Headache in Pregnancy

Headache is one the most common problems that comes for evaluation in a clinical practice. 

Even though most of the headaches are benign and do not need much evaluation but frequent/ episodic headache may cause quite a disability in day to day life and differentiating benign and malignant headaches is important to reduce the anxiety that is so frequently associated with frequent and persistent headaches. 

Headaches may occur frequently during pregnancy, especially first and third trimester.

Sudden hormonal shifts and increase in circulating blood volume may contribute to increase in headache frequency.

In the second trimester, pregnancy-related headaches may disappear as your body becomes used to the hormonal changes.

 Common causes of headache in pregnancy may be as follows:

1. Tension-type headaches (TTH): These are characterized by band like sensation around the head. Woman may feel varied sensation like heaviness, stretching sensation extending from scalp to the neck and shoulders. Following factors may contribute to the development of TTH:

Stress

Fatigue

Lack of sleep

Low blood sugar or hypo-glycaemia

Dehydration

2. Migraines


Episodic headache that is severe, throbbing and affecting both the sides of the head and associated with nausea or vomiting are usually migraine. Even though migraine improves during pregnancy in > 50% of cases, some women may have migraine headaches for the first time in early pregnancy.

3. High Blood Pressure / Pre-eclampsia may present as a sudden, severe unrelenting headache in a pregnant woman.  It may be accompanied by blurry vision, spots in front of your eyes, sudden weight gain, pain in the upper right abdomen, and swelling in the hands or feets and nausea and vomiting.

It requires immediate medical attention, as uncontrolled high BP is associated with complications like placental insufficiency, separation of placenta from the uterus (abruption), decreased platelet count leading to bleeding disorder, cardiovascular insufficiency.

4. Cerebral venous thrombosis - a blood clot in the sinuses of the brain . It may not be a common cause of headache but it is important to recognize this complication as venous sinuses thrombosis occurs more frequently in pregnant and post partum period as compared to general populations and it could be potentially life threatening and could lead to permanent neurological disability. So any new onset headache associated with vision loss and vomiting need neurological evaluation to rule out CVT.

5. Idiopathic intracranial hypertension (IIH). Rarely headache in pregnancy might be due to pressure build-up in the skull, known as IIH. It is more likely to occur in obese women of childbearing age especially if there is an ongoing thyroid problem. It may present as unexplained headache and decreased vision during the pregnancy

HOW DO I MANAGE THESE HEADACHES DURING PREGNANCY

Before taking any painkillers, you must always talk to doctor to check the safety of that drug during pregnancy.  Acetaaminophen (commonly known as Paracetamol) is the safest pain killer during pregnancy, if no medical help is around in a case of acute headache. The following tips may safely help relieve or prevent headaches during pregnancy:

Use warm or cold compresses.

         To soothe a headache in the sinus area, apply warm compresses to the front and sides of your face and around your nose, eyes and temples.

         To relieve a tension headache, apply a cold compress to the back of your neck

Reduce stress.

         Avoid stressful situations.

         Relaxation exercises may help. For instance, try deep breathing or simply closing your eyes and imagining a peaceful scene.

Rest and exercise.

         Resting in a dark, quiet room can soothe headaches.

         Getting good sleep and exercise may help.

Eat well-balanced meals.

         Eat smaller, more frequent meals throughout the day.

         This can help keep your blood sugar from getting too low.

Take care of your body.

         Maintain good posture, especially during the third trimester.

         Get a massage. Massaging your temples, shoulders and neck can help reduce the pain of headaches.

Avoid headache triggers.

         Different kinds of food or stresses can trigger headaches. For instance, triggers of migraine headaches include chocolate, aged cheese, peanuts and preserved meats.

         Keep a diary, and review the kinds of foods and activities that tend to trigger tension or migraine headaches

Medication 

Most of the medicines to treat headache are contraindicated during pregnancy. Even Over the counter drugs should not beg taken without consulting your doctor. Please always ask for pregnancy category of drugs ( according to their potential to cause foetal defects, drugs have assigned pregnancy category and only Pregnancy category A or B should be taken).

Call your doctor for help, if your headache:

         Is sudden and explosive or includes a violent pain that awakens you from sleep

         If headache is associated with decreased vision, seizure, vomiting or any neurological complaint like a limb weakness

         Is accompanied by fever and stiff neck

         Becomes increasingly worse, and you have vision changes, slurred speech, drowsiness, numbness or a change in sensation or alertness

         Occurs after falling or hitting your head

         Is accompanied by nasal congestion, pain and pressure underneath your eyes, or dental pain (these may be signs of sinus infection)

Contributed by:

Dr Sweta Singla

Consultant Neurology and Sleep Disorders

Kalpavriksh Superspeciality Clinic

www.kvsc.in  

Pregnancy: a guide to plan your nutrition

Pregnancy is the time when issues are abound to drive a normal woman crazy. 

Pregnancy is the time of major hormonal shifts that are required to sustain the foetus, which also have a bearing on the emotional health during this time. Emotions, which can change by the minute adds on more to the physical distress in any pregnancy. That is where nutrition walks right in. 

Most of the pregnancy’s emotional roller coaster can be managed with eating right. It has two benefits obviously – you need the baby to be healthy and you need to stay emotionally stable during this turmoil !!

Planning your diet during pregnancy is one of the best things you can do for yourself and your baby. After all, the food you eat is your baby's main source of nutrition. Smart choices about pregnancy nutrition can help you promote your baby's growth and development.

We have discussed in our earlier post the basics about the calorie and nutrition requirements in pregnancy. 

Grains

Grains provide essential carbohydrates, your body's main source of energy. Many whole-grain and enriched products also contain fiber, iron, B vitamins and various minerals. Fortified bread and cereal can help you get enough folic acid.

What to eat: Make sure at least half of your grains each day are whole grains. If that sounds like a lot, don't worry. It might not be as much as you think. You can get most of your day's grains with a bowl of fortified cereal for breakfast, a lunchtime sandwich made with two slices of whole-wheat bread and whole-wheat pasta for dinner.

Fruits and vegetables

Fruits and vegetables are critical components of pregnancy nutrition, since they provide various vitamins and minerals, as well as fiber to aid digestion. Vitamin C, found in many fruits and vegetables, helps you absorb iron. Dark green vegetables have vitamin A, iron and folate — other important nutrients during pregnancy.

What to eat or drink: Top your cereal with slices of fresh fruit. Make a veggie pizza. Add extra vegetables to your casserole.

If you're tired of apples, oranges and green beans, branch out. Try apricots, mangoes, pineapple, sweet potatoes, winter squash or spinach. Make trail mix with a variety of dried fruit. Fruit juices counts, too, but remember that too much juice can lead to undesired weight gain.

Meat, poultry, fish, eggs and beans

Foods in this group have plenty of protein, as well as B vitamins and iron. Protein is crucial for your baby's growth, especially during the second and third trimesters.

What to eat: Try whole-wheat toast with peanut butter for breakfast. Eat a scrambled egg or an omelet for lunch. Serve a salmon fillet for dinner. Add chickpeas or black beans to your salad. Snack on a handful of soy nuts.

If your traditional sources of protein no longer appeal to you — likely during the first trimester — experiment with other options. Fish is an excellent source of protein as well as omega-3 fatty acids, which can promote your baby's brain development.

Dairy products

The calcium in dairy products and calcium-fortified soy milk helps build your baby's bones and teeth. Dairy products also have vitamin D and protein.

What to eat or drink: Eat yogurt for your afternoon snack. Drink the milk in your cereal bowl. Have a glass of skim milk with dinner. Add low-fat cheese to a salad.

If you have trouble digesting dairy products, get creative. Try calcium-fortified orange juice or sardines. Experiment with lactose-reduced or lactose-free products. Use an over-the-counter lactase enzyme product when you eat or drink dairy products.

How much: Choose 3 cups a day, regardless of your height, weight, physical activity level or stage of pregnancy

Water

Water carries nutrients from the food you eat to your baby. It can also help prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. As your pregnancy progresses, drinking too little water can contribute to premature or early labor.

How much: The Institute of Medicine recommends about 10 cups (2.4 liters) of fluids a day during pregnancy. Water, juices, coffee, tea and soft drinks all contribute to your daily fluid needs. Keep in mind, however, that some drinks are high in sugar and too much can cause weight gain. Because of the potential effects on your developing baby, your health care provider might also recommend limiting the amount of caffeine in your diet to less than 200 milligrams a day during pregnancy.

Fats, oils and sweets

There are no minimum requirements for fats and sweets. Choose foods with healthy fats such as nuts, seeds or avocados. Use oil and vinegar as your salad dressing. It's OK to indulge once in a while — as long as you're getting the nutrients you need and your weight gain is on target. To avoid going overboard, control your portion sizes of foods high in fat and sugar.

Ask about supplements

Even women who eat healthfully every day can miss out on key nutrients. A daily prenatal vitamin — ideally starting three months before conception — can help fill any gaps. Your health care provider might recommend special supplements if you follow a strict vegetarian diet, have had bariatric surgery or have any chronic health conditions, such as diabetes. Always consult your health care provider before taking any new vitamins or supplements during pregnancy.

Contributed by:

Shafina Segon

Director

Nourish

Nutrition and Health Consultancy

Diabetes and Pregnancy

Pregnancy may be the time when women undergo screening for various common illnesses and may discover issues like diabetes and thyroid disorders that need serious consideration, keeping in mind the effect they have on both mother and child.

Why do I need to know about Diabetes ?

Upto 17%  pregnant women in India may have diabetes during their pregnancy (as per 2002 data).

Interaction between diabetes and pregnancy can be in two ways:

• somebody who is diabetic gets pregnant or
• somebody who is pregnant develops new onset diabetes (called as gestational diabetes).

What precaution is needed before planning pregnancy in a Diabetic Lady?

Diabetes affects formation of different body parts of the baby. Most of foetus’ organs take shape in first 12 weeks of pregnancy. So, it is prudent that diabetes is optimally controlled even before planning a pregnancy. 

Hence, it is important to screen for diabetes before planning for pregnancy. 

In case, patient is found to be diabetic, the target HbA1c ( blood test that tells us about the mean blood glucose in the last 3 months) should be as near to 6% as possible at time of conception.

Pregnancy can be a testing time for a woman. Some of the pre-existing complications of mother may get worsened during this time, so it is advisable to have a baseline check-up done before planning for pregnancy, for example : eye check-up & tests to assess your kidney functions. 

Even a pre-pregnancy dental examination and good dental hygiene would go a long way to keep your sugars under control while being pregnant, in case a pregnant lady is found to be a diabetic. 

What is gestational diabetes (GDM)?

Gestation is pertaining to prgenancy and gestational diabetes is a term reserved for diabetes detected first during pregnancy. Most of the pregnant ladies would be found to be positive for dibets screening in their second trimester (i.e. 4^th to 6^th month of pregnancy). 

Gestational diabetes usually happens in people who are already predisposed towards diabetes e.g. people with positive family history, with high BMI etc.

How common is GDM?

GDM is more common in India than in western countries. In India, 7-13 out of 100 pregnant women develop GDM.

What are the risk factors for Gestational Diabetes?

• Age >25 years (risk is even greater after age 35)
• Body weight: Especially BMI >30 kg/m²      (Which is a modifiable risk factor)
• Family history of diabetes
• Past history of GDM
• Past history of having delivered a baby weighing >4 kg

How would you know if you have gestational diabetes?

Gestational diabetes is generally a milder form of diabetes and one may not experience typical symptoms associated with diabetes (polyuria, weight loss, increased thirst etc.). So, SCREENING is our best tool to detect diabetes in pregnancy.

In cases of planned pregnancy, every woman should be tested for diabetes prior to conception and if it is an unplanned pregnancy, diabetes should be screened for at very first visit to doctor’s clinic post confirmation of pregnancy.

As GDM is detected in second trimester most of the times, an OGTT (oral glucose tolerance test) is recommended at 22-24 weeks of pregnancy.

Why should we care about diabetes in pregnancy?

Uncontrolled blood sugar levels may affect health of both mother and child.

Mother has higher chance of developing pregnancy-induced high blood pressure and pre-existing complications can worsen if mother had pre-existing diabetes.
 Baby has higher chances of having disordered growth. Baby may grow out to be a big baby and may necessitate caesarean section for delivery or its growth may be compromised leading to low birth weight.

Post Delivery also, the baby is at risk for developing low blood glucose (a potentially dangerous condition), prolonged jaundice and breathing difficulty.
 

How should I manage my pre-existing diabetes in Pregnancy?

For women with pre-existing diabetes, it is always advised that they should be shifted to Insulin well before planning pregnancy and their sugars should be stable at time of conception.

How should I manage my GDM?

Lifestyle modification in form of well-balanced healthy diet and regular exercise form the cornerstone of therapy in any form of diabetes including GDM. Selected women with mild disease may not require medications to control their diabetes, if they do diet control and exercise well ( within the limits and type that pregnancy allows e.g. brisk walking).

But, in majority of cases medications would be required to control blood sugars.

Insulin is preferred and safest medication to be used in pregnancy. Though, some selected cases can be managed with oral drugs like metformin.

Where should I seek help for my diabetes care in pregnancy?

Treating diabetes in a pregnancy requires highest professional qualifications and commitment. So, we strongly recommend that every pregnant women with diabetes should be under care of an endocrinologist to optimize the pregnancy outcome for both mother and child.

Contributed By:

Dr Rajiv Singla

Consultant Endocrinology

MD, DM - Endocrinology & Metabolism.

At KVSC, we believe in providing you updated, ethical and evidence based care to you. We invite your valued feedback.    

Pregnancy: What we forget to discuss about it?

Pregnancy is very special time in the life of any woman. We discussed in our last few articles, that it is a crucial time for foetus development also.

Any event that occur during pregnancy or the prenatal life in terms of child development, affects the end result of the pregnancy at both the ends i.e. the mother and the baby.

Assuming, that most of us are well aware of the basics of the care during the pregnancy as visits to an obstetrician are obligatory for any pregnant lady, we shall discuss here what is usually not discussed in detail during those visits.

During pregnancy, a woman undergoes a gamut of physiological changes, that might take pathological proportions if the body is unable to maintain the delicate balance during this crucial period. That might lead to a myriad of problems like gestational diabetes, thyroid disorders, hypertension, disturbances in calcium metabolism etc to name a few.

We will talk about a few of these problems one at a time.

If you i.e. our valued readers want us to write about any of the problems that we are not discussing here or need further details on any particular topic, please write to us and send your queries & comments at kalpavrikshclinic@gmail.com. We will try to get back to you with the answers as soon as possible.

Wishing you a good health wish...

CHILD HEALTH & NUTRITION

As parents, the specific nutritional choices you make will eventually reflect on your child. In today’s world of information transparency, every parent knows that good nutrition is essential to good health and I would like to encourage you to think of your nutritional decisions as health decisions.For many parents, helping children develop healthy eating habits is a struggle. We all are busy and with the hectic pace of our families today; since more women are working full time - even health-conscious parents are finding it easy to tolerate less than desirable eating habits. 

"A lot of parents don't want to struggle with the issues so they give up, letting kids make their own choices," says Jane Rees, director of nutrition service/education in adolescent medicine and lecturer in paediatrics at the University of Washington schools of Medicine and Public Health. "But children's judgment is less mature and they still depend on parents to guide them."

It is best to start training children about foods as soon as they can talk since they are most influenced by their families during the preschool years. Additionally, research has shown that heart and blood vessel disease can begin very early and that hardening of the arteries (arteriosclerosis or atherosclerosis) can be associated with a high-fat diet.

Parents should carefully read food labels to check nutrients and ingredients. Most kids are attracted to the advertising and packaging of food, including highly sugared cereals. I would suggest fitting them in occasionally as a treat in an overall diet that is focused on low sugar, low fat, and unprocessed foods.

Although it's a myth that children become hyperactive by eating too much sugar, sugary food is still bad for oral health, can be stored as fat, and aggravates diabetes. However, completely denying children sugar will only make it more tempting.

Here’s what you could do for starters:

1. Involve young children in the food preparation process.

2. Teach them how to set the table during their preschool years.

3. Take them grocery shopping. Let them choose some fruits and vegetables as well as the occasional treats. This will help their capabilities grow astronomically. If parents don't follow the natural signs that kids are ready to help, they will lose the window of opportunity." 

Developing children's attitude toward food should be similar to teaching them how to handle money -- by giving them growing responsibility along with sensible access. If children are properly prepared, they are more likely to make healthy food choices once they enter school. They will probably experiment some, but they will have a preference for fresh foods like fruits and vegetables along with foods like french fries.

What about changing the diet of children who have already fallen into the junk food habit? Once children reach age 10 or 12, it is very difficult to change their habits or coerce them into eating healthier foods. That is where the role of a nutritionist comes in. Please consult a nutritionist to rationally discuss ways to eliminate most junk foods and substitute more nutritious ones. If they learn to eat a well-balanced diet, they won't need vitamin supplements.  

Feeding my child is very difficult. How can I make mealtimes less of a hassle?

Here are 6 common unpleasant and unhealthy childhood eating situations and tips to handle them. Also, remember that food should be used as nourishment, not as a reward or punishment. In the long run, food rewards or bribes usually create more problems than they solve.

Feeding Challenges and Solutions

Food Jags: Eats one and only one food, meal after meal

Solution: Let the child eat what he or she wants if the jag food is healthy. Make sure the child is hungry at mealtime and offer other foods at each meal before the jag food. Don’t remove the jag food, but offer it as long as the child wants it. After a few days, the child likely will try other foods. Food jags rarely last long enough to cause any harm.

Food Strikes: Refuses to eat what's served, which can lead to "short-order cook syndrome"

Solution: Make sure the child is hungry when mealtime comes. Do not offer juices, sweetened drinks, or snacks too close to mealtime. Have whole-grain bread and rolls as well as fruit available at each meal, so there are usually choices that the child likes. Be supportive, set limits, and don’t be afraid to let the child go hungry if he or she won’t eat what is served.

"The TV Habit": Wants to watch TV at mealtime

Solution: Turn off the TV. Watching TV during mealtimes is a distraction that prevents family interaction and interferes with a child’s eating. Value the time spent together while eating. Often it is the only time during the day that families can be together.

The Complainer: Whines or complains about the food served

Solution: First ask the child to eat other foods offered at the meal. If the child refuses, have the child go to his or her room or sit quietly away from the table until the meal is finished. Don’t let him or her take food along, return for dessert, or eat until the next planned meal or snack time.

"The Great American White Food Diet": Eats only white bread, potatoes, macaroni and milk

Solution: Avoid pressuring the child to eat other foods. Giving more attention to finicky eating habits only reinforces a child’s demands to limit foods. Continue to offer a variety of foods from all the food groups. Encourage a taste of whole grains as well as red, orange, and green foods. Eventually the child will move on to other foods.

Fear of New Foods: Refuses to try new foods

Solution: Continue to introduce and reinforce new foods over time. It may take many tries before a child is ready to taste a new food…and a lot of tastes before a child likes it. A good starting point is to encourage the child to simply allow a small portion of the new food to sit on his or her plate. Don’t force the child to try new foods. Also, remember that you are a role model—make sure your child sees you enjoying the food.

Note: Do not feed children younger than 4 round, firm food unless it is chopped completely. The following foods are choking hazards: nuts and seeds; chunks of meat or cheese; hot dogs; whole grapes; fruit chunks (such as apples); popcorn; raw vegetables; hard, gooey, or sticky candy; and chewing gum. Peanut butter can be a choking hazard for children younger than 2.

Contributed by:

Shafina Segon

Nutritionist & Life coach

Director - Nourish