What's more, untreated depression isn't likely to affect only you (and those you're close to), it's also likely to affect your baby's health. Depressed mothers- to-be may not eat or sleep as well or pay as much attention to their prenatal care, and they may be more likely to drink and smoke. Any or all of those factors, combined with the debilitating effects of excessive anxiety and stress, have been linked in some studies to an increased risk of preterm birth, low birthweight, and a lower Apgar score for babies. Treating depression effectively, however-and keeping it under control during pregnancy-allows a mother-to-be to nurture her body and her developing baby.

So what does all this mean for you? It means you might want to think twice (and consult with your physician, of course) before you consider tossing your antidepressants. And in doing your thinking-and your consulting-you and your doctor will also want to consider which antidepressant best suits your needs now that you're expecting, which may or may not be the same one (or ones) you were using preconception. Certain meds are safer than others, and some aren't recommended for pregnancy use at all. Your doctor can give you the most up-to-date information, because it's ever-changing. What is known right now is that Wellbutrin is often a good choice during pregnancy. Prozac, Paxil, Zoloft, and other selective serotonin reuptake inhibitors (SSRIs) carry very little risk to the baby and can therefore also be good choices. Studies do show that pregnant women on Prozac might be somewhat more likely to deliver prematurely, and newborns exposed to Prozac and other SSRIs in the womb may experience short-term withdrawal symptoms (lasting no more than 48 hours), including excessive crying, tremors, sleep problems, and gastrointestinal upset immediately after birth. Still, researchers caution that these risks shouldn't keep pregnant women from taking Prozac (or other SSRIs) if their depression can't be treated effectively in other ways, because untreated depression carries its own risks, many with long-term effects.

Your prenatal practitioner-along with your mental health care provider-will be able to steer you toward the best medications for you during pregnancy, so discuss the options with both of them.

Remember, too, that nonmedicinal approaches can also sometimes help manage depression. Psychotherapy may be effective on its own or in conjunction with medication. Other therapies that can sometimes be helpful when used along with medication include bright light therapy and CAM approaches. Exercise (for its release of feel-good endorphins), meditation (which can help you manage stress), and diet (keeping blood sugar up with regular meals and snacks and getting plenty of omega-3 fatty acids may help give your mood a boost) can also be beneficial additions to a treatment program. Talk to your practitioner and mental health care provider to see if these options have a place in yours.

Diabetes "I'm a diabetic. How will that affect my baby?"

There's lots of good news for pregnant diabetics these days. In fact, with expert medical care and diligent self-care, you have about the same excellent chances of having a successful pregnancy and a healthy baby as any other expectant mom.

Research has proven that the key to managing a diabetic pregnancy successfully-whether the diabetes is type 1 (juvenile-onset diabetes, in which the body doesn't produce insulin) or type 2 (adult-onset diabetes, in which the body doesn't respond as it should to insulin)-is achieving normal blood glucose levels before conception and maintaining them throughout the nine months following it.

Whether you came into pregnancy as a diabetic or you developed gestational diabetes along the way, all of the following will help you have a safe pregnancy and a healthy baby: The right doctor. The OB who supervises your pregnancy should have plenty of experience caring for diabetic mothers-to-be, and he or she should work together with the doctor who has been in charge of your diabetes. You'll have more prenatal visits than other expectant moms and will probably be given more doctor's orders to follow (but all for a very good cause). The OB who supervises your pregnancy should have plenty of experience caring for diabetic mothers-to-be, and he or she should work together with the doctor who has been in charge of your diabetes. You'll have more prenatal visits than other expectant moms and will probably be given more doctor's orders to follow (but all for a very good cause).

Good food planning. A diet geared to your personal requirements should be carefully planned with your physician, a nutritionist, and/or a nurse-practitioner with expertise in diabetes. The diet will probably be high in complex carbohydrates, moderate in protein, low in cholesterol and fat, and contain few or no sugary sweets. Plenty of dietary fiber will be important, since some studies show that fiber may reduce insulin requirements in diabetic pregnancies. A diet geared to your personal requirements should be carefully planned with your physician, a nutritionist, and/or a nurse-practitioner with expertise in diabetes. The diet will probably be high in complex carbohydrates, moderate in protein, low in cholesterol and fat, and contain few or no sugary sweets. Plenty of dietary fiber will be important, since some studies show that fiber may reduce insulin requirements in diabetic pregnancies.

Carbohydrate regulation is typically not as strict as it used to be because fast-acting insulin can be adjusted if you go over your limit at one meal or another. Still, the extent of your carbohydrate restriction will depend on the way your body reacts to particular foods. Most diabetics do best getting their carbohydrates from vegetable, grain (whole is best), and legume sources rather than from fruits. To maintain normal blood sugar levels, you'll have to be particularly careful to get enough carbohydrates in the morning. Snacks will also be important (even more important than they are for the average mom-to-be), and, ideally, they should include both a complex carbohydrate (such as whole-grain bread) and a protein (such as beans or cheese or chicken). Skipping meals or snacks can dangerously lower blood sugar, so try to eat on schedule, even if morning sickness or indigestion are putting a damper on your appetite. Eating six mini meals a day, regularly spaced, carefully planned, and supplemented as needed by healthy snacks, is your smartest strategy.

Sensible weight gain. It's best to try to reach your ideal weight before conception (something to remember if you plan another pregnancy). But if you start your pregnancy overweight, don't plan on using your nine-month stint for slimming down. Getting enough calories is vital to your baby's well-being. Aim to gain weight according to the guidelines set by your physician (slow and steady does it best). Your baby's growth will be monitored using ultrasound, because babies of diabetics sometimes grow very large, even if mom's weight is on target. It's best to try to reach your ideal weight before conception (something to remember if you plan another pregnancy). But if you start your pregnancy overweight, don't plan on using your nine-month stint for slimming down. Getting enough calories is vital to your baby's well-being. Aim to gain weight according to the guidelines set by your physician (slow and steady does it best). Your baby's growth will be monitored using ultrasound, because babies of diabetics sometimes grow very large, even if mom's weight is on target.

Exercise. A moderate exercise program, especially if you have type 2 diabetes, will give you more energy, help to regulate your blood sugar, and help you get in shape for delivery. But it must be planned in conjunction with your medication schedule and diet, with the help of your medical team. If you experience no other medical or pregnancy complications and are physically fit, moderate exercise-such as brisk walking, swimming, and stationary biking (but not jogging)-will likely be on the workout menu. Chances are that only very light exercise (leisurely walking, for instance) will get the green light if you were out of shape prior to pregnancy or if there are any signs of problems with your diabetes, your pregnancy, or your baby's growth. A moderate exercise program, especially if you have type 2 diabetes, will give you more energy, help to regulate your blood sugar, and help you get in shape for delivery. But it must be planned in conjunction with your medication schedule and diet, with the help of your medical team. If you experience no other medical or pregnancy complications and are physically fit, moderate exercise-such as brisk walking, swimming, and stationary biking (but not jogging)-will likely be on the workout menu. Chances are that only very light exercise (leisurely walking, for instance) will get the green light if you were out of shape prior to pregnancy or if there are any signs of problems with your diabetes, your pregnancy, or your baby's growth.

Precautions you may be asked to take when exercising probably won't differ much from safe exercise tips for any pregnant woman: Have a snack before your workout; don't exercise to the point of exhaustion; and never exercise in a very warm environment (80F or higher). If you're on insulin, you'll probably be advised to avoid injecting it into the parts of the body being exercised (your legs, for example, if you're walking) and not to reduce your insulin intake before you exercise.

Rest. Getting enough rest is very important, especially in the third trimester. Avoid overdoing it, and try to take some time off during the middle of the day for putting your feet up or napping. If you have a demanding job, your doctor may recommend that you begin your maternity leave early. Getting enough rest is very important, especially in the third trimester. Avoid overdoing it, and try to take some time off during the middle of the day for putting your feet up or napping. If you have a demanding job, your doctor may recommend that you begin your maternity leave early.

Medication regulation. If diet and exercise alone don't control your blood sugar, you'll likely be put on insulin. If you end up needing insulin for the first time, your blood sugar can be stabilized under close medical supervision. If you were taking oral medication before you conceived, you might be switched to injected insulin or an under-the-skin insulin pump during pregnancy. Since levels of the pregnancy hormones that work against insulin increase as pregnancy progresses, your insulin dose may have to be adjusted upward periodically. The dose may also have to be recalculated as you and your baby gain weight, if you get sick or are under emotional strain, or if you overdo your carbs. Studies show that the oral drug glyburide may be an effective alternative to insulin therapy during pregnancy for some mild cases. If diet and exercise alone don't control your blood sugar, you'll likely be put on insulin. If you end up needing insulin for the first time, your blood sugar can be stabilized under close medical supervision. If you were taking oral medication before you conceived, you might be switched to injected insulin or an under-the-skin insulin pump during pregnancy. Since levels of the pregnancy hormones that work against insulin increase as pregnancy progresses, your insulin dose may have to be adjusted upward periodically. The dose may also have to be recalculated as you and your baby gain weight, if you get sick or are under emotional strain, or if you overdo your carbs. Studies show that the oral drug glyburide may be an effective alternative to insulin therapy during pregnancy for some mild cases.

In addition to being sure your diabetes medication is on target, you'll need to be extremely careful about any other medications you take. Many over-the-counter drugs can affect your insulin levels-and some may not be safe in pregnancy-so don't take any until you check with both the physician who is overseeing your diabetes and the one taking care of your pregnancy.

Blood sugar regulation. You may have to test your blood sugar (with a simple finger-prick method) at least four or as often as ten times a day (possibly before and after meals) to be sure it's staying at safe levels. If you have type 1 diabetes, your blood may also be tested for glycosylated hemoglobin (hemoglobin A1c), because high levels of this substance may be a sign that sugar levels aren't being well controlled. To maintain normal blood glucose levels, you'll have to eat regularly, adjust your diet and exercise as needed, and, if necessary, take medication. If you were insulin-dependent before pregnancy, you may be more subject to low blood sugar episodes (hypoglycemia) than when you weren't pregnant, especially in the first trimester-so careful monitoring is a must. And don't leave home (or go anywhere) without packing the right snacks. You may have to test your blood sugar (with a simple finger-prick method) at least four or as often as ten times a day (possibly before and after meals) to be sure it's staying at safe levels. If you have type 1 diabetes, your blood may also be tested for glycosylated hemoglobin (hemoglobin A1c), because high levels of this substance may be a sign that sugar levels aren't being well controlled. To maintain normal blood glucose levels, you'll have to eat regularly, adjust your diet and exercise as needed, and, if necessary, take medication. If you were insulin-dependent before pregnancy, you may be more subject to low blood sugar episodes (hypoglycemia) than when you weren't pregnant, especially in the first trimester-so careful monitoring is a must. And don't leave home (or go anywhere) without packing the right snacks.

Urine monitoring. Since your body may produce ketones-acidic substances that can result when the body breaks down fat-during this close regulation of your diabetes, your urine may be checked for these regularly. Since your body may produce ketones-acidic substances that can result when the body breaks down fat-during this close regulation of your diabetes, your urine may be checked for these regularly.

Careful monitoring. Don't be concerned if your physician orders a lot of tests for you, especially during the third trimester, or even suggests hospitalization for the final weeks of your pregnancy. This doesn't mean something is wrong, only that he or she wants to be sure everything stays right. The tests will primarily be directed toward regular evaluation of your condition and of your baby to determine the optimal time for delivery and whether any other intervention is needed. Don't be concerned if your physician orders a lot of tests for you, especially during the third trimester, or even suggests hospitalization for the final weeks of your pregnancy. This doesn't mean something is wrong, only that he or she wants to be sure everything stays right. The tests will primarily be directed toward regular evaluation of your condition and of your baby to determine the optimal time for delivery and whether any other intervention is needed.

You will probably have regular eye exams to check the condition of your retinas and blood tests and urine collections every 24 hours to evaluate your kidneys (retinal and kidney problems tend to worsen during pregnancy but usually return to prepregnancy status after delivery if you've been taking care of yourself throughout pregnancy). The condition of your baby and the placenta will likely be evaluated throughout pregnancy with stress and/or nonstress tests (see page 348 page 348), biophysical profiles, and ultrasound (to size up your baby to be sure it's growing as it should be and so that delivery can be accomplished before the baby gets too big for a vaginal delivery). And because there's a slightly higher risk of heart problems in the babies of diabetics, you'll get a detailed ultrasound of the fetal anatomy at 16 weeks and a special ultrasound of the fetal heart (fetal electrocardiogram) at about 22 weeks to make sure everything's going well.

After the 28th week, you may be asked to monitor fetal movements yourself three times a day (see page 289 page 289 for one way to do this, or follow your doctor's recommendation). for one way to do this, or follow your doctor's recommendation).

Because diabetics are at somewhat higher risk for preeclampsia, your doctor will watch you closely for early signs of that condition, too.

Elective early delivery. Women who develop gestational diabetes, as well as women with preexisting mild diabetes that is well controlled, can carry to their due date safely. But when mom's normal blood sugar levels have not been well maintained throughout pregnancy, or if the placenta deteriorates early, or if other problems develop late in pregnancy, her baby may be delivered a week or two before term. The various tests mentioned above help the physician decide when to induce labor or perform a C-section-late enough so the fetal lungs are sufficiently mature to function outside the womb, but not so late that the baby's safety is compromised. Women who develop gestational diabetes, as well as women with preexisting mild diabetes that is well controlled, can carry to their due date safely. But when mom's normal blood sugar levels have not been well maintained throughout pregnancy, or if the placenta deteriorates early, or if other problems develop late in pregnancy, her baby may be delivered a week or two before term. The various tests mentioned above help the physician decide when to induce labor or perform a C-section-late enough so the fetal lungs are sufficiently mature to function outside the womb, but not so late that the baby's safety is compromised.

Don't worry if your baby is placed in a neonatal intensive care unit immediately after delivery. This is routine procedure in most hospitals for infants of diabetic mothers. Your baby will be observed for respiratory problems (which are unlikely if the lungs were tested and found to be mature enough for delivery) and for hypoglycemia (which, though more common in babies of diabetics, is easily treated). You should be able to get your baby back soon so you can start nursing, if that's your plan.

Epilepsy "I have epilepsy, and I desperately want to have a baby. Can I have a safe pregnancy?"

With the right precautions, there could definitely be a healthy baby in your future. Your first step-preferably before you take care of the conception part-is to get your condition under the best possible control, with the help of your neurologist and the doctor you've chosen for your prenatal care. (If you've already conceived, getting that help as soon as possible in your pregnancy is crucial.) For best pregnancy results, close supervision of your condition and possibly frequent adjustment of medication levels will be necessary, as will communication between your doctors.

Most women find that pregnancy does not exacerbate their epilepsy. Half experience no change in their disease, and a smaller percentage find that seizures actually become less frequent and milder. A few discover, however, that their seizures become more frequent and severe.

As for how epilepsy affects pregnancy, expectant moms with epilepsy may be slightly more likely to experience excessive nausea and vomiting (hyperemesis), but they aren't at higher risk for any serious complications. There seems to be a slight increase in the incidence of certain birth defects in the babies of epileptic mothers, but these appear to be more often caused by the use of certain anticonvulsant medications during pregnancy than by the epilepsy itself.

Discuss with your doctor ahead of time the possibility of being weaned from your medications prior to conception. This may be possible if you've been seizure-free for a period of time. If you have been having seizures, it's important to try to get them under control as soon as possible. You will need medication to do this, but it may be possible to switch to a less risky drug than the one you've been taking. Taking one drug appears to cause fewer problems in pregnancy than multidrug therapy and is the preferred way to go. And it's important not to stop taking a necessary medication for fear of hurting your baby; not taking it-and having frequent seizures-may be more dangerous.

Helping Others with Epilepsy For more information on epilepsy and pregnancy, check out epilepsyfoundation.org. To help yourself in the future or help other moms with epilepsy, ask your doctor about registering with the Antiepileptic Drug Pregnancy Registry, (888) 233-2334 or aed pregnancyregistry.org. Their goal is to determine which therapies are associated with an increased risk. You will also receive a packet of information about preconception planning and prenatal care.

A detailed structural ultrasound is recommended for anyone on seizure medicine, and certain early pregnancy screening tests may also be ordered. If you've been taking valproic acid (Depakene), the doctor may want to look specifically for neural tube defects, such as spina bifida.

Important for all pregnant women with epilepsy is getting plenty of sleep and the best nutrition, and maintaining adequate fluid levels. Vitamin D supplements may also be recommended, since some epilepsy medications can interfere with metabolism of the vitamin. During the last four weeks of pregnancy, a vitamin K supplement may be prescribed to reduce the risk of hemorrhage, another condition that babies of women taking seizure medications are at slightly greater risk for.

Labor and delivery aren't likely to be more complicated because of your epilepsy, though it is important that anticonvulsant medication continue to be administered during labor to minimize the risk of a seizure during delivery. An epidural anesthesia can be used to manage labor and delivery pain.

Breastfeeding your baby shouldn't be a problem, either. Most epilepsy medications pass into the breast milk in such low doses that they are unlikely to affect a nursing baby.

Fibromyalgia "I was diagnosed with fibromyalgia a few years ago. How will this impact my pregnancy?"

The fact that you're aware of your condition actually gives you a head start many women don't have. Fibromyalgia, a condition that affects 8 to 10 million Americans each year and is characterized by pain, burning sensations, and achiness in the muscles and soft tissues of the body, often goes unrecognized in pregnant women, possibly because the fatigue, weakness, and psychological stress it causes are all considered normal signs of pregnancy.

Making the Most of Your Meds If you rely on oral medications to control a chronic condition, you may have to do a little adjusting now that you're expecting. For instance, if morning sickness has you down in the first trimester, taking your meds right before going to bed in the evening-so that they can build up in your system before the morning upchucking begins-may keep you from losing most of your medication through vomiting. (Check with your doctor first, because some medications must be taken at certain times of the day.) Something else that you'll have to keep in mind-and that your team of doctors will have to keep an eye on: Some medications are metabolized differently during pregnancy. So the dosage you're used to isn't necessarily the right dosage now that you're expecting. If you're not sure whether your dosing is correct now that you're pregnant, or if you have a hunch you're not getting enough medication-or you're getting too much-let your doctors know.

You're probably already used to being frustrated by fibromyalgia and the lack of available information about it and effective treatment for it. Prepare to become even more frustrated because, unfortunately, there's probably even less known about the effect of pregnancy on fibromyalgia and vice versa. From what is known, there is some substantially good news: Babies born to women with fibromyalgia are not affected in any way by the condition. Beyond that, some recent studies and plenty of anecdotal evidence have suggested that pregnancy can be extra tough on a woman with fibromyalgia. You may feel more tired and stiff and experience aches and pains in more parts of your body than an expectant mom without fibromyalgia (though some lucky women do feel better during pregnancy, so you can definitely hope for that). To keep your symptoms to a minimum, try to reduce the amount of stress in your life as much as possible, eat a well-balanced diet, exercise moderately (but never overdo it), and continue doing safe stretches and conditioning exercises (or yoga, water exercises, and so on) that may have helped you before your pregnancy. Women with fibromyalgia do typically gain 25 to 35 pounds during the first year of having the condition, so that during pregnancy, excessive weight gain can be a problem (not to say that you'll balloon up, but you may have trouble staying within the recommended weight gain guidelines). And since the condition is usually treated with antidepressants and pain suppressants, you'll need to make sure your doctor and prenatal practitioner are in contact with each other and only keep you on medications that are safe for use during pregnancy.

Chronic Fatigue Syndrome Fortunately, having chronic fatigue syndrome (CFS) in no way interferes with having a normal pregnancy and a healthy baby. Unfortunately, that's about all scientists know for sure about the effects of CFS on pregnancy. No studies have been done yet, so the little that is known comes from anecdotal evidence, which tends to suggest that CFS affects different women differently during pregnancy. Some moms-to-be note their symptoms actually improve during pregnancy while others say they get worse. It may be hard to tell, since pregnancy is physically exhausting for all women, even those not dealing with CFS.

If you're pregnant with CFS, it's important that the doctor who has been caring for your condition knows about your pregnancy and the practitioner you've chosen for your prenatal care knows about your CFS. Together, incorporating strategies that have helped you in the past, they will be able to help you cope with your CFS while you're nurturing your baby-to-be.

Hypertension "I've had hypertension for years. How will my high blood pressure affect my pregnancy?"

With more and more older women conceiving, more and more are also conceiving with chronic hypertension, a condition that becomes more common with age. So you've got lots of company (even if you developed your hypertension earlier on in life).

Your pregnancy is considered high risk, which means you'll be putting in more time at the doctor's office and putting more effort into following doctor's orders. But all for a very good cause. With well-controlled blood pressure, and carefully monitored self-care and medical care, you're likely to have the best payoff of all-a safe pregnancy and a healthy baby.

All of the following can help increase the odds of a successful pregnancy: The right medical team. The practitioner who supervises your pregnancy should have plenty of experience caring for mothers-to-be with chronic hypertension and should be joined on your pregnancy care team by the doctor who has been in charge of your hypertension. The practitioner who supervises your pregnancy should have plenty of experience caring for mothers-to-be with chronic hypertension and should be joined on your pregnancy care team by the doctor who has been in charge of your hypertension.

Close medical monitoring. Your practitioner will probably schedule more frequent visits for you than for other expectant mothers and may order many more tests-but, again, that's time well spent. Having chronic hypertension increases your risk of developing preeclampsia during pregnancy as well as some other pregnancy complications, so your practitioner will pay particular attention to your well-being during your 40 weeks. Your practitioner will probably schedule more frequent visits for you than for other expectant mothers and may order many more tests-but, again, that's time well spent. Having chronic hypertension increases your risk of developing preeclampsia during pregnancy as well as some other pregnancy complications, so your practitioner will pay particular attention to your well-being during your 40 weeks.

Relaxation. Relaxation exercises are soothing for every expectant soul, but particularly for those with hypertension. Research has shown that these exercises can actually lower blood pressure. Check out-and practice-the one on Relaxation exercises are soothing for every expectant soul, but particularly for those with hypertension. Research has shown that these exercises can actually lower blood pressure. Check out-and practice-the one on page 142 page 142, or consider using a meditation CD or even taking a class.

Other alternative approaches. Try any CAM techniques recommended by your practitioner, such as biofeedback, acupuncture, or massage. Try any CAM techniques recommended by your practitioner, such as biofeedback, acupuncture, or massage.

Plenty of rest. Since both emotional and physical stress can send blood pressure up, don't overdo anything. Take frequent rest breaks during your day, preferably with your feet up. If you work at a high-stress job, rest might not do the trick-you may want to consider a leave of absence or cutting down on hours or responsibilities until after the baby arrives. If you have your hands full at home with other children, get as much help as you can handling the load. Since both emotional and physical stress can send blood pressure up, don't overdo anything. Take frequent rest breaks during your day, preferably with your feet up. If you work at a high-stress job, rest might not do the trick-you may want to consider a leave of absence or cutting down on hours or responsibilities until after the baby arrives. If you have your hands full at home with other children, get as much help as you can handling the load.

Blood pressure monitoring. You may be asked to keep track of your own blood pressure at home. Take it when you're most rested and relaxed. You may be asked to keep track of your own blood pressure at home. Take it when you're most rested and relaxed.

Good diet. The Pregnancy Diet is a smart place to start, but modify it with the help of your practitioner to fit your needs. Eating plenty of fruits and vegetables, low-fat or nonfat dairy products, and whole grains may be especially helpful in keeping your blood pressure down. The Pregnancy Diet is a smart place to start, but modify it with the help of your practitioner to fit your needs. Eating plenty of fruits and vegetables, low-fat or nonfat dairy products, and whole grains may be especially helpful in keeping your blood pressure down.

Adequate fluid. Remember to drink at least eight glasses of fluid a day, which should help relieve any mild swelling of your feet and ankles. In most cases, a diuretic (a drug that draws fluid from the body and is sometimes used in the treatment of hypertension) is not recommended during pregnancy. Remember to drink at least eight glasses of fluid a day, which should help relieve any mild swelling of your feet and ankles. In most cases, a diuretic (a drug that draws fluid from the body and is sometimes used in the treatment of hypertension) is not recommended during pregnancy.

Prescribed medication. Whether your medications will be changed or not during pregnancy will depend on what you've been taking. Some medications are considered safe for expectant moms; others are not. Whether your medications will be changed or not during pregnancy will depend on what you've been taking. Some medications are considered safe for expectant moms; others are not.

Irritable Bowel Syndrome "I have irritable bowel syndrome and was wondering if being pregnant will make my symptoms worse."

Since pregnancy seems to affect irritable bowel syndrome (IBS) differently in different women, there's no way to predict how it will affect you. Some women report being entirely symptom free while they're expecting; others find their symptoms get somewhat worse during their nine months.

One reason why it's so hard to pinpoint the effect of pregnancy on IBS-and vice versa-is that bowels are almost always impacted (so to speak) by pregnancy. Expectant women are more prone to constipation (a symptom of IBS, too), though some pregnant women find themselves with looser stools more often (also a symptom of IBS). Same for gas and bloating, which typically worsen when you're expecting, whether or not you have IBS. And since the hormones of pregnancy wreak havoc on all parts of the body, even IBS sufferers are left guessing: A woman who is normally diarrhea-predominant might suddenly find herself dealing with constipation, while a woman who is usually stopped up might find it's become easy-too easy-to move her bowels.

To keep your symptoms manageable, stick to the techniques you're used to using to combat IBS during other times in your life: Eat small, more frequent meals (good advice for any pregnant woman); stay well hydrated (ditto); eat a high-fiber diet to improve digestion (double ditto); avoid spicy foods; avoid excess stress; and steer clear of foods or drinks that make your symptoms worse. You might also want to consider adding some probiotics (in the form of yogurt or yogurt drinks with active cultures, or in powder or capsule form) to your diet. They're surprisingly effective in regulating bowel function and they're safe during pregnancy. Check with your practitioner.

Having IBS does put you at a slightly increased risk for premature delivery (so be sure to be alert to any signs of impending preterm contractions; see page 300 page 300). There's also a greater chance you might end up delivering via C-section because of your condition.

Lupus "My lupus has been pretty quiet lately, but I just became pregnant. Is this likely to bring on a flare-up?"

There are still some unknowns about systemic lupus erythematosus (SLE), particularly when it comes to pregnancy. Studies indicate that pregnancy doesn't affect the long-term course of this autoimmune disorder. During pregnancy itself, some women find that their condition improves; other women find it worsens. More confusing still, what happens in one pregnancy doesn't necessarily predict what will happen in subsequent ones. In the postpartum period, there does appear to be an increased risk of flare-ups.

Whether and how SLE affects pregnancy, however, isn't absolutely clear. It does seem that the women who do best are those who, like you, conceive during a quiet period in their disease. Though the risk of pregnancy loss is slightly increased, in general, their chances of having a healthy baby are excellent. Those with the poorest prognosis are women with SLE who have severe kidney impairment (ideally, kidney function should be stable for at least six months before conception). If you have lupus anticoagulant or related antiphospholipid antibody, daily doses of aspirin and heparin may be prescribed.

Because of your lupus, your pregnancy care will include more, and more frequent, tests, medications (such as corticosteroids), and possibly more limitations. But if you, your obstetrician or maternal-fetal medicine specialist, and the physician who treats your lupus all work together, the odds are very much in favor of a happy outcome that will make all that extra effort completely worthwhile.

Multiple Sclerosis "I was diagnosed several years ago as having multiple sclerosis. I've only had two episodes of MS, and they were relatively mild. Will the MS affect my pregnancy? Will my pregnancy affect my MS?"

There's good news for both you and your baby. Women with MS can definitely have normal pregnancies and healthy babies. Good prenatal care, beginning early (and better yet, modifying therapies even before conception), coupled with regular visits to your neurologist, will help you achieve that most wonderful of outcomes. And the good news carries over to childbirth, too. Labor and delivery aren't usually affected by MS, and neither are pain relief options. Epidurals and other types of anesthesia appear to be completely safe for delivering moms with MS.

As for pregnancy's effect on MS, some women experience relapses when they're expecting, as well as in the postpartum period, but most women are back to their prepregnancy condition within about three to six months of baby's arrival. Some women with ambulatory problems find that as weight gain increases during pregnancy, walking becomes more difficult, not surprisingly. Avoiding excessive weight gain may help minimize this problem. The happy bottom line: Whether or not you experience relapses, pregnancy doesn't seem to affect the overall lifetime relapse rate or the extent of ultimate disability.

To stay as healthy as possible while you're expecting, try to minimize stress and get enough rest. Also try to avoid raising your body temperature too much (stay out of hot tubs and too-warm baths, and don't exercise too hard or outside in hot weather). Do your best to fight off infections, particularly UTIs, which are more common during pregnancy (see page 498 page 498 for preventative measures). for preventative measures).

Pregnancy can have some impact on MS treatment. Though low to moderate doses of prednisone are considered safe to use during pregnancy, some other medications used for MS may not be. You'll need to work out a medication regimen with your doctors that's safe for your baby and as effective as possible for you.

After delivery, there's a good chance that you'll be able to breastfeed, at least partially. If breastfeeding isn't an option, either because of the meds you need to take or because it's just too physically stressful, don't worry. Not only do babies thrive on good formula, they always do best when mom's feeling well.

Since going back to work early in the postpartum period may increase both exhaustion and stress-which might exacerbate your symptoms-you may want to consider taking that return slowly, finances permitting. If MS does interfere with your functioning while your child is young, see the next page for tips on baby care for parents with disabilities.

One other note: Many women with MS are concerned about passing the disease on to their children. Though there is a genetic component to the disease, placing these children at increased risk of being affected as adults, the risk is really quite small. Between 95 and 98 percent of children of MS mothers end up MS free.

Phenylketonuria "I was born with PKU. My doctor let me off my low-phenylalanine diet when I was in my teens, and I was fine. But when I talked about getting pregnant, my OB said I should go back on the diet. Is that really necessary?"

A low-phenylalanine diet, which consists of a phenylalanine-free medical formula and precisely measured amounts of fruits, vegetables, bread, and pasta (and which eliminates all high- protein foods, including meat, poultry, fish, dairy products, eggs, beans, and nuts), definitely isn't tasty or easy to follow. But for pregnant women with phenylketonuria (PKU), it's absolutely necessary. Not sticking to the diet while you're pregnant would put your baby at great risk for a variety of problems, including serious mental deficits. Ideally, the low-phenylalanine regimen should be resumed three months before conception, and blood levels of phenylalanine kept low through delivery. (Even starting the diet early in pregnancy may reduce the seriousness of developmental delay in children of mothers with PKU.) And, of course, all foods sweetened with aspartame (Equal or NutraSweet) are absolutely off-limits.

Without a doubt, it'll be tough to return to the diet after so many years of being off of it-but clearly, the benefits to your developing baby will be well worth the sacrifice. If in spite of this incentive you find yourself slipping off the diet, it might help to get some professional help from a therapist who is familiar with your type of condition. A support group of other mothers with PKU may be even more helpful; the misery of such dietary deprivation definitely benefits from the company of those similarly deprived. For more information, check out pkunetwork.org.

Physical Disability "I'm a paraplegic because of a spinal cord injury, and I use a wheelchair. My husband and I have wanted a baby for a long while, and I've finally become pregnant. Now what?"

Like every pregnant woman, you'll need to deal with first things first: selecting a practitioner. And as with every pregnant woman who falls into a high-risk category, your practitioner should ideally be an obstetrician or maternal-fetal medicine specialist who has experience dealing with women who face the same challenges as you do. That may be easier to find than you'd think because a growing number of hospitals are developing special programs to provide women with physical disabilities better prenatal and obstetrical care. If such a program or practitioner isn't available in your area, you'll need a doctor who is willing to learn "on the job" and who is able to offer you and your husband all the support you'll need.

Just which additional measures will be necessary to make your pregnancy successful will depend on your physical disabilities. In any case, restricting your weight gain to within the recommended range will help minimize the stress on your body. Eating the best possible diet will improve your general physical well-being and decrease the likelihood of pregnancy complications. And keeping up your exercise regimen will help ensure that you have maximum strength and mobility when the baby arrives; water therapy may be particularly helpful and safe.

It should be reassuring to know that, though pregnancy may be more difficult for you than for other pregnant women, it should not be any more stressful for your baby. And no evidence indicates an increase in fetal abnormalities among babies of women with spinal cord injury (or of those with other physical disabilities not related to hereditary or systemic disease). Women with spinal cord injuries, however, are more susceptible to such pregnancy problems as kidney infections and bladder difficulties, palpitations and sweating, anemia, and muscle spasms. Childbirth, too, may pose special problems, though in most cases a vaginal delivery will be possible. Because uterine contractions may be painless, depending on the kind of damage to your spinal cord, you will have to be instructed to note other signs of impending labor-such as bloody show or rupture of the membranes-or you may be asked to feel your uterus periodically to see if contractions have begun.

Long before your due date, devise a fail-safe plan for getting to the hospital, one that takes into account the fact that you may be home alone when labor strikes (you may want to plan to leave for the hospital early in labor to avoid any problems caused by delays en route). You'll also want to be sure the hospital staff is prepared for your additional needs.

Parenting is always a challenge, particularly in the early weeks, and it's not surprising that it will be even more so for you and your husband (who will have to be your more-than-equal parenting partner). Planning ahead will help you meet this challenge more successfully. Make any necessary modifications to your home to accommodate child care; sign on help (paid or otherwise) to at least get you started. Breastfeeding, which is usually possible, will make life simpler (no rushing off to the kitchen to prepare bottles and no shopping for formula). Getting your diapers and other baby needs delivered will also save effort and time. The changing table should be tailored for you to use from your wheelchair, the crib should have a drop side so you can take baby in and out easily, and-if you'll be doing all or some of the baby bathing-the baby tub should be set up somewhere that's accessible (daily tub baths aren't a must, so you can sponge baby on the changing table or on your lap on alternate days). Wearing your baby in a carrier or sling will probably be the most convenient way to tote him or her, since it'll leave your hands free (putting it on first thing in the morning will allow you to slide baby in and out as needed). Joining a support group of parents with disabilities (or checking out online groups) will provide lots of comfort and empathy and also give you a gold mine of ideas and advice.

For more information, contact Through the Looking Glass at (800) 644-2666 or online at lookingglass.org; or the National Spinal Cord Injury Association at (800) 962-9629 or online at spinalcord.org.

Rheumatoid Arthritis "I have rheumatoid arthritis. How will this affect my pregnancy?"

Your condition isn't likely to affect your pregnancy very much, but pregnancy is likely to affect your condition-and, happily, for the better. Most women with rheumatoid arthritis (RA) notice a significant decrease in the pain and swelling in their joints during pregnancy, though there is also a somewhat greater risk of temporary symptom flare-up in the postpartum period.

The greatest change you may experience while you're pregnant is in the management of your condition. Because some of the medicines used to treat RA (such as ibuprofen and naproxen) are not safe for use later in pregnancy or at all, your physician will need to switch you over to treatments that are safer, such as steroids.

During labor and delivery, it will be important to choose positions that don't put too much stress or strain on affected joints. Discuss with the physician who manages your arthritis, as well as with your prenatal practitioner, which positions might work best.

Scoliosis "I was diagnosed with mild scoliosis as a teenager. What effects will the curve of my spine have on my pregnancy?"

Thankfully, not much. Women with scoliosis usually go on to have uneventful pregnancies and deliveries, with healthy babies as the happy outcome. In fact, studies have shown that no significant problems occur during pregnancy that could be specifically attributed to scoliosis.

Women with severe curvature of the spine, or those whose scoliosis involves the hips, pelvis, or shoulders, may experience more discomfort, breathing problems, or weight-bearing difficulties during later pregnancy. If you find your back pain increases during pregnancy, stay off your feet as much as possible, take warm baths, enlist your spouse to give you some back rubs, and try the tips on page 237 page 237 for combating back pain. You can also ask your practitioner for the name of an obstetric physiotherapist who may be able to help you with some exercises specific to your scoliosis-related pain. Also discuss which CAM approaches ( for combating back pain. You can also ask your practitioner for the name of an obstetric physiotherapist who may be able to help you with some exercises specific to your scoliosis-related pain. Also discuss which CAM approaches (page 85) might be helpful.

If you think you might want an epidural during labor, talk to your practitioner about finding an anesthesiologist who has experience with moms with scoliosis. Though the condition usually does not interfere with the epidural, it may make it a little more difficult to place. An experienced anesthesiologist, however, should have no problem getting the needle where it needs to go.

Sickle Cell Anemia "I have sickle cell disease, and I just found out that I'm pregnant. Will my baby be okay?"

Not too many years ago, the answer would not have been reassuring. Today, there's much happier news. Thanks to major medical advances, women with sickle cell disease-even those with such related complications as heart or kidney disease-have a good chance of having a safe pregnancy and delivery and a healthy baby.

Pregnancy for the woman with sickle cell anemia, however, is usually classified as high risk. The added physical stress of pregnancy increases her chances of having a sickle cell crisis, and the added stress of sickle cell disease increases the risks of certain complications, such as miscarriage, preterm delivery, and fetal growth restriction. Preeclampsia is also more common in women with sickle cell anemia.

The prognosis for both you and your baby will be best if you receive state-of-the-art medical care. You'll likely have prenatal checkups more frequently than other pregnant patients-possibly every two to three weeks up to the 32nd week, and every week after that. Your care should take a team approach: Your obstetrician should be familiar with sickle cell disease and work closely with a hematologist who's knowledgeable about sickle cell in pregnancy. Though it's not certain whetherit's a beneficial therapy or not, it's possible that you'll be given a blood transfusion at least once (usually in early labor or just prior to delivery) or even periodically throughout pregnancy.

As far as childbirth is concerned, you're as likely as any other mother to have a vaginal delivery. Postpartum, you may be given antibiotics to prevent infection.

If both parents carry a gene for sickle cell anemia, the risk that their baby will inherit a form of the disease is increased. For that reason, your spouse should be tested for the trait early in your pregnancy (if he wasn't before conception). If he turns out to be a carrier, you may want to see a genetic counselor and possibly undergo amniocentesis to see if your baby is affected.

Thyroid Disease "I was diagnosed as being hypothyroid when I was a teenager and am still taking thyroid pills. Is it safe to keep taking them while I'm pregnant?"