Archive for category: Pregnancy

Cannabis and Pregnancy

Cannabis and Pregnancy

Cannabis is also known as weed, marijuana, hashish, hash, and pot. There is no amount of cannabis that is known to be safe during pregnancy. For a woman who is pregnant, or who might become pregnant, researchers and doctors recommend that not using cannabis is the safest choice.

If a pregnant woman cannot stop using cannabis, she should try to use smaller amounts and use less often. This may lower the risk of harmful outcomes to the baby.

Research shows that harmful outcomes for children exposed to cannabis during pregnancy are most often seen with women who use cannabis often during pregnancy and throughout the entire pregnancy. Less is known about the potential harms of low to moderate use during pregnancy. Until more is known, it is safest for a woman who is pregnant, or who might become pregnant, to not use cannabis. If you or someone you know needs help quitting, call the HealthLine at 811 for advice and support.



General Information

Cannabis comes from the cannabis plant. Cannabis can be inhaled (smoked), swallowed (e.g., in food and drinks), placed under the tongue (e.g., strips and sprays), or applied on the skin (e.g., oils and creams).

Cannabis contains hundreds of chemicals. The most researched of these is tetrahydrocannabinol (THC). THC is the chemical in cannabis that makes people feel “high”. The strength of the cannabis product depends on the level of THC in the product. The highest THC levels are found in hash oil, followed by hashish (resin), and marijuana (dried leaves/flowers). Cannabidiol (CBD) is another chemical in cannabis. Unlike THC, it does not make people feel “high”.

Short-term effects of using cannabis can include:


  • Euphoria (feeling “high”)
  • Feeling relaxed
  • Feeling hungrier than usual
  • Rapid, strong, or irregular heartbeat
  • Anxiety
  • Problems paying attention
  • Problems with memory
  • Difficulty making decisions

Long-term effects of using cannabis can include:


  • Addiction (psychological and physiological dependence)
  • Problems with lungs and airways (e.g., lung infections; a chronic, long-term cough; bronchitis)
  • Problems with memory, attention, learning, and problem-solving
  • Increased risk of depression and anxiety

Cannabis and Pregnancy

Cannabis is now legal in Canada (as of October 17th), but this does not necessarily mean it is safe to use. It is important that people understand the negative effects that cannabis can have before, during, and after pregnancy.


  • Cannabis use may negatively impact fertility (make it harder to get pregnant).
  • Cannabis use during pregnancy may harm the developing baby (e.g., baby may be smaller than normal, born too early, or have birth defects).
  • Children who are exposed to cannabis during pregnancy (in the womb) may experience negative effects in childhood and adolescence (e.g., poorer memory and verbal skills; behavioural changes, such as increased rates of impulsivity and hyperactivity).
  • Infants and children who are exposed to cannabis through breast milk may experience negative effects, such as lethargy (lack of energy), poor feeding habits, and slower motor development (the ability to move).

Cannabis and Parenting

There are serious, potential risks for young children whose parents use cannabis. These risks include:


  • Poisoning
  • Motor vehicle crashes if parents drive while “high”
  • Risks from second-hand smoke

Children are at risk of poisoning if they eat items containing cannabis. Overdoses of cannabis in children are most common when children mistake foods containing cannabis for regular foods (e.g., gummy bears, brownies, lollipops). Smaller children are at higher risk of poisoning because of their size and weight. It is important that parents keep cannabis out of the sight and reach of children, if possible in a locked cabinet.

Parents can also put their children in danger if they are “high” while driving. It is also important that parents do not smoke cannabis around their children, since second-hand cannabis smoke may cause some of the same health problems for children as second-hand tobacco smoke.


After Pregnancy (Postnatal)

After Pregnancy (Postnatal)

Postnatal health refers to a mother’s health after giving birth and is generally defined as the period beginning immediately after the birth of the baby and extending for six weeks. New parents may be stressed, tired and anxious due to the changes necessitated by the arrival of their baby.

A newborn requires special attention and care and it is important for parents to quickly adjust to manage the demands of a baby.

Just as in pregnancy, a woman’s body changes as it recovers from child birth. Women should take time to heal and rest after the baby’s birth. Support from a partner, friend or family is important to make a smooth transition into new parenthood, allowing for sleep and recovery time. Some elements of pregnancy and birth may result in complications. A woman should talk with a healthcare provider about the best options for treatment and recovery.

Many women may be anxious to lose the weight she gained during pregnancy. Nutrition is very important, especially when a woman is breastfeeding. In fact, breastfeeding has been shown to help promote a healthy return to pre-pregnancy weight while being an excellent opportunity to bond with the baby. Appropriate amounts of physical activity is also a healthy way to lose weight, although a woman should start slowly and build up over time as not to strain her body. Consulting a healthcare professional will help a woman develop an exercise routine that will be safe and appropriate.

A woman should also examine her mental and emotional health after giving birth. A certain level of stress and anxiety is normal for new mothers. Some women may feel sad after giving birth, possibly because of hormonal changes. However, if this sadness continues beyond 10 days, a woman should talk to her healthcare professional about the risk of Postpartum Depression.

Breastfeeding

The benefits of breastfeeding are well established. Breastfeeding provides the newborn with nutrition as well as protection from illness and infection. It provides bonding time with the mother, decreases the risk of Sudden Infant Death Syndrome, and increases performance on neurocognitive testing later in life. There are also benefits to the breastfeeding mother which includes improvement in mood, a decreased risk of ovarian and breast cancer as well as assistance with postpartum weight loss. Breast milk is the only food that a newborn needs for the first six months of its life, making it a healthy, affordable, and accessible way to feed a baby.

Breastfeeding can be difficult at first, and it may take time to adjust. Some woman may also experience certain infections or soreness when breastfeeding but are encouraged to continue trying and to talk with healthcare providers with any questions or concerns. Formula is recommended for use only if the mother cannot breastfeed for some reason or if she has made an informed decision not to breastfeed.

Certain medications, as well as alcohol and most illicit drugs, can be passed to the baby through breast milk. If a woman is taking medication, she should discuss her intake with her healthcare provider. Drugs and alcohol should be avoided throughout pregnancy and lactation.

Infant Sleep

Good sleep among infants and young children is important for their physical, mental, and emotional health and well-being. Sleep issues among infants and young children are often identified by their caregivers. Common sleep issues include difficulties settling to sleep, frequent night waking, and excessive nighttime crying. Many times, behavioural sleep interventions, such as the “crying it out” method or “sleep training”, are recommended to parents as a solution.

It is important that parents are educated about normal sleep development, since they may mistake normal changes that happen at various developmental stages as “sleep problems”. It is also important that parents know what the research says about the effectiveness of behavioural sleep interventions so that they can make informed decisions that are best for their families.

According to the available research, there is not enough evidence to recommend any specific behavioural sleep intervention for infants and young children. Instead, it may be most helpful for parents to learn about normal sleep development and address any concerns that may influence their child’s quality of sleep, like feeding issues or parental anxiety.


External Links

Maternal Mental Health

Having a baby is often a time of joy and excitement for a new mother. However, up to one in five women experience depression during pregnancy (antenatal depression) or up to one year after pregnancy (postpartum depression).

Although pregnancy is a time of emotional and hormone fluctuation, having several of the following symptoms for more than two weeks could mean a woman is depressed:


  • less interest in normal activities
  • crying for no reason
  • irritable, angry or more sensitive
  • more tired or hyper
  • not sleeping or sleeping too much
  • problems concentrating
  • difficulties coping
  • anxious or panicked
  • thoughts of harming herself, her baby, or others

Depression during and after pregnancy can lead to negative impacts on the woman, her baby, and their family:


  • inadequate prenatal and postpartum care for both the woman and her baby
  • unborn babies can be affected by the mother’s stress hormones
  • increased risk of premature birth and/or low birth weight
  • increased risk of poor bonding between the mother and baby
  • less breastfeeding
  • depression in partners
  • possible other long-term effects on children’s health and development

Antenatal and postpartum depression can be very serious conditions affecting the health of the mother, baby and other family members. However, there are treatments and support available for maternal depression including self-care, help from family or friends, and professional help. Depression will not go away by itself. Women who think they could be depressed should contact a healthcare provider immediately.

It is important to remember that depression is a real health issue and not the fault of the person suffering from it. Simply telling someone to get over it, or deal with it, will not help. Appropriate supports and treatment benefit the woman, her child, and her family.

Wellbeing Course


Related Resources

External Links

Environmental Health

Environmental toxicant exposures can affect human health, fertility, reproduction and development. Evidence of the negative impact of environmental toxicants on human health is on the rise. A growing body of research suggests that maternal exposure to environmental toxicants poses a risk to women’s health as well as fetal and child health and development.

The fetus and young infant can be exposed to environmental toxicants through the mother, from exposures that she experienced both before and during pregnancy. During pregnancy a woman experiences a variety of changes to her diet and body that can influence her chemical body burden and the potential exposure to the developing fetus.


  • Increased body weight, blood volume, urine production, and breathing rate can increase concentrations of toxicants in the bloodstream.
  • Food preferences and changes to gut structure and liver function can increase absorption of ingested toxicants.
  • An increased concentration of toxicants in mothers’ blood allows for transfer of higher concentrations of chemicals to the fetus via the umbilical chord, blood and placenta.


All exposure in utero happens through the placenta. Most toxicants can cross the placenta however small fat soluble chemicals such as pesticides and flame retardants tend to cross the placenta easier. The umbilical chord can only stop transfer of some toxicants. Decreasing maternal exposure is the best way to prevent fetal exposure.

After birth, certain toxicants in a woman’s body can be transferred to her infant through her breastmilk. It is important to note that the benefits of breastfeeding, including the nutrition, important enzymes, and antibodies it supplies; as well as the mother/child bonding it provides; far outweigh the risks. Exposure can also take place through the water used to prepare formula.

The fetus and infant are especially vulnerable to environmental toxicants for a variety of reasons. First, they have increased susceptibility to adverse influences during critical periods of development. These critical periods begin during the early months of pregnancy, when cells are differentiating into specific tissues and organs, and continue into childhood, as body systems such as the nervous, immune, reproductive and endocrine systems are further developed.

As well, an immature blood-brain barrier, which is not fully formed until 6 months of age, may allow for greater chemical exposures to the fetus and young infants’ developing brain. The fetus also has less ability to metabolize toxicants, therefore allowing higher levels of the toxicants to circulate in the blood of the fetus than in that of the mother (Houlihan, 2006).

The infant is developmentally susceptible from exposure to toxicants for a number of physiological reasons:


  • Liver is not fully functional so cannot metabolize and excrete toxicants.
  • Lower stomach pH, increased breathing rate, skin surface area, and intestinal absorption can all result in more toxicants being absorbed.
  • Skin is not hardened, is thinner and more permeable so will absorb more chemicals applied to the skin.


Older infants and young children have increased risk of exposure to certain toxicants, because of their size, intake and behaviour. They have a more rapid breathing rate, and eat and drink more than adults per unit of body weight, resulting in higher exposures. They also have more hand-to-mouth activities and play in areas where they may have higher exposures, such as crawling on the floor or playing actively outside.

Finally, children who have been exposed in utero or early in life have more time throughout their life span for the adverse effects of environmental exposures to show themselves (Canadian Partnership for Children’s Health & Environment [CPCHE], 2008).

Widespread awareness of environmental toxicants; their effects on reproductive, fetal and child health; and how to avoid them; is essential in order to decrease exposures during the preconception, prenatal and early childhood periods.

Healthcare providers play a significant role in communicating environmental health risks to parents, as they are a key, trusted source of health information during the preconception and prenatal and postnatal periods.

However, it is important to understand that much of the research on environmental health needs to be interpreted with caution. Research on the impact of environmental exposures is often observational and researchers are not able to control for all of the factors that can influence the effects of exposure. They often cannot be sure of what all participants have been exposed to, exactly when the exposures took place, or for how long, and they often have ineffective ways of measuring the amount of exposure. This means that findings of effects are often uncertain, and sometimes conflicting between studies. As well, many studies are done on animals, which may or may not tell us much about how an exposure impacts humans. All of this leads us to be uncertain about the actual impact of many environmental exposures. The uncertainty of the research leaves healthcare providers in a difficult position of deciding what their role and responsibility is to inform the public of potential health risks.

The Precautionary Principle is a central concept of environmental policy. The principle essentially states that it is not essential to have decisive evidence of harm before action is taken to avoid or diminish the potential harm. This principle has increasingly been used to develop public health policy in Canada and elsewhere.

However, there is also the risk that use of the precautionary principle to protect the public’s health could paradoxically cause harm to the public’s health. This could be through the removal of potentially beneficial products or interventions because of theoretical concerns about harm, e.g. concerns around vaccines and fluoride. Other possible harms could include creating feelings of anxiety, fear or apathy, by providing information about risks due to exposures that the individual has little or no ability to avoid, or by providing information that is confusing and possibly conflicting.

In order for healthcare providers to provide appropriate guidance it is important they ensure that their information is:


  • based on current best evidence (acknowledging that this can be uncertain and could change),
  • appropriate (i.e. provided to those that are actually at risk and the risk is severe enough to warrant action in the face of uncertainty), and
  • sensitive (i.e. does not cause unnecessary anxiety, fear, apathy or confusion).


Guidance must be based on:

  • An understanding of the evidence for an association between exposure to specific toxicants and health outcomes
  • An ability to assess the severity of risk.

There are a variety of factors that influence the risk to human health from exposure to toxicants. First and foremost it is necessary to determine if there is actually a potential for exposure. Once exposure has been determined, factors that influence effects of exposure on human health include the:

  • Type of toxicant
  • Timing of exposure
  • Duration of exposure
  • Amount of exposure

All of these factors must be assessed before conclusions are drawn. If not, this could lead to inadvertent ‘misconceptions of risk’ and the potential for creating unnecessary concern.

External Links

During Pregnancy (Prenatal)

During Pregnancy (Prenatal)

Prenatal refers to the nine months during pregnancy and before delivery. Regular prenatal visits with a healthcare professional are important in order to monitor the development of the baby and pregnancy. A healthcare professional can also provide accurate information to help families make informed decisions regarding prenatal care and any treatment that may be necessary during and after the pregnancy.

A healthcare provider can also provide accurate information to the mother and her partner in order for them to make informed decisions regarding prenatal care and any treatment that may be necessary during and after the pregnancy.

General Information


The following links provide general information about pregnancy. For more detailed information on specific issues related to pregnancy, please see the sub-sections below.


Biophysical Profile


The biophysical profile focuses on the health of the fetus. This includes assessing the fetus’ heart rate using an electronic fetal heart monitor (a test called a Non-Stress test), as well as using an ultrasound to look at muscle tone, movement, breathing, and amniotic fluid level. Gathering this information takes place in the third trimester when it is considered necessary by a healthcare professional.


Caesarean Section


A caesarean section or C-Section is the use of surgery to deliver one or more babies during one pregnancy. This type of delivery may be necessary when a vaginal delivery has a high risk for complications. Vaginal birth may still be an option for subsequent pregnancies.


Counting Baby’s Movements


Being aware of baby’s movements is important during pregnancy. Experiencing a change in fetal activity during pregnancy should prompt a visit to a healthcare professional. Doing daily fetal movement counts may be recommended by the healthcare professional, especially if risk factors are present.


Domestic Violence (Intimate Partner Violence)


Domestic violence refers to behaviours used by one person in a relationship to control the other person. Pregnancy can be a high-risk time for the start or increase in intensity of domestic violence.


Genetic Screening and Testing


Genetic screening and testing are medical tests that are completed during pregnancy to check for chromosomal abnormalities and, less commonly, for fetal infections. These tests are performed by a medical specialist who provides care during pregnancy and identifies certain risk factors in the pregnancy. Genetic screening and testing can be invasive or non-invasive.


Professionals Providing Care During Pregnancy

General Practitioner


A general practitioner, or family doctor, is a doctor who provides general care for patients. Many family physicians provide prenatal care and support during pregnancy. Some also deliver babies.




Obstetrician/Gynecologist


Obstetricians/gynecologists are physicians who provide medical care during pregnancy and birth. They also specialize in disorders and disease of the reproductive system.




Doulas


A doula provides support to families through pregnancy, labour, and birth, as well as the first year of the baby’s life. A doula is not a health professional and is not trained to assist in births without the presence of a healthcare professional.

Midwives


A midwife is a licensed and registered health professional. Midwives provide care and support during low-risk pregnancies, birth, and for six weeks after birth. Midwives are available in limited locations in Saskatchewan.




Nurse Practitioner


Nurse practitioners are registered nurses who provide direct care for health promotion and the treatment and management of health conditions.


Glucose Screening/Gestational Diabetes Mellitus


Glucose screening is completed to determine the presence of gestational diabetes (diabetes during pregnancy). Glucose screening is normally done in the second trimester, but can be done sooner and more often if a high risk for gestational diabetes is determined or the doctor is concerned about the development of gestational diabetes. Treatment for gestational diabetes is important in order to prevent complications during pregnancy and throughout the life of the woman and child.




Group B Streptococcus


Screening for group B streptococcus occurs in the third trimester of pregnancy. Group B streptococcus can be transmitted to the baby during labour and delivery. Group B streptococcus can be treated with antibiotics during labour and delivery.


Hypertension in Pregnancy


Hypertension, or high blood pressure, can develop during pregnancy. This can cause complications during pregnancy. Gestational hypertension is one of the most common complications during pregnancy.


Induction of Labour


Induction of labour is a medical intervention that occurs when labour is artificially started using an external agent or method that causes the uterus to contract, cervix to open, and baby to be born.


Non-stress Test/Fetal Heart Rate Monitoring


A non-stress test or fetal heart rate monitoring is a test that is used during pregnancy to listen to the fetus’ resting heart rate and heart rate after movement. Monitoring the fetus’ heart rate is a part of biophysical monitoring.


Oral Health


Elevated hormone levels can cause gums to swell, bleed, and trap food during pregnancy. Oral health during pregnancy is very important.


Post-date and Post-term Pregnancies


A pregnancy that has gone 10 days past the due date is called a “post-date” pregnancy. Post-term pregnancies are those that are 14 days past their due dates. The most accurate way to determine the due date is through an ultrasound.


Pre-existing Diabetes and Pregnancy


Pre-existing diabetes can impact the health of the mother and fetus during pregnancy. Careful monitoring of both the mother and baby should take place throughout pregnancy.


Preterm Premature Rupture of Membranes


When the amniotic sac breaks before 37 weeks, it is called preterm premature rupture of membranes. This can result in serious complications for the mother and fetus.


Preterm Labour


Preterm labour is the start of labour between 20 and 36 weeks of pregnancy. This is one of the most common problems in pregnancy. Prematurely born babies can have serious health and developmental complications.


Routine Tests During Pregnancy (Prenatal Bloodwork)


As part of good prenatal care, doctors recommend routine blood tests to look for infections and other conditions in pregnancy. If a problem is found, treatment can reduce the risk of harm during pregnancy and delivery. These include tests for:


  • Complete Blood Count (CBC)
  • Hepatitis B and C
  • Human Immunodeficiency Virus (HIV)
  • Antibody Screening
  • Blood Type
  • Rh Status
  • Rubella (German Measles)
  • Syphilis


Pregnancy Loss


If you have experienced a pregnancy loss, there are supports available in Saskatchewan. You can visit the following sites for more information.


Travelling when Pregnant


Travelling during pregnancy can be safe. However, travelling can increase the risk of infections or complications during pregnancy. Individuals who are pregnant should consult their physician before travelling and be aware of public health notices and recommendations for vaccinations when travelling to specific destinations.


Ultrasound


An ultrasound lets healthcare professionals see if a fetus is growing and developing normally. For most women, the first ultrasound is done between 11 and 14 weeks gestation to accurately date the pregnancy. An anatomic ultrasound takes place between 18 and 20 weeks to check on the growth, development, and physical anatomy of the baby. In certain situations, ultrasounds may be conducted in the first trimester.


Vaginitis and Pregnancy


Vaginitis is an infection of the vagina. Individuals who are pregnant should talk to their healthcare professional if they are having symptoms of vaginitis. Symptoms include itching, burning, vaginal discharge, and pain during sex.


Healthy Weight Gain During Pregnancy


Gaining weight is a natural and important part of pregnancy. However, gaining too much weight during pregnancy may lead to health problems and gaining too little weight can increase the risk of low birth weight. An individual’s weight and Body Mass Index (BMI) before pregnancy will help to determine how much weight should be gained during pregnancy.


Click here for more information

Healthy Weight Gain

As the health and development of an unborn baby is closely connected to the mother’s health, it is important for the mother to pay attention to her food choices and physical activity levels in order to promote the health of her baby.

During pregnancy, a woman will need more calories each day to support the growth of her unborn baby. She should also make healthy food choices, consuming fruits and vegetables, whole grains, low fat protein and low-fat milk product in accordance with Canada’s Food Guide. Pregnant women should also take a multivitamin every day that contains at least 0.4 mg of folic acid and contains iron.

Gaining weight is a natural and important part of pregnancy. However, gaining too much weight during pregnancy may lead to health problems and gaining too little weight can increase the risk of low birth weight. A woman’s weight and Body Mass Index (BMI) before pregnancy will help to determine how much weight she should gain during pregnancy.

BMI below 20

if a woman’s BMI is below 20, she should gain between 28-40 pounds (12.5-18 kg)

BMI 20 - 27

if a woman’s BMI is between 20 and 27, she should gain 25-35 pounds (11-15.5 kg)

BMI over 27

if a woman’s BMI is over 27, she should gain between 15-25 pounds (6.5-11 kg)

Physical activity is also important to maintain or begin during pregnancy. If a woman is active before her pregnancy, she can continue to exercise as before making changes as necessary with the changes in her body. If a woman is not active before her pregnancy, she should begin an exercise program slowly. Discussing safe ways to engage in physical activity with a healthcare professional will help develop a routine that is best for mother and baby.


Maternal Obesity, Excessive Gestational Weight Gain and Pregnancy Outcomes Final Report

This literature review, conducted by the Saskatchewan Prevention Institute, aimed to: (a) examine the relationship between maternal obesity and pregnancy outcomes (i.e., maternal outcomes and neonatal, infant and child outcomes); and (b) assess the association between excessive gestational weight gain (GWG) and pregnancy outcomes (i.e., maternal outcomes and neonatal, infant and child outcomes). The document reports on findings from a review of the literature on maternal obesity, excessive gestational weight gain and pregnancy outcomes, conducted between December 1, 2009 and March 31, 2010.



Download the Report


Interventions for Weight Management in Pregnancy – Overview of Systematic Review and Meta-Analysis Studies

More than two-thirds of women of childbearing age are overweight or obese, and these numbers have increased dramatically in the last few decades in Canada. Further, average weight gain in pregnancy has increased over the last four decades from 10 to 15 kg and a significant number of women are exceeding pregnancy weight gain recommendations.

The increasing prevalence of preconception overweight and obesity and excessive gestational weight gain is a significant risk factor for adverse maternal and infant outcomes. The risks may involve the pregnancy, birth, and later life for both the woman and her infant. One important downstream risk is childhood obesity.

Weight management strategies are increasingly focusing on pregnancy as a potentially key time to target weight management to address the rapidly increasing prevalence of obesity in the population. This review of various systematic review and meta-analysis studies examining the effectiveness of weight management interventions during pregnancy discusses potential strategies to enable more effective dialogue between pregnant women and healthcare providers to ensure optimal health and wellness for mom and baby.



Download the Interventions for Weight Management in Pregnancy Report

External Links

Before You Become Pregnant

Before You Become Pregnant

Healthy babies start with healthy mothers. The preconception period, or the time between puberty and pregnancy, is critical to a healthy pregnancy and pregnancy outcome.

When a woman has a healthy lifestyle before pregnancy, there is a good probability that she will have a healthy pregnancy, delivery, and postnatal period (the first six weeks after pregnancy).

Preconception

The Maternal and Infant Health program focuses on the health of the mother and baby by providing current, evidence-based health information to the healthcare providers on best practices of maternal and infant and health promotion. This information focuses on the periods of preconception, pregnancy, postnatal, and infancy.

The goal of the Maternal and Infant Health program is to ensure that all women in Saskatchewan have safe and healthy pregnancies, and all babies are born as healthy as possible and remain so through infancy.

Preconception is the time before a woman becomes pregnant – the best time for a woman to prepare her body for a baby. This is a time when a woman can address any possible risk factors that may affect the baby’s health and development throughout the pregnancy. There are many controllable risk factors in the preconception period that can be addressed to ensure the mother and baby are as healthy as possible. Optimizing health before becoming pregnant can help to create an ideal environment for the developing baby, especially in the first few critical weeks of pregnancy, before many women even know that they are pregnant.

The timing of pregnancy has a significant impact on preconception health. Although it is ideal to make health changes prior to conception, many times a pregnancy is not planned. It is therefore important for all women of childbearing age to know how to reduce the risks of potential health problems should they become pregnant.

Related Resources

Pre-Existing Conditions

Although certain pre-existing conditions do not preclude women from having a healthy pregnancy, it is important for women with these conditions to take certain precautions and measures to ensure the healthiest outcome for their baby.

Meeting with a prenatal healthcare provider before becoming pregnant is important. Certain pre-existing conditions that require medications may harm the developing baby. Pre-existing conditions may also require special maintenance during pregnancy due to the changes in a woman’s body. A woman and her healthcare provider can determine the best way to manage any conditions that existed prior to or during the pregnancy. A healthcare provider can recommend medications and treatment options that are safer for the developing baby while still managing the mother’s condition (e.g. diabetes, high blood pressure, epilepsy, chlamydia, HIV, etc.).

Pre-Existing Diabetes and Pregnancy

If a woman has diabetes, it is important for her to talk to her doctor before becoming pregnant to discuss how to manage her diabetes during pregnancy. Achieving and maintaining proper control over insulin is important in the prevention of poor outcomes for the baby.

During pregnancy, the baby will use some of the mother’s glucose, and therefore glucose levels may need to be adjusted. Pregnant women should be prepared for low blood sugar reactions by monitoring their insulin, meals and exercise closely to ensure their insulin requirements are being met.

Blood sugar control is extremely important before and during pregnancy as it decreases the risk of certain congenital anomalies (e.g., heart, neural tube, genital and/or urinary system defects). During labour and delivery, blood sugar levels should be monitored and maintained to ensure the healthiest outcomes for the mother and child.

If any of the following symptoms occur during pregnancy, contact a healthcare provider immediately:


  • High or low blood glucose levels
  • High HbA1c levels
  • Positive urineketones
  • Symptoms of a bladder infection (e.g., frequent urination, pain or burning when urinating)
  • Unable to eat due to nausea or vomiting
  • Decrease in the baby’s movements
  • Decrease of more than 5-10% in insulin requirements after 32 weeks

Related Resources

Hepatitis B and C

Hepatitis B (HBV) and Hepatitis C (HCV) are viruses that cause serious liver disease. Both forms of the virus can be passed to a baby during pregnancy. It is therefore important to be tested prior to pregnancy as a woman may not even realize she has the virus.

If Hepatitis B is detected before pregnancy, a woman can be treated to prevent her baby from being infected. If the virus is detected during pregnancy, treatment should begin for both the woman and her developing baby. If a woman is not treated for Hepatitis B, there is an increased risk of her passing the virus onto her baby.

There is no vaccine for Hepatitis C. However, a newborn baby can be vaccinated with the Hepatitis A and Hepatitis B vaccines to provide some protection from the Hepatitis C virus.

HIV and Pregnancy

HIV is the acronym for Human Immunodeficiency Virus. This name highlights the fact that HIV can only be transmitted from one human to another human, and that it is a virus that causes a deficiency in the immune system. Once a person becomes infected with HIV, the virus begins destroying the cells that are responsible for the human immune system, making it difficult for the body to fight off infections and diseases.

HIV is a progressive disease that continually causes changes and damage to an individual’s immune system. When a person’s immune system becomes damaged and they contract one or more opportunistic infections (e.g. respiratory infections, fungal infections, cancer) they are said to have AIDS (Acquired Immune Deficiency Syndrome).

HIV can only be transmitted when there is a direct exchange of specific bodily fluids between two humans. The five fluids capable of transmitting HIV are blood, semen and pre-cum, vaginal and anal fluid, and breast milk. HIV can also be transmitted from mother to child during pregnancy and/or delivery. Although there is no cure for HIV or AIDS, with appropriate care and treatment the risk of transmission from mother to infant can be reduced to less than 2%. Without treatment, the risk of transmission from mother to infant is approximately 25%. A woman may not know that she has been exposed to the HIV virus and therefore a doctor will advise women who are pregnant or thinking of becoming pregnant to be tested for HIV.

Related Resources

Sexually Transmitted Infections and Pregnancy

Sexually Transmitted Infections (STIs) are spread through unprotected sexual contact. Many people who have STIs do not know that they are infected because many STIs do not produce visible symptoms. Testing for STIs during pregnancy is very important, as some STIs can be passed on to the developing baby prenatally, during delivery, or during breastfeeding.

There are many different STIs, such as syphilis, chlamydia, gonorrhoea, nongonococcal urethritis, trichomoniasis, hepatitis B, hepatitis C, human papilloma virus, and genital herpes. Certain STIs can cause very serious damage to a baby. For example, untreated syphilis can cause brain damage, blindness, deafness or even death in the developing baby. Many STIs can be treated during pregnancy (e.g., chlamydia, gonorrhoea, syphilis). There are others that cannot be treated (e.g., genital herpes), but knowing a woman’s status presents the opportunity to reduce the risk of transmitting the infection to the baby. For this reason, testing for STIs informs health professionals of the woman’s condition, which can in turn, help to prevent the baby from becoming infected.

Related Resources

External Links

Folic Acid

Folic acid is important for the prevention of neural tube defects. Neural tube defects are congenital malformations of the neural tube; the embryonic structure that develops into the brain and spinal cord. Every unborn baby’s spine is open when it first forms, and normally closes by day 26 to day 28 post-conception; this often occurs before the pregnancy is confirmed. In the case of an NTD, the backbone and spinal cord never completely close.

Studies show that women who consume recommended doses of folic acid can reduce the risk of having a child with an NTD by 50% – 70%. However, it is important to note that not all NTDs can be prevented by maternal intake of folic acid. It is therefore very important that all women of childbearing age take folic acid supplements, even if they are not planning a pregnancy, as neural tube defects can occur before a woman even knows that she is pregnant.

The amount of folic acid a woman should take before and during pregnancy, as well as while breastfeeding, is dependent on a number of maternal and paternal risk factors. The Society of Obstetricians and Gynaecologists of Canada classify women as either low risk, moderate risk, or high risk for having a baby with an NTD. Healthcare providers assist women to determine the amount of folic acid they should be taking.

Related Resources

External Links

Healthy Lifestyles

The lifestyle choices a woman makes prior to becoming pregnant and during pregnancy can affect her health and the health of her baby. What a woman ingests (e.g. eats, drinks, smokes) when pregnant, can affect her unborn baby. Women should avoid smoking, drinking alcohol, and using street drugs. Women should check with their healthcare provider whether prescription drugs and over-the-counter medications she is taking are safe to take during pregnancy. It is also important to eat a nutritional diet and stay active to maintain a healthy weight. If a woman is in an unhealthy relationship she may need to seek help as domestic violence may begin or intensify during pregnancy.

If a woman finds it difficult to abstain from smoking, drinking or taking drugs; or if she is in an abusive relationship, she should seek help and guidance from a healthcare provider, counselor or close friend to discuss her options.

Related Resources

External Links

Alcohol Use and Pregnancy

When a pregnant woman drinks alcohol, there is a chance that her baby will be born with Fetal Alcohol Spectrum Disorder (FASD). FASD describes the range of disabilities that can occur when the unborn baby is prenatally exposed to alcohol. Prenatal alcohol exposure primarily affects the central nervous system (the brain), and can affect physical, behavioural, learning, and social development. It is also strongly associated with mental illness. Because the damage to the fetus affects the developing brain, FASD is life long and is not something that can be “cured”. However, with support, individuals with FASD can lead fulfilling and productive lives.

FASD is a preventable condition … if a woman does not drink during pregnancy there is no chance that her child would be born with FASD. There is no known safe time, kind, or amount of alcohol to drink while pregnant. Binge drinking and heavy drinking have been found to be especially damaging to the developing baby. Stopping or reducing drinking at any time in pregnancy will benefit the child’s health. If a woman is having difficulty stopping drinking, she should ask for assistance from a healthcare provider, counselor, or someone she trusts.

Related Resources

External Links

Pregnancy and Physical Activity

Pregnancy should not stop women from being active. Exercise can be safe and enjoyable during pregnancy. In fact, healthy pregnant women should participate in regular physical activity. It’s good for both women and their unborn children.

During pregnancy, women who exercise may benefit from:


  • fewer musculoskeletal problems, including less back and pelvic pain
  • increased maternal cardiovascular fitness
  • lowered risk of gestational (pregnancy-related) diabetes
  • increased management of pre-existing diabetes
  • increase in maternal positive body image, well-being and self-esteem

Things to remember
  • Every pregnancy is different. Women should consult their healthcare provider before beginning or changing their physical activity program.

  • If a woman has been active (3x a week for 30 minutes) before becoming pregnant and has her pregnancy healthcare provider’s approval, she can safely continue to exercise during her pregnancy.

  • If a woman did not exercise prior to becoming pregnant, it is safest to begin a new fitness program during the second trimester. She should slowly increase the length of aerobic activity from 15 to a maximum of 30 minutes per session, for a maximum of four sessions per week.

  • Pregnant women can safely perform strength training activities two or three times per week. For muscles to recover, one day of rest should be allowed between sessions. High repetitions (12 to 15) and low weight are recommended.

  • During pregnancy, it is important to consider aerobic activities where the body is supported, such as swimming or cycling. Some other safe activities may include walking, low-impact aerobics, and stair climbing.

  • Pregnant women should include stretches as part of their warm up and cool down.

  • Drinking water before, during, and after activities to replace lost body fluids is important.

  • Pregnant women should be advised to breathe normally throughout activities and never hold their breath.

  • If a separation of the abdominal muscles has occurred, women should not perform abdominal exercises as this might make the condition worse.

  • Women should consult their physician before continuing any physical activity program after birth.

Cautions for physically active pregnant women

References

  • Davies, G. A., Wolfe, L. A., Mottola, M. F., MacKinnon, C. (2003). Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period. Canadian Journal of Applied Physiology, 28(3), 329-341. doi: 10.1139/h03-024
  • Ferraro, Z. M., Gaudet, L., Adamo, K. B. (2012). The Potential Impact of Physical Activity During Pregnancy on Maternal and Neonatal Outcomes. Obstetrics and Gynecology Survey, 67(2), 99-110. doi: 10.1097/OGX.0b013e318242030e

External Links

Related Resources

Prescription Drugs, Over-the-Counter Drugs, Supplements, Illicit Drugs, and Pregnancy

During pregnancy, a woman’s body needs certain nutrients and supplements to give her baby what it needs for proper development. However, there are medications, supplements and drugs that can be detrimental to a developing baby. During pregnancy, an unborn baby is nourished through the mother’s placenta, and this connection allows many substances, including the by-products of many drugs, to pass from the mother to the fetus.

Some prescription medications are teratogenic (agents that can disrupt normal development of the embryo or fetus) and can cause congenital anomalies. It is important for a woman to see her healthcare provider, to discuss her options for managing her condition while pregnant. In some cases the risk to mother, by not taking the medication, may outweigh the risks to the fetus, in which case a doctor will recommend continuing therapeutic use of the medication.

Over-the-counter medications such as cough syrups, painkillers, antacids, nose drops, laxatives, sedatives, diuretics, and vitamin supplements are drugs that should be used carefully and only on the advice of a healthcare provider. Even if a medication has been found to be safe during pregnancy, it is important that women adhere to the recommended doses that have been tested for safety. Illicit or street drugs can have harmful effects on the developing baby and expectant mother. Some drugs are associated with a risk of congenital anomalies, miscarriage, preterm birth and low birth weight as well as possible withdrawal in the newborn. Drugs may also be passed through the mother’s breast milk and can have varying effects on the infant. If a woman has difficulty stopping her drug use, she should seek assistance from a trusted healthcare provider or counselor.

Related Resources

External Links

Smoking and Pregnancy

Smoking has a negative effect on a woman’s health before she becomes pregnant and can be very harmful to both the woman and her baby during and after pregnancy. Any exposure to cigarette smoke can affect a woman’s reproductive, prenatal and physical health. Pregnant women who smoke or who are exposed to second-hand smoke have a higher risk of pregnancy complications such as miscarriage, ectopic pregnancy or gestational hypertension. Chemicals from tobacco smoke, such as carbon monoxide and nicotine, can cross the placenta to affect the unborn baby. Babies born to mothers who smoke have a greater risk of preterm birth and low birth weight, as well as low oxygen levels, developmental and learning problems, visual and respiratory problems, bleeding in the brain and jaundice.

Environmental tobacco smoke (ETS), also known as second-hand and third-hand smoke can also cause health problems for children after birth. The harmful products in tobacco smoke can also be passed to the infant in breast milk. When children breathe in second-hand smoke, they are passively smoking, which can cause ear, throat and/or lung infections, asthma, allergies, coughing and wheezing. Babies born to mothers who smoke are also at a greater risk of dying of SIDS (Sudden Infant Death Syndrome).

Third-hand smoke, the chemicals from smoke that remain even after the smoke is gone, is also dangerous. Third-hand smoke can get trapped in hair, skin, fabric, carpet, furniture and dust, and buildings over time. These chemicals pollute the air and can therefore adversely affect people’s health. Infants are especially susceptible to third-hand smoke because they breathe more quickly and spend more time on the floor where there is a build-up of chemicals. The effects of ETS will continue to harm the health of children and their mothers until smoking is completely removed from their environment.

For more specific information on tobacco use and pregnancy, see the resources below:
Newland, J. (2009). Do your patients know about third-hand smoke? The Nurse Practitioner, 34(2), 5. doi: 10.1097/01.NPR.0000345259.26880.43

Related Resources

External Links

Infant Mortality

Infant mortality is a universal indicator for the overall health of a population. Health Canada describes it as the “single most comprehensive measure of health in a society” (Health Canada – Government of Canada, 2011). It is measured using the infant mortality rate, calculated as the number of deaths of infants less than one year of age per 1,000 live births.

Although the infant mortality rate in Saskatchewan has decreased since 2005, as of 2009 it was still well above the Canadian average and the highest among all the provinces in Canada. In 2009, the rate of infant mortality in Canada was 4.9/1,000 live births. The rate in Saskatchewan in the same year was 6.7/1,000 live births (Statistics Canada, 2012).

The infant mortality rate of a given population can provide valuable information about the health of that population. It can speak to the behavioural and social factors affecting the population and the interventions that may be required. The leading causes of infant mortality in Saskatchewan are:


  • Congenital anomalies (birth defects)
  • Preterm birth
  • Sudden Infant Death Syndrome (SIDS)

For more information about infant mortality and its risk factors, please read the Saskatchewan Prevention Institute’s report on Infant Mortality in Saskatchewan: Evidence to Inform Public Health Practice.


This report outlines some promising practices to reduce infant mortality. A report from Health Canada, titled “Healthy Canadians – A Federal Report on Comparable Health Indicators 2010”, is also a valuable source of information on this very important topic.

References

  • Davies, G. A., Wolfe, L. A., Mottola, M. F., MacKinnon, C. (2003). Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period. Canadian Journal of Applied Physiology, 28(3), 329-341. doi: 10.1139/h03-024
  • Ferraro, Z. M., Gaudet, L., Adamo, K. B. (2012). The Potential Impact of Physical Activity During Pregnancy on Maternal and Neonatal Outcomes. Obstetrics and Gynecology Survey, 67(2), 99-110. doi: 10.1097/OGX.0b013e318242030e
  • Newland, J. (2009). Do your patients know about third-hand smoke? The Nurse Practitioner, 34(2), 5. doi: 10.1097/01.NPR.0000345259.26880.43
  • Irvine, J., Quinn, B., & Stockdale, D. (2011). Northern Saskatchewan Health Indicators Report 2011. Retrieved from www.athabascahealth.ca
  • Health Canada. (2011). Healthy Canadians – A Federal Report on Comparable Health Indicators 2010. Retrieved from www.hc-sc.gc.ca
  • Opondo, J. & Marko, J. (2012). Medical Health Officer Report: Reducing Infant Mortality in Saskatoon Health Region. Retrieved from www.saskatoonhealthregion.ca
  • Saskatchewan Prevention Institute. (2009). Infant Mortality in Saskatchewan: Evidence to Inform Public Health Practice.
  • Statistics Canada. (2012). Infant mortality rates, by province and territory. CANSIM, table 102-0504. Retrieved from www.statcan.gc.ca

Related Resources

Saskatchewan Prevention Institute