Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Most women equate a
missed menstrual periodwith
the possibility of being pregnant, but other symptoms and signs are experienced by most women in the
early stages of pregnancy. It's important to remember that not all women will
experience all of these symptoms or have the symptoms to the same degree. Even
the same woman can have different types of symptoms in a subsequent pregnancy
than she had in previous pregnancies.
The following are the most common pregnancy symptoms in the first
trimester:
A missed menstrual period is most often the first sign
of pregnancy,
although a woman may still experience some bleeding or spotting around the time
of the expected period. However, if a woman does not have regular menstrual
cycles, she may notice some of the other symptoms of early pregnancy before it
is apparent that the menstrual period has been missed.
Feelings of breast swelling, tenderness, or pain are also commonly
associated with early pregnancy. These symptoms are sometimes similar to the
sensations in the breasts in the days before an expected menstrual period.
Pregnancy planning can address issues of nutrition,
vitamins, body weight, exercise, and potentially harmful medications and
illnesses as well as immunizations and genetic counseling.
Women who take folic acid at least four weeks prior to
conception can reduce their baby's risk of birth defects of the spinal cord
and skull by 70%.
Alcohol has been implicated in infertility, early
miscarriage, and birth defects.
Certain acne medications and other prescription and OTC
medications can cause birth defects.
Babies of older women have an increased risk of
having chromosomal abnormalities.
The timing of sexual intercourse in relation to ovulation does not
influence the gender of the baby.
What is pregnancy planning and why is it important?
Having a baby is one of the most important events in a woman's life. Women considering
pregnancy are encouraged to start planning for the pregnancy with their doctors early. This early planning process is called pregnancy planning. The goals of pregnancy planning are to create a healthy environment for the fetus and to prevent birth defects and other pregnancy related problems to the greatest extent possible. The issues addressed during pregnancy planning include
nutrition,
vitamins, body weight, exercise, avoidance of certain medications and alcohol,
immunizations, and genetic counseling. Even though many women will have normal pregnancies without any planning, pregnancy planning improves the chances of a smooth pregnancy and a healthy baby. Unfortunately,
many more women who are
anticipating conceiving do not seek prior medical consultation.
Pregnancy planning can help prevent exposure of the mother to potentially harmful medications or substances during the early days of pregnancy. The baby's organs begin developing as early as 17 days after conception, and the fertilized egg begins to grow even before the first day of the missed period. Some women continue to have light bleeding that may be mistaken for a
menstrual period during the
first few months of pregnancy and may not even realize that they are pregnant.
Others may not recognize that they are pregnant until they experience
weight gain or abdominal enlargement. By then, they may have already been exposed to
medications or substances potentially harmful to the fetus.
In addition to avoiding medications and substances that are potentially harmful to the fetus, other important health issues are addressed during pre-pregnancy planning.
The status of the woman's immunity against
German measles (rubella) and varicella (chickenpox) is also determined. Women lacking rubella antibodies are immunized before conceiving (see medical issues below). Women who are not immune to varicella (chickenpox) can be vaccinated, but should wait 30 days after vaccination before becoming pregnant.
Women who are carriers of the
hepatitis B virus can be identified by blood tests, and their infants can be protected from hepatitis B infection by immunizations at the time of delivery. Women with HIV (human immunodeficiency virus) infection should take certain medications during pregnancy to decrease not only their risks but those of the fetus as well.
The effects of diet, exercise, and each of the medical conditions previously discussed will be reviewed below.
Alcohol intake by a pregnant mother may result in fetal alcohol syndrome (FAS) in her child. A child with FAS may be hyperactive and have a low IQ, a small head, a growth lag, short eye openings, flattened cheekbones, a short nose, a smooth, thin upper lip, shortening of the fourth and fifth fingers, and a heart murmur.
It's important to know whether you will breastfeed or bottle-feed your baby prior to delivery, as the breasts' ability to produce milk diminishes soon after childbirth without the stimulation of breastfeeding. Breast milk is easily digested by babies and contains infection-fighting antibodies and cholesterol, which promotes brain growth. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. This article explores the advantages and disadvantages of both forms of feeding.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
Pycnodysostosis (pyknodysostosis) is an inherited disease of the bone. Characteristics of individuals with pycnodysostosis are short stature, brittle bones, short fingers, the midface is less full than usual, a prominent nose, small jaw, and more. There is no cure for pycnodysostosis.
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is cause by an inherited abnormal hemoglobin. Symptoms may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
Varicose vein: A dilated (widened) tortuous (twisting) vein, usually involving a superficial vein in the leg, often associated with incompetency of the valves in the vein. These visible and bulging veins are often associated with symptoms such as tired, heavy, or aching limbs. Spider veins are a group of widened veins that can be seen through the surface of the skin.
Prolactinoma is an adenoma (benign tumor) of the pituitary gland. Causes of many prolactinomas are unknown. Symptoms in women include changes in menstruation and infertility, decreased libido, or painful intercourse due to vaginal dryness. The most common symptom in men is impotence (erectile dysfunction). Treatment of prolactinomas are medication or surgery.
Down syndrome is a chromosomal disorder that results in the presence of an additional third chromosome 21, also referred to as trisomy 21. Most individuals with Down syndrome have widely recognizable physical characteristics. The severity of Down syndrome ranges from mild to severe. Diagnostic testing for Down syndrome include amniocentesis, chorionic villus sampling, and percutaneous umbilical cord sampling. The most common risk factor for Down syndrome is a woman's age.
Phenylketonuria (PKU) is a disorder that is inherited. PKU disorder increases the levels of phenylalanine in the blood. Phenylalanine is an amino acid that is obtained through diet, and is found in some artificial sweeteners. Signs and symptoms of PKU may vary from mild to severe. PKU has an autosomal ressesive pattern of inheritance.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Group B strep are bacteria called Streptococcus agalactiae that may sometimes cause infections both in a pregnant woman and her newborn. Symptoms include fever, seizures, heart rate abnormalities, breathing problems, and fussiness. Intravenous antibiotics are used to treat group B strep infections.
Hydronephrosis is a condition in which the kidney swells, due to a backup of urine. Hydronephrosis generally occurs with another disease.Symptoms of hydronephrosis include nausea, vomiting, urinary tract infection, fever, painful urination, increased urinary frequency and urgency, flank pain, and swelling of the abdomen. Treatment of hydronephrosis depends on the cause.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Vitamins are organic substances that are essential for the proper growth and functioning of the body. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting.
Spina bifida is the most common neural tube defect in the United States. There are four types of spina bifida; 1) occulta, 2) closed neural tube defects, 3) meningocele, and 4) myelomeningocele. The cause of spina bifida is not known. Theories include genetic, nutritional, and environmental factors. Lack of folic acid during pregnancy is highly suspected. Symptoms of spina bifida vary from individual to individual. Treatment depends on the type of spina bifida the person suffers.
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems. When four genes are impaired, the production of fetal and adult hemoglobin is prevented, resulting in hydrops fetalis and leading to death before birth.
Yeast vaginitis is a yeast infection of the vagina. Symptoms include itching, burning, soreness, pain during intercourse and urination, and vaginal discharge. Yeast infections can be treated with over-the-counter and prescription medications.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
Though human milk is the preferred feeding for infants, parents may consider formula-feeding if there is an inadequate supply of breast milk, the baby sucks inefficiently, the parents want to monitor how much the baby is receiving, or the mother is taking medications that are unsafe for the baby and may be passed through the breast milk.
Hypothyroidism during pregnancy can be treated with synthetic thyroid hormones to maintain the proper thyroid hormone balance. Hypothyroidism symptoms include fatigue, weight gain, lethargy, and constipation. Treatment of hypothyroidism in pregnant women is important, because inadequate levels of thyroid hormones may affect the fetus, and child during growth and development.
Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge resulting from an overgrowth of normal bacteria in the vagina. Although it may cause some disturbing symptoms (discharge and odor), it is not dangerous and cannot be passed by sex. Diagnosis becomes important to exclude serious infections like gonorrhea and Chlamydia. Many treatment options are available such as oral antibiotics and vaginal gels.
The cause of sudden infant death syndrome (SIDS) is unknown. The risk of SIDS peaks in infants 2-4 months of age. SIDS is more common among male infants, particularly African American and Native American infants, during the winter months. Putting the baby to sleep on his/her back, avoiding fluffy, loose bedding, using a firm mattress, and avoiding co-sleeping may help to prevent SIDS.
If you are trying to conceive, the first step is to be aware of your
menstrual cycle and changes that happen to your body during that time.
It helps to know when you are fertile. There are three ways to track your fertile times: 1) basal body temperature method, 2) Calendar method, and 3) Cervical mucus method (ovulation method).
Some women have problems conceiving due to
miscarriages or cannot conceive (infertility).
Causes of infertility include age, health problems (both men and women), and lifestyle factors.
There are several options for infertile couples including drugs, surgery, intrauterine insemination (artificial insemination), assisted reproductive technology, third party assistance, adoption, and foster care.
