Connie L. Agnew, M.D., answers your questions about pregnancy.
What is Rh disease?
My blood type is A-negative and my husband's is B-positive. I'm 14 weeks pregnant, and my doctor said I'll need to get a shot after my amniocentesis to head off Rh disease. What is this?
Rh disease is a possibility only when a mother's blood is Rh-negative, the father is Rh-positive and their baby is Rh-positive. Under those circumstances, if a pregnant woman's circulating blood is exposed to fetal blood cells--such as during a medical procedure, an abdominal trauma or, most likely, during delivery--her immune system may respond by producing antibodies to destroy the Rh-positive cells. Without treatment, this could put a developing baby at risk for serious anemia and other complications.
To prevent this disease, all Rh-negative mothers are given an injection of anti-D immunoglobulin (also called Rhogam) after medical procedures such as amniocentesis and as a prophylactic measure at 28 weeks gestation; mothers of Rh-positive babies also are given an injection within 72 hours of childbirth. This helps confer protection for future pregnancies by keeping a woman's body from storing an "immune memory" of her baby's Rh-positive cells.
New help for gestational diabetes
I had gestational diabetes six years ago. I'd like to get pregnant again and heard about a treatment for this condition that uses oral antihypoglycemics rather than insulin. What is it?
Since you have a history of gestational diabetes, there is a strong likelihood that you'll develop it again, so you're wise to ponder your options. In the past, if diet and exercise did not bring blood-sugar levels under control, doctors prescribed insulin--an effective treatment, but one that often required daily injections. Today, there's a medication called Glyburide that can be as effective as insulin. Since it's taken orally, it is easier to administer than insulin injections. And because it does not cross the placenta, it poses no risk to the fetus.
Glyburide does have potential side effects, including causing low blood sugar if you're not eating properly. But tracking your food intake, exercise and blood-sugar levels throughout the day can help you head off problems.
Prudence and the pill
I want to have a baby, so I just stopped taking my birth-control pills. Could the hormones hurt the fetus if I conceive right away?
It will likely take several months for your body to resume ovulation and a normal menstrual cycle after stopping your oral contraceptives, which means you probably won't get pregnant right away. But even if you do conceive immediately after discontinuing your pills, the hormones will not be present in your body at a level that would be a problem for your baby. On the other hand, if you want to attend to your health before getting pregnant (such as losing a few pounds or quitting smoking), consider using a barrier method of contraception, such as a diaphragm, or have your partner wear a condom for a few months after discontinuing your pills.