Pregnancy is an extraordinary event in any woman's life. Therefore, the Health+ gynecologist, MUDr. Ivan Ročárek, has advised expectant mothers on several essential areas that need to be paid attention to during pregnancy in order for the development of the fetus to proceed properly.
Pregnancy is certainly a crucial and welcome stage in a woman's life, but unfortunately it can also cause a number of health complications for both the woman and the fetus. In practice, we distinguish so-called gestosis, which is a disease that occurs only during pregnancy, cannot occur outside of pregnancy and disappears very quickly after childbirth. Another group of risks are diseases that occur outside pregnancy which can be aggravated by the pregnancy and possibly harm the health of the pregnant woman and the fetus. These diseases persist after birth and should be treated by appropriate specialists. Doctors are often asked whether both groups of diseases are preventable, how they can be treated and whether the complications associated with them can be minimized. It has to be said that gestosis is virtually impossible to prevent; it is treated symptomatically. Various theories trying to explain its origin have so far failed. In the second group of diseases, which are treated either by a gynecologist or in collaboration with the necessary specialists from the fields of internal medicine, neurology, orthopedics, etc., the therapy is more causal, i.e. according to the specific cause. Quite often the time factor of the onset of the disease is important, whether it occurred before the onset or during pregnancy. This area is quite extensive and it is often necessary to change the prescribed medication because of the potentially negative effect on the fetus. In the area of prevention, there is mention of so-called preconception preparation, which is usually recommended several weeks or months before conception. It is desirable to bring the mother-to-be's existing disease to a resting phase and to stabilize medication that does not endanger pregnancy or fetal development. Therefore, before conception, women should consult their general practitioner or the specialists who care for them.
How important a role does the age of the mother-to-be play in pregnancy and how can it affect her health and the development of the baby?
Nowadays, the increasing age of pregnant women is often mentioned. Age is certainly important for the proper development of pregnancy. However, I sometimes feel that it is somewhat overestimated, which can often lead to unnecessary stress for mothers-to-be. I have seen many pregnant women in their 40s who managed everything very well and cooperated fully in the outpatient clinic or in the delivery room. There are legitimate concerns about possible genetic damage to the fetus, but these can be minimized thanks to the development of biochemical and genetic diagnostics. Of course, this is not to say that women should postpone getting pregnant until as late as possible, but I do not like to scare up catastrophic scenarios. The foundation of a proper pregnancy is responsible adherence to all recommendations from the doctor.
For what reasons do women have risky pregnancies?
We often come across the term high-risk pregnancy. It is a condition when the pregnancy is complicated by a more serious gynecological disease, complications in a previous pregnancy, or a more serious accompanying disease from a field of medicine other than gynecology. This term is rather Czech and non-exact. In Anglo-Saxon countries, the term high-risk pregnancy is reserved for situations where there is an explicit risk to the pregnant woman’s life, such as post-transplant conditions, serious heart disease or serious cancer treatment.
Is it necessary to avoid contact with pets during pregnancy? For example, what about the risk of contracting toxoplasmosis from domestic cats?
In the context of pregnancy, questions often arise about whether the presence of a pet can pose a risk. There are so-called anthropozoonosis, which are infectious diseases transmitted from animals to humans. They can cause abortion, often recurrent, and also congenital developmental defects in the fetus. However, thanks to good veterinary care, they are fortunately very rare. A parasitic disease called toxoplasmosis, which can be transmitted by a cat or imperfectly cooked pork, is also mentioned in Czech sources. I confess that I have seen acute toxoplasmosis in about seven pregnant women in my 35 years of practice. More common is the presence of chronic toxoplasmosis antibodies prior to pregnancy. These antibodies are found in nature, preventing acute reinfection and therefore protective. Today, we are able to detect the level of acute or chronic antibodies and consider the possibility of treatment in pregnancy. This is usually long-term, antibiotics (Rovamycine) are administered and treatment is guided by the infectious disease specialist according to antibody levels.
What dietary composition is ideal for a healthy pregnancy? What vitamins, minerals or combined supplements do you recommend for prevention for pregnant women?
Vitamins and trace elements in pregnancy are a rewarding topic in many publications. Some of them warn women about selenium, molybdenum and other element deficiencies in pregnancy, which they say can lead to concerns that the child will require special education, be physically disabled or suffer from severe developmental defects. But women with normal eating habits and normal dietary composition need not worry about these gloomy outlooks. This is because a varied diet supplies enough of the vast majority of the necessary vitamins and minerals. I see a certain problem with iodine, because in the Czech Republic its only source is table salt, and due to the limited consumption of sea fish, which is a rich source of iodine, the Czech population is generally on the low side with this element. The problem can easily be solved in the pharmacy, where expectant mothers can be sold a whole range of suitable pregnancy vitamins and trace elements in tablets; one tablet a day is quite sufficient. A higher intake of iron and folic acid, which are essential building blocks for the mother's and the fetus's hematopoiesis, is also advisable.
One of the risks is gestational diabetes. What is the specific investigation and what is the procedure if gestational diabetes is detected?
Nowadays, all pregnant women are tested for gestational diabetes, and the result of the test is recorded in their pregnancy certificate. The essence of the test is to determine the fasting glucose level and then after a standardized glucose dose. In the case of a positive finding, dietary treatment with blood sugar control is usually sufficient; if the level rises, treatment with oral antidiabetic drugs or insulin is sometimes necessary, which is managed by a diabetologist.
How is the life of pregnant women affected by the prolonged pandemic of covid-19? Is it advisable to be vaccinated during pregnancy? And what should be done if a pregnant woman becomes ill with covid?
The covid pandemic has raised a number of questions related to pregnancy and, of course, to the possibility of vaccination in pregnancy. According to the statistics so far in pregnant women with covid-19, it can be said that the feared effect of the new coronavirus on fetal development has not been conclusively confirmed. It is generally accepted that the course of covid infection in pregnant women is more severe and more dangerous in relation to the length of gestation. There are also cases where the pregnancy had to be terminated by premature cesarean section, but this is fortunately very rare. Treatment in complicated cases must be managed by a team of medical intensivists who also determine the prognosis for the fetus. This brings us to the much-discussed issue of covid-19 vaccinations for pregnant women. Despite the original, rather reserved attitude towards vaccination of pregnant women in the Czech Republic, thanks to statistics from the USA, Canada and Great Britain, we are coming to a clear opinion – vaccinate, and the earlier the better. In the UK, they even recommend that pregnant women with serious diseases outside gynecology and obstetrics should be vaccinated in preference, as possible covid disease is a much greater threat to women than the possible side effects of vaccination. It is therefore safe to say that we recommend vaccination for pregnant women at any stage of pregnancy.
Can you advise on how to deal with some typical problems in pregnancy, such as nausea and vomiting, heartburn, leg cramps and varicose veins, back pain or constipation?
In these cases, sometimes "grandmotherly" advice will help, but usually appropriate medication is needed, which is best addressed directly with the gynecologist.
Thank you for the interview.