the risk factors.

6. After 32 weeks, screening for Group B streptococcal infection is done.

7. The brain development of a baby depends on conditions inside the uterus, on birth and most importantly, on the crucial first few years of life. No test can assess the brain function or IQ of a child, only the structural development of the brain.

8. Normal chromosomes are indicated only by amniocentesis, which is not a routine procedure, and should be done, only if any of the tests for genetic screening, which I enumerated earlier, are abnormal.

9. By performing all the genetic tests, you can be reasonably sure of the baby being free from birth defects, but no test can give you 100 % assurance. Avoid smoking/drinking/heavy caffeine intake/ teratogenic drugs and follow all precautions as advised by your doctor. Take regular antenatal supplements as advised.

9. Depression is thought to be partially heritable, but none of the genes for depression has been yet concretely identified, so it is impossible to predict your baby's risk for inheriting depression. As your wife is not having this condition and has not taken any drugs for it, you should not worry about the risk to your baby. Provide adequate vitamin D supplements to your wife, as it is linked with depression. Talk to your obstetrician about it, so that regular psychological screening can be offered to your wife .

I hope I have answered all your queries.
Feel free to ask for further clarifications.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 21 hours later
Genetic test:
What are the risks associated with miscarriage?

Amniocentesis test:
What are the risks associated with miscarriage?

Thanks a million for your great help!
doctor
Answered by Dr. Aarti Abraham 22 minutes later
Hello
Thanks for your appreciation.
As far as genetic tests such as double marker, triple and quadruple marker are concerned, they are biochemical tests, and have zero risk of miscarriage, as is also the case with genetic ultrasound.
Amniocentesis is recommended only if any of these are positive, or there is a strong history such as very advanced maternal age, uncontrolled diabetes in mother, previous abnormal child in family etc.
Risk of miscarriage with amniocentesis is approximately 1 in 100.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 22 hours later
Thanks a million for all your help Doctor!

I just learned that my wife to be has been diagnosed with schizophrenia years ago. After approx. 5 years of treatment I understand that she disease free for 2 years.

I now understand the disease in question a bit better, as I asked a question to one of your doctors specialized in that field.

My question now is related to a woman impacted by schizophrenia while being pregnant. Even if my wife to be seems to be disease free for now:

what are the risk for the pregnancy?

What are the risk for the mom?

What are the precautions we must take during the pregnancy to ensure delivery of a healthy baby?

I understand the risk to get a baby with schizophrenia is approx 15% higher than a normal pregnancy, how and when can know if the baby has been impacted by the disease?

Now that I know what should be our next step?

Best.
doctor
Answered by Dr. Aarti Abraham 53 minutes later
Hello
As your wife is disease free now, the risk for the current pregnancy is almost nil. Most of the drugs given to treat schizophrenia are harmful to the baby, but if she has not been on treatment in the few months prior to conception, and is not so now, there is no risk to the pregnancy.
For the mother, some patients exhibit an exacerbation of schizophrenia, that is , a flare up of the disease, so please make sure your wife is under close surveillance. However, most patients go through pregnancy uneventfully.
For a healthy baby, have regular antenatal check ups as advised earlier, all the routine tests, genetic tests, avoid smoking, alcohol and drugs, maintain a healthy lifestyle and nutritious diet. Take all supplements as advised. Continue taking folic acid throughout pregnancy.
Schizophrenia is a psychiatric and behavioural disorder - no test can diagnose it while the baby is inside the uterus, and even in infancy , because it does not manifest that early. Also, no definite proof or percentage of heredity in schizophrenia is proved yet.
The next step is to remain cautious and compliant with all medical advice, and relax.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 33 hours later
I now understand the medication was stopped w/o the doctor's consent 2 years ago. I also understand that no episode occurred during these two years. When I mentioned risk free for 2 years it was not totally accurate.

Is the risk as describe in my previous mail still almost equal to nil?
What if my partner does not want to consult a specialist?
What shall I do?

Thanks in advance for your great help!
doctor
Answered by Dr. Aarti Abraham 31 minutes later
Hello
Thanks for writing back.
The baby is still risk free, because no medications have been consumed that harm the baby, atleast, it is risk free from the teratogenic side effects of anti schizophrenia drugs.
For your wife, she is definitely at risk, because stopping medications without doctor's consent is a grave mistake, she might have had episodes that you are not aware of, or is at risk for recurrence anytime.
There is no option, but to consult a specialist for this issue, as only a Specialist can assess the current status of her disease, need for drugs etc.

Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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