Dr. Kevin Most: Pregnancy health issues – Miscarriage, Diabetes, Depression

Dr. Kevin Most

Beyonce, Courtney Cox, Nicole Kidman, Mariah Carey, Celine Dion, Brooke Shields, Christie Brinkley, Barbara Walters. What do they all have in common? They all publicly shared their struggle with personal miscarriages and the impact it made on their lives.

Carrie Underwood who is now pregnant with her second child shared very publicly how difficult it was for her and her husband, Mike Fisher to conceive their second child. She has shared that she had three miscarriages in the past two years.

We can use the strength of these women to educate all of us about miscarriages and share the need for support.

Many couples have no problems conceiving a child, but that is not always the case. In fact nearly 1 million miscarriages occur in the US every year. Miscarriages end one in four pregnancies and are the most common of all pregnancy complications. However a study completed a few years ago had 55% of those surveyed think that miscarriages are uncommon. Uncommon was defined as less than 6% of pregnancies.

The discussion about miscarriages are unfortunately much like depression used to be, never discussed almost taboo. Fortunately we again look to individuals in the media to come out and share their story, allowing us to discuss this condition and share how many can help. The survey actually showed that close to 30% of women who suffered thru a miscarriage found that celebrity disclosure of their miscarriage eased their feelings of isolation.

Other misperceptions include that lifestyle choices of the mother are the number one cause of the miscarriage, although it is known that alcohol use and smoking raise the chance of a miscarriage significantly, the number one cause of miscarriages is genetic, with the fetus being noted to have abnormal chromosomes.

Almost 80% of those surveyed felt that a stressful event or long term continued stress can cause a miscarriage, even 20% felt that getting in an argument can cause this to occur. 65% felt that lifting a heavy object can cause a miscarriage. All of those are false and do not lead to or bring on a miscarriage.

I bring the results of this survey up, as you can now imagine what is going thru the minds of the women who suffered thru this. These women often feel guilty, thinking an action they did caused this to occur. Spouses may feel guilty as the thought of allowing their wife to lift something heavy or participating in an argument caused the miscarriage.

It is important to understand that there are many misconceptions about miscarriages and often it is a genetic issue or anatomic issue that caused this to occur and has nothing to do with the faulty misperceptions that many have. We need to educate about miscarriages in order to eliminate or decrease the shame and stigma the public has placed on miscarriages.

This discussion is important as the psychological impact on the mother can be severe. They have feelings of guilt, depression, they isolate themselves, some are ashamed and embarrassed. They ask themselves or look for something they did to give them an understanding of why it occurred. We all need to understand that women do not do actions that cause miscarriages, with the exception of smoking and alcohol use will increase the chance of a miscarriage. Women need support and reassurance during this time.

The medical definition of a miscarriage is the loss of a baby prior to 20 weeks’ gestation. The occurrence of miscarriage is difficult to estimate, as many miscarriages occur before a woman knows she is pregnant. The estimates are that up to 50% of pregnancies end with a miscarriage. In cases where the pregnancy has progressed the rate approaches 15% with most occurring during the first trimester, or 12 weeks of the pregnancy.

The causes of miscarriage are numerous and in many cases not identified at the time. The causes of a miscarriage include genetics or chromosomal abnormalities , anatomy of the uterus, infections, hormone imbalances and auto immune diseases. Notice that none of these major causes the patient has any control over.

We all think of pregnancy without really understanding just how complex pregnancy is. Women who have preexisting condition and become pregnant have a higher chance of some of those conditions worsening. Asthma, Diabetes, Depression and Anemia are just a few of the medical conditions that may worsen during pregnancy and must be monitored closely by your primary care physician as well as your obstetrician.

Diabetes during pregnancy is called Gestational Diabetes. This type of diabetes only occurs during pregnancy, it occurs in over 200,000 women in the US each year. For women with this condition, they were not diabetic before their pregnancy, and in most cases will not be diabetic after they deliver, however they will be at a higher risk of type 2 diabetes later in life. This type of diabetes often will occur in the final trimester. The physician will be checking blood sugars looking for this condition. The reason for concern is that the mother will share that high blood sugar with the baby which can result in a large baby and a need to monitor the baby more closely after birth for changes with their blood sugar. The treatment for this is often a change in diet, exercise and close monitoring of the size of the baby. In some cases the mother may need insulin to control the blood sugar.

Another condition that is rarely discussed but somewhat common is depression during pregnancy or peripartum depression. This is a condition that occurs in about 20% of women who are pregnant. Many in society think that pregnancy and having a baby is the happiest period of a woman’s life, when in fact women experience a whole spectrum of emotions during this time. Many have feelings of confusion, fear, stress and depression. During pregnancy hormone changes can affect the chemicals in your brain that are directly related to depression and anxiety. Patients and families should look for signs of sadness, excessive sleeping, or not sleeping enough, loss of interest in activities, anxiety, feelings of guilt, any of those signs that are noted should be addressed and encouraging the mother to seek help is what is needed.

The much more common condition is postpartum depression, this is depression symptoms that occur following the delivery of a child. It is quite common with over 3 million cases in the US each year. This is different from the more common postpartum “baby blues” which is mood swings, crying spells, anxiety and difficulty sleeping. This often occurs within a few days after the delivery and can last for a few weeks. However some new moms experience more severe and longer lasting depression. We need to understand that this is not a flaw in the mother it is a complication of giving birth. Postpartum depression can initially look like baby blues, but the signs and symptoms are more intense and last longer, and often interfere with the ability to care for the baby. The timing for this can be during pregnancy all the way up to a year after delivery. Symptoms are listed below. If a friend or family member note this, the importance of seeking treatment and help cannot be minimized. Please encourage the mother and the family to seek evaluation.

Depressed mood or severe mood swings
Excessive crying
Difficulty bonding with your baby
Withdrawing from family and friends
Loss of appetite or eating much more than usual
Inability to sleep (insomnia) or sleeping too much
Overwhelming fatigue or loss of energy
Reduced interest and pleasure in activities you used to enjoy
Intense irritability and anger
Fear that you’re not a good mother
Hopelessness
Feelings of worthlessness, shame, guilt or inadequacy
Diminished ability to think clearly, concentrate or make decisions
Restlessness
Severe anxiety and panic attacks
Thoughts of harming yourself or your baby
Recurrent thoughts of death or suicide