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Pregnancy Bliss | Reproductive Health Hub

Metformin use in pregnancy

Question:  should I still take Metformin even when expecting? Am suspecting to be five weeks and have started taking 75mg of aspirin. N.S.N(Zambia)  

Answer: Congratulations on your good news. Yes; Metformin is perfectly safe to take during pregnancy. The most important thing is to ensure the blood sugar control is optimal. For some people with Type 2 diabetes, this is achieved using Metformin only. Others need to be switched to insulin. As long as you are having regular blood sugar checks, ideally checking before and after meals, and as long as the control seems good, you can continue with Metformin.

As for the aspirin, which is meant to minimise the risk of recurrent miscarriage, you should stay on this until the third trimester. Use beyond 36 weeks is not recommended. My very best wishes.

Sickle cell and smoking in pregnancy

Question:  Hi, we just found out that my girl just starting her pregnancy. I don't have sickle cell but she does.  What is the percent that the child will come out having sickle cell? Also wit her smoken. Does it affect blood flow from her to the child? R. (USA)

Answer: Congratulations to you both. I take it your girlfriend has got sickle cell disease and not sickle cell trait. This is important in predicting the likelihood of your offspring having the condition. I also take it you do not have sickle cell trait. You may need to be aware that many people with sickle cell trait are actually unaware because they are completely healthy. I hope you have had your status checked.

Regarding the smoking, that is particularly bad for women with sickle cell disease during pregnancy. Their ability to carry oxygen is already compromised due to their chronic anemia. Add to this the smoking which reduces the oxygen carrying capacity farther. That is on top of the carbon monoxide which is carried to the baby. A combination of sickle cell and maternal smoking can prove lethal to the baby. She needs to be helped in any way possible to quit during this time.

‘Golf balls’ in the heart of the baby on ultrasound scan

Question:  Hello, my wife had her 20 weeks scan today and the report says golf balls in the heart. The doctor explained and reassured us but im still confused. What is this and how did it get there? N.S. (UK)

Answer: The so-called ‘golf balls’ are one of the recognised soft markers that are occasionally seen when a detailed anatomy scan of the baby is done in the mid-trimester. The medical term for this is ‘echogenic intracardiac focus or EIF. ‘Golf balls is a descriptive term based on the fact that these areas appear round and white; like a golf ball. They tend to be found in particular areas of the heart. Their importance lies in the fact that, in some cases, they could be associated with a chromosomal disorder. Only a small minority of babies found to have these are actually affected by these disorders. Up to 4% of babies will be found to have these. That’s one in 25. Normally, when found, this will trigger a careful look for any other soft markers. When a scan confirms that there are no other soft markers or major structural anomalies, no further action is called for. The exception could be in cases of a mother with a family history of Down’s syndrome or if she is of advanced age. In such a case, she may be advised to consider a diagnostic test since the risk of her baby being affected is inherently higher.

When home birth is not ideal

Question:  Under which conditions is the mother advised against home delivery?  K.N. (India)

Answer: As a general rule of thumb, when everything is normal in a pregnancy and there is an easy access to a hospital (in case of unforeseen problems during labour at home), a home birth can be aspired for. The other side of this is that, if there are identifiable risk factors which could potentially complicate labour or harm the mother or baby, planning for a home birth may be unacceptably risky. Such risk factors include known pre-existing diseases such as diabetes, asthma or heart disease; pregnancy complications such as pre-eclampsia, placenta praevia or intrauterine growth restriction (IUGR) and others. The same advice against a home birth goes for situations where there are no identifiable risks but there is no easy and quick access to a hospital. We have covered this subject under the heading ‘Is home birth suitable for everybody?’ On the Home Birth section. You can reach this by clicking here:

Trying to conceive at 41

Question:  My partner and I have been thinking of trying for a baby but I am 41 next month. What are the risks? P.A. (UK)

Answer: It can be misleading to give a generalised opinion about these matters. Age is only one factor that needs to be considered in these situations and when making these plans. You have not said whether there are any health issues  or, indeed, whether you have been pregnant before/have children. If we were to work on the premise that there are no other issues, there are two main areas you need to bear in mind when planning:

At 41, most women will not be ovulating regularly. The rate of ovulation falls quite markedly from around 37 years of age for many women. This makes it less likely (but not impossible) to conceive spontaneously. When you ovulate and successfully conceive, the next area of concern is the risk that your baby will end up with an abnormality. The rate of miscarriage is significantly increased in this age group partly because of these abnormalities, some of which are lethal leading to these early pregnancy losses. Other abnormalities are compatible with life. Down’s syndrome comes quickly to mind. The risk of this for a woman of 41 is around 1 in 85. You may see different rates quoted but they will be around this figure. It is therefore quite high. Compare this to a woman even 5 years younger: At 36, the risk of Down’s syndrome is estimated to be 1 in 287. This means, within 5 years, the risk more than triples. Even with a pregnancy unaffected by any of these, the risks of pregnancy complications such as pre-eclampsia and bleeding conditions are increased. Those are some of the issues you will need to consider. My best wishes.

More questions and answers on the next page

Intimate partner participation in the birth is one of the ‘perks’ of a home birth. Proper planning remains essential and it is important to heed advice of the professionals if the option is deemed unsuitable.