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PREGNANCY
by Sr. Anilla Asghar

Women have held an esteemed, respected and pivotal position throughout the history of Islam, and in the Qu’ran God clearly states,

Men are the protectors and maintainers of their women, because Allah (swt) has given the one more strength than the other, and because they support them from their means.
Surah Al Nisa 4:34

We have enjoined on man, kindness to his parents. In pain did his mother bear him, and in pain did she give him birth.
Surah Al Ahqaf 46:15

One of the greatest gifts given to the female body by Allah (swt) is the ability to produce, carry and subsequently raise children. Pregnancy is an amazing period of a woman’s life, albeit a daunting one especially for first time mothers. The following article aims to identify and explain common questions about the pregnant period, and how to ensure the best for both a mother and child.



	Introduction
	What are the common signs of pregnancy?
	What is involved in antenatal care?
	What can I do to safeguard my baby’s health?
	Common problems experienced during pregnancy?.
	Complications of pregnancy

Introduction
The idea of pregnancy may prove frightful for some women, if not all. Every mother wishes to ensure that her child will receive the best possible care whilst inside the womb, and this can be achieved in a number of ways;

By the mother herself – by leading a healthy lifestyle
By the Healthcare Team who provide the ‘Antenatal Care’ scheme
By the family – through support and assistance

Pregnancy usually lasts for a time period of 40 weeks, but this can vary from woman to woman, and is dependent upon a number of factors such as whether the mother smoked during pregnancy or if there is a family history of premature babies etc.

What are the common signs of pregnancy?
To begin with it is important for every individual to recognise the usual signs and symptoms of pregnancy. In the first 10 weeks of pregnancy women may experience any of the following [1];

Absent periods (most common)
Nausea/Vomiting
Increase in the frequency of urination
Increase in temperature
Headaches
Fainting
Sweating

If you have experienced any of the above and you suspect pregnancy, it is best to go to your G.P straight away, where a pregnancy test can easily be conducted; otherwise one may be purchased over the counter at any good pharmacy.

The pregnancy test itself measures the level of a hormone excreted in the urine and produced solely in pregnancy, which is known as Human Chorionic Gonadotrophin (HcG). HcG can be detected in the urine by the 8th day of pregnancy [2]. However the outcome of an early pregnancy test can be affected by medications such asThiazide

Diuretics/Hormones/Steroids/Thyroid drugs, so if you are on any medications it is best to remind your doctor as to what you are taking.

What is involved in antenatal care?
Once it has been confirmed that a woman is indeed pregnant, it is important for that individual to notify and stay in contact with the health professionals responsible for the care of mother and baby, so that they can track progress of the pregnancy. The health professionals who are usually responsible for this care include the local G.P, a community midwife, a health visitor and the occasional visit to the local hospital consultant. These professionals are there to provide the best possible healthcare for mother and baby throughout the pregnancy, in order to ensure the optimum outcome for both. This is commonly known as Antenatal care. During the pregnancy the healthcare team will routinely take histories, perform examinations, screen and assess mother and baby using a variety of methods such as ultrasounds and blood/urine analysis [3].

Below is a table of the typical antenatal schedule:

Visit no.	Gestational (Pregnancy) week	Content of visit
1	8-14	Doctor takes detailed history (personal details/menstrual/ contraception/past medical/past pregnancy details/potential Genetic problems) Examination – Mothers Height/ Weight/Blood Pressure/Breasts/ Pulse/(possibly)Cervical Smear
2	16	Blood Test–Haemoglobin level/ Blood group/Rhesus status/ Hepatitis b/Syphilis/Rubella status and possibly HIV status (The Triple Test which measures the risk of Down’s Syndrome may also be carried out at this stage, as well as Amniocentesis to check for genetic problems- this is left to the mother’s discretion) Urine analysis – checking for levels of glucose/protein/infection. Ultrasound Scan–checking for ovarian cysts, foetal abnormalities & used to date the pregnancy At this point a management plan is drawn up based upon the mother and baby’s risk of being harmed during pregnancy, for example if the mother is diabetic she may be referred to a combined clinic/if there are genetic problems she may be referred to a foeto-maternal specialist
3	20-24	Doctor reviews results from past visits Ultrasound may be offered if mother is at high risk of pre-eclampsia/Intra- Uterine growth retardation) Examination - Maternal weight/Blood Pressure/Abdominal (foetal growth) Urine Analysis Discussion of plans for birth
4	28	Blood Test – Haemoglobin levels and (for Rhesus negative mothers) Rhesus antibody levels
5	36-38	Examination – of Abdomen (foetal growth/presentation/heart rate etc) Maternal Blood pressure/weight Urine analysis Blood test (as visit 4) Discussion-problems with birth place, delivery etc
6	41-42	(Post dates visit) Deciding whether labour should be artificially brought on – to prevent stillbirths)

Ultrasound Scans may be performed at any point if there are any concerns.
It is vital to attend all scheduled appointments so that all concerned are up-to-date with the mother and baby’s progress.

What can I do to safeguard my baby’s health?
Assessing the progress of the baby using the variety of methods described previously is essential in identifying and acting upon any recognised abnormalities. Nevertheless, it is just as critical for the mother to provide the optimum environment in which her baby can develop. This can be achieved in a variety of ways;

DIET - it is very wise to eat foods rich in Folate (spinach, sprouts, asparagus, blackeye beans), and when planning pregnancy to take Folic Acid supplements before conception up until the 13th week of pregnancy, in order to reduce the risk of Neural Tube defects. It is also best to avoid high intake of Vitamin A and Liver [1,3,4]

SMOKING - the disadvantages of smoking are numerous and well known. During pregnancy it is thought that smoking increases the risks of miscarriage/having a small baby/premature labour, as well as having other toxic effects on mother and child

EXERCISE - excessive exercise and build up of heat are best avoided, especially during early pregnancy, as an increase in the mother’s body temperature can increase the risk of neural tube defects. However, moderate physical activity in a healthy woman with a normal pregnancy is beneficial (increases Oxygen capacity and stamina, etc) [2]

MEDICAL HISTORY - it is essential for anyone who already suffers from a medical condition, to control it well, and communicate any problems to the health professional concerned

Common problems experienced during pregnancy
During pregnancy the body undergoes a number of changes in order to accommodate the growing foetus. The mother may therefore experience a number of symptoms, which are perfectly normal in pregnant women.

The most obvious change is that of weight gain, as the womb increases in size. By term (40 weeks) it is usual to put on 1kg of weight [1,3,5]

CARDIOVASCULAR SYSTEM - pulse rate increases by about 15 beats per minute. Many women experience lower leg and ankle swelling due to an increased pressure on the inferior vena cava (a blood vessel which returns blood to the heart). This can be relieved by rest and elevating the legs

GASTROINTESTINAL SYSTEM - heartburn/nausea/vomiting are all common problems, therefore it is best to avoid spicy foods/cigarettes/large meals, as they can all irritate the stomach [1,6]. As the movements of the bowels decrease during pregnancy, constipation may also be encountered. To prevent this a high-fibre diet and increase in fluid intake is suitable.

GENITO-URINARY SYSTEM - as the womb enlarges it places pressure on the bladder, which can increase the urgency and frequency of urination [1,4,6]

RESPIRATORY SYSTEM - a rise in the amount of air inhaled and exhaled is normal, to compensate for foetal demands, breathlessness is also common [ 1,6]

SKIN - some women experience an itch/itchy rashes/increased pigmentation around eyes, cheeks, nipples and lower abdomen. Stretch marks may also become apparent over the lower abdomen as the womb enlarges [1,6]

MUSKULOSKELETAL SYSTEM - Backache is an extremely common symptom, and is most obvious in the lower back, due to the swayed-back posture adopted by most pregnant women. It may be useful to lie on a firm mattress, wear flat shoes and try standing up straight [1]

OTHER CHANGES – it is worth to note that the breasts and nipples also enlarge in preparation of breastfeeding. Headaches, sweating, fainting and palpitations are more apparent in pregnancy, and may be alleviated by upping oral fluid intake and taking more showers. Almost one-third of women experience painful leg cramps (worse at night) in the second half of pregnancy; raising the foot of the bed by 30 cm may help with this complaint [1,3,6]

Complications of pregnancy
It is only to be expected that where there is a major change to the body, the risk of complications is also increased. This can be the case in pregnancy. Although, most pregnancies go without any major problems, some have higher chances of contracting certain conditions. However, with modern-day diagnostic techniques swift action can be taken to control such setbacks during the pregnant period and thereafter.

Below you will find a list of the most common complications

PRE-ECLAMPSIA (Pregnancy-induced Hypertension with Proteinuria) - this condition is defined as a high blood pressure on at least 2 occasions in the second half of pregnancy [2]. It occurs in 5-10% of pregnancies [3,5]. Risk Factors include; Past/Family history of pre-eclampsia, Pre-existing high blood pressure, pre-existing diabetes, age under 20 or over 35 years, past migraine and renal disease [1,3,5,6]. Pre-eclampsia can show no symptoms at all, which is why your blood pressure and urine are routinely checked at antenatal visits. Sympyomatic pre-eclampsia may present with headaches/chest or stomach pain/vomiting/visual disturbances/swelling [1,5]. Treating this condition prevents foetal/maternal illness from the subsequent condition ‘Eclampsia’ where seizures are encountered, or even stroke/heart, liver or kidney failure [1,5,6]. Although women may be given certain medications to control the high blood pressure, delivery is the only cure.

IRON-DEFICIENCY ANAEMIA - in pregnancy the rate of iron-absorption increases by 9 times, to meet foetal demands, therefore it is important for pregnant women to increase their iron-intakes. Anaemia is defined as a haemoglobin level below 11g/dL. Risk factors include; pre-existing anaemia, twin pregnancy and poor diet [1,5,6]. Antenatal screening also routinely measures the haemoglobin levels, in order to identify any anaemic episodes. Treatment usually involves oral iron tablets, however if anaemia is severe, a blood transfusion may be required [1].

GESTATIONAL DIABETES - this is a relatively common disorder, affecting 1-2% of pregnant women. Here the diabetes typically develops toward the last 3 months of pregnancy [3,5]. This is caused by the hormonal changes during pregnancy, which subsequently affect carbohydrate breakdown and usage within the body [3]. Risk Factors include; Family history of diabetes, obesity, past history of unexplained stillbirth, previous baby over 4.5 kg [3,6,7]. Gestational diabetes is associated with large babies, congenital malformation (e.g. Cleft Palate), pre-eclampsia and increased risk of miscarriage. Maternal complications include; coronary artery disease, infection and thromboembolism (blood clots) [3,6,7]. Antenatal checks measure glucose levels in order to pick up any changes which may lead to this condition. If GD is confirmed, the control of the blood-glucose level throughout pregnancy is essential in terms of management, and insulin is usually required, as well as advice from a dietician [1,6,7]. Ultrasound may also be recommended to assess foetal growth [3]. If pregnancy is otherwise ok, normal vaginal delivery is permitted between 38-40 weeks gestation [6,7].

VENOUS THROMBOEMBOLISM – the risk of developing a blood clot in the legs or lungs in pregnancy increases by six-fold [1]. It occurs in approximately 1% of pregnancies, and is the leading cause of maternal death in the U.K, therefore it is vital to recognise the signs and symptoms. Risk factors include; obesity, past history of blood clot, older age (over 35), prolonged immobility, pre-eclampsia. Deep Vein Thrombosis = blood clot in legs, signs and symptoms = calf pain & tenderness, leg swelling; management = giving a drug known as Heparin throughout pregnancy (it breaks up the clot and prevents further clotting) [1,3,7]. Pulmonary Embolism = blood clot in the lung; signs and symptoms = chest pain, coughing up blood, breathlessness, fever, cough; management = Heparin until at least 3 months after the onset of the clot.
In some patients who are at a high risk of developing a clot, Heparin may be given throughout pregnancy [1,6]. In women who are at a low risk, heparin may be administered during labour, C-Section operation, or when inducing labour [1,3].

MISCARRIAGE – unfortunately, 30-40% of pregnancies miscarry (abort), usually in the first 3 months of pregnancy [1]. Risk factors for miscarriage include; smoking, infections (especially those of the genital tract), previous history of miscarriage and previous premature birth [3]. Some women may also miscarry due to physiological incompetencies, e.g. the cervix may be incompetent, there may be abnormalities of the womb, or it may be due to maternal disease (diabetes mellitus/SLE) [1]. Signs and symptoms of miscarriage may be quite vague and include vaginal bleeding (very common), lower abdominal discomfort, backache and generally unwell [3,7]. Sometimes, symptoms may be mild but no foetal products are released, this is known as ‘threatened abortion’ and 75% of cases settle with rest [1]. In other cases, some of the foetal products may be retained and therefore an evacuation procedure may be used to take out the retained tissues, or drugs may be administered to cause contractions of the womb, so that the retained tissues are released.
Miscarriage is obviously a sorrowful event with many women needing time for grieving, and many hospitals now have specialist midwife co-ordinators to deal with such issues, to therefore try and prevent such events in the future.