OBGYNDoc
Minneapolis, MN
Female, 36
I am a practicing Obstetrician and Gynecologist, providing care for women in all stages of life. Approximately half of my practice consists of pregnancy-related care, including routine prenatal care, high risk obstetrics, and delivering babies at all hours of the day. The other half consists of gynecologic care, which ranges from routine annual check-ups to contraception and menopause. I perform many surgeries, including laparoscopies and hysterectomies.
Yes. The active ingredient in marijuana, THC, crosses the placenta and enters the circulation of the baby. Use of marijuana in pregnancy can result in poor blood flow and growth of the baby. In addition, there have been studies that have shown cognitive delays, hyperactivity and behavioral disorders in babies born to mothers who abused marijuana.
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As women age, risks of complications such as infertility, miscarriage, chromosomal abnormalities such as Down Syndrome, preterm labor, diabetes, hypertensive disorders and stillbirth increase. There is no black and white cutoff at which one reaches a "high risk" age. We choose the age of 35 as our designation of Advanced Maternal Age because this is the age at which we see a sharp rise in the risk of chromosomal abnormalities such as Down Syndrome, as well as an increase in the medical problems listed above. Although the risks are much higher at 35 than at 25, they are still relatively low. The risk of having a baby with Down Syndrome at age 35 is still <1%. But I don't think the risks are exaggerated- they are certainly real and should be taken seriously. If you have underlying medical problems such as obesity, hypertension, diabetes or pre-diabetes, then your risk of having a complication in pregnancy is much higher. However, if you are in good health and have the approval from your physician, then you are statistically likely go on to have a normal, healthy pregnancy.
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It is absolutely true that the risk of complications in pregnancy increase as maternal age increases. In particular, the risk of genetic disorders such as Down Syndrome, miscarriages, preterm labor, gestational diabetes, stillbirth and cesarean section rises with maternal age. However, if a patient is in good health and does not have a significant history of obstetric complications, then I support her in pursuing her pregnancy goals. As our society continues to delay childbearing to later ages, we see more and more patients beginning their families in their 40's. Advances in treatment of infertility have made it possible for these individuals to aggressively pursue childbearing. There certainly are examples of misuse of this technology- for example pregnancies that result in high order multiples, or pregnancies in patients with serious chronic medical problems. However, in general, this technology has allowed for countless women to conceive babies in the face of a heartbreaking struggle with infertility.
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While I am certainly not a therapist or psychiatrist, postpartum depression and other mood disorders are absolutely something I diagnose and treat on a daily basis. Although I don't know that we can prevent postpartum mood disorders, I certainly think we can prepare ourselves for and lessen the severity of postpartum mood disorders. Firstly, its important that you take care of your physical health- healthy diet, exercise and healthy sleep habits are the first line treatment for depression at any stage of life. Secondly, its important to utilize all of the social supports available- when a friend, neighbor or family member offers to help so that you can take a break from your newborn, then by all means, accept. Being cooped up with a fussy newborn while suffering from extreme sleep deprivation will lower anyone's threshold for a mood disorder. Lastly, but certainly not least, we need to be educated and informed on the signs and symptoms of postpartum mood disorders. Many times the earliest warning signs are attributed to "hormones" or "baby blues" when, in fact, they are a red flag for something much more serious. As an OBGYN, it is my job to educate my patients so that they can recognize the symptoms should they develop.
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After having one miscarriage, the risk of having subsequent miscarriage is only slightly higher (approximately 30% rather than 25%).
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We screen all newly pregnant patients for HIV, and early detection is the key to a healthy pregnancy. If an HIV infected mother has a very low viral load, then she has a very good chance of delivering an HIV uninfected baby. Recent studies show that the risk of transmission is <2% if the mother is appropriately treated. The medical advances in treating HIV in pregnancy have made incredible progress such that HIV infected women have an excellent chance of having a healthy baby.
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Most couples do relax a bit with their second and subsequent pregnancies because most of the anxiety is related to the fear of the unknown. Just having had the experience of knowing what a labor room looks like, what it feels like to have an IV, what to expect when it is time to push, and how to cope with the sleepless nights of caring for a newborn can alleviate the stress that a first-time parent experiences.
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