In addition, your doctor will probably prescribe a vitamin and mineral supplement to take during your pregnancy and while breastfeeding to ensure that you get enough of this important mineral.

Exercise: Like muscles, bones respond to exercise by becoming stronger. Regular exercise, especially weight-bearing exercise that forces you to work against gravity, helps build and maintain strong bones. Examples of weight-bearing exercise include walking, climb-ing stairs, dancing, and lifting weights. Being active and exercising during pregnancy can benefit your health in other ways, too. According to the American College of Obstetricians and Gynecologists, it can: Like muscles, bones respond to exercise by becoming stronger. Regular exercise, especially weight-bearing exercise that forces you to work against gravity, helps build and maintain strong bones. Examples of weight-bearing exercise include walking, climb-ing stairs, dancing, and lifting weights. Being active and exercising during pregnancy can benefit your health in other ways, too. According to the American College of Obstetricians and Gynecologists, it can: * help reduce backaches, constipation, bloating, and swelling; 101 Pregnancy and Birth Sourcebook, Third Edition * help prevent or treat gestational diabetes; * increase energy; * improve mood; * improve posture; * promote muscle tone, strength, and endurance; * help you sleep better; and * help you get back in shape after your baby is born.

It is important to talk to your doctor about your plans before you begin or resume an exercise program.

Healthy lifestyle: Smoking is bad for your baby, bad for your bones, and bad for your heart and lungs. Talk to your doctor about quitting. He or she can suggest resources to help you. Alcohol also is bad for pregnant and breastfeeding women and their babies, and excess alcohol is bad for bones. So, be sure to follow your doctor's orders to avoid alcohol during this important time. Smoking is bad for your baby, bad for your bones, and bad for your heart and lungs. Talk to your doctor about quitting. He or she can suggest resources to help you. Alcohol also is bad for pregnant and breastfeeding women and their babies, and excess alcohol is bad for bones. So, be sure to follow your doctor's orders to avoid alcohol during this important time.

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Chapter 12.

Carpal Tunnel Syndrome More Common during Pregnancy What is carpal tunnel syndrome (CTS)?

Carpal tunnel syndrome (CTS) is the name for a group of problems that includes swelling, pain, tingling, and loss of strength in your wrist and hand. Your wrist is made of small bones that form a narrow groove or carpal tunnel. Tendons and a nerve called the median nerve must pa.s.s through this tunnel from your forearm into your hand. The median nerve controls the feelings and sensations in the palm side of your thumb and fingers. Sometimes swelling and irritation of the tendons can put pressure on the wrist nerve causing the symptoms of CTS. A person's dominant hand is the one that is usually affected.

However, nearly half of CTS sufferers have symptoms in both hands.

CTS has become more common in the United States and is quite costly in terms of time lost from work and expensive medical treatment. The U.S. Department of Labor reported that in 2003 the average number of missed days of work due to CTS was 23 days, costing over $2 billion a year. It is thought that about 3.7 percent of the general public in this country suffer from CTS.

What are the symptoms of CTS?

Typically, CTS begins slowly with feelings of burning, tingling, and numbness in the wrist and hand. The areas most affected are the "Frequently Asked Questions about Carpal Tunnel Syndrome," by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, June 1, 2005.

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Pregnancy and Birth Sourcebook, Third Edition thumb, index, and middle fingers. At first, symptoms may happen more often at night. Many CTS sufferers do not make the connection between a daytime activity that might be causing the CTS and the delayed symptoms. Also, many people sleep with their wrist bent, which may cause more pain and symptoms at night. As CTS gets worse, the tingling may be felt during the daytime too, along with pain moving from the wrist to your arm or down to your fingers. Pain is usually felt more on the palm side of the hand.

Another symptom of CTS is weakness of the hands that gets worse over time. Some people with CTS find it difficult to grasp an object, make a fist, or hold onto something small. The fingers may even feel like they are swollen even though they are not. Over time, this feeling will usually happen more often.

If left untreated, those with CTS can have a loss of feeling in some fingers and permanent weakness of the thumb. Thumb muscles can actually waste away over time. Eventually, CTS sufferers may have trouble telling the difference between hot and cold temperatures by touch.

What causes CTS and who is more likely to develop it?

Women are three times more likely to have CTS than men. Although there is limited research on why this is the case, scientists have several ideas. It may be that the wrist bones are naturally smaller in most women, creating a tighter s.p.a.ce through which the nerves and tendons must pa.s.s. Other researchers are looking at genetic links that make it more likely for women to have musculoskeletal injuries such as CTS. Women also deal with strong hormonal changes during pregnancy and menopause that make them more likely to suffer from CTS. Generally, women are at higher risk of CTS between the ages of 45 and 54. Then, the risk increases for both men and women as they age.

There are other factors that can cause CTS, including certain health problems and, in some cases, the cause is unknown.

These are some of the things that might raise your chances of developing CTS: * Genetic predisposition: Genetic predisposition: The carpal tunnel is smaller in some people than others. The carpal tunnel is smaller in some people than others.

* Repet.i.tive movements: Repet.i.tive movements: People who do the same movements with their wrists and hands over and over may be more likely to develop CTS. People with certain types of jobs are more likely 104 People who do the same movements with their wrists and hands over and over may be more likely to develop CTS. People with certain types of jobs are more likely 104 Carpal Tunnel Syndrome More Common during Pregnancy to have CTS, including manufacturing and a.s.sembly line workers, grocery store checkers, violinists, and carpenters. Some hob-bies and sports that use repet.i.tive hand movements can also cause CTS, such as golfing, knitting, and gardening. Whether or not long-term typing or computer use causes CTS is still being debated. Limited research points to a weak link, but more research is needed.

* Injury or trauma: Injury or trauma: A sprain or a fracture of the wrist can cause swelling and pressure on the nerve, increasing the risk of CTS. A sprain or a fracture of the wrist can cause swelling and pressure on the nerve, increasing the risk of CTS.

Forceful and stressful movements of the hand and wrist can also cause trauma, such as strong vibrations caused by heavy ma-chinery or power tools.

* Pregnancy: Pregnancy: Hormonal changes during pregnancy and build-up of fluid can put pregnant women at greater risk of getting CTS, especially during the last few months. Most doctors treat CTS in pregnant women with wrist splits or rest, rather than surgery, as CTS almost always goes away following childbirth. Hormonal changes during pregnancy and build-up of fluid can put pregnant women at greater risk of getting CTS, especially during the last few months. Most doctors treat CTS in pregnant women with wrist splits or rest, rather than surgery, as CTS almost always goes away following childbirth.

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Chapter 13.

Vision and Oral Changes Chapter Contents.Section 13.1-Pregnancy and Your Vision ................................ 108 Section 13.2-Pregnancy and Oral Health ................................ 110 107.

Pregnancy and Birth Sourcebook, Third Edition Section 13.1 Pregnancy and Your Vision "Pregnancy and Your Vision," 2004 Prevent Blindness America (www .preventblindness.org). Reprinted with permission. Reviewed by David A.

Cooke, MD, FACP, March 31, 2009. Dr. Cooke is not affiliated with Prevent Blindness America.

Pregnancy brings an increase in hormones that may cause changes in vision. In most cases, these are temporary eye conditions that will return to normal after delivery. It's important for expectant mothers to be aware of vision changes during pregnancy and know what symptoms indicate a serious problem.

Refractive Changes During pregnancy, changes in hormone levels can alter the strength you need in your eyegla.s.ses or contact lenses. Though this is usually nothing to worry about, it's a good idea to discuss any vision changes with an eye doctor who can help you decide whether or not to change your prescription. The doctor may simply tell you to wait a few weeks after delivery before making a change in your prescription.

Dry Eyes Some women experience dry eyes during pregnancy. This is usually temporary and goes away after delivery. The good news is that lubricating or rewetting eye drops are perfectly safe to use while you are pregnant or nursing. They can lessen the discomfort of dry eyes.

It's also good to know that contact lenses, contact lens solutions, and enzymatic cleaners are safe to use while you are pregnant. To reduce the irritation caused by a combination of dry eyes and contact lenses, try cleaning your contact lenses with an enzymatic cleaner more often. If dry, irritated eyes make wearing contacts too uncomfortable, don't worry. Your eyes will return to normal within a few weeks after delivery.

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Vision and Oral Changes Puffy Eyelids Puffiness around the eyes is another common side effect of certain hormonal changes women may have while pregnant. Puffy eyelids may interfere with side vision. As a rule of thumb, don't skimp on your water intake and stick to a moderate diet, low in sodium and caffeine.

These healthy habits can help limit water retention and boost your overall comfort.

Migraine Headaches Migraine headaches linked to hormonal changes are very common among pregnant women. In some cases, painful migraine headaches make eyes feel more sensitive to light. If you are pregnant and suffering from migraines, be sure to talk to your doctor before taking any prescription or non-prescription migraine headache medications.

Prenatal care helps keep both you and your unborn child healthy. Be sure to tell your doctor if you are having any problems. Keep your eye doctor up-to-date about your overall health. Tell him or her about any pre-existing conditions, and about any prescription and non-prescription medications you are taking.

Diabetes Women who are diabetic before their pregnancy and those who develop gestational diabetes need to watch their vision closely. Blurred vision in such cases may indicate elevated blood sugar levels.

High Blood Pressure In some cases, a woman may have blurry vision or spots in front of her eyes while pregnant. These symptoms can be caused by an increase in blood pressure during pregnancy. At excessive levels, high blood pressure can even cause retinal detachment.

Glaucoma Women being treated for glaucoma should tell their eye doctor right away if they are pregnant or intend to become pregnant. While many glaucoma medications are safe to take during pregnancy, certain glaucoma medications such as carbonic anhydrase inhibitors can be harmful to the developing baby.

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Pregnancy and Birth Sourcebook, Third Edition Just because you are expecting a baby doesn't mean you have to put off your regular eye exam! You can have your eyes safely dilated while you are pregnant. If you suffer from any pre-existing eye conditions, like glaucoma, high blood pressure, or diabetes, it's very important to tell your eye doctor that you are pregnant. Your eye doctor may watch closely for changes in your vision during this exciting time in your life.

Section 13.2 Pregnancy and Oral Health "How Does Pregnancy Affect My Oral Health?" reprinted with permission from General Dentistry, General Dentistry, March 2007. Academy of General Dentistry. All rights reserved. On the Web at www.agd.org. License # AGD-5542-MES. March 2007. Academy of General Dentistry. All rights reserved. On the Web at www.agd.org. License # AGD-5542-MES.

It's a myth that calcium is lost from a mother's teeth and "one tooth is lost with every pregnancy." But you may experience some changes in your oral health during pregnancy. The primary changes are due to a surge in hormones-particularly an increase in estrogen and progesterone-can exaggerate the way gum tissues react to plaque.

How does a build-up of plaque affect me?

If the plaque isn't removed, it can cause gingivitis-red, swollen, tender gums that are more likely to bleed. So-called "pregnancy gingivitis" affects most pregnant women to some degree, and generally begins to surface as early as the second month. If you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodont.i.tis, a more serious form of gum disease.

Pregnant women are also at risk for developing pregnancy tumors, inflammatory, non-cancerous growths that develop when swollen gums become irritated. Normally, the tumors are left alone and will usually shrink on their own after the baby's birth. But if a tumor is uncomfortable and interferes with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove it.

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Vision and Oral Changes How can I prevent these problems?

You can prevent gingivitis by keeping your teeth clean, especially near the gumline. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You should also floss thoroughly each day. If brushing causes morning sickness, rinse your mouth with water or with antiplaque and fluoride mouthwashes. Good nutrition-particularly plenty of vitamin C and B -help keep the oral 12 cavity healthy and strong. More frequent cleanings from the dentist will help control plaque and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the likelihood of pregnancy tumors.

Could gingivitis affect my baby's health?

Research suggests a link between preterm, low birthweight babies and gingivitis. Excessive bacteria can enter the bloodstream through your gums. If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called prostaglandins, which are suspected to induce premature labor.

When should I see my dentist?

If you're planning to become pregnant or suspect you're pregnant, you should see a dentist right away. Otherwise, you should schedule a checkup in your first trimester for a cleaning. Your dentist will a.s.sess your oral condition and map out a dental plan for the rest of your pregnancy. A visit to the dentist also is recommended in the second trimester for a cleaning, to monitor changes and to gauge the effectiveness of your oral hygiene. Depending on the patient, another appointment may be scheduled early in the third trimester, but these appointments should be kept as brief as possible.

Are there any dental procedures I should avoid?

Non-emergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through sixth month. Women with dental emergencies that create severe pain can be treated during any trimester, but your obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.

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Chapter 14.

Emotional Concerns and Pregnancy Chapter Contents.Section 14.1-Depression and Pregnancy ................................. 114 Section 14.2-Stopping Antidepressant Use May Pose Risks to Pregnant Women .................................. 120 Section 14.3-Abuse during Pregnancy Affects One in Five Pregnant Women ................................................. 121 113.

Pregnancy and Birth Sourcebook, Third Edition Section 14.1 Depression and Pregnancy From "Pregnant and Depressed?" by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2007.

Hormones, body changes, and new emotions make you vulnerable to emotional ups and downs during and after pregnancy. Learn to spot the signs of depression so you can take care of you and your baby.

What is depression?

Depression can be described as feeling sad, blue, unhappy, miser-able, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time.

Depression can be mild, moderate, or severe. The degree of depression, which your doctor can determine, influences how you are treated.

How common is depression during and after pregnancy?

Depression that occurs during pregnancy or within a year after delivery is called perinatal depression. The exact number of women with depression during this time is unknown. But researchers believe that depression is one of the most common complications during and after pregnancy. Often, the depression is not recognized or treated, because some normal pregnancy changes cause similar symptoms and are happening at the same time. Tiredness, problems sleeping, stronger emotional reactions, and changes in body weight may occur during pregnancy and after pregnancy. But these symptoms may also be signs of depression.

What causes depression?

There may be a number of reasons why a woman gets depressed. Hormone changes or a stressful life event, such as a death in the family, 114 Emotional Concerns and Pregnancy can cause chemical changes in the brain that lead to depression. Depression is also an illness that runs in some families. Other times, it's not clear what causes depression.

During pregnancy: During pregnancy, these factors may increase a woman's chance of depression: During pregnancy, these factors may increase a woman's chance of depression: * history of depression or substance abuse; * family history of mental illness; * little support from family and friends; * anxiety about the fetus; * problems with previous pregnancy or birth; * marital or financial problems; and * young age (of mother).

After pregnancy: Depression after pregnancy is called postpartum depression or peripartum depression. After pregnancy, hormonal changes in a woman's body may trigger symptoms of depression. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period. Depression after pregnancy is called postpartum depression or peripartum depression. After pregnancy, hormonal changes in a woman's body may trigger symptoms of depression. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period.

Occasionally, levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps to regulate your metabolism (how your body uses and stores energy from food).

Low thyroid levels can cause symptoms of depression including depressed mood, decreased interest in things, irritability, fatigue, difficulty concentrating, sleep problems, and weight gain. A simple blood test can tell if this condition is causing a woman's depression. If so, thyroid medicine can be prescribed by a doctor.

Other factors that may contribute to postpartum depression include: * feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks; * feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother; 115.

Pregnancy and Birth Sourcebook, Third Edition * feeling stress from changes in work and home routines. Sometimes, women think they have to be "super mom" or perfect, which is not realistic and can add stress; * having feelings of loss-loss of ident.i.ty of who you are, or were, before having the baby, loss of control, loss of your pre-pregnancy figure, and feeling less attractive; and * having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with your partner and loved ones.

What are warning signs of depression?

Any of these symptoms during and after pregnancy that last longer than 2 weeks are signs of depression: * feeling restless or irritable; * feeling sad, hopeless, and overwhelmed; * crying a lot; * having no energy or motivation; * eating too little or too much; * sleeping too little or too much; * trouble focusing, remembering, or making decisions; * feeling worthless and guilty; * loss of interest or pleasure in activities; * withdrawal from friends and family; and * having headaches, chest pains, heart palpitations (the heart beating fast and feeling like it is skipping beats), or hyperventi-lation (fast and shallow breathing).

After pregnancy, signs of depression may also include being afraid of hurting the baby or oneself and not having any interest in the baby.

What's the difference between "baby blues," postpartum de- pression, and postpartum psychosis?

The baby blues can happen in the days right after childbirth and normally go away within a few days to a week. A new mother can have sudden mood swings, sadness, crying spells, loss of appet.i.te, sleeping 116 Emotional Concerns and Pregnancy problems, and feel irritable, restless, anxious, and lonely. Symptoms are not severe and treatment isn't needed. But there are things you can do to feel better. Nap when the baby does. Ask for help from your spouse, family members, and friends. Join a support group of new moms or talk with other moms.

Postpartum depression can happen anytime within the first year after childbirth. A woman may have a number of symptoms such as sadness, lack of energy, trouble concentrating, anxiety, and feelings of guilt and worthlessness. The difference between postpartum depression and the baby blues is that postpartum depression often affects a woman's well-being and keeps her from functioning well for a longer period of time. Postpartum depression needs to be treated by a doctor. Counseling, support groups, and medicines are things that can help.

Postpartum psychosis is rare. It occurs in 1 or 2 out of every 1,000 births and usually begins in the first 6 weeks postpartum. Women who have bipolar disorder or another psychiatric problem called schizo-affective disorder have a higher risk for developing postpartum psychosis. Symptoms may include delusions, hallucinations, sleep disturbances, and obsessive thoughts about the baby. A woman may have rapid mood swings, from depression to irritability to euphoria.

What should I do if I show signs of depression during or after pregnancy?

Some women don't tell anyone about their symptoms because they feel embarra.s.sed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry that they will be viewed as unfit parents. Perinatal depression can happen to any woman. It does not mean you are a bad or "not together" mom. You and your baby don't have to suffer. There is help.

There are different types of individual and group talk therapies that can help a woman with perinatal depression feel better and do better as a mom and as a person. Limited research suggests that many women with perinatal depression improve when treated with antidepressant medicine. Your doctor can help you learn more about these options and decide which approach is best for you and your baby. The next section contains more detailed information about available treatments.

Speak to your doctor or midwife if you are having symptoms of depression while you are pregnant or after you deliver your baby. Your doctor or midwife can give you a questionnaire to test for depression 117 Pregnancy and Birth Sourcebook, Third Edition and can also refer you to a mental health professional who specializes in treating depression.

Here are some other helpful tips: * Try to get as much rest as you can. Try to nap when the baby naps.

* Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest!

* Ask for help with household ch.o.r.es and nighttime feedings.

Ask your husband or partner to bring the baby to you so you can breastfeed. If you can, have a friend, family member, or professional support person help you in the home for part of the day.

* Talk to your husband, partner, family, and friends about how you are feeling.