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May06

Travelling During Pregnancy

Pregnancy lasts nine months, so the odds are good that you will need or want to travel at least once during that time.  You may be wondering whether it’s safe and how you can stay comfortable.

Whether you are travelling by car, plane, bus, or train, sitting for long periods of time in cramped spaces can make a pregnant person very uncomfortable.  Here are some things you can do to make your trip more enjoyable:

●     Drink water.  Dehydration can cause fatigue, headaches, and lightheadedness, so it is important to stay hydrated.

●     Bring healthy snacks.  The motion involved with travel can make first trimester nausea worse, but you can help by eating small healthy snacks frequently and avoiding getting either too hungry or too full.

●     Bring a pillow (assuming you are not the driver.): you will be more comfortable if you need a little nap.

●     Wear loose-fitting comfortable clothes and slippers or shoes.  It is also a good idea to dress in layers, so you can adjust to indoor air conditioning/heat and the outdoor elements.

●     Wear support hose: both pregnancy and prolonged immobility increase your risk for blood clots.  Support stockings put mild pressure on the blood vessels of the lower extremities to improve blood flow and help counteract this risk.  They can also decrease swelling.

●     Take breaks regularly: every 90 minutes or so try to get out, walk around, stretch your legs, and use the restroom.  You can also do some seated leg exercises to keep the blood flowing.

If you are driving or riding in a car, always wear your seatbelt.  If you get in a car accident, the risk for injury to you and the baby is far greater if you fly out of the car than any seatbelt injury you or the baby may acquire.  However, it is recommended that pregnant women wear their seatbelts low across their abdomens below their bellies.  The reason for this is that if it is worn higher, a sudden jolt could tear the placenta away from the uterus (although this is not common.)

Assuming you are having a normal healthy pregnancy, airplane travel is generally unrestricted during the first and second trimesters.  If you have diabetes, high blood pressure, bleeding, placenta problems, preterm labor, a history of clots, or other complications it is a good idea to consult your doctor before booking your flight.  Different airlines have different restrictions regarding flying during the third trimester, not because it is necessarily unsafe for you or the baby, but because they do not want you to go into labor while in the air.  If you planning to fly in the third trimester, it is a good idea to contact the airline to make sure you are aware of their specific policies and to have a note from your doctor stating your due date and giving his/her permission for you to fly.  Most doctors discourage flying after 36 weeks, but if you do, ask your doctor for a referral to another provider in the area so that you have someone to contact if you do go into labor or have other pregnancy-related problems.  It is also a good idea to bring part of your chart containing things like number and outcome of previous pregnancies, lab and ultrasound results, a few recent blood pressure readings, any medical allergies, and current medications as well as a name and phone number for your doctor.

Airport screening is also considered safe in pregnancy.  Metal detectors are still the most common screening modality and emit low frequency electromagnetic waves which are considered safe for everyone.  However, there are also two newer technologies being used in some airports.  Both create an image of the surface of the body to detect objects that might be hidden under clothes.  The back-scatter machine emits low level xrays (about 1/1000 of the radiation of one chest xray or the equivalence of two minutes of a high-altitude flight.)  The other is mm-wave scanners.  These emit non-ionizing millimeter length radiation that does not have the strength to damage DNA.  The radiation for both of these is minimal and considered safe even in pregnancy, but because the technology is relatively new, the effects have not been thoroughly studied.  Typically these methods are used as a secondary screening, so you may be able to opt to go through the metal detector instead.  If not, you can always ask for the pat-down if you or your doctor are uncomfortable with these newer scanners.

Apr29

The Role of Folic Acid in Preventing Neural Tube Defects

It is common knowledge that pregnant women need to take a prenatal vitamin containing folic acid, and the primary reason for this is to prevent neural tube defects.

Folic acid is a B-vitamin that is required for the production of DNA and essential for the rapid cell division needed to form fetal tissues and organs during pregnancy. If there is an inadequate amount of folic acid, the neural tube, which will later become the spinal cord, brain, and vertebral column, may not form correctly or close completely. When either of these things happen, a neural tube defect occurs. The neural tube (and thus neural tube defects) form very early in pregnancy, usually 4-6 weeks from the first day of the woman’s last menstrual period (or 2-4 weeks after conception); this is often before the woman even knows she is pregnant.

The two most common types of neural tube defects are spina bifida and anencephaly. Anencephaly is a condition where the upper part of the neural tube fails to close, causing the brain to either not develop completely or be completely absent. Pregnancies affected by anencephaly often result in miscarriage or the baby will die soon after birth. Spina bifida occurs when the lower portion of the neural tube does not close, which leads to improper develop of the spinal cord and vertebrae. There will often be a sac of fluid that protrudes through an opening in the back with a portion of the spinal cord also contained in it. There is a wide range of severities, but paralysis of the legs, lack of bowel or bladder control, hydrocephalus, and learning disabilities are all possible results of spina bifida.

Any woman could have a baby with a neural tube defect. However, there are some known risk factors. If you have had a previous pregnancy that was affected by a neural tube defect, your risk increases about 20 times. Women with insulin-dependent diabetes, women who take seizure medication, women who are obese, women who are exposed to high temperatures early in pregnancy (high fevers or hot tub/sauna use), and white or hispanic women (more often than black women) of lower socio-economic status appear to be at higher risk. Regardless of your risk status, all women should take at least 400 micrograms of folic acid daily to reduce your risk. Because the neural tube begins to form before you are aware of your pregnancy, it is a good idea to take folic acid before you are pregnant. If you are at particularly high risk, ask your doctor about taking a much larger dose of folic acid while you are trying to conceive and for the first three months of your pregnancy.

Not all of neural tube defects can be prevented, but 50-70% of them can just by getting adequate amounts of daily folic acid starting BEFORE you are pregnant. You can easily do this by taking a daily multivitamin containing at least 400 micrograms of synthetic folic acid and eating foods fortified with folic acid like cereals and breads. Naturally occurring folate founds in foods like leafy greens is slightly harder for the body to utilize, but still serves as a source for folic acid. It is recommended that ALL women CAPABLE of becoming pregnant consume adequate daily folic acid and not just those planning a pregnancy. If this would occur, the incidence of neural tube defects would be significantly reduced.