Monday, February 5, 2018

10 steps to a healthy pregnancy

Pregnancy is an ideal time to start taking really good care of yourself both physically and emotionally. If you follow the few simple guidelines below, you should give yourself the best chance of having a problem-free pregnancy and a healthy baby.

1. See your doctor or midwife as soon as possible

As soon as you find out you're pregnant, get in touch with your GP or a midwife to organise your antenatal care. Organising your care early means you'll get good advice for a healthy pregnancy right from the start. You'll also have plenty of time to organise any ultrasound scans and tests that you may need.

2. Eat well

Aim to eat a healthy, balanced diet whenever you can. Try to have: 
  • At least five portions of fruit and vegetables daily.
  • Plenty of carbohydrates, such as bread, pasta and rice, as the basis of your meals. Choose wholegrain carbohydrates rather than white, so you get plenty of fibre.
  • Daily servings of protein, such as fish, lean meateggsnuts or pulses, and some milk and dairy foods.
  • Two portions of fish a week, at least one of which should be oily. Fish is packed with protein, vitamin D, minerals and omega-3 fatty acids. Omega-3 fatty acids are important for the development of your baby's nervous system.
You don't need to eat for two when you're pregnant. You don't need extra calories for the first six months of pregnancy. In the last three months you'll need about an extra 200 calories a day. You can keep up your energy levels with healthy snacks

See our pregnancy meal planners for each trimester.

3. Take a supplement

Pregnancy vitamin supplements aren't a substitute for a balanced diet. But they can help if you're worried you're not eating well, or you're too sick to eat much

Make sure your supplement contains 400 micrograms (mcg) of folic acid. You need this while you're trying for a baby and for the first three months of pregnancy. Taking folic acid reduces the risk of your baby developing a neural tube defect such as spina bifida

Also, check that your supplement contains 10mcg of vitamin D. Vitamin D is important for your baby's future bone health. 

Talk to your GP or a pharmacist before taking an antenatal supplement. If you don't take a multivitamin for pregnant women, you can buy folic acid and vitamin D supplements separately. 

If you're on a low income, you might be able to get pregnancy vitamin supplements free of charge under the government's healthy start scheme. Go to www.healthystart.nhs.uk for more information. 

If you don't eat fish, fish oil supplements may be helpful. Choose a supplement made from the body of the fish, not the liver. This is because fish liver oils (such as cod liver oil) may contain the retinol form of vitamin A, which isn't recommended in pregnancy.

4. Be careful about food hygiene

There are some foods it's safest not to eat in pregnancy. This is because they can carry a health risk for your baby. 

Listeriosis is an infection caused by listeria bacteria. It's rare and doesn't usually pose a threat to your health. However, it can cause pregnancy or birth complications. Listeriosis can even lead to miscarriage

The following foods may harbour listeria and so are best avoided: 
  • pate of any type
  • unpasteurised milk
  • undercooked ready meals
  • soft, mould-ripened cheeses, such as brie
  • blue-veined cheeses, such as roquefort
As listeria bacteria are destroyed by heat, make sure you heat ready meals thoroughly

Salmonella can cause food poisoning. You can catch it from eating: 
Cook eggs until the white and yolk are solid. Thoroughly wash utensils, boards and your hands after handling raw poultryFood hygiene is especially important now you're pregnant. Toxoplasmosis is an infection caused by a parasite. It's also rare, but it can affect your unborn baby. You can cut down your risk of catching it by: 

5. Exercise regularly

Regular exercise has many benefits for mums-to-be. It can: 
Good exercise choices for pregnancy include: 
If you play sport, you can continue as long as it feels comfortable for you. However, if your particular sport carries a risk of falls or knocks, or extra stress on your joints, it's best to stop. Talk to your GP if you're unsure.

6. Begin doing pelvic floor exercises

Your pelvic floor comprises a hammock of muscles at the base of your pelvis. These muscles support your bladder, vagina and back passage. They can feel weaker than usual in pregnancy because of the extra pressure upon them. Pregnancy hormones can also cause your pelvic floor to slacken slightly. 

Weak pelvic floor muscles put you at risk of developing stress incontinence. This is when small amounts of urine leak out when you sneeze, laugh or exercise

Strengthening your muscles by doing pelvic floor exercises regularly throughout your pregnancy can help. Having a toned pelvic floor may help your baby's birth go more smoothly too. You'll feel the benefit if do eight pelvic floor squeezes, three times a day.

7. Cut out alcohol

Any alcohol you drink rapidly reaches your baby via your blood stream and placenta. 

There is no way to know for sure how much alcohol is safe during pregnancy. That's why many experts advise you to cut out alcohol completely while you're expecting

It's particularly important to avoid alcohol during the first trimester, as drinking during this stage can increase your risk of miscarriage. If you do decide to drink after your first trimester, stick to no more than one or two units of alcohol, no more than once or twice a week

Drinking heavily or binge drinking during pregnancy is especially dangerous for your baby. Mums-to-be who drink heavily on a regular basis are more likely to give birth to a baby with fetal alcohol spectrum disorders (FASD). These are problems ranging from learning difficulties to more serious birth defects.

8. Cut back on caffeine

Coffee, tea, cola and energy drinks are mild stimulants. There are concerns that too much caffeine may increase your risk of miscarriage. It's also thought possible that too much caffeine may contribute to your risk of having a low-birth-weight baby. 

Current guidelines state that up to 200mg of caffeine a day won't hurt your baby. That's the equivalent of two mugs of instant coffee. 

As with alcohol, you may prefer to cut out caffeine altogether, particularly in the first trimester. Decaffeinated tea and coffee, fruit teas and fruit juices are all safe alternatives.

9. Stop smoking

Smoking during pregnancy can cause serious health problems, for you and your baby. These risks include an increased risk of: 
Smoking may even be associated with the loss of a baby at birth

Smoking makes the following pregnancy complications more likely: 

If you smoke, it's best to stop, for your own health and that of your baby. The sooner you stop smoking, the better, but it's never too late. Even stopping in the last few weeks of your pregnancy can benefit you both. Watch a video about how smoke reaches your unborn baby

Ask your GP or midwife to help you with ways to give up. You can also call the confidential NHS pregnancy smoking helpline on 0800 1699 169 or visit www.gosmokefree.nhs.uk.

10. Get some rest

The fatigue you feel in the first few months is due to high levels of pregnancy hormones circulating in your body. Later on, it's your body's way of telling you to slow down. 

If you can't sleep at night, try to take a quick nap in the middle of the day to catch up. If that's impossible, at least put your feet up and try to relax for 30 minutes. 

If backache is disturbing your sleep, try lying on your left-hand side with your knees bent. Placing a wedge-shaped pillow under your bump may help ease the strain on your back

Exercise may also give you some relief from backache. It can help with sleep problems, too, as long as you don't exercise too close to bedtime

To wind down ready for bed, try relaxation techniques, which are safe in pregnancy, such as: 
Always let your exercise teacher know that you're pregnant or, ideally, choose classes tailored to pregnant women. 

Learn more about diet and exercise in pregnancy, or check out our 50 reasons to be glad you're pregnant.

KEJANG DEMAM PADA ANAK

dr. Tri Wahyuningrum


Kejang demam selalu menjadi momok bagi orang tua. Fenomena yang terjadi pada saat anak kejang yaitu mata mendelik, kaku kelojotan, dan lidah tergigit, tak ayal membuat orang tua panik.

Apakah kejang demam itu?
            Kejang demam adalah kejang yang terjadi pada kenaikan suhu tubuh 38 derajat celcius atau lebih yang disebabkan proses di luar otak. Kejang demam merupakan penyakit yang sering dijumpai pada anak dan merupakan gangguan kejang tersering pada anak usia 6 bulan sampai 5 tahun. Faktor penyebab kejang demam antara lain adalah derajat demam, umur, dan genetik.
            Kejang demam dapat dibedakan menjadi 2, yaitu kejang demam sederhana dan kejang demam kompleks. Kejang demam sederhana adalah kejang kurang dari 15 menit, tidak berulang, dan kejangnya mengenai seluruh tubuh (kelojotan). Kejang demam sederhana merupakan bentuk yang paling sering ditemukan dan memiliki resiko komplikasi rendah. Sedangkan kejang demam kompleks adalah kejang demam adalah kejang lebih dari 15 menit yang dapat berulang dalam 24 jam, dan kejangnya hanya mengenai satu atau beberapa bagian tubuh.

Apa penyebab kejang demam?
            Penyebab kejang demam adalah demam yang terjadi secara mendadak. Demam dapat disebabkan infeksi bakteri atau virus, misalnya infeksi saluran napas atas. Tidak diketahui secara pasti mengapa demam dapat menyebabkan kejang pada satu anak dan tidak pada anak lainnya, namun diduga ada faktor genetik yang berperan. Setiap anak juga memiliki suhu ambang kejang yang berbeda, ada yang kejang pada suhu tubuh 38 derajat celcius, ada pula yang baru mengalami kejang pada suhu 40 derajat celsius.

Apa yang terjadi bila anak kejang?
            Sebagian besar kejang demam merupakan kejang umum. Bentuk kejang umum yang sering dijumpai adalah mata mendelik atau terkadang berkedip – kedip, kedua tangan dan kaki kaku, terkadang diikuti kelojotan, dan saat kejang anak tidak sadar tidak memberi respons apabila dipanggil atau diperintah.

Apa yang harus dilakukan bila anak kejang?
            Bila melihat anak kejang, usahakan untuk tetap tenang dan lakukan hal – hal berikut :
1.      Letakkan anak di tempat yang aman, jauhkan dari benda – benda berbahaya seperti listrik dan pecah belah
2.      Baringkan anak dalam posisi miring agar makanan, minuman, muntahan, atau benda lain yang ada dalam mulut akan keluar sehingga anak terhindar dari bahaya tersedak.
3.      Jangan memasukkan benda apapun ke dalam mulut. Memasukkan sendok, kayu, jari orang tua, atau benda lainnya ke dalam mulut, atau memberi minum anak yang sedang kejang, beresiko menyebabkan sumbatan jalan napas apabila luka
4.      Jangan berusaha menahan gerakan anak atau menghentikan kejang dengan paksa, karena dapat menyebabkan patah tulang
5.      Amati apa yang terjadi saat anak kejang, karena ini dapat menjadi informasi berharga bagi dokter, sambil bawa anak ke pelayanan kesehatan terdekat
6.      Apabila anak sudah pernah kejang demam sebelumnya, dokter mungkin akan membekali orang tua dengan obat kejang yang dapat diberikan melalui dubur. Setelah melakukan langkah – langkah pertolongan pertama di atas obat tersebut dapat diberikan sesuai instruksi dokter.

Bagaimana cara mencegah kejang demam?
         Pencegahan kejang demam yang pertama tentu dengan usaha menurunkan suhu tubuh apabila anak demam. Hal ini dapat dilakukan dengan memberikan obat penurun panas, misalnya parasetamol atau ibuprofen. Hindari obat dengan bahan aktif asam asetilsalisilat, karena obat tersebut dapat menyebabkan efek samping serius pada anak. Pemberian kompres air hangat (bukan dingin) pada dahi, ketiak, dan lipatan siku juga dapat membantu.
         Sebaiknya orang tua memiliki termometer di rumah dan mengukur suhu anak saat sedang demam. Pengukuran suhu berguna untuk menentukan untuk menentukan apakah anak benar mengalami demam dan pada suhu berapa kejang demam timbul.
         Pengobatan jangka panjang hanya diberikan pada sebagian kecil kejang demam dengan kondisi tertentu.
         Pada umumnya kejang demam adalah penyakit yang tidak membahayakan dan memiliki resiko komplikasi yang rendah. Beberapa komplikasi yang mungkin terjadi antara lain adalah kejang demam berulang, epilepsi, penurunan IQ, dan gangguan neurologis.



Kejang yang perlu diwaspadai ?
         Tidak semua kejang yang disertai demam adalah kejang demam. Apabila terjadi kejang disertai demam di luar rentang usia 6 bulan sampai 5 tahun, maka perlu disingkirkan penyebab kejang lainnya, misalnya epilepsi atau radang otak. Jika sesudah kejang anak tidak segera sadar kembali, lebih banyak tidur, atau tidak dapat mengadakan kontak dengan baik, dokter akan melakukan pemeriksaan penunjang untuk mencari penyebab kejang lain, terutama radang selaput otak (meningitis) atau radang otak (ensefalitis). Evaluasi lebih lanjut juga diperlukan apabila anak pernah kejang tanpa demam.