LISTERIOSIS AND PREGNANCY
By Dr. Octavia Cannon

What is listeriosis?
Listeriosis or Listeria is an infection caused by Listeria monocytogenes bacteria. The most common source of infection is contaminated food (deli meats, unpasteurized milk/dairy products, soft cheeses, and pate). Once infected, Listeria lives in the gastro-intestinal tract. Only the monocytogenes species is a cause for concern in humans.

Who is at risk for Listeria?
Listeria occurs in 0.7 per 100,000 people or (2500/year). One-third of the Listeria cases are in pregnant women. Pregnant woman and those with a weakened immune system are 20 times more likely to become infected.

What precautions should be taken to avoid infection?
Listeria is usually killed by pasteurization or cooking. Wash all raw vegetables and separate uncooked food from cooked food. Washing your hands, cutting boards, and knives is important. In addition, pregnant women should avoid soft cheeses (Brie, Camembert, Mexican-style, bleu-veined) unless they are in a fully cooked dish. Food should be stored within 2 hours of serving (1 hour in hot weather). Pregnant woman should also refrain from eating pate, meat spreads, refrigerated smoked seafood, and salads made in the grocery store (ham, chicken, egg, tuna, seafood).

How do I know whether I’ve been infected?
Blood tests can detect Listeria. Symptoms range from none to diarrhea, fever, muscle/joint pain, headache, stiff neck, backache, chills, sensitivity to bright light, and sore throat with swollen glands. Symptoms usually begin 2-8 weeks after eating the contaminated food.

Will this affect my baby if I am pregnant?
It is likely that although you have been infected your baby has not. There is a risk of miscarriage, stillbirth, uterine infection, preterm labor and neonatal death. The complications may occur 2-14 days following maternal infection. Early diagnosis and high doses of antibiotics (Ampicillin/PCN) may prevent infection of the unborn baby. No increased risk for pregnancy loss or birth defects has been reported in women who did not have symptoms of infection. There is no evidence that Listeria is a cause for repeat miscarriages in women. There is a slightly increased risk for meningitis in babies, occurring 2 weeks after delivery; likely due to Listeria in the mother’s birth canal.

How can I know if the baby has been infected/harmed?
The same blood test can be performed on the baby after birth. An ultrasound can be used to check for an enlarged heart, thickened bowel, and increased stomach wall thickness in-utero. There is no evidence that breast milk can pass the infection from mother to baby.

Vaginal Yeast Infections

WARMER WEATHER IS ON ITS WAY; AND WITH THE PLEASANTRIES OF THE SEASON COME THE PROBLEMS OF FEMININE HYGIENE!

This is a brief overview of just one type of infection that might irritate you or someone you know!

A vaginal yeast infection is a condition caused by a fungus called CANDIDA ALBICANS. Yeast is always present in the vagina in small amounts, but when it overgrows it may cause the symptoms of a yeast infection. Yeast grows in warm, dark environments that are less acidic-like a vagina! You may also encounter yeast in skin folds, underneath larger breasts or even on your inner thighs. Yeast infections also result from the use of antibiotics which decrease the “good bacteria” present in the body. This “good bacteria” works in your body to help maintain yeast at normal levels.

What are some factors that may increase your chance of getting this infection?

• being a female
• situations that cause hormonal changes such as pregnancy and menopause
• steroid use or birth control pills
• taking antibiotics
• having diabetes, especially if your blood sugar is not well-controlled
• having a compromised immune system, like HIV infection or cancer
• wearing tight pants, underwear without a cotton crotch, or wet swimsuits for a prolonged period of time
• deodorant tampons, perfumed feminine hygiene sprays or scented bubble baths
• douching

Although these are examples of factors which increase your chances of suffering from a yeast infection, everyone’s body is different. You may find that doing some of these activities may not affect you.

What are some of the symptoms of a yeast infection?

• mild to severe vaginal itching
• clumpy, vaginal discharge that may look like cottage cheese and be white or yellow (usually no strong odor)
• vaginal soreness, irritation, or burning
• a rash or redness on the skin outside the vagina (may include thighs)
• pain with urination and/or sexual intercourse

How do you diagnose this infection?

It is important to see your doctor the first time you have symptoms. There are other infections that have similar symptoms but must be treated differently. Your doctor will take a history and do a pelvic exam, analyzing any vaginal discharge and treating it. If you have had a yeast infection in the past and are sure it has reoccurred, it is safe to use over-the-counter medications. Consult your doctor if you have any doubt.

How do you treat this infection?

There are many antifungal medications available, like Monistat, Gyne-Lotrimin, Fem-stat, Terazol and Mycelex. They are available as creams or suppositories that are placed into the vagina. The treatments come in one, three, or seven-day packs. The seven day treatment is the least convenient but most effective. Your doctor may prescribe a pill call Diflucan; which is a single-dose treatment. If you are pregnant, talk with your doctor before using anything.

How do I prevent myself from getting a yeast infection?

There are several things that may help, but keep in mind that if you participate in any of the risk factors listed above, you may get an infection anyway. Do not be discouraged, try these preventative measures.

• dry the outside vaginal area thoroughly after a shower, bath or swim
• change out of a wet swimsuit or damp workout clothes quickly
• wear all-cotton or cotton crotch underwear and avoid tight pants
• do not douche unless your doctor says it is okay (this washes out the “good bacteria” that is present in the vagina and disturbs the acid balance
• if you have diabetes, try to control your blood sugar
• avoid bubble baths, perfumed feminine hygiene sprays and scented soaps if you find that you keep getting yeast infections
• consider adding yogurt to your diet, L. acidophilus which is present in yogurt can keep Candida Albicans at healthy levels in the body
• if you have chronic yeast infections, try cutting out alcohol, sugar, caffeine and carbohydrates from your diet. Yeast feed on glucose, so any food that increases your glucose level will exacerbate a yeast infection

Dr. Octavia Cannon
Board Certified Ob/Gyn

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Weight Management

CHILDBIRTH BRINGS A JOY THAT MANY WOMEN HAVE NEVER KNOWN.

However, pregnancy and childbirth bring about changes that make our bodies seem foreign. Our pre-pregnancy clothes are pushed to the side of the closet where we seldom go. The size 8, 10 or 12 of the past quickly becomes the size 12, 14, and 16 of the future. Alas, the fashion industry does little to reassure us since the average fashion model is a size 4. Well, don’t worry and certainly don’t beat yourself up over it. Studies show that we aren’t alone as 66%, yes, that’s two out of three Americans, are either overweight or obese.

But what is contributing to this epidemic? Is it merely just the lack of exercise or possibly the “supersizing” of the average meal? It is likely a combination of both of these factors and in addition food addiction, stress, self control and moderation issues, self esteem and our learned relationship with food as it relates to others in our community and society. In any event for many women attempts at losing weight have become a futile exercise.

There is help in sight. Thank heavens it’s a New Year and we can start anew. If you are ready, willing and able to lose weight, it can be done. First, think of what barriers you might have to successful weight loss. Is it a lack of time, poor meal planning, or is it simply that you have no idea how to make healthy choices. Luckily, many weight loss strategies can be objectively evaluated and a plan for success can be made. If you’re not expecting overnight success but instead smooth and steady progress, you can expect that by this time next year, a new you can emerge. Simple steps such as eliminating high calorie sodas and juices and replacing them with water, 8-10 glasses per day, can be a good start. Eliminate deserts and generally limit your intake of sweets. Many of us fail to realize how many calories we consume in a bag of chips or by drinking 3-4 sodas a day. Many patients ask me about good food choices for people on the run. I jokingly tell them that if they are getting their lunch through a little window served to them by a person wearing a cap, they probably shouldn’t be eating it. This is generally true as “fast food” can be extremely unhealthy, and the foods that are healthy, are difficult to eat while driving down the road.

Similarly, exercise is an essential way of speeding up your metabolism both by building muscles, which burn more calories than fat. When the energy you expend is greater than the calories eaten, the result is generally weight loss. Luckily, you don’t have to start off by training for a marathon. You can start by simply walking 15 minutes per day for 3-4 days per week and then adding 5-10 minutes each week until you are up to 30 minutes. This is an especially good plan for those whose bodies may not be accustomed to exercise. Once you are up to 30 minutes of walking, you can quicken the pace or try a fast trot or jog.

Any new diet or exercise regimen, however, should be done in consultation with your physician or bariatrician, a doctor who specializes in weight loss. If you have other health related issues such as high blood pressure, diabetes or have discomfort in your joints with exercise, you may need screening blood work or a physical exam prior to beginning a program.

Whether you choose to start with diet, exercise or a combination of both, the key is to DO SOMETHING! Losing just 10% of your current body weight can provide you with a significant amount of energy, reduce your blood pressure or blood sugar, and contribute to an overall feeling of wellness. Now that’s a great way to start a new year!

Dr. Mala Freeman-Kwaku
Board Certified OB/Gyn

Is it just the baby blues?

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CHILDBIRTH CAN BE ONE OF THE MOST EXHILERATING TIMES IN A WOMAN'S LIFE.

Becoming a new mother, is one of life’s greatest joys. However, long days, sleepless nights, endless diaper changes, and the constant and unrelenting neediness of this new life can prove to be a more stressful experience than any book could describe. Many women may be susceptible to intense feelings of sadness, fatigue and anxiety that, prior to this event, were unknown emotions. While some women may simply experience the “baby blues”, others may suffer from postpartum depression.

Many new moms may experience tearfulness, anxiety, mood swings, fatigue, and increased sensitivity. These “baby blues” tend to peak within the first week after delivery and can last hours or even days. Most women with “baby blues” will be able to “snap out of it” without any assistance. Generally a bit of family support and rest are enough to help the new mom transition out of this slump. Mothers with “baby blues” are, however, at increased risk of developing postpartum depression.

Postpartum depression is more intense and generally is present for at least two weeks to distinguish it from the “baby blues”. It is thought to be triggered by hormonal shifts that occur after delivery exacerbated by the stress of this major life change. The symptoms generally include having a persistent sad mood, fear of being alone, guilt, shame, confusion, fear of harming the baby or generally feeling exhausted and empty. Women experiencing postpartum depression generally lack interest in their usual activities, have difficulty sleeping or sleep too much, have nightmares, eat little or too much, exhibit poor self-care or personal hygiene and lack motivation. They may have persistent thoughts or fantasies of running away from all responsibilities, fear of being rejected by their partner, obsess about harming their self or the baby and be unable to think clearly. Even though these symptoms are common, not everyone will experience these symptoms.

Some women may be screened prior to delivery for their risk of postpartum depression. You may also help your doctor identify if you might be at risk. If you have had previous postpartum depression, have a family history of depression, are lacking adequate family support or emotional support, you might be at higher risk. Similarly, if you have a complicated pregnancy, delivery, or your baby has a birth defect, you might be at higher risk of postpartum depression.

Don’t despair-there is hope! Postpartum depression can be successfully treated with medications, therapy, or a combination of both. Many of the medications are also safe for breastfeeding mothers. If you are concerned that you may be experiencing postpartum depression, please see your doctor and discuss your feelings with her. Although most women will see their physician six weeks postpartum, you can make an appointment at any time to discuss your feelings if you are concerned. Your physician can help you discern between the “blues” and true depression and be a valuable asset to get you back on track.

Dr. Mala Freeman-Kwaku
Board Certified Ob/Gyn

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