Search Results for: preeclampsia

Preeclampsia

Melinda was a beautiful, 37 year-old woman who was pregnant with her second baby. After divorcing her first partner, she decided to try IVF with her new partner as she was getting older. Unfortunately, she died in childbirth as a complication of a medical condition called preeclampsia.

So what is preeclampsia, you may ask?

Preeclampsia is a condition seen in pregnant women and it shows the following characteristics:

  • High blood pressure
  • Presence of proteins in the urine
  • Swelling of the legs and hand due to accumulation of fluid in the body.
High blood pressure is one of the symptoms of preeclampsia

Preeclampsia is usually seen at after the 20th week of pregnancy, although it can occur before that.

Some women may also complain of other symptoms like severe headaches, nausea and vomiting, a dramatic weight gain due to increase in body fluid, belly pain and dizziness.

Signs of pre-eclampsia

What are the causes of preeclampsia?

Preeclampsia develops only as a complication of pregnancy. Some studies attribute it to issues with the way the placenta implants to the mother’s womb. There has been no certified reason. However, risk factors include:

Age. If you are quite young (less than 18 years) or older than 35, you have a higher chance of getting it.

Obesity. The risk of preeclampsia is higher if you’re overweight or obese.

Multiple pregnancy. Women carrying more than one baby (twins or more) are at a higher risk of developing preeclampsia.

Interval between pregnancies. If you have less than two years’ interval between your children, or there are are more than 10 years between them, you might be at higher risk.

History of certain conditions. Women with a previous history of diabetes, chronic hypertension are also at higher risk.

New paternity. Like Melinda, each pregnancy with a new partner increases the risk.

First pregnancy. The risk is highest during your first pregnancy.

Race. Black women have been shown to be at higher risk of developing preeclampsia.

History of preeclampsia. If anyone in your family has had pre-eclempsia, there is a chance it might occur again.

Complications

Some complications of preeclampsia include:

  • Fetal growth restriction. Preeclampsia may affect the arteries carrying blood to the placenta. This would lead to a reduction in nutrients reaching the baby and thus, stunted growth of the baby.
  • Preterm birth. Severe preeclampsia is a medical emergency and can lead to preterm. Prematurity can lead to breathing and other problems for your baby.
  • Eclampsia. In severe cases, the woman might progress to eclampsia, which is characterised by seizures
  • Organ damage. Preeclampsia may result in damage to organs like the kidneys, liver, lung, heart, or eyes. It can also cause a stroke or other brain injury. The extent of the damage depends on how severe the preeclampsia.

The earlier it occurs in pregnancy, the greater the risks for mother and child.

Prevention

There is no clear-cut way that has been proven to treat this condition. However, some studies have reported an association between vitamin D deficiency and increased risk of preeclampsia.

Before you become pregnant, it is quite important to be in your best state of health. Also, using your Body Mass Index (BMI), try to attain your optimal weight and make sure other conditions, such as diabetes, are well-managed. Last but not the least, please visit your antenatal clinic as regularly as possible.

ADVANCED MATERNAL AGE: IS GETTING PREGNANT AFTER 35 RISKY?

Pregnancy in women over 35 is referred to medically as “advanced maternal age” (AMA). Today, a large number of children are being born to women in this category. 

Advanced maternal age
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According to a 2014 survey, the number of expectant women giving birth to their first child in their 40s is up to four times more than it used to be. Thus, it is now common for people to start a family when they are over 35 compared to older generations. 

Notwithstanding, the term “advanced maternal age” is used due to the potential risks associated with getting pregnant after the age of 35.

Risks of Advanced Maternal Age

No matter your age, pregnancy carries some level of risk. But as you age, the likelihood of complications increases. This is mostly because you are born with all the eggs you will have throughout your lifetime. 

The older your age, the older your eggs and the greater the risks of abnormalities or complications during pregnancy. Some common risks associated with advanced maternal age include: 

  • low birth weight in the baby
  • premature birth
  • miscarriage
  • Stillbirth
  • postpartum haemorrhage
  • chromosomal abnormalities
  • birth defects
  • labour complications, such as early labour
  • cesarean delivery
  • preeclampsia, a serious form of high blood pressure
  • gestational diabetes
  • multiple pregnancies, such as twins or triplets

The most effective way to lower these risks is to take care of your health throughout the entire process of pregnancy and childbirth. This is especially important if you are planning to get pregnant over the age of 35.

Advanced Maternal Age
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Tips For Advanced Maternal Age

Although getting pregnant at an older age can come with challenges, there are some things you can do to reduce the risk of developing complications. Some of these include:

  • Taking prenatal vitamins containing folic acid
  • Choosing the right healthcare team for you
  • Managing underlying health conditions before getting pregnant
  • Take advantage of additional check-ups and tests
  • Eat a healthy nutrient-dense diet
  • Exercise regularly and maintain a healthy weight
  • Avoid substances like alcohol, tobacco, and narcotics
  • Explore the option of preconception testing
  • Seek informed consent on labour induction
  • Find ways to relax and manage stress

When Should You Talk to Your Doctor?

It’s recommended you visit your healthcare provider before attempting to conceive if possible. They can assist you in taking the initial steps towards having a healthy baby.

Geriatic Pregancy
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When you get pregnant, be prompt about seeking antenatal care. Consult your healthcare provider for advice on how to ensure you have the best chance of having the healthiest pregnancy possible.

Take Home Message

The health of your pregnancy is not dependent on your age alone. However, if you plan to have a baby over the age of 35, you should consult your healthcare provider. To ensure you are having a safe pregnancy, your healthcare provider may probably advise some additional monitoring throughout your pregnancy.

Due to your age, you may have concerns about having a difficult pregnancy, labour, or delivery. These concerns are very valid. However, be rest assured that women who are above 35 can still have healthy pregnancies.

Intrauterine Pregnancy: Process, Confirmation and Complications

An intrauterine pregnancy (IUP), or uterine pregnancy, occurs when a fertilized egg implants and begins to develop within the uterus, where it should be. This is really important because pregnancy can only develop and progress to full term in the uterus.

In this article, you’ll learn all there is to know about intrauterine pregnancy; the process, confirmation, and possible complications.

Keep reading.

Intrauterine Prengancy

An intrauterine pregnancy discovered via ultrasound indicates that the pregnancy is developing in the proper location.

after pains

Early pregnancy symptoms, such as abdominal or pelvic pain and vaginal bleeding, should be investigated to determine the location of the pregnancy and rule out any complications. Ectopic pregnancies develop elsewhere in the female reproductive tract (cervix, ovary, fallopian tubes) and are not viable, meaning they will not result in the birth of a child.

You can also read this post to learn more about ectopic pregnancy.

 Intrauterine pregnancy is the desired conception outcome for most couples wishing to have a child. However, it is vital to understand the various stages of intrauterine pregnancy and its potential risks.

Process of intrauterine pregnacy 

Intrauterine pregnancy begins when the ovary releases a mature egg during ovulation and this egg travels through the fallopian tube toward the uterus. If the egg is fertilized by a sperm cell during this journey, it forms a zygote, which then travels down the fallopian tube and implants in the lining of the uterus.

embryo transfer

This implantation usually occurs around 6-10 days after fertilization.

The embryo’s development characterizes the early stages of intrauterine pregnancy. The first two weeks after implantation are known as the germinal stage, during which the zygote divides and forms a ball of cells known as a blastocyst. The blastocyst then implants more deeply into the uterine lining, forming the placenta and embryonic tissues.

At around five weeks of gestation, the embryo develops a heartbeat and takes on a recognizable human form. This is also when the placenta starts to produce hormones that support the pregnancy, such as human chorionic gonadotropin (hCG). Over the next few weeks, the embryo develops various organ systems, including the central nervous, heart, lungs, and digestive systems.

Intrauterine pregnancy is typically monitored through regular prenatal care, which includes regular check-ups with an obstetrician or midwife and various diagnostic tests to assess the health of the mother and the developing fetus. One of the most common tests used to monitor intrauterine pregnancy is an ultrasound, which uses sound waves to create images of the developing fetus and can detect any potential abnormalities.

How to confirm an Intrauterine pregnancy 

Using specific tests, it is possible to confirm an intrauterine pregnancy. One of the most common and widely used tests for confirming an intrauterine pregnancy is ultrasound. The following tests can confirm an intrauterine pregnancy:

Fetal Heart Activity

Examining fetal heart activity is another way to confirm an intrauterine pregnancy. After 6 weeks of pregnancy, fetal heart activity is visible. The heart rate of a fetus increases every week, and the average heart rate ranges from 100 to 120 beats per minute.

intrauterine pregnancy

A visible Yolk Sac

With a transvaginal ultrasound, it is possible to identify a visible yolk sac at about the 5th week of gestation. This yolk sac provides nutritional support to the developing embryo until the placenta forms.

Complications that can occur in intrauterine pregnancies 

While intrauterine pregnancies are generally safe and normal, specific risks and complications can arise.

Some of these complications include:

1. Miscarriage

This is one of the most common complications of intrauterine pregnancy. A miscarriage occurs when the developing fetus stops growing or dies before the 20th week of gestation.

Although miscarriages often result from chromosomal abnormalities, they may also arise due to maternal health conditions such as diabetes, thyroid disorders, or infections.

2. Preterm Labor

This is another potential complication of intrauterine pregnancy, which occurs when the mother enters labor before the 37th week of pregnancy. Preterm labor can also increase the risk of complications for the developing fetus. Some of the fetal complications of preterm labor include respiratory distress syndrome and neurological problems.

3. Intrauterine Growth Restriction (IUGR)

Intrauterine growth restriction (IUGR) is a condition where the developing fetus is smaller than expected for its gestational age. IUGR can occur for various reasons, including maternal health problems, placental problems, and genetic abnormalities. IUGR can increase the risk of complications for the developing fetus, including respiratory distress syndrome and neurological problems.

4. Preeclampsia

Preeclampsia is a potentially life-threatening complication of intrauterine pregnancy that occurs when the mother develops high blood pressure and protein in her urine after the 20th week.

Causes of complication during intrauterine pregnancy 

Several factors can increase the likelihood of complications during intrauterine pregnancy. These include advanced maternal age, pre-existing health conditions such as hypertension or diabetes, and lifestyle factors such as smoking or drug use.

To minimize the risks of intrauterine pregnancy, women need to receive regular prenatal care and make lifestyle changes such as quitting smoking and avoiding alcohol and illicit drugs. Prenatal vitamins, a healthy diet, and regular exercise can also help promote a healthy pregnancy.

The Takeaway

In cases where complications do arise, there are various treatments and interventions that can be used to improve outcomes. For example, women who are at high risk of preterm labor may be prescribed medications such as progesterone to help prevent early delivery.

In cases where the developing fetus has a medical condition or abnormality, doctors may recommend additional testing or procedures such as amniocentesis or fetal surgery.

Finally, it always helps to remember that your doctors and healthcare professionals are always available to help you through every step of this journey.

You are not alone.

Energy Drinks During Pregnancy – Is It safe?

The pregnancy period can be all shades of amazing. You are happy and patiently waiting for the arrival of your baby. That is not to say that there are no days when you’ll be down. During pregnancy, you may have work piled up for you and your baby just wants you to rest. On days like this, energy drinks may be one of the options on your mind.

Energy drinks during pregnancy

First, What Are Energy Drinks?

Energy drinks contain stimulants such as caffeine that can keep you going all day. They help you stay awake and active. Now that you are pregnant, energy drinks should no longer be your go-to drink for “energy.”

Why is this so? What are the risks associated with taking energy drinks during pregnancy? Can energy drinks affect your pregnancy test results? Will energy drinks affect your baby?

You will find answers to these questions as you continue reading this article.

What is contained in energy drinks?

Energy drinks are so called because they contain substances that can stimulate the body. They have the capacity to increase energy, maintain mental alertness and also increase physical performance.

Substances contained in energy drinks include:

  • Caffeine
  • Carbonated water
  • Sugar
  • Artificial sweetener
  • Certain herbs

Caffeine is a stimulant that can be addictive. Some energy drinks contain these ingredients in excess amounts. This can have a detrimental effect on you and your baby during pregnancy.

Energy drinks during pregnancy

Risks associated with taking energy drinks during pregnancy

It is advisable to avoid energy drinks during pregnancy. This is due to the high amount of caffeine and other ingredients used to make the drink. Are you wondering how this impacts your health and that of your baby?

Keep reading.

Most of the time, you’re taking energy drinks to stay awake and to boost your energy level. Sadly, excess caffeine in your body has the potential to raise your blood pressure and your heart rate. When taken in excess, caffeine can cause psychosis, seizures, and irregular heartbeat. It can also make you irritable, nervous, and sleepless.

You can also read this post about healthy Starbucks drinks for pregnant women.

Caffeine during pregnancy does not affect you alone, it affects your baby too. The excess amount of caffeine content in energy drinks can result in preterm delivery and other pregnancy complications.

In Addition,

Caffeine has stimulant and diuretic properties. Hence, it can increase the frequency at which you urinate. This causes the fluid level in your body to drop and can lead to dehydration. Take a moment to understand the causes of increased urination during pregnancy.

Energy drinks during pregnancy

Furthermore, caffeine also has the capacity to cross the placenta and get to the system of your developing baby. At this stage, your baby does not have the necessary enzymes needed to break down caffeine. Even if the amount of caffeine you consume is tolerable for you, it may not be for your baby.

In large doses, caffeine can disrupt your baby’s sleep pattern. This can make both of you restless. It can also affect the typical movement of your baby in the third trimester.

Apart from caffeine, energy drinks also contain high amounts of sugar. This high amount of sugar can put you at risk of gestational diabetes and preeclampsia. It can also affect your baby’s health by causing some congenital disabilities. Sadly, most energy drinks do not specify the amount of sugar contained in each drink. The fact is simple: you may not know the exact amount of sugar you are consuming daily.

Energy drinks also contain some herbs which are said to be health-promoting supplements. These herbs are advised to be taken with caution during pregnancy. This is because even though they may be helpful to the body, too many of them can have adverse effects on the body during pregnancy.

Can energy drinks affect pregnancy test results?

The ingredients contained in energy drinks cannot directly affect your pregnancy test result. However, they have an indirect effect on the test result.

A pregnancy test result is determined by the concentration of the hormone, hCG (human chorionic gonadotropin). HCG is produced following the implantation of your developing baby into the wall of the uterus. It can be detected in the urine about two weeks after conception has taken place.

Energy drinks can slightly affect your pregnancy test result when you consume them in large amounts. Usually, a pregnancy test is done in the morning when the concentration of hCG is expected to be high. However, the caffeine contained in the drink makes you urinate more since it is a diuretic, thereby affecting the concentration of hCG in the urine, and producing an inaccurate result.

However, if you think you may be pregnant and the test keeps giving you a negative result, it is good for you to check with your healthcare provider.

Which energy drinks are good for pregnancy?

Now that we’ve struck off energy drinks as a safe energy source during pregnancy, does this mean there’s no reliable way to boost energy levels during pregnancy?

Not Really.

Safer options to consider include:

1. Go for Drinks Rich In Protein and Complex Carbohydrates

It is good for you to stay hydrated during pregnancy, but it does not have to always be water. Simple carbohydrates cause an early rise in blood sugar level after eating, As time goes on and digestion progresses, this blood sugar level crashes.

Energy drinks during pregnancy

On the other hand, complex carbs and proteins do not do this. They break down slowly, ensuring you have a good supply of energy until your next meal. Some of the proteins you can go for include smoothies, milk, nuts, or seeds.

2. Go For Low Sugar Juices

Thankfully, with the right juice blend, you can stay hydrated and boost energy levels during pregnancy. All you’ve got to do is ensure that the sugar content is very low. To increase your fiber intake, you can add the pulp of these fruits (like oranges) to the juice.

3. Whole Fruit Juices

Another reliable option to try during pregnancy is whole fruit juices. This is because they contain the right blend of vitamins, minerals, and sugar you need to meet the ever-changing energy demands during pregnancy.

Conclusion

It is very important to reduce fatigue and tiredness during pregnancy. Asides from taking these energy drinks, you can also cultivate healthy living habits by having enough rest. Take a nap and sleep well at night. This will help you stay healthy and active during the day.

If you are usually tired and fatigued, it may be a sign of anemia. You would do well to see your health care provider for an appropriate check-up.

We are always here to lend a helping hand.

Can Pregnant Women Eat Bacon? Is It Safe?

Pregnancy comes with a lot of caution, especially if you’re a first-time mom. Like many other pregnant women, you’ll receive a lot of advice and tips on what you eat, like bacon, and the things you do, like regular exercise. This is for your health and also for the health of the new life growing inside you.

In fact, bacon may be one of the many things you may be counseled not to eat. You may be reading this article now because someone told you to avoid bacon now that you’re expecting your baby.

Really, should you avoid bacon as a pregnant woman? You will find the ultimate answer to that question in this article.

You will also get to know what bacon is, the health benefits of eating bacon, why it is discouraged for pregnant women, the safety of bacon during pregnancy, and how to cook bacon properly.

What is bacon?

Bacon is meat gotten from the side of a pig after the spare ribs have been removed. Sometimes, it is taken from the thigh part of the pig, which is leaner meat. The meat is then cured, dried, or pickled and then smoked.

Bacon is generally sold in two major styles; slab and sliced (regular sliced, thin sliced, thick sliced, and ends and pieces). After the slab of bacon is taken from the pig’s side or belly, it is cured for 10–14 days under refrigeration and then cooked and smoked. One side of the meat is usually covered with skin, and it contains streaks of fat and lean meat. The sliced bacon is cut from the slab and does not contain any skin.

Bacon is generally enjoyed for its smoky flavor and it is usually eaten with eggs.

Can Pregnant Women Eat Bacon

What are the health benefits of eating bacon?

Bacon contains an extremely high amount of fat. It is not really nutritious meat as it doesn’t provide your body with many nutrients. The few nutrients bacon does provide can be gotten from less processed meats. The processing of bacon makes it contain high amounts of sodium and nitrite. These substances are not good for your health, whether you’re pregnant or not.

Why is bacon discouraged for pregnant women?

Bacon is not one of the best meats to eat while you’re pregnant. Some of the reasons it is discouraged include:

1. High risk of contamination

As a pregnant woman, you are at a higher risk of food infection from poorly processed foods. This is due to the reduced immune function that comes with pregnancy. Furthermore, raw meat can serve as a breeding ground for some pathogens. When they are not properly handled or cooked, they can result in food poisoning.

Some of the pathogens that may be present in raw meat, including pork are:

  • Staphylococcus aureus
  • Listeria monocytogenes
  • Yersinia enterocolitica
  • Salmonella
  • Toxoplasmosis gondii

Some of these bacteria can still continue to grow, even in the refrigerator! Fortunately, they can be killed under high heat. This is why you should properly cook your meat before eating it. Failure to thoroughly cook your meat during pregnancy can result in infection. These infections can cause miscarriage, stillbirth, premature delivery, and infection in the newborn baby.

Can Pregnant Women Eat Bacon

2. High nitrates and nitrites content

Processed meats like bacon are preserved by the addition of chemicals known as nitrates and nitrites. The mixture of these chemicals gives bacon its bright red color; bacon would naturally turn brown in the absence of these chemicals.

A build-up of nitrates and nitrates in the body during pregnancy puts you at risk of preterm delivery. Preterm delivery can sometimes cause serious health complications for the baby.

Also, nitrates and nitrites are classified as highly carcinogenic substances (cancer-causing substances). This effect is increased in pregnant women due to their low immunity. High nitrates and nitrites in food also put the baby at risk of childhood cancers, brain tumors, and autism.

3. High Fat Content

Bacon is a kind of red meat, and all red meats are high in saturated and unsaturated fats. Fat is an essential nutrient for everyone. It helps to absorb and use other nutrients, like vitamins. All fats are needed by the body (in different proportions) for effective functioning. During pregnancy, your body needs fat to help nourish and develop your baby.

Bacon contains a very high amount of fat without providing so much of other nutrients. This can lead to a high cholesterol level in the body. If you have high cholesterol or heart disease, you should steer clear of bacon. Also, if you are at risk of preeclampsia, it is best to avoid bacon until your baby is born.

4. High sodium content

Highly processed foods like bacon contain a very high amount of salt and other additives. Consistent consumption of bacon during pregnancy will lead to a buildup of sodium, which is not good for your blood pressure.

Can Pregnant Women Eat Bacon

When is bacon safe during pregnancy?

For bacon to be safe during pregnancy, it must be properly stored, cooked, and handled. It must also be void of bacteria. If you want to eat bacon to satisfy your pregnancy cravings, it is best if you prepare it yourself.

Other tips to ensure your bacon is safe include:

  • Store the bacon in the refrigerator as soon as you buy it.
  • Wash your hands thoroughly before touching the raw meat and after you have handled it in hot, soapy water.
  • Ensure that all your cooking utensils are also properly washed to avoid cross-contamination.
  • Cook the bacon under high heat. The heat will help to kill any bacteria that may be present. Also, cook the bacon until it is crispy.

Conclusion

It is best to avoid bacon during pregnancy.

This is because you really can’t tell when the bacteria are all gone or when the nitrates are too much. Staying off bacon for nine months is a big sacrifice, but it is worth it. By so doing, you and your baby will not be exposed to any threat that may be as a result of eating bacon. Apart from bacon, you should do away with highly processed foods, especially during pregnancy.

Fetal distress: All You Need To Know

As you anticipate and prepare for the big day when your baby will come, there are some unplanned processes that may come up. Labor can be long and very uncomfortable such as induced labor. Sometimes, it may bring with it some risks and threats to you, your baby, or both of you. One of these risks is fetal distress.

When your baby is in distress during labor, it is a sign that he or she is not coping well and your doctor needs to speed things up in order to save you and your baby.

This article provides you with all the info you need to have about fetal distress is; the causes, risk factors, complications, and the next steps to take.

What is fetal distress?

Fetal distress is also called “non-reassuring fetal status.” This rare complication is often associated with labor. However, it may also occur during pregnancy. It is a sign that your baby is not getting enough oxygen through the placenta.

Fetal Distress

Loss or reduction in the amount of oxygen supplied to your baby can lead to a reduced heart rate for your baby in the womb or during delivery. This always requires urgent medical attention. Most times, surgery is the best possible option.

If your baby does not get sufficient oxygen, he or she can end up breathing in amniotic fluid which contains meconium. (Meconium is the waste product or feces of your child produced while in the womb). This can make breathing difficult for your baby after delivery, and in some bad cases, he or she may not breathe at all.

What Causes Fetal Distress?

The commonest cause of fetal is distress is a disruption in the supply of oxygen to the baby due to problems associated with the placenta or the umbilical cord. Problems of the placenta include placenta insufficiency or placenta abruption. Sometimes, umbilical cord compression may also cause fetal distress.

In addition, underlying health conditions such as uncontrolled diabetes, problems with the kidneys, or liver disease may also lead to fetal distress. Furthermore, studies have shown that overdue pregnancies and prolonged labor also cause fetal distress in most women.

Other times, too strong or too close contractions during labor can also be a precipitating factor for fetal distress. Other major causes of fetal distress include:

  • Preeclampsia.
  • Placenta abruption.
  • Intrauterine growth restriction (IUGR).
  • Lying flat on your back for a long period of time during labor. This eventually puts pressure on your big and major arteries, cutting off the supply of blood, and ultimately, oxygen, to your baby.
  • Excess amount of amniotic fluid.
  • Insufficient amount of amniotic fluid.
Fetal Distress Image

Risk Factors for Fetal Distress

Your baby is at risk of experiencing fetal distress if:

  • There’s a long or complicated labor.
  • The pregnancy is overdue.
  • You have preeclampsia.
  • There is a history of uncontrolled diabetes.
  • You have excess or insufficient amniotic fluid.
  • Your baby has intrauterine growth restriction.
Fetal Distress Baby at Risk
  • There’s a problem with the placenta.
  • You have had a stillbirth before.
  • You have a multiple pregnancy (i.e., being pregnant with more than one baby at a time).
  • There’s a problem with the umbilical cord.
  • You smoke.
  • You are obese.
  • If you have an underlying chronic disease like kidney problem.

Diagnosing fetal distress

To diagnose fetal distress, the baby’s heart rate must be read.

A slow heart rate or a heart rate with an unusual pattern is a pointer to fetal distress. Fetal distress can also be picked sometimes during routine antenatal checkups. This is done when your doctor or midwife listens to your baby’s heart during pregnancy.

During labor, your baby’s heart rate is usually monitored to check for signs of fetal distress.

Diagnosing Fetal Distress

Fetal distress can also be diagnosed if there is meconium in the amniotic fluid. A greenish or brown-colored amniotic fluid suggests the presence of meconium in the amniotic fluid which can lead to fetal distress.

What Can Be Done if Your Baby is in Distress?

Before labor,

  • If you notice a change in the movement or kick count of your baby, you need to call your doctor.
  • If your water breaks and it is greenish or brownish in color, you need to go to the hospital immediately. It is a sign that that amniotic fluid is stained with meconium already.

During labor,

  • You will be placed on a fetal monitor to check the activities of your baby and to know whether he or she is in distress.
  • If your doctor or midwife notices your baby is in distress, you will be given oxygen and some IV fluids.
  • Also, you may be asked to change or move position by turning to another side. This can help to reduce the baby’s distress.
  • Labor-inducing drugs like oxytocin may be withrawn in cases of fetal distress.
  • If your labor is natural, you may be given drugs to reduce your contractions because contractions that are too strong can cause fetal distress.
  • If these methods above do not work, your doctor or midwife may need to assist your delivery. This is because a baby in distress has to be born quickly. This can be achieved via assisted delivery with the use of a forceps or vacuum extractor or you may need to undergo an emergency cesarean section.

Complications of fetal distress

Although fetal distress can be managed adequately, babies who experience it are at risk of greater complications after birth. The complications can also result from the cesarean section or the assisted delivery process used. Some of these complications are:

  • Injury to the brain due to lack of oxygen supply.
  • Cerebral palsy.
  • Loss of blood by the mother during cesarean section.
  • Infections.
  • Mild difficulty in feeding
  • Jaundice which is usually short-term
  • Sometimes, still birth.

Conclusion

Every pregnancy is different and each comes with its own peculiarities. That your baby experienced distress in this pregnancy does not mean babies in subsequent pregnancies will suffer the same.

You can speak with a counselor or your doctor if you are traumatized by your experience during your previous pregnancy.

References

Parer, J. T. and Livingston E. G. (1990). What is fetal distress? American Journal of Obstetrics and Gynecology. Jun;162(6):1421-5; discussion 1425-7. Accessed on 7th January, 2022 from https://doi.org/10.1016/0002-9378(90)90901-I

Suresh Tharmaratnam (2000). Fetal distress. Best Practice & Research Clinical Obstetrics & Gynaecology. Volume 14, Issue 1, February 2000, Pages 155-172. Accessed on 7th January, 2022 from https://doi.org/10.1053/beog.1999.0069

Importance of Sex During Pregnancy: 12 Helpful Benefits

Sex may be the last thing on your mind during pregnancy. Most times, this is a function of the hormonal and physical changes in this period. However, sex is a great way to maintain a strong emotional and physical relationship with your partner during pregnancy. In addition, it also has important benefits for you and your baby!

In this article, you’d find more truths about sex during pregnancy, the benefits of having sex while pregnant, and how to stay safe while at it.

Is it safe to have sex during pregnancy?

Yes, it is safe to have sex during pregnancy.

However, it is important to get your doctor’s approval first. This is just to ensure you wouldn’t have any complications later. This is also important if you have any history of miscarriage or you’re at risk for one. In that case, you’d be advised to stay off sex, especially for the first few months of pregnancy.

Benefits of Having Sex During Pregnancy

Pregnancy sex provides numerous benefits for every would-be-mom. Some of the benefits are physiological and some are emotional. Some of these benefits are discussed below:

1. Better Orgasms

The release of the two main pregnancy hormones, oestrogen and progesterone, help you experience better orgasms that last longer and are stronger during pregnancy. Furthermore, increased oestrogen levels lead to more blood flow to the pelvic area, making you more aroused.

Importance of sex during pregnancy: couple in bed

2. Sex Improves Sleep

Rest is really important while expecting.

Thankfully, sex during pregnancy helps you relax and provides you with good sleep. This is actually due to increased oxytocin levels.

3. Improved Immunity

Here’s the fact: Pregnant women experience a dwindling immunity. As a result, doctors recommend a healthy diet and lifestyle to make sure you don’t fall ill in this period.

Interestingly, sex plays an important role in strengthening your immunity.

Studies show that sexual activity during pregnancy increases the level of IgA antibodies that improve your immunity and provide resistance to cold and flu which are common during pregnancy.

4. Sex Lowers Blood Pressure

The hormones released post-orgasm help your body attain a relaxed state, and this, in turn, lowers your blood pressure. However, this does not reduce the risk of preeclampsia.

Importance of sex during pregnancy: Pregnant woman checking blood pressure

It is very important for you to consult your doctor in cases of preeclampsia.

5. Sex Strengthens Your Pelvic Floor Muscles

In the third trimester, sex strengthens your pelvic floor muscles. Regular sex at this time helps to keep these muscles toned and strong in preparation for the great deal of work they’ll do during vaginal delivery.

6. Sex Reduces Bathroom Leaks

Frequent urination is a normal part of pregnancy. In fact, you may even leak some pee when you sneeze or laugh. This is because as your pregnancy progresses, your baby gets bigger and presses on your bladder. Sex helps to contract your muscles and make them strong.

Importance of sex during pregnancy: woman wit tissue in toilet

The beautiful part is that the muscles you will be strengthening for labour are the same you use to pee. This helps to regulate your flow of urine.

7. It Improves Bonding With Your Partner

During pregnancy, having sex helps to release endorphins, the hormones that reduce stress levels. This provides a healthy environment for you and your baby.

Sex during pregnancy also increases the production of oxytocin, a hormone responsible for love and emotional attachment. This helps to build a better bond between you and your partner and also help in the complication-free progression of your pregnancy and labour.

8. Sex Prepares You for Labour

If you’re full-term already or past your due date, having sex prepares your body for childbirth. This is because semen also contains prostaglandins which help to ripen your cervix.

9. It Induces Labour and Easy Delivery

Regular sex during pregnancy helps to contract your pelvic muscles and open your cervix. This helps in vaginal delivery, making the process of labour easier. In fact, some doctors encourage regular sex close to your due date to help induce labour.

10. It accelerates postpartum recovery

Orgasms during sex while pregnant prepares your pelvic floor muscles for childbirth, this, in turn, helps to speed up your postpartum recovery. Indulging in sex helps to contract your pelvic muscles.

11. Sex Improves Self-esteem

During pregnancy, your body may feel like it’s not your own. You may feel less attractive and sometimes, older. This is because of the many physical changes you are experiencing. Having regular sex can help restore your body confidence and positive feelings about yourself. It helps to make a difference in how you see yourself and how others see you too.

12. It Helps Blood Circulation

During pregnancy, your blood supply doubles to meet your needs and the needs of your growing baby. Sex helps to increase your blood circulation during pregnancy.

When Is Sex Not Safe During Pregnancy?

Depending on your situation, your doctor may restrict you from having sex while you’re pregnant. This can be for the full nine months or for a certain period of time. Some of the reasons for this restriction include but are not limited to:

  • Vaginal bleeding, discharge or cramping of unknown cause
  • Leakage of amniotic fluid
  • Diagnosis of an incompetent cervix or placenta previa
  • History or symptoms of preterm labour or premature birth
  • Multiple Pregnancy (i.e. twins, triplets, etc)

It is also advisable to avoid sex if you’re having contractions or if your water has broken.

Conclusion

Sex is good for you and your baby during pregnancy. Engage in regular sexual activity during pregnancy to help you maintain good health and also to prepare you for your delivery process.

Nothing stops you from having a good time, Mama

References

Mahboobeh Kafaei Atrian, Zohre Sadat, Mahbobeh Rasolzadeh Bidgoly, Fatemeh Abbaszadeh, and Mohammad Asghari Jafarabadi (2015). The Association of Sexual Intercourse During Pregnancy With Labor Onset. Iranian Red Crescent Medical Journal. Accessed on 11th August, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341500/#__ffn_sectitle

Shiva Alizadeh, Hedyeh Riazi, Hamid Alavi Majd and Giti Ozgoli (2021). The effect of sexual health education on sexual activity, sexual quality of life, and sexual violence in pregnancy: a prospective randomized controlled trial. BMC Pregnancy and Childbirth. Accessed on 11th August, 2021 from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03803-8

Anna Fuchs, Iwona Czech, Jerzy Sikora, Piotr Fuchs, Miłosz Lorek, Violetta Skrzypulec-Plinta, and Agnieszka Drosdzol-Cop (2019). Sexual Functioning in Pregnant Women. International Journal of Environmental Research and Public Health. 2019 Nov; 16(21): 4216. Accesed on 11th August, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862185/#__ffn_sectitle

Singleton Pregnancy: All You Need To Know

Each pregnancy is unique for every woman; from the symptoms to the duration, and even the number of growing babies. Although it is less common, it is possible to have more than one baby growing in your uterus at the same time. In this article, we’d walk you through the commoner alternative; a singleton pregnancy.  

Read on to learn more.

What’s A Singleton Pregnancy?

In plain terms, a singleton pregnancy means being pregnant with only one baby at a time. It is the direct opposite of a multiple pregnancy, which occurs when a woman is expecting more than one baby in the same pregnancy.

A woman with a singleton pregnancy

Are Singleton Pregnancies More Common?

Yes.

Medical studies show that singleton pregnancies are more common than multiple pregnancies. In fact, the American Pregnancy Association postulates that there are only about 32.6 multiples per 1,000 births per year in the United States.

This means that you’re 96.74% more likely to have a singleton pregnancy.

However, it is important to remember that any of the following factors can increase the possibility of having a multiple pregnancy:

  • Age
  • Genes
  • Fertility Treatments

Antenatal Care for Singleton Pregnancies

Proper antenatal care is an important part of pregnancy, even for singleton pregnancies.

This is a form of essential healthcare with the ultimate aim of ensuring a healthy pregnancy, labor, and delivery for both mother and child.

Regular antenatal clinics would help your doctor monitor your pregnancy, identify potential complications, and guide you to a healthy delivery.

A singleton pregnancy doctor with nylon gloves

During your singleton pregnancy, your antenatal care may include:

  • Routine Blood Tests: to check for anemia, HIV, blood type, genotype, hormonal fluctuations and other blood-related factors during pregnancy.
  • Blood Pressure Checks: This is very important to reduce the possibility of high blood pressure or preeclampsia during pregnancy.
  • Ultrasound Scans: to monitor your baby’s growth and heart rate
  • Weight Measurement
  • Dietary Advice

Your doctor may even recommend special breastfeeding or baby care classes that would teach you how to breastfeed and care for your little one effectively.

Postpartum Care for Singleton Pregnancies

Although most of the hype is usually about antenatal care and staying healthy in all the stages of pregnancy, postpartum care is also very important.

In most cases the postpartum period lasts for about 6 to 8 weeks, starting from the day your little one is born.

During this period, most women undergo a lot of physical and emotional changes as they learn to care for the newborn.

Proper postpartum care after a singleton pregnancy includes:

1. Proper Rest

Rest is super important for all new moms. With the right amount of rest, your body gets all it needs to return to its pre-pregnancy state. Getting enough rest also helps to keep your skin firm and healthy after pregnancy.

After a singleton pregnancy, you can get enough rest by:

  • Sleeping when your baby sleeps
  • Reducing your caffeine intake
  • Eating well
  • Receiving help from friends and family

2. Healthy Diets

A healthy diet is very important for every new mom.

In addition to providing your little one with all he/she needs for a healthy life, a healthy diet would strengthen you and help your body heal faster.

As you recover from the rigors of pregnancy, you can follow a diet that is rich in:

  • Fluids
  • Vegetables
  • Fruits
  • Protein
  • Healthy Fat

3. Proper Vaginal Care

Vaginal care is another essential part of postpartum care after a singleton pregnancy. If you’re experiencing any form of vaginal soreness, urination problems, vaginal discharge, or postpartum cramps, please visit your doctor for a proper diagnosis and treatment.

Differences between Singleton and Multiple Pregnancies

1. A Smaller Bump

Although most moms-to-be may not notice this, one of the major differences between a singleton and twin pregnancy is the size of your baby bump.

Some experts agree that a singleton baby bump may be about 20% smaller than a multiple pregnancy belly. Thankfully, a lighter (or smaller) baby bump is less stressful for the uterus and mother.

2. Reduced Fatigue

Here’s the fact: more babies come with increased demands on your body and mind.

Although fatigue is one of the earliest signs of pregnancy, women with singleton pregnancies usually don’t have to deal with as much fatigue as moms with multiples.

This may be a function of hormonal fluctuations, increased urination, and sleep interruptions during pregnancy.

To reduce the severity of fatigue during pregnancy, you can:

  • Drink less caffeine
  • Eat healthy
  • Move your bedtime earlier

3. Reduced HcG Levels

Human Chorionic Gonadotropin (hCG) is an important pregnancy hormone which forms the basis of pregnancy tests. In fact, home pregnancy test kits are specially designed to detect this hormone in your urine to confirm pregnancy.

If you’re trying to conceive or undergoing fertility treatment, your doctor may conduct some blood tests to establish your average hCG level. After this, he/she will continue to monitor your numbers for any drastic changes.

In 2018, a research study showed that women pregnant with singletons may have lower hCG baseline levels than those pregnant with multiples.

4. Single Heartbeat

With a fetal doppler, it is possible to hear your baby’s heartbeat as early as the 8th or 9th week of pregnancy.

A singleton pregnancy due date calculator

In a multiple pregnancy, the doctor may detect a second heartbeat and schedule an ultrasound scan to get a clearer picture. However, this is not the case with a singleton pregnancy.

5. Reduced Weight Gain

Weight gain is a common concern for most moms-to-be.

A singleton pregnancy reduce weight gain

Although this difference may not become obvious till the later stages of pregnancy, women with singleton pregnancies usually don’t add as much weight as those with multiple pregnancies.

In addition to the changes listed above, studies show that women with singleton pregnancies tend to get to term and have vaginal deliveries a lot more than those with multiple pregnancies.

Conclusion

Every pregnancy, whether singleton or multiple, is an exciting and unique process. Although it comes with some changes and risks, it is important to focus on your health and seek proper antenatal care during pregnancy.

It is also essential to note that the early signs of pregnancy may not confirm whether or not you have a singleton, however, proper prenatal tests can.

If you have any concerns or worries about your pregnancy, please contact your healthcare provider.

We are always here to help you.

References

Lochia: All You Need To Know About Postpartum Bleeding

Vaginal bleeding after delivery is normal. In fact, it is part of the normal recovery process at the beginning of motherhood. This blood flow (or Lochia) is a sign that your body, especially your uterus, is returning to its pre-pregnancy state.

Are you wondering why you’re still having blood flow even after delivery? Do you want to know the cause, duration, and treatment options?

Read on to find out.

What is Lochia?

Lochia is a normal discharge of blood and mucus from the uterus after childbirth. It is also known as postpartum bleeding. The discharge begins right after childbirth and can continue for about 4 to 6 weeks after delivery.

lochia signs

In most cases, the heaviest flow is usually observed in the first two weeks after birth. Although the duration varies from woman to woman, it often ranges from two to six days.

Lochia looks a lot like menstrual blood, however, it lasts longer and is heavier than normal period bleeding. Furthermore, lochia comes in various colors; it may look pink, brown, or yellow.

What Causes Lochia?

During pregnancy, your uterus houses your baby, the placenta, excess uterine tissue, and of course, blood.

After childbirth, your uterus sheds out all these excess materials and fluids through postpartum contractions. These postpartum contractions are normal, they help to return your already enlarged uterus to its normal size.

However, if these contractions don’t occur properly, something called uterine atony can occur. This causes heavy bleeding even after childbirth

The chances of experiencing heavy lochia are increased if you have any of the following:

  • Multiple delivery (i.e. giving birth to more than one child at a time)
  • If you have given birth several times before
  • Giving birth to a child weighing more than 8 pounds
  • Induced labor with oxytocin (Pitocin)
  • Placenta problems
  • Uterine rupture
  • Prolonged labor
  • Vaginal or cervical tear during delivery
  • Given birth through a cesarean section (your chances for postpartum hemorrhage is increased with a C-section compared with a normal vaginal delivery)
  • General anesthesia (if you had a C-section)
  • Postpartum hypertension
  • Preeclampsia (high blood pressure and protein in your urine that develops during pregnancy)
  • Obesity

What Are The Contents of Lochia?

Most times, lochia contains:

  • Blood
  • White blood cells
  • Mucus
  • Pieces of the uterine lining

The Stages of Lochia

As the uterus clears out the excess blood and tissue, the appearance of lochia changes over time.

It may follow this pattern:

1. Lochia Rubra

In the early days, lochia rubra may appear dark red and very heavy. Then, after about four to ten days, the lochia will lighten up and look brownish or pinkish in appearance.

2. Lochia Serosa

At this point, lochia may look thin, brownish, or pink in color. It usually appears after ten to fourteen days and is quite similar to spotting. Most times, it contains blood cells, cervical mucus, and some microorganisms.

3. Lochia Alba

For the remaining days or weeks, the lochia will look like watery mucus and appear white or yellow in color.

In this stage, Lochia Alba is no longer tainted with blood. Furthermore, the flow of lochia may become very irregular.

Lochia alba

Treatment of lochia

Lochia is normal and should happen, just like your monthly menstrual flow.

It is a normal part of your body’s postpartum healing process.

When your uterus has returned to its normal size, you won’t be passing lochia again. But you should watch the flow of blood to be sure it is within normal range.

lochia alba treatment

Although you can’t make lochia go away any sooner, you can try the following tips to stay comfy during this phase:

  • Wear pads and not tampons after birth to avoid infection and irritation of the vagina. You can start with heavy duty pads since the flow will be quite heavy.
  • Use pain relief drugs as recommended by your doctor to reduce the pain of postpartum cramps.
  • Rest as much as possible.
  • Wear loose-fitting clothes and comfortable underwear.

When to Seek Medical Help

It is normal to pass fluid after delivery. However, excessive bleeding (or postpartum hemorrhage) is not. This should be reported immediately to the doctor.

Call your doctor immediately if you experience:

  • Heavy bleeding (which causes you to change your pad more than once within the same hour)
  • Passing large clots for more than three days after childbirth
  • Fever
  • Blurred vision
  • Lightheadedness or confusion
  • Nausea
  • Pain, cramping, or swelling in the abdomen or vagina
  • Rapid heartbeat
  • Foul-smelling lochia

These signs may be indications of an infection or hemorrhage, which is potentially dangerous. You should seek medical attention immediately.

Lochia rubra cramps

Conclusion

Call your doctor if lochia remains heavy for more than two weeks after delivery, or you are still having it for more than eight weeks postpartum. You should also see your doctor if you have signs of excessive bleeding especially if your pad soaks every hour or two.

You are not alone.

REFERENCES

Cho, Seung-Hee, and Kim, Song-Baek (2013). A Study on the Duration and Character of Lochia in Women Hospitalized at Korean Medical Postpartum Care Center. The Journal of Oriental Obstetrics and Gynecology. Accessed on 7th July, 2021 from https://www.researchgate.net/publication/290467002_A_Study_on_the_Duration_and_Character_of_Lochia_in_Women_Hospitalized_at_Korean_Medical_Postpartum_Care_Center

Susan Fletcher, Chad A Grotegut and Andra H James (2012). Lochia Patterns Among Normal Women: A Systematic Review. Journal of Women’s Health. Accessed on 7th July, 2021 from https://www.researchgate.net/publication/232717497_Lochia_Patterns_Among_Normal_Women_A_Systematic_Review

Claudia Chi, Mira Bapir, Christine A. Lee and Rezan A. Kadir (2010). Puerperal loss (lochia) in women with or without inherited bleeding disorders. Research Obstetrics. https://doi.org/10.1016/j.ajog.2010.02.042

Cloudy Urine in Pregnancy

Frequent urination is one of the earliest signs of pregnancy. Sometimes, you may even observe different colors and consistencies of urine that were not present before you became pregnant. A typical example of this is the occurrence of cloudy urine in pregnancy.

In this article, we’d talk about the features of normal urine, different colors of urine, causes of cloudy urine during pregnancy, and how to reduce the symptoms.

What Are The Features of Normal Urine?

Normal urine is a clear, sterile, and pale-yellow fluid. It has a characteristic chemical-like smell that may be slightly offensive. Sometimes, your urine can appear to be colorless, especially if you’ve just taken large amounts of water.

How Common Is Cloudy Urine During Pregnancy?

Cloudy urine is one of the many changes that come with pregnancy. In fact, it is even more common than you may think. While expecting your little one, there’d be changes to your hormones, medication, and diet. These changes, as well as other important factors, can make your urine look cloudy.

cloudy-urine-in-pregnancy

As a result, cloudy urine is a common occurrence in pregnancy

What Causes Cloudy Urine In pregnancy?

The common causes of cloudy urine in pregnancy are:

1. Hormonal changes.

This is the primary cause of cloudy urine during pregnancy.

While expecting, your body undergoes diverse hormonal changes to support your growing baby. For example, there is an increase in the level of human chorionic gonadotropin (hCG) in the first trimester, which is passed out through urine. Sometimes, the increased presence of hCG can make your urine cloudy.

2. Dehydration.

Most times, pregnancy comes with nausea and vomiting. When this happens, the consistent fluid loss via vomitting can cause dehydration.

Dehydration during pregnancy will lead to dark and concentrated urine, that also appears cloudy.

3. Urinary tract infection (UTI)

Sadly, UTIs are common during pregnancy. When this happens, it can also result in cloudy urine.

During pregnancy, if you notice a marked increase in the frequency of urination, as well as a foul-smell, please consult your doctor immediately.

cloudy-urine-in-pregnancy-test

4. Excess Protein In Urine.

This condition is called proteinuria. Excess protein content in your urine can also make it look cloudy or foamy. This usually occurs in the second or third trimester.

If this excessive amount of protein in urine is accompanied by high blood pressure, it may be a sign of preeclampsia.

5. Dietary modifications.

No doubt, your diet and food cravings would change during pregnancy. You may even begin to crave meals you didn’t like before pregnancy. In some instances, these sudden and abrupt changes may cause your urine to appear cloudy.

This usually occurs if your new diet contains high amounts of phosphorous or Vitamin D. When this happens, you can just remove the foods you weren’t eating before pregnancy and watch out to see if that’s the actual cause.

6. Vaginal discharge.

Vaginal discharge is not strange during pregnancy. However, excess discharge can also cause cloudy urine.

cloudy-urine-in-pregnancy-vaginal-discharge

If you experience this symptom, please consult your doctor.

7. Diabetes Mellitus

Diabetes Mellitus causes an abnormal increase in blood sugar level. When this sugar moves into the urine, it can also cause it (your urine) to appear cloudy. In addition, diabetes mellitus may also cause urine to have a sweet or fruity smell.

Different Colors of Urine

As we mentioned earlier, normal urine should be clear, sterile, and pale-yellow. However, several factors can alter the color of your urine.

In this section, we’ve compiled some common urine colors and the possible causes:

  • Red or pink colored urine: This is usually due to the presence of blood in the urine and can be a symptom for a serious health condition. In other instances, red-colored urine may result from dietary modifications, like increased consumption of beets or blackberries.
  • Brown or dark orange urine. This is not a good sign at all. Brown or dark orange urine indicates that there is excessive secretion of bile, which could be a symptom of a serious liver problem.
  • Blue or green urine: Using certain drugs can make your urine appear bluish-green. However, if you are not on any medication and your urine looks this way, you should see a doctor.

How To Manage Cloudy Urine In Pregnancy

Treatment options for cloudy urine during pregnancy depend on the underlying cause. Some home therapies may help you alleviate some symptoms. In other cases, you may need to see your doctor.

how-to-manage-cloudy-urine-in-pregnancy.

Here are some simple home therapies to relieve cloudy urine in pregnancy:

1. Drink Water

Water is really important in pregnancy. In addition to keeping you refreshed always, water also flushes out toxins and makes your urine look less cloudy.

Furthermore, studies show that pregnant women need to drink about 10 cups of water daily to prevent dehydration.

2. Take Some Cranberry Juice

This juice contains a lot of phytonutrients which are helpful in relieving the symptoms of UTI, kidney stones, and other underlying conditions that may cause cloudy urine.

3. Don’t self-medicate

Self-medication may be the cause of cloudy urine during pregnancy.

Here’s the fact: It is wrong to self-medicate during pregnancy. In fact, it is advisable to receive prescriptions from only your attending physician in this period.

4. Use hot/warm compresses.

Sometimes, cloudy urine comes with abdominal pain. When this happens, you can relieve the pain by applying hot or warm compresses.

5. Reduce your salt and sugar intake

Meals with high sugar content may increase your risk for developing diabetes and, by extension, cloudy urine. Also, salty meals predispose you to kidney problems. Therefore, reducing your salt and sugar intake would reduce the symptoms of cloudy urine.

Conclusion

It is always good to consult your doctor if you notice any change in your body function during pregnancy. Although cloudy urine is not strange, you should keep an eye out for any drastic changes and report it to your doctor immediately.

References

Joanna Matuszkiewicz-Rowińska, Jolanta Małyszko, and Monika Wieliczko (2015). Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Archives of Medical Science. Accessed on 27th June, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379362/#__ffn_sectitle