ANSWERS FROM A FETAL MEDICINE SPECIALIST

Dr Prayatna Shetty is a Maternal and Fetal medicine specialist at Westmead public Hospital.  She offers her private services at Westmead Private Hospital.

Follow her for regular pregnancy education on facebook or Instagram @docprayatnas

1.What foods should I avoid in pregnancy?
Answer: Most foods are safe in pregnancy. But some food groups have potential to harm your pregnancy, and these should be avoided. Here is a list of food items to avoid:

• Unpasteurized semi-hard and soft cheeses (unless cooked until steaming hot)
• All mould-ripened soft cheeses with a white coating on the outside, such as brie, camembert and chèvre (unless cooked until steaming hot)
• Soft blue cheeses such as Danish Blue, Gorgonzola and Roquefort (unless cooked until steaming hot)
• Unpasteurised cow’s, goat’s or sheep’s milk or cream
• Liver and liver products such as pâté or liver sausage can have large amounts of vitamin A. This can be harmful for your baby. All types of pâtés, including vegetable versions, can have listeria in them. It’s best to avoid them.
• Do not eat swordfish, marlin, shark, or raw shellfish. Do not eat smoked fish products, including smoked salmon and smoked trout, unless thoroughly cooked as they can present a risk of Listeria. This includes in sushi.
• You should not eat game meat, such as hare, partridge, or pheasant due to the presence of lead. You should also not eat raw or rare meat as this can cause food poisoning.
• Unwashed fruits and vegetable / store bought salads as these may contain listeria.

Always make sure any meat you eat is well cooked and steaming hot all the way through. You should not be able to see any pink meat and the juices should run clear. Sprouted seeds need to be cooked well until they are hot throughout to make sure they do not make you ill.

2. Can I eat sushi or sea food in pregnancy?

 Answer: Some sea foods and Fishes can be safely eaten in pregnancy. It is safe to eat the following types of seafood:

• Cooked fish. Sushi only if the fish has been cooked thoroughly.

• Seafood/shellfish as long as it has been cooked, for example mussels, lobster, crab, oysters, scallops, clams and cold, pre-cooked prawns.
• Eating oily fish at least 2 times per week gives you a good source of protein and omega acids which are good for baby brain development.

3. Can I drink coffee or tea in pregnancy?
Answer: Caffeine is present in chocolate, coffee, and tea (including green tea). Some soft drinks and energy drinks will also have caffeine. Having too much caffeine can increase your risk of miscarriage or fetal growth restriction. When you are pregnant, avoid having more than 200 mg Caffeine.

4. Should I have a NUCHAL SCAN or NIPT?
Answer: Tests commonly used for downsyndrome screening or aneuploidy screening are nuchal scan or NIPT . A Nuchal scan involves structural assessment of your baby as well as measurement of nuchal thickness along with some placental biomarkers. The final risk score is calculated based on your age, obstetric history as well as these measurements. The detection rate of Nuchal scan for trisomy 21 approaches 95%.
NIPT is based on doing a blood test on the mother and picking up fetal DNA in mother’s blood. NIPT has higher pick-up for chromosomal abnormality , especially for Down’s syndrome the detection rates approach 99.9 %.
But this test cannot detect early structural abnormalities in the fetus .
As a fetal medicine expert, I recommend early structure assessment of your baby even if you have NIPT.

5. Am I at risk of miscarriage?
Answer: Up to 20% of early pregnancies can end up in a miscarriage. Having a miscarriage is not your fault. It does not happen because you ate or drank something or because you exercised or had sex. Most of the early miscarriages are chromosomal abnormalities and these are pregnancies that normally could not have continued to viability. Most women will have a successful pregnancy after having an early miscarriage.

But some women may have recurrent miscarriage. Generally, three or more subsequent miscarriages are called recurrent. Common risk factors for recurrent miscarriage include advanced maternal age, uterine or cervical anomalies, drug use or smoking in pregnancy, medical conditions like anti phospholipid syndrome, diabetes, or thyroid disease. Fetal infections can also cause miscarriage.

If you are concerned, please see a fetal medicine specialist to discuss if any of these risks can be reduced. A preconception counselling is most helpful in these situations.

6. Can I have sex in pregnancy?
Answer: Sex is completely safe in pregnancy. As long as you are in a comfortable position, having sex does not cause preterm labour or infection. Sometimes your clinician may advise you to avoid sex. Conditions like low lying placenta, premature rupture membranes, symptoms of preterm labour etc can be common reasons to avoid intercourse as this can lead to bleeding, infection, or preterm birth respectively.

Sex should not be painful in pregnancy. If you feel uncomfortable or distressed, please speak to your clinician. This could be due to conditions like vaginal dryness or thrush which are easily treatable.

7. Am I at risk of preterm birth?
Answer: Preterm birth affects 7-8% of pregnancies. This is a very distressing situation for the whole family as premature neonates end up spending a lot of time in neonatal ICU. Premature babies are also at risk of several complications like poor growth and development, breathing difficulty, infections etc.

The biggest risk of preterm birth is a history of preterm birth in previous pregnancy. Smoking, urinary infection, bacterial vaginosis and medical conditions in pregnancy can increase your risk. Cervical insufficiency, preterm rupture of membranes, preeclampsia, fetal growth restriction and multiple pregnancies all increase your risk of having a preterm birth.
Preterm birth risk can be assessed by taking a detailed history, vaginal cervical length assessment and placental biomarkers. Once a risk is identified, you may need a cervical cerclage, medications as well as regular review to prevent you from having a preterm birth.

8. Is bleeding common in pregnancy?
Answer: Early pregnancy bleeding (< 12 weeks) is quite common. This does not mean you will miscarry. But it is important to get a check up and an ultrasound to make sure your pregnancy is progressing.

Some women will continue to have some mild spotting throughout the pregnancy. Most pregnancies would continue as normal. But in these situations, it is important to have an ultrasound for cervical length screen as well as fetal wellbeing.

Conditions like a low-lying placenta can make you at high risk of severe bleeding. Your clinician should make a detailed follow up plan for your antenatal care in such situations. Conditions like cervical polyp or placental haematoma etc can also cause bleeding in pregnancy.

When ever you have a bleed in pregnancy, see your clinician and avoid intercourse till the situation is resolved.

9. Is it important to have growth scan in pregnancy? How is my baby’s growth measured?
Answer: Growth ultrasounds are scans that your obstetrician prescribes when they are worried about your baby’s growth or if your pregnancy is at increased risk of growth restriction. Sometimes you may be advised to have a growth scan as a routine to evaluate your baby’s growth.

A growth scan is generally done at 36 weeks in low-risk pregnancy. If your pregnancy is high risk (Like preeclampsia, previous growth disorder in pregnancy, diabetes etc) then you may have regular growth scans starting from 24-28 weeks of pregnancy.

Your baby’s growth is measured as an estimate. There are formulas that consider the baby’s femur length (thigh bone), abdomen circumference, and head measurements (head circumference as well as biparietal diameter). Your baby’s estimated weight is then plotted on a graph to understand how small or big your baby is in comparison to the rest of the population. If your baby’s growth is within the normal range, then it is reassuring. Along with growth we also check blood flow in various fetal and placental vessels as well the amniotic fluid to ascertain your baby’s well-being. Visit our website to know more about each type of scan that you may require in pregnancy. Visit our website at www.obstetriciansydney.com.au to know more.

10. Am I at risk of preeclampsia?
Answer: Preeclampsia is a serious disease with significant maternal and neonatal morbidity and mortality. You may be deemed at high risk of preeclampsia if you have certain conditions like: Previous existing hypertension, obesity, previous preeclampsia, twins or triplets, autoimmune disorders, and diabetes etc.

But preeclampsia can happen in any low-risk pregnancy as well. Many of you may have heard about preeclampsia risk scoring. This is done at the time of nuchal scan to evaluate your risk of preeclampsia. This test can determine easily if you are at high risk of preeclampsia or not in an otherwise low risk pregnancy.

If you are at high risk of preeclampsia, then you should take Aspirin 150 mg every night staring from 10-12 weeks of your pregnancy. This medication can significantly lower your risk. Apart from Aspirin there are various other measures or medications that you may be suitable for to reduce your risk. Visit our website at www.obstetriciansydney.com.au to know more.