Personal Health : Experts Give Advice to Pregnant Women

Pregnant for the third time, Bobbie Eisenstock follows the same time-tested rules. She doesn’t drink caffeinated coffee. She only uses over-the-counter medicine when absolutely necessary to ease her migraine headaches. “And just with my doctor’s permission,” says the Cal State University Northridge professor of journalism and mass communications.

And that includes aspirin.

Low doses of aspirin, two recent studies found, can help prevent complications of pregnancy that sometimes necessitate premature delivery: toxemia and high blood pressure .

But this advice doesn’t apply to most healthy pregnant women, Southern California obstetricians say, nor does it warrant self-medication. “Aspirin may help prevent (complications), but not every pregnant woman should run out and take an aspirin every day,” says Dr. Robert Resnik, UC San Diego obstetrician and chair of reproductive medicine.

In excess, aspirin can cause dangerous side effects. For instance, Dr. Raul Artal, USC professor of obstetrics and gynecology, says that aspirin, taken right before delivery, can affect the baby’s blood-clotting ability.

So what’s the best way for healthy pregnant women to improve the odds of delivering a normal baby? Beyond eating a balanced diet, exercising and not smoking, here’s advice gleaned from a half-dozen recent research studies and four respected obstetricians:

MEDICINE: “Take only Tylenol (acetaminophen) and vitamins without your doctor’s advice,” advises Dr. William A. Frumovitz, an obstetrician-gynecologist at St. John’s Hospital and Health Center. Don’t take any other medicine--even if prescribed by another doctor--without your obstetrician’s clearance, he says. Taking medicine doesn’t just carry the risk of fetal harm, adds Artal. “It may hide a (maternal) symptom of importance.”

WEIGHT GAIN: “More is better,” suggests a study in this month’s Obstetrics & Gynecology, particularly for teen-age mothers, first-time mothers, older mothers and underweight mothers. Researchers from Hebrew University analyzed 14,000 births, finding an average weight gain of 23.5 pounds. The more weight the mothers gained, the less likely they were to have a low-birth weight infant who is more at risk for illness and death. They recommend that underweight women put on at least 33 pounds.

“The average-build woman should gain only about 26-30 pounds,” says Dr. Reinhold Ullrich, a Torrance obstetrician-gynecologist and past president of the Los Angeles County Medical Assn. “And it should be steady throughout the pregnancy.”

STREET DRUGS: Cocaine-addicted babies aren’t just an inner-city tragedy, says Ullrich. “I’ve seen them in my Torrance practice too.” Even if the mothers only take cocaine once early in pregnancy, says USC’s Artal, they are at higher risk for premature separation of the placenta, sometimes resulting in fetal death.

Government researchers at the Centers for Disease Control found that women who use cocaine early in pregnancy increase the risk of serious urinary tract birth defects in their infants. They reported their findings in Friday’s Journal of the American Medical Assn.

CAFFEINE: “Caffeine has been variously vilified and vindicated in pregnancy,” says Frumovitz. “I tell patients not more than one cup a day, and I prefer none at all.” Resnik disagrees: “I don’t know of a shred of evidence that caffeine is bad for babies. “ Even so, he tells patients to limit coffee to a couple of cups a day.

Need to Limit Coffee

Male coffee drinkers, take note. If you have a family history of high blood pressure, cut down on caffeine, especially if you’re facing a grueling mental challenge.

That’s the advice of a study published in this month’s Hypertension journal and released today by the American Heart Assn. Researchers compared 17 men, ages 21-35, considered at risk for hypertension because at least one parent suffered from it, with 17 en of the same ages whose parents did not have high blood pressure.

After ingesting the equivalent of caffeine found in three cups of coffee and performing a difficult motor task, the high-risk men experienced a greater rise in cortisol, a stress-related hormone that can contribute to elevated blood pressure. About 52% of the high-risk men experienced borderline hypertension, defined in this study as 140/90 to 159/95, but only 26% of the low-risk men did. A reading of 120/80 is considered normal.

Advising coffee lovers to cut down on caffeine when facing mental challenges runs counter to habit, acknowledges Gwen Pincomb, a researcher at the Oklahoma City Veterans Administration Medical Center who co-authored the study.

The findings may apply to women as well, she says, admitting she has yet to write a research grant proposal without a cup of coffee nearby.

Middle-Age Sex Life

Sexual function doesn’t decline much in healthy middle-aged men, report researchers in the current issue of the journal Sleep.

In a three-night sleep study of 48 healthy men, ages 20-59, those in their 20s averaged four or five erections a night, while those in their 50s had three or four, termed a “modest difference” by the researchers. Middle-aged men can expect to maintain a healthy sex life, conclude University of Pittsburgh psychiatrists Charles Reynolds and Michael Thase, if they follow common sense health habits. Even though the study was short term and sleep measurements in the laboratory don’t always reflect true-life situations, USC urologist Dr. Jeffry Huffman believes it has important practical implications. “There’s a clear relationship between alcohol, smoking and erectile dysfunction. Men often don’t realize the connection.”

X-Ray Interpretation

Suppose you turn an ankle, limp to the hospital and have it X-rayed. The emergency room doctor tells you not to worry. He’s confident it’s not broken. What are the odds he’s wrong?

Low, according to a new study published in the Annals of Emergency Medicine. The University of Illinois study looked at how often emergency room doctors, who routinely order X-rays, agree with the findings of radiologists who review the films later--and whether the chance of agreement increases if the emergency doctor was confident of his X-ray interpretation.

Emergency room doctors confident of their X-ray interpretation were usually right when it came to X-rays of the chest and extremities. But the rate of agreement between emergency room doctors and radiologists wasn’t as high on X-rays of the skull, spine and abdomen.

The study results mirror clinical experience, believes Dr. Ashok Madahar, emergency physician at the Hospital of the Good Samaritan. Spinal X-rays, he says, are the most difficult for anyone to interpret; those of the extremities the easiest.

“If a patient is told to call back in the morning for an ‘official’ reading (by a radiologist),” says Madahar, “he should be sure to follow up.”