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Pregnancy Bliss | Reproductive Health Hub

Thinking about conception

Question:  Hello, I am after some professional advice..... I am 40 years old and have two beautiful, healthy boys (4 and 15 months.

I suppose I should be happy that our family is complete but recently I feel an increasing sadness that I will never be pregnant again, never breastfeed and never hold a newborn baby. I think about having another baby every day now, but in many, many ways it just wouldn't be practical - my age and my husband's age (he's 53), financially we are stretched as it is, the fact we have no help as such, and I suppose more importantly, the fact that I have Arthritis - it seems to be Lupus, although it hasn't been confirmed yet. It is a very mild form (now) and I am not on any medication. The arthritis first started in my last pregnancy and caused a lot of acute joint pain in the 5th month and then 3 months after the birth (although we didn't know then it was arthritis). I had suffered a miscarriage before this pregnancy and now I'm wondering if it was caused by the Arthritis although I'd had no symptoms then.

So as you can see, there are quite a lot of reasons why having another child would NOT be a good idea. What should I do - ignore this strong feeling and just be happy that I have two healthy children? Medically, what would you advise? Thank you for your time. E.S. (Greece)

Answer: This, in my view, is more of a psychological conundrum rather than obstetric. There are really two issues that I can comment upon from an obstetric point of view: Your age and the presumed diagnosis of lupus-type arthritis.

At 40 years of age, you really do need to think carefully about whether to pursue a pregnancy. You clearly appear to be doing a lot of thinking. The age related concern is mainly based on the significantly increased risk of all manner of pregnancy complications ranging from miscarriage to such things as molar pregnancy, pre-eclampsia and many others. The most worrisome for many prospective mothers is the increased risk of fetal abnormalities and especially chromosomal disorders such as Down’s syndrome. These are real issues and you will be best advised to give them clear headed thought. The issue of arthritis is probably still unclear. The evolution of your condition makes me think it is probably unlikely to be lupus. However, for the sake of your immediate issue calling for a decision, the arthritis does not present a strong case against embarking upon a pregnancy. Were you to do this in the current circumstances where the diagnosis remains unclear, I would strongly suggest that you take low dose Aspirin (75mg daily) starting soon after you confirm the pregnancy. Remember, don’t take this before you conceive as it actually reduces the chances of a successful conception. My best wishes going forward.

Excess amniotic fluid

Question:  My question is - i am 38 weeks pregnant and i am carryig excess fluid - this level is increasing not decreasing. My dr has stated all along that i wont go this long - but here i am !! He has booked me in for a sweep this week - but i cant be induced due to a previous section - what is the liklyhood that they will do the sweep given the increased fluid - AFI is 28.9 - and what happens if this doesnt work - they are very worried about placental abruption, prolapsed cord and heamorraging. How much longer will they let me go?? Thanks. B.S. (UK)

Answer: It is certainly the case that presence of excessive amniotic fluid (polyhydramnios) does significantly increase the chances of going into labour early. However, this does not always happen. The mentioned potential complications associated with excessive amniotic fluid are real enough and you have rightly been informed so you can understand all the precautionary measures being put in place. What I don’t understand is why you are under the impression that just because you had a caesarean section in the past, you cannot be induced. This is absolutely not true. You can have induction of labour with previous caesarean section. In fact, in your particular case, your obstetrician may be ( or should be) looking to assess your cervix for possible ‘stabilising induction’. This is done in a case of excessive amniotic fluid. That is as long as the head is the leading part. A previous caesarean section makes this an attractive option.

Light bleeding in early pregnancy

Question: I am a 9 and half weeks pregnant and i had a light bleeding. Should i be worried? O.K. (UK)

Answer: Vaginal bleeding in early pregnancy, regardless of the amount, should be regarded as a threatened miscarriage until proven otherwise. Even if the bleeding stops, it is important that viability is verified. I would suggest therefore that you bring this to the attention of your doctor or your local hospital’s early pregnancy assessment unit. My best wishes.

On methadone and trying to conceive

Question: If I am on methadone will it affect my chances of becoming pregnant? A. (UK)

Answer: No; your being on methadone will not affect your chances of becoming pregnant. However, you do need to think carefully whether you want to subject your baby in the womb to opiates.

If you are completely unable to successfully wean yourself off Methadone, then you should at least try to go down to the lowest possible dose to minimise the fetal exposure.

Safety of nutritional supplements in pregnancy

Question:  I am 6 weeks pregnant and have been taking a prenatal vitamin every day since before conception. I have also been taking fish oil concentrate plus GLA. But I am now very worried, as I have just read that pregnant women should not take borage seed oil, which is contained in the capsules i have been taking. I will stop taking them now, but feeling very anxious that i may have harmed my little fetus. Can you offer me any more advice? Also, should I continue taking omega 3? and if so, can you recommend a safe one during pregnancy? Thank you. L. (UK)

Answer: It is standard practise to advise against using any preparations whose effect in pregnancy are unknown. This applies to Borage seed oill, mainly used for relieving arthritis related pain. This is not the same as saying it is harmful. We simply don’t have enough information to declare it safe. As for Omega 3, you have not said why you are taking this. It is true that Omega 3 fatty acids are essential for neurodevelopment of the fetus and an adequate intake during pregnancy is a good idea. Just make sure you do not use fish liver oil supplements which have real potential for causing harm. You may also wish to know that robust scientific studies have failed to show the claimed benefits of Omega 3 in pregnancy namely making babies ‘brainier’ or helping to reduce postnatal depression.

X Ray in very early pregnancy

Question: i went for a dental x-ray although by then, i did not know i was pregnant.(i was about 4 weeks pregnant) i am now so worried for my baby. what are the dangers of dental x-rays during pregnancy? is there need for alarm? please help, i am so stressed. W. (Kenya)

Answer: While it is not ideal, it is reasonable to say that, for a dental x ray, the amount of radiation you were exposed to is likely to be quite small and well within what is regarded to be a safe limit during pregnancy. In addition, the meam was directed at a part that is remote from the site of the pregnancy. Both these factors mean that you probably don’t need to get yourself so stressed. Your anxiety is understandable but is, in all likelihood, uncalled for. My best wishes in your pregnancy.