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WHAT YOU SHOULD KNOW ABOUT DRINKING APPLE CIDER VINEGAR WHILE PREGNANT & BREASTFEEDING || ACV FACTS

Apple Cider Vinegar is not the most pleasant tasting drink, but what if you learned that it had the potential to help ease suffering from some of the most common pregnancy ailments? Would you fill your cup up?

Apple Cider Vinegar is not a new trend. It has been used for centuries as a go-to in the kitchen and in the natural world of health. It has, however, gained quite a following in recent years. Without a little honey, it can be hard to choke down, but there are ways to better the flavor. Once you read the benefits, you may want to give it a shot! The good news is that it only takes 2-3 teaspoons a day to feel the effects (and you can dilute it with water).

Apple Cider Vinegar and Pregnancy

Glowing Skin

You can use ACV as a toner on your skin and consume it each morning. You’ll have skin glowing from the inside out in no time. Your pregnancy hormones are the cause to your inflamed and clogged pores, but ACV battles the inflammation and illuminates the skin.

Bye-Bye Bloat

In the first trimester, there are weeks of bloating that just feel unnatural. It can cause stomach pain, heartburn, slow digestion, and gas. ACV taken after a meal can keep the food flowing through the digestive track, aiding in the breakdown and passing of it, but also allowing nutrients to still be absorbed as needed. The result tends to be less bloating and a happier stomach.

See-Ya Sickness

Morning sickness (or all day sickness) occurs when the stomach acid becomes unbalanced. An organic ACV has a neutralized pH and can rebalance the stomach and calm a sick belly.

Help for UTI’s

Urinary Tract Infections are awful, especially during pregnancy. As the uterus grows, there is more pressure placed on the bladder, which can make it hard for urine to be completely eliminated during a trip to the bathroom. Bacteria then builds up and triggers pain. ACV creates an environment in which bacteria struggle to grow, basically preventing a UTI from forming.

Fighting the Common Cold

Sniffles, sneezes, coughs, and allergies all leave you feeling helpless when pregnant. No over the counter medicines are 100% approved to take, so most women suffer through their colds. However, ACV has beneficial enzymes that are essential in improving the body’s immune system. When you take ACV, the reoccurring sinus infections are reduced, and mucus is thinned, shortening the length of the illness.

Regulating Blood Sugar Levels

When you drink ACV, it plays a role in the absorption rate of sugars into the blood and in slowing the breakdown of carbohydrates. This means that after you eat carbs, drinking ACV keeps the blood sugar levels from increasing in huge amounts. It can possibly be used to help prevent gestational diabetes, too.

Sorry Charlie - No More Charlie Horse Cramps

The leg cramps that make you jump out of bed and bring tears to your eyes can be warded off with ACV. Using ACV topically and orally seems to have the greatest impact!

A Wonderful Detox

Pregnancy and detox don’t typically go hand in hand; however, ACV has a natural way of cleansing the body. It has a positive impact on the kidneys and blood circulation, which directly impacts the baby. ACV helps move that nutrient-rich blood from you to the placenta.

Pregnancy is a time when the mother faces a lot of discomfort with the body. This may be because of the hormonal imbalances and weakening of the immune system. Because of this, the pregnant lady is vulnerable to many infections, diseases. Hence doctors suggest pregnant women follow a strict diet and also the products which are nutritious and beneficial for both the mother and the unborn baby. One such product to consume during pregnancy is apple cider vinegar. In this article, we will discuss the benefits of apple cider vinegar elaborately during pregnancy and also the risks associated with it.

Acv While Pregnant

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What is ACV and How it Made?

Apple cider vinegar (ACV) is a vinegar made from the fermented, crushed apple juice. The cider first ferments to alcohol before turning into acetic acid. This acetic acid is called apple cider vinegar. This is sold in two forms pasteurized and unpasteurized. The pasteurized vinegar is safe to consume as it is free from any harmful bacteria. This vinegar can be used for different purposes like salads, sandwiches, etc. Remember, not to drink this vinegar without diluting as it may burn your esophagus when consumed raw.

Is Apple Cider Vinegar Safe During Pregnancy?

Drinking apple cider vinegar during pregnancy can be safe only if the pregnant lady consumes the pasteurized vinegar in dilution with water. The study says that there are no shreds of evidence stating that drinking apple cider vinegar is safe or unsafe. However, drinking pasteurized apple cider vinegar in a limited amount and that too, diluting it with water is only safe for pregnant women because the unpasteurized ones contain harmful bacteria that may affect the fetus present inside the mother.

See More: Is Turmeric Safe During Pregnancy

Benefits of Apple Cider Vinegar During Pregnancy:

The apple cider vinegar, when consumed in moderate amount, is recommended because of its immunity-boosting benefits. Here are listed a few of them:

1. Morning Sickness:

Women during pregnancy usually face morning sickness.ACV is pH neutral and helps the acids in the stomach to settle down, which reduces nausea. Therefore, ACV provides relief from morning sickness, mostly in the first trimester.

2. Prevents Urinary Tract Infections:

Cloudy urine in pregnant women is the first sign of urinary tract infections. Apple cider vinegar contains the enzymes and minerals which help in the prevention and treatment of these infections.

3. Regulates Heartburn:

Heartburn is very common in pregnant women because of the acid refluxes into the food pipe and also because of the growing fetus. Incorporating apple cider vinegar in the diet can help in reducing heartburn. ACV is considered as one of the quickest natural remedies for heartburn.

4. Maintains Blood Pressure:

Pregnant women often face issues with blood pressure. It sometimes becomes high and occasionally low. Drinking the right amount of ACV helps in maintaining blood pressure. The acetic acid present in the ACV lowers the blood pressure by reducing the activity of the rennin enzyme, the one responsible for high blood pressure.

5. Aids Digestion:

Proper digestion is a sign of a healthy pregnancy. Pregnant women usually face digestion issues because of a weakened immune system. The antibiotic properties of ACV fight stomach problems and improve digestion by regulating metabolism and promoting good bacteria in the stomach. Apple cider vinegar also contains pectin, which soothes an upset tummy.

6. Combats yeast infections:

Pregnant women experience yeast infections very commonly during their pregnancy. ACV has distinctive components that can cure and control yeast infections such as candida infections. The topical application of ACV can reduce the infection and its symptoms.

7. Streamlines blood circulation:

ACV is known to regulate blood flow inside the body. During pregnancy, the pregnant woman will have the problem of swelling and varicose veins because of improper blood flow. Consuming of ACV eases the blood flow, thereby relieving from these conditions.

8. Detoxification:

Apple cider vinegar has antioxidant properties in it. This helps in detoxifying the body, cleanses the body. A cleansed body absorbs nutrients better, which in turn leads to better metabolism.

9. Treats Diabetes:

ACV is considered to maintain blood sugar levels in the body. During pregnancy, the sugar levels fluctuate very often if a proper diet is not taken. ACV can lower blood sugar levels and improves insulin sensitivity when consumed with certain foods.

10. Combats Acne:

Acne is quite a common problem faced by pregnant women during and after pregnancy. ACV is well known to fight acne problems. It acts as a toner, and helps rebalance the pH of the skin, removes any dead cells.

11. Fights common cold:

Pregnant women are generally hesitant to take over the counter medications for cold and sore throat; instead, look out for home remedies. ACV is one such type of solution which fights common cold and sore throat because of the anti-bacterial and immunity-boosting present in it.

See More: Sausage While Pregnant

Side Effects of ACV during pregnancy:

Consuming raw apple cider vinegar harms your digestive system because of its acidic property. It can burn through the food pipe.

Drinking raw ACV can erode the teeth because of the acetic acid present in it.

ACV can react badly with insulin, the diabetic drug. Hence consult your doctor before incorporating ACV in your diet during pregnancy.

Unpasteurized ACV, when consumed, causes some foodborne illness. Some of this illness can be deadly and may cause miscarriage, stillbirth, etc. Hence it is recommended to avoid unpasteurized ACV during pregnancy.

How to Consume Apple Cider Vinegar While Pregnancy:

Apple cider vinegar should always be consumed in dilution because of the acetic acid present in it. Pregnant women should only drink pasteurized ACH. Some of the ways to consume ACV are given below:

Take a glass full of filtered water or coconut water and add one spoon full of apple cider vinegar and drink it on an empty stomach. If required, add 2-3 spoons of honey for better taste.

Dilute one spoon of ACV with fruit juice, preferably non-acidic fruit juice. If required, add 1-2 spoons of honey in it. Mix it well and enjoy drinking the mixture.

Add two teaspoons of grape juice, two tablespoons of ACV, half teaspoon of cinnamon powder, and half teaspoon stevia with a glass full of filtered cold water and enjoy the elixir.

See More: Drinking Milk During Pregnancy

Apple Cider vinegar during pregnancy is more beneficial for your body. It has various health benefits and is quite safe. The consumption of ACV can be once or twice a day, a tablespoon of vinegar mixed with a glass of water, depending on the dose advised by your doctor. Pasteurized apple cider vinegar is recommended for pregnant women.

Frequently Asked Questions and Answers:

Q1. What is the Safe Quantity of ACV During Pregnancy?

Ans: Usually, 2-3 tablespoons of ACV diluted in a glass full of filtered water is the safest quantity to consume daily.

Q2. Which is the Best ACV Brand to use During Pregnancy?

Ans: There are many brands of ACV available in the market which have their own specialities. The one which we recommend is Bragg Organic Raw Apple ACV. But, before using it, check for any allergic reactions in your body.

Q3. Can ACV Terminate the Pregnancy?

Ans: ACV in moderate quantity cannot harm the pregnancy. But, if consumed excessively, you may face foodborne illnesses, which may lead to miscarriage or stillbirth.

Q4. Is it Safe to Drink ACV During Breastfeeding?

Ans: ACV during breastfeeding is safe but only in moderate quantities because of the acetic acid present.

Pros and Cons of drinking *Apple Cider Vinegar* while PREGNANT & BREASTFEEDING

Disclaimer: Since this is a medical article related to pregnancy, the information provided above is only for educational purposes and should not be considered as a piece of medical advice. Consult your gynecologist before consuming apple cider vinegar during pregnancy.

Drinking apple cider vinegar while pregnant is secure. You have entered an incorrect email address! Please read our Disclaimer. With the first symptoms of a cold, you need to gargle thoroughly with apple cider vinegar and everything will be all right. Pasteurized form is safe for unborn babies when the mothers consume it. Oral thrush during first trimester : Hello all, Even though I've been 'stalking' these boards since I found out I was pregnant, I didn't actually join till today - so first post here :-) I'm 10 wks 4d right now and still dealing with rough morning sickness most of the day. You may not always feel like having apple cider vinegar with water as it tastes bitter. Rubbing apple cider vinegar, in this case, can be of great help as it reduces the signs of swelling. Apple cider vinegar is a product made from crushed apples through a process of fermentation. Apple cider vinegar , also commonly referred to as “ cider vinegar ” or “ ACV ” is the result of crushed apples that are left to ferment. You will have swollen hands, feet, and varicose veins due to poor blood circulation. Apple cider vinegar is one of the most used ingredients for natural foods in the world. However, many have yet to be scientifically proven. Momjunction believes in credibility and giving our readers access to authentic and evidence-based content. But is apple cider vinegar safe for the fetus? It may sound counterintuitive, since grapefruit is known … Manufacturers make apple cider vinegar through the process of fermentation. Eases Nausea: Some women also add a drop of vinegar to some morning foods to ease nausea. Many pregnant women complain about this issue as many have gestational diabetes which can cause more glucose levels. Vinegar group is one of them, with apple cider vinegar being the most discussed. A cleansed body system absorbs the nutrients better, which in turn leads to better metabolism (13). It was known as an effective remedy for managing and treating a lot of symptoms. However, you should always consult your doctor before adding ACV to your diet, especially when you are on medication for diabetes (14). ACV reduces blood sugar levels and insulin sensitivities when taken with some foods. For a long time, people have been using it for treating specific dermatological issues and joint conditions such as osteoarthritis. Mix ACV with any regular lotion and use on the affected parts. Also, consult your health practitioner before taking any of them. Moreover, the apple cider vinegar is helpful in clearing up the tract. In the case of acne or varicose veins, and even swollen hands and feet, it is not essential to use pasteurized vinegar. The answer is yes. Are There Any Benefits of Consuming Apple Cider Vinegar During Pregnancy? This acetic acid sets the base for the product that gets ready to go for sale after it is aerated. A good massage in the morning, as well as night, is good for combating swelling. Also, you need to take care while consuming it. Benefits Of Eating Vinegar During Pregnancy: 1. Cloudy urine during pregnancy can be an underlying symptom of urinary tract infections. Avoid ACV when you have any stomach problems. Therefore, consult your healthcare practitioner if you can take ACV with your diet. If you are pregnant, you would be stormed with information from a lot of people on how to give yourself the best nutrition. Apple cider vinegar contains distinctive components, which can control and cure yeast infections such as candida infections. There are some tasty and safe ways to include ACV in your diet during pregnancy: Note: Do not drink these as water but have them in small sips. Aloe Vera Gel. If you are keen on choosing the ACV supplements, then check the ingredients and constitution of the product before buying. You can also make a homemade cream by mixing half a glass of ACV, half carrot, and three tablespoons of aloe vera gel. We need more research to confirm all of its risks and benefits. You should have a nutritional and well-balanced diet to nourish yourself and your baby (15). This ensures the safety of the final product which enhances the quality. Regulates Heartburn – Pregnant women are commonly … Eat 1 grapefruit after each meal. Supplements can be risky during pregnancy, especially if raw apple cider vinegar is the ingredient. Your feedback helps us serve you better and maintain a long-term relationship with the most important people in our business — you. Rinse your mouth after drinking anything that contains ACV. 6 ) us serve you better and maintain a long-term relationship with the first trimester of.! 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During pregnancy, many common foods and beverages can cause unanticipated problems for the expectant mother or her unborn baby. The American Pregnancy Association advises pregnant women to avoid undercooked meats, undercooked eggs, caffeine, soft cheeses, raw shellfish and many potentially hazardous seafood dishes.

Common vinegar, also known as acetic acid, is nontoxic and ultimately harmless during pregnancy. There are no known risks associated with drinking vinegar at any stage of pregnancy, and it may even offer health benefits to the expectant mother.

Is It Okay to Drink Apple Cider Vinegar During Pregnancy?

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Benefits

Traditionally, midwives have advised pregnant women to drink vinegar as a holistic method for preventing iron deficiency anemia. In 2002, a group of German scientists investigated the effects of vinegar on the blood iron levels of pregnant women. The authors of the study found that vinegar helped to prevent anemia, and no adverse reactions were recorded. Some women use vinegar to treat discomforts such as nausea and heartburn during pregnancy, but no clinical trials have investigated the efficacy of these folk remedies.

Significance

Vinegar and other tart treats are common cravings during pregnancy. According to the American Pregnancy Association, pickles are a popular, if stereotypical, food interest among expectant mothers. Although cravings for tart foods are ultimately harmless to pregnant mothers, it is important to consult your health care provider if you begin experiencing strong cravings for vinegar itself. A desire to eat non-nutritive substances such as vinegar, starch, clay, sand or ashes may indicate the presence of pica -- a pregnancy symptom related to nutritional deficiencies and mental illness.

Vinegar as an Abortifacient

According to Planned Parenthood, a nonprofit organization that advocates legal access to birth control and abortion, some women try to use vinegar as an abortifacient -- a product to terminate an unwanted pregnancy. There is no evidence that vinegar can effectively abort a pregnancy during any stage of gestation. This home abortion method is supported solely by urban folklore and anecdote.

Potential Risks

If you are facing an unwanted pregnancy, vinegar is unlikely to successfully trigger a miscarriage or preterm labor. Although vinegar is nontoxic and associated with no known risks, any home abortion method is inherently dangerous. Without medical supervision, even "natural" miscarriages can carry the risk of infection, hemorrhage and other life-threatening complications for the mother.

Warning

Although vinegar itself is safe during pregnancy, pregnant women should consult their health care providers if they feel a strong urge to drink vinegar or any other product that lacks nutritional value. According to the American Pregnancy Association, pica may be a sign of anemia or trace-mineral deficiencies. It can also lead to nutritional deficits if a woman drinks vinegar instead of more nutritious products. Always talk to your physician or midwife before using nutritional supplements during pregnancy or making radical changes to your diet.

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Diet & Fitness

Chai Tea & Pregnancy

By: Juniper Russo

●

08 July, 2011

Chai tea, also known as masala chai, is a fragrant, spicy beverage originating on the Indian subcontinent. This delicious concoction includes black tea with a combination of herbal seasonings.

When consumed in moderation, chai tea and similar drinks are considered safe for use during pregnancy, with some caveats.

Not all herbs are safe during pregnancy. Consult your obstetrician or midwife with any questions regarding the use of caffeine or herbal teas during any stage of gestation.

Ingredients

Black tea is the primary ingredient in traditional chai beverages.

Some manufacturers also offer novel chai drinks made with green or white tea leaves. Cardamon, ginger and black pepper provide bold, spicy flavors to the drink. Other ingredients may include cinnamon, star-anise, fennel seed, saffron, clove, nutmeg, rose, licorice or almond.

When used in moderation, most of chai's ingredients are considered to be safe during pregnancy. However, some may theoretically increase the risk of pregnancy complications.

Caffeine Concerns

Traditional chai tea contains roughly 40-50 milligrams of caffeine per cup.

According to the American Pregnancy Association, caffeine does cross the placenta and may affect a growing fetus. Excessive caffeine consumption during pregnancy may cause miscarriage, birth defects and other complications during pregnancy. The APA recommends limiting your caffeine consumption as much as possible and limiting your total caffeine intake to 150 milligrams per day.

Hormonal Effects

Some chai beverages contain hormone-affecting herbs such as fennel, star-anise or licorice root. According to a report by the Journal of Ethnopharmacology, these sweet-tasting plants contain estrogenic compounds that have been used historically to promote menstruation and induce labor. Chai drinks containing these herbs may cause miscarriage or preterm birth, particularly if they are used frequently or during a high-risk pregnancy.

Considerations

For some women, chai tea's potential risks during pregnancy may be greater.

A woman carrying a high-risk pregnancy may be at a greater risk of experiencing preterm labor after exposure to anise seed. Obstetricians and midwives generally advise women with pre-eclampsia, or pregnancy related hypertension, to avoid any source of caffeine. Caffeinated chai tea is also a powerful diuretic and may cause fluid loss; this could lead to dehydration and subsequent preterm labor.

Prevention

Several common-sense precautions can prevent any dangers associated with chai tea.

Decaffeinated formulas can prevent any potential problems associated with excessive caffeine consumption.

Although trace amounts of fennel and anise are considered to be safe in moderation, it is prudent to choose chai drinks that do not contain these hormone-affecting herbs. Discuss any concerns with your prenatal health care provider, particularly if you have a medical condition or a complicated pregnancy.

Pregnancy is a time when extra care and precaution must be exercised. A woman’s health goes through various changes like hormonal imbalance and weakening of the immune system. During this period, it is vital that she takes care of herself. If you are pregnant, too, you would have come across several tricks or remedies to get through the term. One such remedy is to consume apple cider vinegar. But, is it safe during pregnancy? Let’s find out!

What Is Apple Cider Vinegar?

Apple cider vinegar (AVC) is one of the most common types of vinegar available. It is made from cider, a type of concentrated apple that has been left to ferment over a period of time. The cider first ferments to alcohol before finally transforming into acetic acid. It is safer to consume pasteurised vinegar, as it is free of harmful bacteria that can cause E. coli in pregnancy.

This versatile ingredient can be used in salads, sandwiches, etc. However, it is most beneficial to drink a teaspoon of apple cider vinegar every day in a glass full of warm/lukewarm water. Remember that unfiltered, unpasteurised apple cider vinegar is extremely potent and can burn your oesophagus if consumed raw.

Is Apple Cider Vinegar Safe to Consume During Pregnancy?

Although there hasn’t been any study to prove apple cider vinegar is harmful to consume during pregnancy, you must practise caution and check with your doctor before making it a part of your diet. Usually, drinking apple cider vinegar is safe, as long as it is pasteurised and diluted.

Consumption of raw apple cider vinegar during pregnancy is not recommended due to its potency, its potentially harmful bacterial content, and a weakened state of the immune system during pregnancy. Therefore, pregnant women must be cautious as a foetus has requirements different from that of a fully developed baby.

Another consideration is the antibodies that support the immune system are overworked during pregnancy and could fail to combat the adverse effects of this kind of bacteria. It is, therefore, best to consult a doctor and seek appropriate medical guidance before consuming apple cider vinegar.

Once the doctor has given the go-ahead and decided upon a quantity of apple cider vinegar, you can include in your diet, you are bound to reap some of the benefits given below.

Benefits of Consuming Apple Cider Vinegar During Pregnancy

Consuming apple cider vinegar is not always recommended during pregnancy. It is strictly advisable that pregnant women consult their doctor before adding any dose of apple cider vinegar into their diet to gain some health benefits, such as the ones given below. Please bear in mind that there are hardly any studies to prove the benefits of consuming apple cider vinegar during pregnancy. Therefore, we urge readers to seek guidance and inputs from their medical practitioners.

Preventing Urinary Tract Infections (UTI) – Apple cider vinegar is known to have enzymes and minerals to help with the prevention and treatment of UTIs. It is recommended to dilute apple cider vinegar (ACV); the ideal ratio would be 1 teaspoon of ACV in 1 glass of water. It is advised that you check with your medical practitioner for the quantity and frequency of having ACV. Having said that, you must also bear in mind that its effectiveness to prevent UTI stands unproven due to the lack of adequate studies.

Regulates Heartburn – Pregnant women are commonly afflicted by heartburn around the 12th week of pregnancy. Apple cider vinegar is often considered as one of the quickest acting natural remedies for heartburn; however, its effectiveness to regular heartburn during pregnancy has not yet been established.

Controls Blood Sugar – The enzymes in ACV are believed to help control blood sugar levels. Again, there is no medical study that proves that pregnant women who have blood sugar issues could control their blood sugar levels by consuming ACV.

Moderates Blood Pressure – ACV has minerals that are believed to work in cohesion with the enzymes that help control blood sugar to help moderate spikes and drops in blood pressure. This again has no studies to help establish its credibility. Therefore, it is highly unlikely that ACV could provide relief from any blood pressure issues that are common during the second and third trimester of pregnancy.

Helps Combat Cold – Cold and blocked nose are very common during pregnancy. ACV mixed with warm water could help clear the nostrils, prevent sinus infections and combat viruses like the common cold, but none of it has been proven yet. You must check with your doctor for more guidance on this.

Streamlines Blood Circulation – ACV is known to regulate the circulation of blood, and help one remain active and energised. It may seem like one of the best remedies to deal with the feeling of heaviness and lethargy, especially during the second and third trimester, but there isn’t enough research to confirm its usefulness for pregnant women.

Reduces Swelling & Bloating – ACV is known to have anti-inflammatory and digestive properties that could help prevent, manage, and relieve bloating and help reduce swellings as well, but not much has been proven when it comes to pregnant women. If swelling and bloating have been serious issues for you, you must consult your medical practitioner.

Combats Acne – Another common problem during pregnancy is an acne breakout, especially if you had acne before. ACV is believed to help keep the skin healthy and combat acne, none of which is medically proven. Also, remember that the acids in AVC can cause burns and leave scars on the skin. Therefore, it is best to consult a dermatologist who can work along with your OB/GYN to prescribe appropriate treatment for severe acne.

Apple cider vinegar may have been known to combat a lot of conditions, but due to the absence of adequate research and studies, we strictly recommend that you consult your medical practitioner before including it in your pregnancy diet.

What are the LIMIT of "Apple Cider Vinegar" During Pregnancy? Only Pasteurized Allowed~!

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Bad Advice: Don’t Go Swimming

“I was told that swimming in a pool could cause my baby to drown.” — Lyzette M.

The truth: Babies won’t drown while you’re taking a dip. In fact, Prabhu says, “swimming is an excellent form of exercise during pregnancy” and she strongly recommends it. Don’t worry about the chlorine, either—it’s only a problem if you spend an unusual amount of time in the pool. But do steer clear of hot tubs. Spending more than a few minutes in water at 101 degrees Fahrenheit or hotter is associated with higher risks for neural tube defects.

Bad Advice: Eat as Much as You Like

“I was always told to gain as much weight as you want!” — Keyla C.

The truth: Unfortunately, life doesn’t turn into an all-you-can-eat buffet when you’re eating for two. There is such a thing as too much weight gain. Healthy weight gain during pregnancy should be about 25 to 35 pounds for women with a normal BMI, although you should ask your doctor what the recommended weight gain is for you based on your specific situation. “Too little or too much weight gain in pregnancy can lead to less healthy outcomes for mom and baby,” Prabhu says. On average, you should add one to five pounds in your first trimester and one or two pounds every week after that—and the weight should come mostly from healthy foods instead of, say, a nightly bowl of ice cream, says Prabhu.

Bad Advice: Stay Away from Coffee

“I was drinking a cup of coffee, and a guy told me that I might as well be drinking a beer. I was like, ‘Hey buddy, you can comment when you push a basketball out of your downstairs parts!’” — Danielle V.

The truth: While you should limit your caffeine intake during pregnancy, a cup won’t hurt (and no, it isn’t the equivalent of boozing while pregnant). The key is moderation. “Doctors usually recommend limiting your intake to 200 milligrams of caffeine per day, which you’ll get in 8 to 12 ounces of coffee,” Parker says.

If you typically drink more than that, then it’s probably worth cutting back. Try mixing a little bit of decaf into your brew, slowly upping the amount over the course of several days, Parker suggests.

Apple Cider Vinegar and Pregnancy | How I Lost the Baby Weight Fast With Apple Cider Vinegar | -7lbs

Bad Advice: Eat Pineapple to Induce Labor

“One of my friends told me to eat a lot of fresh pineapple to induce labor. That didn’t help; it just made me really sick.” — Caressa R.

The truth: Sorry, but eating pineapple hasn’t been proven to induce labor naturally, Parker says. You can try having sex, exercising and acupressure (if your doctor okays it), although these aren’t surefire ways to induce labor at home. Stay away from nipple stimulation, since it could lead to contractions that last too long and are too frequent; drinking castor oil, since it will dehydrate you, and anything else you’ve tried that’s made you more uncomfortable—like eating so much pineapple that you end up vomiting!

Bad Advice: Smoke Pot to Treat Pain

“I kept getting terrible headaches, and I didn’t want to take Tylenol. Someone told me to try smoking pot, because it’s a natural pain reliever.” — Shannon M.

The truth: You shouldn’t smoke during pregnancy—whether it’s cigarettes or marijuana or anything else. Smoking pot during pregnancy can affect the function of the placenta and may cause low birth weight or fetal distress during labor. “Legalization does not mean safety,” Prabhu warns. “Moreover, self-treatment in pregnancy is never recommended.” So talk with your doctor for the best way to treat headaches and other types of pain. It’s usually safe to take acetaminophen (Tylenol) during pregnancy, but stay away from ibuprofen and aspirin, which have been associated with heart and amniotic-fluid issues.

To treat your headaches naturally, place a warm towel on your face or a cold towel on the back of your neck. Rest in a room with the shades drawn, eat small meals throughout the day and take a warm shower. To avoid headaches, get plenty of sleep, exercise, eat healthy and drink lots of water.

Bad Advice: Opt for a C-Section

“I was told by a colleague not to give birth vaginally because my baby’s head would be deformed, and I wouldn’t be able to have sex again. What?!” — TLB

The truth: It might look a little funny at first, but, no, baby’s head won’t stay disfigured forever with a vaginal birth. “When a baby is born vaginally, the head is typically swollen into a cone shape,” Parker notes. But before long—usually within a few days—it’ll mold into the cute, round shape you were expecting. Keep in mind too that your OB will be monitoring your pregnancy progress at every checkup, and they’ll recommend a c-section if baby is too big to deliver vaginally.

Delivering vaginally won’t stop you from having sex ever again either. (Phew.) It’s typically advised that women avoid sex after birth until they’re cleared by their doctor—usually around six weeks postpartum. “After that, you can resume sexual intercourse as usual,” Parker says.

Bad Advice: Don’t Wear Fitted Clothing

“I’ve heard that you shouldn’t wear clothes that are too tight because it will squish the baby.” — Hannah E.

The truth: They might feel uncomfortable, but no, tight clothes won’t hurt baby, Prabhu says. So go ahead and show off your baby bump in skinny maternity jeans or a slinky dress, though of course there are plenty of other options when it comes to maternity clothes these days.

Bad Advice: Never Pick up a Cat

“The funniest advice I’ve heard was this: Don’t carry a cat or it will steal your baby’s soul.” — Kyla C.

The truth: Cats are fine—it’s their poop that’s the problem. Cat feces can carry a parasite that causes an infection called toxoplasmosis, which can cause headaches, body aches and fever (among other ailments) in humans. If you get infected, there’s a risk of transmitting it to baby, Parker says, even if you don’t show any symptoms. Baby is most at risk of contracting toxoplasmosis if you become infected in the third trimester—but by that point most of the important development has already happened and the chance of any lasting harm to baby is lower. Baby is at the least risk of developing toxoplasmosis if you become infected during the first trimester, but the earlier in your pregnancy the infection occurs, the more serious the outcome for baby. To be safe, ask your partner or a friend to change the litter box.

Updated February 2020

Expert bios:

Malavika Prabhu, MD, is an ob-gyn at NewYork Presbyterian/Weill Cornell Medical Center in Manhattan, specializing in high-risk maternal medical conditions. She received her medical degree from Stanford University.

Juliana Parker, RN, RNC-OB, CLE, is a labor and delivery nurse and certified lactation educator in Kensington, Maryland. She is the founder of My Pregnancy Pro’s Positive Childbirth Preparation Program, which offers online programs, resources and one-on-one coaching for expectant parents.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

How do you drink apple cider vinegar on your period?

Cramps. You get them, I get them, and we all feel the pain of them at one point during our cycle. Menstrual cramps can cause a lot of pain and inconvenience-but they don’t have to! We have found 5 natural methods to ease those annoying cramps- they really work!

Heat – Applying a heating pad to your lower abdomen will loosen those tense muscles and provide relief from cramps. If you do not have a heating pad, a hot bath will also work wonders! In the field, Days for Girls Ambassadors of Women’s Health teach girls dispel the fear of pain of cramps by explaining that they are a natural part of the process for some of us. But they also give practical resources including explaining that girls can repurpose disposed water bottles by adding their own water and letting the contents warm in the sun. Roll up and down with mild pressure over the abdomen. An instant massaging “hotwater bottle”!

Bananas- Research has shown that potassium can ease the pain of menstrual cramps. Bananas are known for having a high level of potassium, making it the perfect medicine and healthy snack

Yoga-Yoga is a great way to unwind and find that “zen” in your life. Not only is it great for the mind, but it does wonders for your muscles! The Days for Girls website has a video for some great options. Click on DaysforGirls.org > then media > then Videos and scroll down from there. (Direct link to video page: http://www.daysforgirls.org/#!videos/c13ms.) Here are a few of the poses to try out: Child’s Pose -Fish Pose Supported Bridge Pose Goddess Pose (my personal favorite)

Ginger- Ginger is a great way to reduce inflammation. When your muscles feel sore and inflamed during your period, crush up a small ½ inch piece of ginger and place it in a cup of boiling water for 3-5 minutes. Drink slowly and let the ginger ease your pain!

Apple Cider Vinegar- Apple cider vinegar helps to regulate blood clotting, and contains both potassium and calcium that will ease cramping in the uterus muscles. Mix 1 tablespoon into a 16 ounce glass of cold or hot water, and drink! You can add ginger to get make it an even tastier and more effective pain soother!

We are strong and powerful women. Don’t ever let those cramps get you down!

What does apple cider vinegar do for a woman's body?

Apple cider vinegar (ACV) contains probiotics and antioxidants, making it rich in nutrients that are good for your health.

ACV is made by fermenting apple juice. During the process, bacteria or yeasts interact with the natural sugars, transforming them into alcohol and then vinegar. It is mainly composed of two active components: acetic acid and polyphenolic compounds.

While there are different kinds of ACV available in the market, only raw, unfiltered, or unpasteurized ACV contains the “mother” or cloudy substance that floats in the bottle, which is the by-product formed during fermentation and what is especially beneficial to the body.

9 health benefits of apple cider vinegar for women

Helps with painful periods: ACV can help relieve bloating, cramps, and irritability caused by PMS or periods.

Regulates blood sugar levels: ACV may help regulate blood sugar levels, especially after a starchy meal.

Fights dandruff: Diluted ACV sprayed onto the scalp is believed to combat flaking, inflammation, and itchiness. The acetic acid changes the pH of the scalp, making it harder for yeast to develop.

Kills body odor: ACV is believed to prevent bad body odor by balancing the pH of the skin and killing bacteria that cause odor.

Helps weight loss: Research suggests that apple cider vinegar can increase the feeling of fullness and thus reduce craving. This can help you eat fewer calories.

Improves digestion: Taking ACV before eating protein-rich meals may help promote digestion. ACV increases the acids in the stomach, which increases the activity of pepsin, an enzyme that breaks down protein.

Manages cholesterol: According to some studies, ACV may help lower both total cholesterol and triglyceride levels, which can lead to serious diseases such as heart attack or stroke.

Boosts hair and skin health: Using diluted ACV as a hair rinse can help promote shiny hair, while ACV in toners may help with treating acne.

Antioxidant benefits: Polyphenols and vitamins in apple cider vinegar offer protection against oxidative damage caused by free radicals, which are related to premature aging and cancer growth.

Precautions to take with apple cider vinegar

Since ACV is highly acidic, it should be diluted before use. Some recommend diluting 1-2 tablespoons in 240 mL of water and taking it before meals. Also, ACV should not be directly applied to the skin, as it can be damaging.

Before using ACV for medicinal purposes, consult your doctor to be aware of the potential risks and side effects.

Can drinking hot tea cause miscarriage?

High doses of daily caffeine during pregnancy -- whether from coffee, tea, caffeinated soda or hot chocolate -- cause an increased risk of miscarriage, according a new study by the Kaiser Permanente Division of Research. The study controlled, for the first time, pregnancy-related symptoms of nausea, vomiting and caffeine aversion that tended to interfere with the determination of caffeine's true effect on miscarriage risk.

While previous research showed a link between caffeine consumption and miscarriage, this is the first study to thoroughly control for morning sickness, which typically causes many women to avoid caffeine, explained De-Kun Li, MD, Ph.D., an investigator with the Kaiser Permanente Division of Research and lead investigator of the study. "This study strengthens the association between caffeine and miscarriage risk because it removes speculation that the association was due to reduced caffeine intake by healthy pregnant women," Li said.

To address that speculation, the study, which looked at 1,063 pregnant Kaiser Permanente members in San Francisco from October 1996 through October 1998, examined the caffeine effect among women who never changed their pattern of caffeine consumption during their pregnancy.

Women who consumed 200 mg or more of caffeine per day (two or more cups of regular coffee or five 12-ounce cans of caffeinated soda) had twice the miscarriage risk as women who consumed no caffeine, said Li. Women who consumed less than 200 mg of caffeine daily had more than 40 percent increased risk of miscarriage.

The increased risk of miscarriage appeared to be due to the caffeine itself, rather than other possible chemicals in coffee because caffeine intake from non-coffee sources such as caffeinated soda, tea and hot chocolate showed a similar increased risk of miscarriage.

"The main message for pregnant women from these findings is that they probably should consider stopping caffeine consumption during pregnancy because this research provides clearer and stronger evidence that high doses of caffeine intake during pregnancy can increase the risk of miscarriage," said Li.

The reasons that caffeine can harm a fetus have been suspected for some time. Caffeine crosses through the placenta to the fetus, but can be difficult for the fetus to metabolize because of the under-developed metabolic system. Caffeine also may influence cell development and decrease placental blood flow, which may lead to an adverse effect on fetal development.

Women in the study were asked about their intake of caffeinated beverages as well as the type of their drinks, timing of initial drink, the frequency and amount of intake, and whether they changed consumption patterns since becoming pregnant. Sources of caffeine included coffee, tea, caffeinated soda and hot chocolate.

Researchers estimated the amount of caffeine intake in various types of beverages using the following conversion: For every 150 milliliters of beverage, 100 milligrams for caffeinated coffee, 2 milligrams for decaffeinated coffee, 39 milligrams for caffeinated tea, 15 milligrams for caffeinated soda, and 2 milligrams for hot chocolate. Information on other potential risk factors for miscarriage -- including maternal age, race, education, household income marital status, smoking, alcohol consumption, hot tub use, exposure to magnetic fields during pregnancy, and symptoms related to pregnancy such as nausea and vomited -- also were collected during the in-person interview and controlled during analyses. Pregnancy outcomes up to 20 weeks of gestation were determined for all participants.

My Early Miscarriage Symptoms...

Overall, 172 of women in the study (16.18 percent) miscarried. Whereas 264 women (25 percent) reported no consumption of any caffeine containing beverages during pregnancy, 635 women (60 percent) reported 0-200 mg of caffeine intake per day, and 164 women (15 percent) had 200 mg or more of daily caffeine consumption.

Critics had maintained that the association was not so much a high dose of caffeine intake that increased the risk of miscarriage, but that women with a healthy pregnancy are more likely (than those about to miscarry), to reduce their caffeine intake due to nausea, vomiting, and aversion to caffeine," Li said. "Therefore, the critics claimed that the observed association was a result of reduction of caffeine intake by healthy pregnant women."

So what's a fatigued mom-to-be supposed to do for her daily energy jolt?

"If you definitely need caffeine to get you going, try keeping it to one cup or less a day. Avoiding it may be even better. Consider switching to decaffeinated coffee and other decaffeinated beverages during your pregnancy," said Tracy Flanagan, MD, Director of Women's Health, Kaiser Permanente Northern California. "Learn to perk up instead with natural energy boosts like a brisk walk, yoga stretches, snacking on dried fruits and nuts."

The research appears in the current online issue of American Journal of Obstetrics and Gynecology.

Co-authors on the study included Xiaoping Weng, Ph.D. and Roxana Odouli, MSPH, also with the Kaiser Permanente Division of Research. The Study was supported in part by the California Public Health Foundation.

Story Source:

Materials provided by Kaiser Permanente Division of Research. Note: Content may be edited for style and length.

Journal Reference:

Xiaoping Weng, Roxana Odouli, De-Kun Li. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. American Journal of Obstetrics & Gynecology, 2008; 198 (3): 279.e1-279.e8 DOI: 10.1016/j.ajog.2007.10.803

What are the exercises for miscarriage?

Miscarriages are usually no one’s fault. Sometimes people worry that exercising in early pregnancy increases the risk of miscarriage, but this is very unlikely. In fact, doctors encourage most women to exercise throughout pregnancy and after they give birth.1

One research analysis that reviewed over 100 other studies on physical activity and pregnancy found less than 1% of "adverse events" were related to exercise, and these adverse events were uterine contractions—not miscarriages or other pregnancy complications. This review, published in 2017, concluded that even vigorous activity could not be tied to miscarriage risk.2

Another more recent research review published in 2019 came to a similar conclusion. After analyzing 23 studies of miscarriage, this review noted that "prenatal exercise is not associated with increased odds of miscarriage."3

Benefits of Exercise During Pregnancy

Doctors recommend exercise during pregnancy because it is beneficial for both pregnant women and their babies, according to the American College of Obstetricians and Gynecologists (ACOG). Women who exercise regularly during pregnancy have a lower incidence of:1

Cesarean (C-section) delivery

Excessive weight gain

Gestational diabetes

High blood pressure and preeclampsia

Low birthweight babies

Postpartum depression

Preterm birth

Causes of Miscarriage

If you have had a pregnancy loss, it is natural to speculate about whether something that you did might have caused it. But the majority of early pregnancy losses (50% or more) result from chromosomal abnormalities.4 Exercise does not change a baby’s chromosomal makeup.

Other risk factors include medical conditions such as obesity, sexually transmitted infections (STIs), poorly controlled diabetes or thyroid disease, or uterine malformations and lifestyle factors such as smoking or drinking alcohol. Again, exercise will not change or worsen these risk factors.

It is unlikely that exercise is a factor in the great majority of miscarriages, but it may be a concern for women with certain medical conditions.1 Talk to your doctor about whether you should make modifications to your exercise regimen.

Truths and Myths About Causes of Miscarriage

How to Exercise Safely During Pregnancy

The ACOG's stance is that exercise in pregnancy has few risks and has been shown to benefit most women. However, you may need to modify some exercise routines because of the way your body changes during pregnancy.

When you're pregnant, the ligaments that support your joints relax, which increases your risk of injury. Plus, your center of gravity shifts as your body grows, which can put more pressure on your pelvis and lower back and cause you to lose your balance more easily as you get later into pregnancy.

Consider Your Fitness Level

If you worked out regularly before you were pregnant, then your doctor is likely to encourage you to keep up with your usual program. If you're just starting an exercise routine, on the other hand, your doctor may recommend doing so gradually.

Go Low-Impact

Again, if you have an established running routine, stick with it (with your doctor's OK). If not, try brisk walking or swimming; both are easy on the body but still good cardiovascular workouts. Many yoga poses are also safe during pregnancy (some studios even offer prenatal yoga classes), but avoid doing any exercises that keep you lying flat on your back in the second and third trimesters.

Stop exercising and contact your doctor if you experience dizziness, shortness of breath, chest pain, headache, muscle weakness, calf pain or swelling, uterine contractions, or if there is fluid or blood leaking from your vagina.

Reduce the Risk of Falls

Falling in the first trimester is very unlikely to cause a miscarriage. But later in pregnancy, a hard fall could cause a placental abruption, which is dangerous to your baby. This is why doctors recommend avoiding activities like horseback riding, mountain biking, and downhill skiing.

Avoid Overheating

Elevated body temperature can cause pregnancy complications, but doctors say that exercise won't cause body temperature to rise high enough to be of concern. Still, avoid hot tubs and saunas, and try to work out in an air-conditioned space if it is hot outside.1

Stay Hydrated

Your body needs more fluids during pregnancy, so be sure to replace what you are losing in sweat. Drink plenty of water before, during, and after exercise.

A Word From Verywell

Exercising during pregnancy, even in the first trimester, is not associated with miscarriage. In fact, exercise is beneficial for the great majority of pregnant people. If you have any concerns about whether exercise is right for you, talk with your healthcare provider. They can offer personalized advice about exercise and wellness during your pregnancy.

Can pushing cause a miscarriage?

Many women experience some bleeding in early pregnancy. About 1 in 5 recognised pregnancies end in miscarriage. Most are caused by a one-off fault in the genes. Always tell your doctor if you have vaginal bleeding when you are pregnant. Call an ambulance if the bleeding is very heavy or if you have severe tummy (abdominal) pain. Bleeding with pain can also be a sign of an ectopic pregnancy. This is less common than miscarriage but is serious and needs urgent medical care. Losing a pregnancy can be hard for both partners. However, most couples who experience this will go on to have a successful pregnancy next time.

IN THIS ARTICLE

What causes bleeding in early pregnancy?

How common is miscarriage?

What causes miscarriage?

What is a threatened miscarriage?

What are the symptoms of miscarriage?

Do I need to go to hospital?

Do I need any treatment?

Feelings

What causes bleeding in early pregnancy?

What is a miscarriage?

Prof Lesley Regan

Many women may have a small amount of bleeding (spotting) at the time of their missed period. This is sometimes called an 'implantation bleed'. It happens when the fertilised egg implants itself in the wall of your womb (uterus). It is harmless.

The most common cause of bleeding after the time of the missed period is miscarriage. Miscarriage is the loss of a pregnancy at any time up to the 24th week. A loss after this time is called a stillbirth. At least 8 miscarriages out of 10 actually occur before 13 weeks of pregnancy. These are called early miscarriages. A late miscarriage is one that happens from 13 weeks to 24 weeks of pregnancy.

A less common cause of bleeding in pregnancy is an ectopic pregnancy. This is a pregnancy that occurs outside the womb. It occurs in about 1 in 100 pregnancies.

Always tell your doctor if you have vaginal bleeding when you are pregnant

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How common is miscarriage?

Miscarriage accounts for over 40,000 hospital admissions in the UK each year. About 1 in 4 recognised pregnancies end in miscarriage. Far more pregnancies than this do not make it - as many as half. This is because in many cases a very early pregnancy ends before you miss a period and before you are even aware that you are pregnant.

The vast majority of women who miscarry go on to have a successful pregnancy next time. Recurrent miscarriages (three or more miscarriages in a row) occur in about 1 in 100 women.

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Miscarriage Q&A

Why do miscarriages happen? When is a miscarriage most likely to occur? Who should you call if you have a miscarriage? All your questions answered.

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What causes miscarriage?

It is thought that most early miscarriages are caused by a one-off problem with the chromosomes of the developing baby (fetus) in the womb. Chromosomes are the structures that contain the genetic information that we inherit from our parents. If a baby (fetus) doesn't have the correct chromosomes it can't develop properly and so the pregnancy will end. This is usually a one-off mistake and rarely occurs again. Such genetic mistakes become more common when the mother is older - that is, over 35 years old. This means women aged over 35 years who are having children are more likely to have a miscarriage. This may also be why, if your partner is aged over 45 years, you are more likely to have a miscarriage, even if you are under 35 years old.

You are also at a greater risk of having a miscarriage if you:

Smoke. The risk increases the more cigarettes you smoke.

Drink too much alcohol. Even drinking four units of alcohol a week (one unit is half a pint of beer or a small glass of wine) has been shown to increase the risk of miscarriage.

Use recreational drugs.

Have had fertility problems or it has taken a long time to conceive.

Have any abnormalities of your womb (uterus) or a weakness of the neck of your womb (the cervix).

Have certain medical conditions (for example, systemic lupus erythematosus, antiphospholipid syndrome).

Have diabetes mellitus that is not well controlled.

Have particular infections like listeria and German measles (rubella).

Investigations into the cause of a miscarriage are not usually carried out unless you have three or more miscarriages in a row. This is because most women who miscarry will not miscarry again. Even two miscarriages are more likely to be due to chance than to some underlying cause. Even after three miscarriages in a row, more than seven women out of every ten will not have a miscarriage next time around.

Is it safe to consume vinegar during pregnancy? Benefits & side effects of vinegar in Pregnancy

Some myths about the cause of miscarriage

After a miscarriage it is common to feel guilty and to blame the miscarriage on something you have done, or failed to do. This is almost always not the case. In particular, miscarriage is not caused by lifting, straining, working too hard, constipation, straining at the toilet, sex, eating spicy foods or taking normal exercise.

There is also no proof that waiting for a certain length of time after a miscarriage improves your chances of having a healthy pregnancy next time.

What is a threatened miscarriage?

It is common to have some light vaginal bleeding at some point in the first 12 weeks of pregnancy. This does not always mean that you are going to miscarry. Often the bleeding settles and the developing infant is healthy. This is called a threatened miscarriage. You do not usually have pain with a threatened miscarriage. If the pregnancy continues, there is no harm done to the baby.

In some cases, a threatened miscarriage progresses to a miscarriage.

What are the symptoms of miscarriage?

The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) cramps. You may then pass something from the vagina, which often looks like a blood clot or clots. In many cases, the bleeding then gradually settles. The time it takes for the bleeding to settle varies. It is usually a few days but can last two weeks or more. For most women, the bleeding is heavy with clots but not severe - it is more like a heavy period. However, the bleeding can be extremely heavy in some cases.

In some cases of miscarriage, there are no symptoms. The baby stops developing or dies but it remains in the womb. You may have no pain or bleeding. You may no longer experience symptoms to suggest you are pregnant (for example, morning sickness or breast tenderness). This type of miscarriage may not be found until you have a routine ultrasound scan. This may be referred to by doctors as a missed miscarriage (also called early fetal demise, an empty sac or a blighted ovum).

The typical pain with a miscarriage is crampy lower tummy pain. If you have severe, sharp, or one-sided tummy pain, this may suggest ectopic pregnancy. This is a pregnancy that develops outside the womb. The symptoms of an ectopic pregnancy usually occur at around 6-8 weeks of pregnancy. There may be very little blood lost, or the blood may look almost black. Other symptoms may also occur such as diarrhoea, feeling faint and pain when you open your bowels. Sometimes there are no symptoms until you collapse because of heavy bleeding into the inside of your tummy (internal bleeding). This is called a ruptured ectopic pregnancy and is a potentially life-threatening situation that needs emergency surgery. You should call an ambulance or go to your nearest Accident and Emergency department if you are worried that you may have an ectopic pregnancy.

Do I need to go to hospital?

You should always report any bleeding in pregnancy to your doctor. It is important to get the correct diagnosis, as miscarriage is not the only cause of vaginal bleeding. However, if you are bleeding very heavily or have severe tummy (abdominal) pain when you are pregnant, call for an ambulance immediately.

EDITOR'S NOTE

Dr Sarah Jarvis, November 27th 2021

NICE guidance on miscarriage

The National Institute for Health and Care Excellence (NICE) has updated its recommendations on investigations and treatments in miscarriage. Your doctor will use this guidance to advise on next steps.

The first recommendation is for women who:

Have a threatened miscarriage; and

Have had an ultrasound scan which confirms the baby's heartbeat; and

Have never had a miscarriage before.

If this applies to you, the new guidance recommends that you may not need to be referred straightaway for a scan. However, if your bleeding gets worse or goes on for at least two weeks, you should contact your doctor again. If your bleeding stops, you can continue routine antenatal care.

If you have a scan to confirm your pregnancy but have had a previous miscarriage, you should be offered vaginal progesterone pessaries to use until you have completed 16 weeks of pregnancy.

Most women with bleeding in early pregnancy are seen by a doctor who specialises in pregnancy - an obstetrician. This is often in an Early Pregnancy Assessment Unit at your local hospital. It is usual to have an ultrasound scan. This is usually done by inserting a small probe inside your vagina. This helps to determine whether the bleeding is due to:

A threatened miscarriage (a heartbeat will be seen inside the womb (uterus)).

A miscarriage (no heartbeat is seen).

Some other cause of bleeding (such as an ectopic pregnancy - see above).

If it is unclear from your ultrasound scan whether the pregnancy is healthy or not then you may be asked to return for a repeat scan in one to two weeks.

The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) cramps

Do I need any treatment?

Once the cause of bleeding is known, your doctor will advise on your treatment options.

Natural or expectant management

Many women now opt to 'let nature take its course'. This is called expectant management. In most cases the remains of your pregnancy are passed out naturally and the bleeding will stop within a few days after this, although can take up to 14 days to occur. However, if your bleeding worsens and becomes heavier or does not settle then you may be offered alternative treatment. Expectant management may not be offered if you have had a miscarriage in the past or if you have a bleeding disorder or any evidence of infection. You may decide that you would prefer to have a definitive treatment rather than taking this approach.

If your bleeding and pain settle then you should perform a pregnancy test after three weeks. If this is positive then you will need to see your doctor for an assessment.

Treatment with medicines

In some cases you may be offered what doctors call medical treatment for your miscarriage. That is, you may be offered a tablet to take either by mouth or to insert into your vagina. The medicine helps to empty your womb (uterus) and can have the same effect as an operation. You do not usually need to be admitted to hospital for this. Some women experience quite severe tummy (abdominal) cramps with this treatment.

You may continue to bleed for up to three weeks when medical treatment is used. However, the bleeding should not be too heavy. Many women prefer this treatment because it usually means that they do not need to be admitted to hospital and do not need an operation.

You should perform a pregnancy test three weeks after receiving medical treatment. If this is positive then you will need to see your doctor for an assessment.

An operation may be offered to you, however, if the bleeding does not stop within a few days, or if the bleeding is severe.

Treatment with an operation

If the options above are not suitable or are not successful then it is likely you will be offered an operation. The operation most commonly performed to remove the remains of your pregnancy is called surgical management of miscarriage (SMM). In this operation, the neck of your womb (the cervix) is gently opened and a narrow suction tube is placed into your womb to remove the remains of your pregnancy. This operation takes around 10 minutes.

This may be performed without the need for a general anaesthetic in some cases. This is called a manual vacuum aspiration (MVA). Your doctor will be able to discuss the procedure in more detail with you.

A few women develop an infection after having this operation. If you experience a high temperature (fever), any offensive-smelling vaginal discharge or abdominal pains then you should see a doctor promptly. Any infection is usually treated successfully with antibiotics.

Feelings

Many women and their partners find that miscarriage is distressing. Feelings of shock, grief, depression, guilt, loss and anger are common.

It is best not to bottle up feelings but to discuss them as fully as possible with your partner, friends, a doctor or midwife, or anyone else who can listen and understand. As time goes on, the sense of loss usually becomes less. However, the time this takes varies greatly. Pangs of grief sometimes recur out of the blue. The time when the baby was due to be born may be particularly sad.

Can pregnant drink apple cider vinegar?

Apple cider vinegar is simply vinegar made from apple juice and water. You can find it in salad dressings, sauces for meats, and even on its own as a shot – bottoms up!

It also has a growing reputation as a natural home remedy for a range of ailments, from heartburn to headaches.

Apple Cider Vinegar During Pregnancy

Yet, before you reach for a swig of ACV, is it safe to do so while pregnant? And if so, what do you need to know? Here, we’ve got the answers.

In this article 📝

Can you drink apple cider vinegar while pregnant?

What brand of apple cider vinegar is pasteurized?

What are the benefits of apple cider vinegar?

Does apple cider vinegar help with morning sickness?

Does apple cider vinegar for heartburn during pregnancy work?

How to take apple cider vinegar during pregnancy

Can you drink apple cider vinegar while pregnant?

Yep, you can — but with a degree of caution.

Like a lot of foods that are safe to eat while pregnant, it’s a certain type of ACV that gets the thumbs up.

That’s pasteurized apple cider vinegar, to be exact.

The process of pasteurization removes any harmful bacteria, lowering the risk of the vinegar causing nasty (and potentially life-threatening) foodborne illnesses.

However, many of the suggested benefits of ACV are actually attributed to the unpasteurized variety.

That’s because it plays host to probiotics or so-called “good” bacteria that may help alleviate tummy troubles.

Unfortunately, it’s widely suggested that you avoid unpasteurized products in general throughout your pregnancy.

Whether it’s unpasteurized juice, milk, or apple cider vinegar, the risk of exposure to listeria, salmonella, or toxoplasma just isn’t worth the potential benefits — especially when your immune system is weaker than normal when pregnant.

What brand of apple cider vinegar is pasteurized?

There are several popular brands of pasteurized apple cider vinegar on the market today. If you’d like to try ACV for yourself, always check the label first.

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Beyond that, look at the contents of the bottle. Unpasteurized ACV, like Braggs, will look cloudy and contain sediment.

Pasteurized apple cider vinegar is usually filtered and will appear clearer.

What are the benefits of apple cider vinegar?

It’s important to know that the safety and efficacy of apple cider vinegar during pregnancy are still largely unknown and unproven.

That said, anecdotally, ACV may help alleviate certain pregnancy symptoms, such as morning sickness and heartburn — however, there are other, better-studied remedies available.

Does apple cider vinegar help with morning sickness?

If you’ve been experiencing the nauseating symptoms of morning sickness, you may have been suggested apple cider vinegar as a remedy by a friend or relative.

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The acidic quality of ACV has been known to help bring relief where other gastrointestinal complaints are concerned. So, in theory, it could potentially help with pregnancy nausea too.

However, there aren’t any studies out there to back this up. And if you drink too much ACV, it might just leave you feeling worse.

If you’re struggling with morning sickness, check out these 13 tips from mamas who’ve been there instead.

Does apple cider vinegar for heartburn during pregnancy work?

It’s common to experience heartburn, indigestion, and acid reflux during your second trimester. Not fun. So, could a glug of ACV do the trick?

A 2016 study discovered that apple cider vinegar might help heartburn sufferers who didn’t respond to over-the-counter antacids.

The bad news? The study specifically looked at the effects of unpasteurized ACV — not recommended for mamas-to-be.

How to take apple cider vinegar during pregnancy

If you’re wondering, how can I use vinegar during pregnancy?, here are a few ideas.

Remember to use pasteurized ACV to stay on the safe side.

As a drink: Simply mix one to two tablespoons of ACV in a tall glass of cold water. Drink up to twice per day. As mentioned above, the acidity of the vinegar could help settle your stomach.

As an ingredient: If you don’t like the taste of ACV, you could sneak it into your food or smoothies. Use it as a salad dressing in a nutritious kale and chicken salad, or stir it into a slow-cooked winter stew. Yum!

For headaches: Another remedy that’s not yet scientifically proven, but this won’t do you any harm. In fact, it’ll feel quite nice if your head is throbbing. Soak a clean washcloth in cold ACV for a few minutes before wringing it out. Then place the cold compress on your forehead to soothe the pain. Ahh, sweet relief.

Curious to learn more about ACV and pregnancy? Chat to your fellow mamas-to-be in the Peanut Community.

Can sit ups cause miscarriage in early pregnancy?

Your body experiences significant changes during pregnancy, particularly your abdominal muscles, which stretch to make room for your little one.

To help cope with these changes, many moms-to-be follow a regular fitness routine that includes abdominal (aka core) strengthening exercises like planks, pelvic tilts, crunches, and situps.

Although a strong core can help you maintain a neutral spine, reduce muscle fatigue, and minimize back pain, specific exercises, including full situps, may cause more trouble than they’re worth (1).

Read on to learn whether situps are safe and recommended during pregnancy, understand how your abdominal muscles change during pregnancy, and get inspired by some core exercises to add to your routine.

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Is it safe to do situps or crunches while pregnant?

Many moms-to-be worry that certain activities may hurt their baby. However, when it comes to situps, Dr. Vonne Jones, MD, FACOG, says this exercise won’t harm the baby.

“There’s essentially no risk to the baby because the amniotic fluid protects it in the uterus, and the uterus is also protected by an abdominal sheet, which is called the abdominal peritoneum,” she says.

So, if there’s no risk to the baby, why the hesitation to include situps in a pregnancy workout?

“There is some risk of increasing the outward pressure on the abs and the downward pressure on the pelvic floor with these exercises,” says Helene Darmanin PT, DPT, CSCS.

She explains that this pressure can worsen separation of the ab muscles (diastasis recti) and pelvic floor conditions such as prolapse and incontinence.

Plus, putting pressure on the inferior vena cava can cause problems. “Being supine and rounding the spine to perform a crunch or situp can increase pressure on the inferior vena cava, the main vein that returns blood to the heart from the lower body,” says Darmanin.

Darmanin says the body can interpret the pressure as high blood pressure and cause a sudden compensatory drop in blood pressure, which could decrease blood flow to your heart, brain, and fetus.

However, she points out that this effect is most likely symptomatic, and you could roll onto your side to alleviate any dizziness or lightheadedness.

SUMMARY

Situps are not a safety risk for your baby, but they may contribute to diastasis recti or uterine prolapse. Plus, it’s recommended that you avoid lying on your back for extended periods of time after the first trimester.

Risks of doing situps when pregnant

If situps are not a risk to the baby, why should you consider avoiding them during pregnancy?

“Situps work the rectus abdominis muscles, which requires a ‘pushing out’ of your abdominal muscles during these movement patterns,” says Natalie Niemczyk, DPT, CSCS.

As you progress through your pregnancy, Niemczyk says you want to avoid these particular movements due to the risk of diastasis recti abdominis (DRA). This is a separation of the two sides of the rectus abdominis muscle, and it runs vertically up the front of your stomach.

Sometimes called “mummy tummy,” diastasis recti can appear as a bulge down the middle of the abdomen, separating the right side from the left, when exercising.

DRA can cause symptoms, including:

bloating

constipation

low back pain

pelvic floor dysfunction

poor posture

pelvic pain

hip pain

a feeling of weakness or disconnection through the trunk

a doming of the abdominals during activity

belly “pooching” or still appearing pregnant

One study found that 33% of first-time moms had diastasis recti at 21 weeks gestation. This number jumped to 60% at 6 weeks postpartum but went down to 45.4% at 6 months and 32.6% at 12 months postpartum (2Trusted Source).

An OB-GYN, physical therapist trained in postpartum care, or other medical professional can diagnose this condition. In general, a diagnosis is made if the separation is wider than 2 centimeters, although some experts use 1.5 centimeters as the minimum (3Trusted Source).

SUMMARY

Diastasis is a separation of the two rectus abdominis muscles. Full situps can contribute to or worsen diastasis recti.

What happens to your abdominals when you’re pregnant?

When you’re pregnant, the increased size of your pelvic contents creates an increase in outward pressure, which Darmanin says goes forward through the abdominal wall. Yet, some of it also goes upward, and the diaphragm changes shape to accommodate this change.

“This forward pressure causes the abdominal muscles to stretch, including the linea alba, which is the line of connective tissue between the two halves of the rectus abdominis,” says Darmanin.

Although you can’t prevent your abs from stretching, you can incorporate exercises that focus on your deeper abdominal muscles, which Niemczyk says support your spine.

She also suggests exercises that focus on the pelvic floor muscles, as they help maintain continence, provide support for your pelvic organs and growing baby, and assist with labor, delivery, and recovery.

That’s why Niemczyk says to focus on your transverse abdominis and pelvic floor musculature, which all help to stabilize your belly and spine during pregnancy.

“The transverse abdominis wrap around your body like a corset, and the pelvic floor supports your baby from below. You want to focus on abdominal drawing-in techniques and bracing your abdominals to help strengthen this musculature, as these muscles help to support you most during pregnancy,” she says.

SUMMARY

As your pregnancy progresses, your abdominal muscles stretch. This is normal and typically resolves itself after pregnancy. However, if the stretching becomes excessive, you can develop diastasis recti, which is a separation of the rectus abdominis muscles.

What core exercises can I do instead?

To reduce the risk of developing or worsening diastasis recti, aim to include exercises that focus on strengthening your transversus abdominis. This muscle runs horizontally underneath the rectus abdominis or “six-pack.” It plays a critical role in stabilizing your pelvis.

Here are six exercises you can incorporate into a prenatal fitness routine.

Remember to talk with your OB-GYN before starting any exercises or regimens. Also, some of the exercises below may not be safe during all stages of pregnancy or require modifications. Again, it’s best to consult your doctor.

Bear plank

Bear plank is a great alternative to the traditional plank during pregnancy. It will help you engage your core, arm, and leg muscles while minimizing the pressure on your abdominal wall.

Start on all fours with a neutral spine and your toes tucked.

Engage your core muscles to draw your navel to your spine, pressing into the balls of your feet to lift your knees off of the ground.

Hold this position for 3–5 deep breaths, then release back down to the starting position.

Bird Dog

Darmanin says exercises on your hands and knees are great for the core during pregnancy if you can still draw your abs up into your spine and don’t see your belly coning, doming, or tenting.

Get on all fours with your back flat, hands beneath your shoulders, and your knees under your hips.

Contract your core muscles and extend your left leg behind you while simultaneously extending your right arm in front.

Hold in this position. After a few seconds, slowly return to the starting position.

Repeat on the other side.

Do 2 sets of 10 reps on each side.

Cat-Cow

Start on the floor on all fours with your spine neutral, wrists under your shoulders, and your knees under your hips. Curl your toes under.

Contract your core muscles.

Take a deep breath in, and on the exhale, get ready to move into Cat pose.

Round your spine toward the ceiling as your head and tailbone move closer to each other — gaze toward your navel.

Hold for 2 seconds.

Pass back through a neutral spine as you release Cat pose. Then arch your back and lift your head and tailbone toward the ceiling to transition to Cow pose.

Hold for 2 seconds.

Repeat for 30–60 seconds.

Side plank on knees

Sit on your right hip with your knees bent, off to the left side. Keep your knees in line with your hips and your feet behind you.

Bend your right elbow and place your forearm on the ground. Reach your left arm up to the ceiling, or place it on the floor in front of you for balance. Inhale.

Drawing your belly button to your spine, exhale to engage your right obliques and lift your hips off of the floor, making a straight line through your body from your knees to your head.

Hold for a full inhale and exhale, and then lower to the starting position.

Do 6–8 reps on each side.

Pelvic tilts

This exercise is best performed in the first trimester. When your healthcare professional says you should no longer lie supine on your back, forego this exercise.

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Lie down on an exercise mat with your knees bent and arms at your sides. Inhale.

Exhale to lightly tilt your hips toward your belly button without pushing into your feet or lifting your glutes off of the floor. Use your obliques to perform the movement, imagining drawing your hips closer to your ribs.

Inhale to release back to the starting position.

Do 2 sets of 10–12 reps.

SUMMARY

Focusing on the transverse abdominis muscle and performing core exercises other than full situps might be the way to go during pregnancy. Moves like the Bird Dog, plank, and pelvic tilt all activate the critical abdominal muscles.

The bottom line

Overall, it’s safe to continue exercising if your pregnancy is normal (4).

Including exercises to strengthen your abdominal muscles should be part of a prenatal fitness routine. Although traditional situps don’t pose a risk to your baby, they may contribute to diastasis recti.

Consider swapping out full situps and crunches for pelvic tilts, plank variations, and yoga moves like Bird Dog and Cat-Cow.

If you have questions or concerns, talk to your doctor during an early prenatal visit. They can also help you decide which activities are safe to continue and which ones to avoid until the postpartum period.

Adapting your core routine just a little bit will yield big results when it comes time to have your baby and beyond.

Can dehydration cause miscarriage?

During pregnancy, water is vital to your health and your baby’s health. Pregnancy is associated and leads to a significant weight gain, which averages 12 kg (26lb) at term in women with a healthy BMI (IoM, 2009).

The major contributor to this weight gain is water. It increases 1.5 to 2 gallons in healthy pregnant women during pregnancy. (2)

Where does all this water go? Water helps to form your placenta, build your amniotic fluid and increase blood volume for the benefit of your little one. Your baby is mostly water about 80% (2), and all of that water has to come from you.

image source

This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

So it is essential you stay hydrated during pregnancy. You need to take care of yourself (including your health and diet) to ensure the best start in life for your precious bundle of joy.

If you aren’t drinking enough water, dehydration can occur. Dehydration describes when your body doesn’t have enough water and other fluids to function properly. Dehydration can range from mild to severe, but even mild dehydration can be dangerous for pregnant women.

Mild dehydration can cause low energy levels and depressed moods. That’s the last thing a pregnant momma needs! Dehydration can lead to more serious problems, such as a low amniotic fluid.

Amniotic Fluid

Amniotic fluid is the fluid that surrounds your baby within the amniotic sac (amnion). Amniotic fluid serves as a shock absorber and protects your unborn child from physical harm. It also protects your baby from infection. Amniotic fluid helps your baby’s lungs and digestive system to grow and mature properly.

In a healthy pregnancy, the amount of amniotic fluid increases each week, until a few weeks before full-term. At the peak, the average pregnant woman carries about 27 ounces of amniotic fluid. After reaching its peak, the amount of amniotic fluid gradually decreases until the baby is born.

When you’re pregnant, your doctor will monitor your amniotic fluid levels to ensure they’re within proper ranges. Complications increase if there is too much, or too little, amniotic fluid.

Ultrasound is the best tool for evaluating amniotic fluid levels

Ultrasound is the only practical tool for assessing amniotic fluid level while pregnant. A regular Black/white (or 2-D) ultrasound measure amniotic fluid levels by obtaining either an amniotic fluid index (AFI) measurement or a single deepest pocket (SDP) measurement. Your doctor should review these measurements each time you receive an ultrasound that has included gauging the fluid levels.

Ultrasound is the best method for your doctor to ensure you have enough, but not too much, amniotic fluid.

Too Little Amniotic Fluid (Oligohydramnios)

Your doctor may be concerned if there is not enough amniotic fluid if your SDP is less than 2 cm, or your AFI is less than 5 cm. Not having enough amniotic fluid is called oligohydramnios. Oligohydramnios can be caused by a variety of reasons, including dehydration (3). Not enough amniotic fluid early in the pregnancy can lead to congenital abnormalities or miscarriage.

In later stages of pregnancy, oligohydramnios can cause labor complications and pre-term birth. During the second and third trimester, there are only three reasons for contractions: full-term birth, bladder infection or pre-term labor. If you’re severely dehydrated, your blood volume decreases, which can raise the concentration of oxytocin. Since oxytocin induces contractions, it can lead to premature labor.

Too Much Amniotic Fluid (Polyhydramnios)

Your physician will get concerned if your baby has too much amniotic fluid around it if your largest fluid pocket depth (maximal vertical pocket (MVP) greater than 8 cm, or your overall AFI (Amniotic Fluid Volume) exceeds 25 cm.

Having too much amniotic fluid surrounding your baby is called polyhydramnios. It is a relatively rare condition only occurring in about 1% to 3% of pregnancies. There are many reasons you may have too much amniotic fluid. Maternal causes, multiple births, and even unknown reasons can result in polyhydramnios.

Most women with polyhydramnios give birth to healthy babies, so don’t worry yet. Familiarize yourself with possible effects of polyhydramnios, such as early or premature labor. In some polyhydramnios cases, the baby does not turn before birth, requiring a cesarean section for delivery.

Talk to your doctor about risks and options if they’re concerned about your amniotic fluid levels.

Healthy Hydration for Best 3D Ultrasound Pictures

While elective 3-D ultrasounds are not practical for measuring amniotic fluid levels or determining if you’re dehydrated, they are still a very fun and important part of pregnancy! If you’re having a 3-D ultrasound performed, be sure to stay well hydrated before your scan. Good hydration is not only good for you and your baby; it helps to get the best 3D Ultrasound pictures!

We advise that you check with your OB provider on the amount of daily fluid intake and starting to drink the amount of the fluid recommended by your doctor at least a week before your 4D ultrasound scan will lead to the best ultrasound results.

The sound waves of a 3D/4D ultrasound pass through fluid easily and a pocket of the fluid around the baby’s face is required to obtain a good 3D ultrasound picture that will highlight facial features in great details, so this is why more fluid produces better quality ultrasound pictures.

It takes about two to four days for water you drink to affect the fluid levels in your uterus. That’s why it’s important to plan your fluid intake for an entire week before your scheduled ultrasound procedure. Last minute increases in water intake do not affect your uterus quickly enough.

Please note, drinking enough fluid for your elective ultrasound does not mean you will need a full bladder for an excellent 3D/4D ultrasound picture. You do not (thankfully) have to hold off on relieving yourself before your 4D scan. Just try to retain your recommended intake of fluids for the week before your 3D sonogram scan. You’ll appreciate it later when you’re looking at those incredible pictures of your little one(s).

Complications & Side Effects of Dehydration during Pregnancy

Dehydration can cause other complications to both mother and child. Although not common, dehydration can cause spotting in pregnancy. It’s believed some women experience spotting when dehydrated, as their hCG levels temporarily stop increasing, or dip.

Once re-hydration is reached, hCG levels level out and spotting may stop. Sometimes, bleeding during pregnancy may be a sign of a threatened miscarriage. Moderate or severe dehydration may cause a threatened miscarriage.

Severe dehydration during pregnancy can induce serious complications such as blood clots, neural tube defects, and seizures. Dehydration while pregnant can increase body temperature, which can complicate heat-related issues such as muscle cramping and heat exhaustion. Continued dehydration can lead to inadequate breast milk production and changes in breast milk composition.

Preventing Dehydration

Because of the risks of dehydration, while pregnant, it’s important you stay as hydrated as possible by following your doctors’ advice. While pregnant, your total water intake (from food and drinks) should be about 100 ounces per day.

Your fluid intake (from just-drinks) should be a minimum of approximately 64 ounces, or 8 cups, per day. Please, check with your OB provider to make sure the amounts provided are matching your particular situation.

Remember, everything you drink, including water, coffee, tea, juice, milk and even caffeinated sodas count toward your total fluid intake. Although it’s healthiest to drink primarily water, it’s almost impossible in real life, especially when you’re pregnant. Occasional caffeine won’t be a problem, but it might increase your urine output as it is considered a diuretic. In other words, it might make you pee more!

Every pregnant woman understands morning sickness can make it difficult to intake enough fluid! Not only are you feeling tired and sick – you may be vomiting without warning. Vomiting, of course, increases your chances of dehydration.

Some tips to help nausea and stay hydrated, especially when you’re pregnant:

• If you have nausea mostly in the morning, start your day with something other than plain water. Just as crackers can help settle a stomach, flavored water, juice or tea can stay down better than plain water on an empty stomach.

• If you don’t find plain water tasty, flavor it with some lemon or another flavor to make it more palatable.

• Try to avoid drinking too much caffeine, as it can decrease hydration by increasing urine output.

• If you’re nauseous and vomiting throughout the day, try drinking some broth (chicken, beef or vegetable). For some women with severe morning sickness, the extra protein, vitamins, and minerals help stay down better than sweet juices or sports drinks.

• Try to keep a bottle within reach at all times and take small sips throughout the day. This will keep your hydration levels more level throughout the day.

• Drink plenty of water before, during and after activity, especially in hot weather.

• Popsicles (which are mostly water) are another great option for hydrating when you don’t want yet another glass of water.

• It’s easier to keep down little bits of drink and food when suffering from morning sickness. Often eating six small, light meals can help women suffering from morning sickness feel better.

• If it’s hot out, drink extra water or fluids to offset the water you’ll lose through sweat.

• Try not to spend too much time in a hot environment. The longer you spend, the more energy your body expends to keep you cool, and the more fluid loss you’ll suffer.

• If it’s hot out, avoid strenuous exercise during the hottest parts of the day. Plan physical activity for early morning or late evening to stay cooler.

• Avoid alcohol, including wine and beer, as alcohol can contribute to dehydration.

Remember, fruits and vegetables are also an excellent source of water. Some fruits and vegetables are mostly water, such as celery and watermelon. Other high-water content fruits and vegetables include strawberries, cantaloupe, cucumber, leafy greens, zucchini, tomatoes and bell peppers. See, it is just like mom said: “Eat your fruits and veggies!”

Electrolytes are chemicals that help your body produce ions in your bodily fluids. These ions carry the energy your body needs to produce movement or work. Many bodily functions rely on electrolytes, such as muscle contractions and nerve impulses.

The proper ratio of electrolytes is critical, as both too much and too little electrolytes can cause problems such as muscle cramping. Your body needs a consistent influx of electrolytes to stay balanced and healthy.

While drinking water is the best thing to stay hydrated, some people prefer sports drinks with electrolytes, or hydration tablets added to water. While sports drinks will replace some of the electrolytes you’ve lost during intense exercise or perspiration, they tend to be high in extra sugar and calories. Water, or flavored water, remains the healthiest choice for staying well hydrated.

Dehydration Treatment

If you think you are mildly dehydrated, you may be able to treat yourself by increasing your fluid intake, but you should talk to your doctor. If you are pregnant and think you are more than mildly dehydrated, please seek immediate medical care. If you think you are severely dehydrated, get immediate medical attention or if life-threatening, call 911.

Signs and symptoms of mild to moderate dehydration include:

• dry skin, mucous membranes

• headache

• sweating too much, or not sweating at all

• few tears when crying

• dizziness or lightheadedness

• constipation (although this can occur without dehydration in pregnant women)

• nausea (although this can also be caused by morning sickness when pregnant)

• dark urine color or strong smelling urine

• minimal urine production

• may feel thirsty; dry or sticky mouth

• muscle cramps

Signs & Symptoms of Moderate and Severe Dehydration:

• lack of urination

• urine that is very dark

• severe thirst

• shriveled skin

• sunken eyes

• severe headache

• low blood pressure

• rapid heartbeat

• rapid breathing

• no tears when crying

• little to no sweat production

• fever

• unconsciousness

• dizziness

• confusion or delirium

1. Givens and Macy, 1933; Ziegler et al. 1976

2. Chesley, 1978; Hytten, 1980

3. Patrielli et al. 2012

What happens if u drink vinegar while pregnant?

We all know that regularly consuming apple cider vinegar is good for our bodies. It has many benefits, be it for weight loss, constipation or any other health issues. However, one question that often pops up when it comes to pregnant women. Is it safe to consume vinegar during pregnancy? So let’s know more about it today.

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Most/ All of us are over-cautious during our pregnancy period and we don’t like to experiment with anything new at this point in time. Many say that it is useful and helps the baby develop faster and better. It is very good to consume from the first month of pregnancy.

At OVUM Hospitals, we are committed to providing you with the best maternal health care possible.

Firstly, you should know that ACV is made from apples by fermenting them. You will find two types of apple cider vinegar pasteurized and non-pasteurized. Pregnant women should take only pasteurized one as it is the pure form of the apple cider vinegar. This will not contain any kind of harmful bacteria that can cause side effect to your baby.

The unpasteurized variety contains bacteria that make it more potent and not very suitable for pregnant women. It is extremely good for health and it is most ideal for gut. But it is still not recommended to consume during pregnancy as it can trigger and complicate pregnancy. You should speak to your doctor before having apple cider vinegar.

Apple cider vinegar is not a new concept; actually it is a very old concept that had been by generations. Let’s know how ACV will help us-

Keeps bloating at bay– One of the most troubling symptoms in early pregnancy is bloating. Bloating mainly happens due to the hormonal changes in the body that makes intestinal muscles work in a relaxed fashion, this slow down the digestion and that will lead to heartburns and gas. To reduce this, take two spoons of apple cider vinegar in a glass of water and consume half before the meals and another half after the meals.

Heartburn and acidity – During your 12th to 27th week of pregnancy, heartburn and acidity become a common problem. Apple cider vinegar comes handy to help this situation. You can take 1 tablespoon of ACV in one glass of water; it will solve the problem immediately.

Glowing skin during pregnancy – Pregnancy is known to have glowing skin but due to the hormonal changes, it takes a toll on your health. Because of which you may get acne and pimples. As the hormones are changing, the level of androgens in the body increases; it starts to clog the skin pores and leads to pimples and acne. For this, you can use acv as a tonner and by drinking acv while pregnant gives you a glowing skin.

Morning sickness – during pregnancy you may have morning sickness, this happens because of the acidity in the stomach. Consume apple cider vinegar twice a day to overcome this problem.

ACV prevents urinary tract infection – Urinary tract infection is very common during pregnancy. As your baby starts growing, it creates pressure on your bladder. That is the reason it becomes hard for you to urinate every time. This may lead to multiplying bacteria in your urinary tract system. To naturally treat it, you can consume two tablespoons of apple cider vinegar in a glass of water every day.

Helps to cure indigestion – You may sometimes experience indigestion during pregnancy that may cause discomfort. Diluted apple cider vinegar will give you huge relief.

Helps to cure leg cramps – There are many reasons for leg cramps in pregnant women. By consuming acv helps to boost up the potassium level in the body that may ease the discomfort.

We have the best team of gynecologists in Bangalore who are experienced in preventive care along with other women’s health-related issues.

What everyday things can cause a miscarriage?

Miscarriage refers to the spontaneous ending of a pregnancy before the 20th week of gestation. According to estimates by the American Pregnancy Association (APA) miscarriages happen in 10 to 25 percent of all pregnancies.

But the real number of miscarriages is likely greater as many of them happen quite early during pregnancy and by that time many women don’t get to know they were pregnant. Miscarriage is quite common, but it is undoubtedly a difficult experience. You can take a step forward and heal emotionally by understanding what could cause a miscarriage. The article discusses the various causes of miscarriage, risk factors of miscarriage and what you can do to prevent a miscarriage.

Most common reasons for miscarriage

Your body provides nutrients to the developing fetus during pregnancy to help with its normal development. One of the main causes of miscarriage during the first trimester is the abnormal development of a fetus. This may occur due to different factors.

Genetic issues

Half of the miscarriages may occur because of chromosome issues. The errors occur randomly during the division of fetal cells.

They may also occur as a result of a damaged sperm or egg cell.

Some examples of causes of miscarriage due to chromosomal abnormalities are:

The intrauterine demise of the fetus: There is a formation of the embryo but it stops developing before there is a development of any symptoms of miscarriage.

Blighted ovum: In this condition, there is no formation of an embryo. This is one of the reasons for early miscarriage.

Molar pregnancy: in this condition, the father provides both sets of chromosomes, but there is no development of a fetus. Instead, there is an abnormal growth of the placenta.

Partial molar pregnancy: In this condition, the chromosomes from the mother remain; but the father also provides two sets of chromosomes. It is associated with placental abnormalities and growth of an abnormal fetus.

Long-term health conditions

Long-term health conditions of the mother may be one of the causes of miscarriage at 20 weeks of pregnancy.

Some of these health conditions include:

uncontrolled diabetes

thyroid disease

heart disease

hypertension

antiphospholipid syndrome

lupus and other types of immune system disorders

kidney disease.

Infections

Many infections in the mother may result in a miscarriage. These infections include:

chlamydia

gonorrhea

syphilis

malaria

German measles

AIDS

Weakened cervix

One of the causes of miscarriage during the second trimester of pregnancy is a weakened cervix also known as the incompetent cervix or cervical incompetence. In this condition, the cervical muscles are weaker and are not able to hold the fetus. It may occur as a result of a previous injury to the cervix such as after a surgery. Due to the weakness of muscles, the cervix may open too early often during the second trimester of pregnancy resulting in miscarriage.

PCOS

Polycystic ovary syndrome (PCOS) is a disease in which multiple cysts are present in the ovaries making them larger in comparison to normal ovaries. It occurs due to hormonal changes in a female. It causes infertility in females as it reduces the production of eggs.

There's some evidence to suggest it may also be linked to an increased risk of miscarriages in fertile women.

Miscarriage risk factors

There are several factors that may increase the likelihood of miscarriage in women.

Age

Women 35 years of age or older may have an increased risk of miscarriage in comparison to younger women. The risk of having a miscarriage is about 20 percent when you are 35 years old, the risk increases to 40 percent at age 40 and to 80 percent when you are 45 years old.

Excessive weight

Being overweight or obese may increase your risk of having a miscarriage.

Smoking

If you smoke during your pregnancy, then your risk of having a miscarriage may get increased in comparison to nonsmoker women.

Alcohol

Drinking alcohol heavily during pregnancy may also increase the risk of having a miscarriage.

Drugs

Use of illicit drugs during pregnancy may increase the risk of having a miscarriage.

Caffeine

Having an excessive amount of caffeine during pregnancy (more than 200 mg per day) may also increase the risk of miscarriage.

Food poisoning

Food poisoning that occurs due to consuming contaminated foods may also increase your risk of having a miscarriage. For instance:

Listeriosis: It is most commonly present in unpasteurized dairy products; for instance, blue cheese.

Salmonella: It occurs due to eating partly cooked or raw eggs.

Toxoplasmosis: You may get this infection by eating undercooked or raw infected meat.

Trauma

Physical trauma may also increase your risk of having a miscarriage.

Certain medications

Taking certain medicines during pregnancy may also increase the likelihood of having a miscarriage. Some of these medicines are:

Misoprostol: It is given for the treatment of conditions such as rheumatoid arthritis.

Retinoids: It is given for skin conditions such as acne and eczema.

Methotrexate: It is also given to treat autoimmune diseases such as rheumatoid arthritis.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These drugs such as ibuprofen are given to relieve inflammation and pain.

To make sure that a particular medicine is safe to take during pregnancy, always check with the pharmacist or physician before taking it.

Infections

There are various types of infections that may increase the risk of miscarriage if you get them during pregnancy:

German measles (Rubella)

HIV

Cytomegalovirus

Bacterial vaginosis

Gonorrhea

Chlamydia

Malaria

Syphilis

Diabetes

Several chronic diseases may increase the risk of miscarriage in the second trimester of pregnancy, particularly if they are poorly controlled or not treated and uncontrolled diabetes is one of them.

Misconceptions about miscarriage

There are several misconceptions related to the miscarriage reasons in early pregnancy and the risk factors of miscarriage.

The emotional state of women during pregnancy: the emotional state of women during pregnancy including being depressed or stressed is not linked to the increased risk of having a miscarriage.

Having a fright or shock during pregnancy: if you suffer from a fright or shock during pregnancy, it may also not increase your risk of having a miscarriage.

Exercising during pregnancy: exercising during pregnancy does not increase your risk of miscarriage. This includes doing high-intensity exercises such as cycling and jogging. But you should definitely discuss the kind and amount of exercise you may do during pregnancy with your physician or obstetrician.

Straining or lifting during pregnancy: lifting and straining do not really increase your risk of miscarriage.

Working during your pregnancy: you don’t have to stop working, even if your work involves standing or sitting for a long time as working during pregnancy is not connected to the likelihood of having a miscarriage. However, you should make sure that you have no exposure to harmful radiation or chemicals at work. Discuss with your physician if you have concerns about any risks related to work.

Having sexual intercourse during pregnancy: having sex is not among the reasons for miscarriage. So, you may enjoy sex with your partner during pregnancy for as long as you feel comfortable.

Air travel during pregnancy: air travel is not harmful to pregnancy and is considered safe; therefore, pregnant women are allowed to travel by air until the 36th week of pregnancy by most commercial airlines.

Eating hot and spicy food: eating hot and spicy food may neither cause a miscarriage nor increases your risk of having it.

How to prevent miscarriage

In many cases, causes of miscarriage aren’t known; hence, you can’t prevent them. But you may reduce your risk of having a miscarriage. Here are the ways to reduce the risk of miscarriage by controlling the possible causes:

Foods That can Cause Miscarriage In Early Pregnancy | Foods to Avoid in Early Pregnancy

Not smoking tobacco during pregnancy

Not drinking alcoholic beverages during pregnancy

Not using illicit drugs while pregnant

Eating a well-balanced and healthy diet

Making sure to avoid getting infections such as rubella while pregnant

Avoiding contaminated foods while pregnant as these may cause food poisoning and increase the risk of miscarriage

Attaining your healthy or optimum weight before conceiving

Treating the identifiable causes such as antiphospholipid syndrome or weakened cervix may also prevent miscarriage

Recovering from miscarriage

A miscarriage may have a great emotional impact on the woman and her partner, family, and friends. You may ask for support and advice during this hard time. You may feel the emotional impact of the miscarriage immediately or after several weeks. You may feel fatigued, and have reduced appetite, and difficulty in sleeping after having a miscarriage. You may develop feelings of sadness, shock, guilt, and anger. Different women grieve after a miscarriage in different ways. Some may feel better by talking about what they feel while others may find it too painful to talk about the subject.

Can a yeast infection cause a miscarriage in early pregnancy?

Vaginal yeast infections called vulvovaginal candidiasis is a common gynecologic malady affecting many women, especially those who are pregnant. The results from a recent study found that a common yeast infection medication is linked to miscarriage. The Journal, ‘Contemporary OB/GYN’ issued a clinical alert to all OB/GYN physicians warning of the risk of miscarriage in women taking an often prescribed medication to treat this condition during pregnancy. Fluconazole also known as Diflucan is customarily given in 150 mg increments to women suffering candidiasis. Unfortunately even low doses of fluconazole (<150 mg) may increase the chance of miscarriage. Dosages of 150 mg or greater was associated with a 2-3 X Risk of miscarriage. Using fluconazole during the first trimester of pregnancy was also associated with an 80% higher risk of neonatal cardiac closure defects (hole in the heart).

Fluconazole while safe to use when not pregnant, should not be used during pregnancy. Anti-fungal medications that are reported to be safe to use during pregnancy include Clotrimazole (Mycelx, Lotrimin) and Miconazole (Monistat). Topical preparations of azole for 7 days is the treatment of choice.

Can kidney stones in early pregnancy cause miscarriage?

New research suggests that pregnant women are slightly more likely to develop kidney stones than non-pregnant women—especially when these kidney stones are occurring for the first time in that woman’s life. The development of kidney stones can pose additional risks and health complications for pregnant women suffering from this condition, and raise concerns in pregnant women about the condition’s threat to the health of their pregnancy.

Despite the alarming pain and other symptoms that accompany kidney stones, prompt diagnosis and treatment can remedy this condition and the other complications it brings, allowing pregnant mothers to move forward with a healthy pregnancy.

Kidney Stones While Pregnant: Symptoms to Monitor

Kidney stones are solid masses that develop when calcium binds with other materials in your urine, creating calcifications that build up and are unable to pass through the vessels that carry urine from your kidneys to your bladder. As this buildup forms a blockage in those vessels, a number of kidney stone symptoms in pregnancy may develop, including:

Pain when urinating. This is often sharp pain that can make urinating unbearable.

Nausea and/or vomiting. The discomfort of kidney stones, as well as the buildup of urine in your kidneys, can make you feel sick.

Blood in your urine. The development of hematuria in pregnancy can be very alarming to pregnant mothers who fear the blood is a sign of miscarriage or other health problems, although bloody urine caused by kidney stones is not a serious health concern by itself.

Sharp back or abdominal pain. This may be a sign of urinary retention in pregnancy, caused by a kidney stone blockage that is backing up urine in one or both kidneys. Pregnant women should also be aware that urine buildup stretching and swelling the kidneys—a condition known as hydronephrosis—is also more likely in later stages of pregnancy as the baby is producing its own urine. For this reason, be aware that kidney stones could complicate your management of hydronephrosis in pregnancy.

Can Kidney Stones Early in Pregnancy Cause Miscarriage?

While kidney stones do not directly cause miscarriage, untreated kidney stones can lead to other health complications, such as preeclampsia and urinary tract infections, that could increase the risk of miscarriage. While this outcome is uncommon, it should be taken seriously by both patients and clinicians.

Treatment Options for Passing a Kidney Stone While Pregnant

Treatment options for kidney stones can vary depending on the size of the stone. In addition, pregnancy may restrict the types of treatment options your doctor recommends for your specific circumstances. Some of the most common kidney stone treatments include:

Medication. Certain muscle relaxants may be prescribed to relax the ureters where kidney stones have formed a blockage.

Breaking up stones with sound waves. This treatment will target stones with strong vibrations that reduce the size of stones and make them possible to pass. While non-invasive, it can be a painful procedure that may require sedation, which some pregnant women may prefer to avoid.

Surgery. Invasive surgical procedures now offer minimal recovery time and may be necessary if other non-invasive procedures fail.

Scope procedure. This may be an option for smaller stones, inserting a scope up your urethra and into your ureters to break up the stone. However, it may require a stent while you heal, and the procedure itself may require anesthesia.

How to Relieve Kidney Pain While Pregnant

While it’s essential that you seek out treatment for kidney stones as soon as possible, many pregnant women are understandably eager to alleviate their pain and prevent the development of future instances of kidney pain.

Take a pain reliever recommended by your doctor. Since pregnant women are restricted from taking certain types of pain-relieving medications, such as ibuprofen, consult your doctor for a recommendation or prescription for a pregnancy-approved pain reliever while waiting for kidney stone treatments to offer relief.

Drink plenty of water. If you haven’t been drinking water regularly, increasing your intake of water could dilute your urine and make kidney stones easier to pass. Even if drinking water isn’t sufficient to help pass kidney stones, drinking plenty of water throughout the day will reduce the risk of recurrent cases of kidney stones. Doctors recommend drinking between two to three quarts of water daily (64 to 96 ounces). Again, consult with your doctor to determine the right amount of daily water consumption while pregnant.

Ask your doctor if you can cut back on calcium supplements. While some pregnant women are encouraged to take calcium supplements during pregnancy, this could be increasing the likelihood of kidney stones.

If you have developed symptoms of kidney stones, prompt treatment is key to minimizing the risk of health complications. Consult your doctor today to get a clear diagnosis and develop a treatment plan that addresses your condition while prioritizing the health of your pregnancy.

Can BV cause miscarriage?

Bacterial vaginosis (BV) is related to the increased risk of miscarriage, preterm labor, and postpartum endometritis.

Aims:

The aim of this study was to evaluate the association between BV and the history of spontaneous abortion and recurrent pregnancy losses. We also examined periods of gestation, including the first and second trimester miscarriages.

Materials and Methods:

The study population consisted of 200 fertile women. Sixty one (30.5%) of 200 women had the history of a spontaneous abortion in the last six months (N = 30) and at least three recurrent pregnancy losses (N = 31). BV was diagnosed either by using Papanicolaou staining, Gram staining, or by culturing with BV-associated bacteria, Gardnerella vaginalis.

Results:

The presence of BV was statistically associated with the history of a spontaneous abortion in the last 6 months (P < 0.05), whereas there was no significant relationship between BV and recurrent pregnancy losses (P > 0.05). These women were also evaluated in view of periods of gestation. Forty-seven (77%) of 61 women had first trimester miscarriage (≤12 weeks) and 14 (23%) of 61 women had second trimester miscarriage (>12 weeks). There was a statistically significant relationship between BV and second trimester miscarriage (P < 0.05). Positive BV findings were not associated with discharge, itching, and pain (P > 0.05).

Conclusion:

BV may contribute to spontaneous abortion and second trimester miscarriage.

Keywords: Bacterial vaginosis (BV), Gardnerella vaginalis, recurrent pregnancy losses, spontaneous abortion

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Introduction

Vaginitis is the most common gynecological infection among women of fertile age.[1] Bacterial vaginosis (BV) comprises the 50% of the all cases of vaginitis.[2] To understand the pathological events related to vaginitis, it is necessary to understand the normal vaginal flora. In normal vaginal flora, there are Lactobacillus species in 95% and facultative anaerobic and anaerobic microorganisms, including Gardnerella vaginalis, Staphylococcus epidermis, Mycoplasma hominis, Streptococcal species, Bacterioides species, Prevotella bivius, Peptostreptococci species, in 5%.[2,3] Lactobacillus species protect the vaginal flora from genital pathogens by producing lactic acid, H2O2, and antimicrobial proteins. In case of a decrease in the number of Lactobacillus species, these are replaced by anaerobic and facultative anaerobic microorganisms.

The presence of BV during pregnancy attracts the attention of physicians due to adverse pregnancy outcomes. These adverse outcomes related to BV are the increased risk of late miscarriage, preterm labor, low-birth-weight infants, chorioamnionitis, postpartum endometritis, and postabortion pelvic inflammatory disease.[4,5,6,7,8,9]

BV-associated microorganisms in amniotic fluid and the placenta coming from the cervicovaginal mucosa were found in association with abortion and preterm labor.[10,11,12] Ralph et al. indicated when BV is identified before 16 weeks of gestation, the highest rates of preterm labor was detected, and BV was responsible for twofold risk of miscarriage in the first trimester.[13] Similar to these results, Ugwumadu et al. found threefold increase in the risk of miscarriage in the first trimester.[14] Contrarily, BV is found to be related to the late miscarriage in comparison with the first trimester pregnancy loss.[4,11] In a large study that is conducted with 10,397 women, BV had caused low-birth-weight infant in more than 40% of women without BV in the second trimester of pregnancy.[6] These previous studies were performed in pregnant women. Llahf-Camp et al. indicated that BV is not related to the history of recurrent pregnancy losses in fertile women.[15] Except for this report, there is no previous documentation enlightening the relationship between BV and the history of abortion in fertile women. Therefore, we aimed to understand the relationship between BV and the history of abortion using Papanicolaou staining for cytological investigation, Gram staining, and culture of G. vaginalis for microbiological examination. Presence of BV was correlated with the history of a spontaneous abortion and recurrent pregnancy losses as well as gestation periods, including the first and second trimester miscarriages.

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Materials and Methods

Case selection

In our study, 200 fertile women with varied gynecological complaints were seen at the outpatient clinic of the gynecology and obstetrics. Pregnant women were not included in this study. This study was applied according to the principles of The Declaration of Helsinki. Before pelvic examination, data on age, menstruation date, pregnancy outcomes, contraception methods, gravidity, and clinical symptoms were enrolled.

Cytological examination

For cytological examination, the cervicovaginal fluid samples were taken from each woman with a cytobrush before conducting the pelvic examination. pH was measured by putting a drop of the cervicovaginal fluid on a pH strip (ranging pH = 4-7). For Whiff test, the cervicovaginal fluid was smeared on slide, and one drop of 10% potassium hydroxide (KOH) was added. Smears having fishy odor were accepted as Whiff (+). After that, the cervicovaginal fluid was smeared on slide in one direction and fixed with 96% ethanol without air-drying. Smears were stained using Papanicolaou (PAP) method and examined by light microscope in detail.

In the cytological examination, the diagnosis of BV was established by detecting clue cells covered by adherent bacteria. The absence of Lactobacilli, the lack of neutrophil leukocytes, and increase in the number of free cocci were accepted as the other identification criteria of light microscopic examination for BV. A homogeneous, thin, gray vaginal discharge; a fishy odor with Whiff test; and a vaginal pH of >5 were also considered.[16]

Gram stain method

The cervicovaginal fluid was smeared on slides and these slides were air-dried. Gram staining differentiates bacteria by properties of their cell walls. Gram-positive bacteria that have thick cell wall stained purple, whereas Gram-negative bacteria that have thin cell wall stained pink. After staining with the Gram stain, some bacteria showed a mix of pink and purple stain. These bacteria were considered Gram variable. All slides were examined under an oil immersion objective. Gram-stained smears were evaluated according to Nugent et al. The Nugent score was calculated in the following methods.[17] The decrease in large Gram positive rods; Lactobacillus spp. were scored as 0-4. Gram variable small rods, G. vaginalis, were scored as 0-4, whereas curved Gram variable rods, Mobilincus, spp., scored as 0-2. Scores summed, and results graded as 0-3 (normal vaginal flora), 4-6 (intermediate flora), and 7-10 (BV).

Culture

The cervicovaginal fluid was obtained and transferred to the Microbiology Laboratory by Stuart Transport Media (Thermo Scientific, UK) and was then cultured on Blood agar (Neogen, US) and Gardnerella Selective Agar with 5% human blood (Mast Diagnostics, UK). These plates were incubated at 37°C for 48 h in 5-10% CO2. After the incubation period, G. vaginalis were identified for a positive beta-hemolysis and hippurate hydrolysis as well as negative catalase and oxidase reactions.

Statistical analysis

The aim of this study was to find out whether or not the presence of BV was associated with the history of abortion. For these comparisons, χ2 or Fischer's exact test was used, and P values less than 0.05 were considered as statistically significant.

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Results

In this study, 200 fertile women were evaluated in view of the presence of BV and the history of abortion. Sixty-one (30.5%) of 200 women had the history of a spontaneous abortion in the last 6 months and recurrent pregnancy losses (at least three times). These women were taken as a study group (N = 61) and 139 (69.5%) women not having the history of abortion were accepted as the control group. The percentage and the mean of ages of groups were shown in Table 1.

Table 1

Percentages and the mean of ages of the study and control groups

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When we examined the study group with regard to the kind of abortion, 30 (49.2%) of the 61 women were detected as having the history of a spontaneous abortion in the last 6 months, 31 (50.8%) of 61 women had recurrent pregnancy losses. The women in the study group were also evaluated in view of the abortion whether it has happened in the first or second trimester of gestation. Forty-seven (77%) of the 61 women had the first trimester miscarriage (≤12 weeks), and the remaining 14 (23%) of 61 women had the second trimester miscarriage (>12 weeks).

According to the cytological examination, BV was diagnosed in 17 (27.9%) women in the study group (n = 61) and BV was positive in 19 (13.7%) women in the control group [Figure [Figure1a1a and andb].b]. In BV (+) women, pH was higher than 5 in 14 (82.4%) and 17 (89.5%) women of the study and control groups, respectively. In the study group, Whiff test was positive in 5 of 17 (29.4%) women with BV.

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Figure 1

(a) Clue cell (arrow) and free cocci were seen around the squamous epithelial cells (PAP stain, ×400). (b) The cell borders were irregular (arrow) in clue cell (PAP stain, ×1000). (c) The cytoplasmic loss was observed (arrow) in clue cell (Gram stain, ×1000)

To obtain microbiological data, Gram staining and culture methods were employed. According to Gram staining results, Nugent score ranged 7-10 (BV) was observed in 7 (11.5%) of 61 in the study group and 6 (4.3%) of 139 in the control group [Figure 1c]. G. vaginalis was isolated by culture method in all women diagnosed as BV (+) by Gram stain in both study and control groups.

All women who were accepted as BV (+) by microbiological methods (Gram staining and culture) were also found positive by cytological examination. Therefore, PAP stain results were used for statistical comparison. As seen in Table 2, when the study and control groups were compared to each other, there was a significant correlation between the presence of BV and the history of abortion (P < 0.05). In the study group, 12 of 17 (70.6%) women with BV had a history of spontaneous abortion in the last 6 months and only 5 of 17 (29.4%) women with BV had recurrent pregnancy losses [Table 3]. According to the statistical data, a significant association between BV and the history of spontaneous abortion (P < 0.05) was determined; however, there was no association between BV and the history of recurrent pregnancy losses (P > 0.05). The effect of BV on the gestation periods was also examined. The presence of BV had no effect on the first trimester miscarriage (P > 0.05), but BV had strongly affected the second trimester pregnancy losses (P < 0.05). These results were shown in Table 4.

Table 2

Correlation of the study and control groups in view of BV

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Table 3

Relationship among the presence of BV, history of spontaneous abortion, and recurrent pregnancy losses

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Table 4

The effect of BV on the gestation periods (≤12 week, >12 week)

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The gynecological complaints of women were analyzed statistically, and these data were shown in Table 5. There was no association of the presence of BV with the gynecological complaints, such as vaginal discharge, itching, and pain (P > 0.05).

Table 5

Relationship between gynecological complaints and the presence of BV in the study and control groups

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Discussion

BV is associated with pregnancy outcomes, including abortion, preterm labor, and premature rupture of membranes.[4,18,19] According to the National Health and Nutrition Examination Survey, BV was positive in 29% of the fertile women aged 14-49 years.[20] Jacobsson, Svare, and McGregor et al. studied pregnant women, and the prevalence of BV was found between 15.6% and 32.5% among their study subjects.[7,8,21] The effects of BV on abortion were examined generally in pregnant women so far. For this reason, we aimed to understand the relationship between BV and the history of abortion using cytological and microbiological methods in fertile women.

When NOT to Take Apple Cider Vinegar (ACV)

In our study, BV was detected in 17 of 61 (27.9%) women by cytological methods (we accepted cytological results to make statistical analysis because only G. vaginalis was isolated microbiologically. The other microorganisms associated with BV, such as Bacterioides, Mobilincus spp., Ureaplasma urealyticum, M. hominis, and Prevotella, were not isolated). In the study group, there was a statistically significant association between the history of abortion and the presence of BV (P < 0.05). We obtained significant findings in light microscopic examination of cervicovaginal smears. The cell borders of clue cells were irregular, and cytoplasmic loss was observed [Figure [Figure1b1b and andc].c]. We thought that lytic enzymes produced by BV-associated microorganisms may have caused these changes in clue cells. According to studies which examined the reason of abortion, lytic enzymes, such as proteases, Phospholipase A2 and Phospholipase C produced by BV-associated microorganisms cause lysis of phospholipids of fetal membranes and cell membranes of clue cells. In other studies, after lysis of phospholipids, arachidonic acid is formed, and this acid causes induction of prostaglandins (PGs). PGs induce uterine muscle contraction, sulfated Glucoseaminoglycan (GAG) decreasing, reorganization of collagen fibrils, and decrease the cervical resistance.[22,23,24] Some cytokines, such as interleukine-1 (IL-1), IL-6, IL-8, granulocytes stimulating factors, and tumor necrosis factor alpha (TNFα), have increasing level in amniotic fluid of women with BV.[23,25] These cytokines also cause synthesis of PGs. In addition, PGs induce the release of inflammatory cytokines for stimulating the release of metalloproteinases (MMPs) from neutrophils. MMPs degrade connective tissue, such as chorioamniotic membranes, and it can be cause of abortion.[26]

The relationship between BV and the history of spontaneous abortion was investigated by the large meta-analysis, including 20,232 women, and BV was observed to be significantly associated with the spontaneous abortion.[27] Recent studies showed women with BV during pregnancy increased two- to threefold spontaneous abortion risk compared to women without BV.[13,14] In addition, Meningistie et al. and Goffinet et al. showed that BV was observed in pregnant women with the history of spontaneous abortion.[28,29] In our study, BV was found in 12 of 30 (40%) women with a history of spontaneous abortion in the last 6 months. Consistent with previous reports, our data showed that BV is more frequent in fertile women with the history of spontaneous abortion in the last 6 months (P < 0.05) than the women with recurrent pregnancy losses (P > 0.05).

Study related to the recurrent pregnancy losses, Llahf-Camp et al. aimed to state whether or not BV was related to a history of recurrent pregnancy losses in 500 women. This report indicated that BV is more frequent in women with a history of late miscarriage (21%) than women with recurrent pregnancy losses (8%).[15] Consistent with this study, only 5 of 17 (29.4%) women with BV had at least three recurrent pregnancy losses. As a result of these findings, we concluded that there was no association between BV and the history of recurrent pregnancy losses (P > 0.05).

In this study, the effects of BV on different periods of gestation were also evaluated. Some authors indicated that BV may cause the first trimester miscarriages even though the others stated that BV infection in the early periods of pregnancy may cause the second trimester miscarriage and preterm labor.[4,11,13,14] In our study, we observed that percentages of BV (+) women with first trimester abortion (N = 10, 58.8%) are less than that of the women without BV (N = 37, 84.1%). The frequencies of second trimester miscarriage in women with BV (N = 7, 41.2%) are higher than that in the women without BV (N = 7, 15.9%). In statistical analysis, the presence of BV is also significantly associated with second trimester miscarriages (P < 0.05). Rai et al. reported that untreated infections going on for a long time without any symptoms cause pregnancy losses.[30] To our opinion, consistent with these results, untreated and asymptomatic BV infection in first trimester or before pregnancy may cause second trimester miscarriage.

In this study, the gynecological complaints of women were also correlated with BV [Table 5]. There were no significant relationship between the complaints, such as discharge, itching, and pain, and the presence of BV (P > 0.05). In previous studies, BV was asymptomatic in women with a prevalence of 50%.[31] Consistent with this previous report, BV was also found to be asymptomatic in our study.

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Conclusion

In conclusion, women who had a spontaneous abortion in the last 6 months and recurrent pregnancy losses in the study group were evaluated in view of BV, and it was found that there was a significant correlation between the presence of BV and the history of abortion. BV was significantly higher in women with the history of spontaneous abortion than those with recurrent pregnancy losses and in the women with second trimester miscarriage than those with first trimester miscarriage. As a result, we suggest that the screening of BV in fertile women with the history of abortion is necessary to prevent from spontaneous abortion and second trimester miscarriage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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References

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Can cranberry juice cause a miscarriage?

It’s another one of those things you (almost) forget when you hold your little one for the first time: Urinary tract infections (UTIs) are common during pregnancy.

Your growing uterus and roller coaster hormones lead to a relaxed and fuller bladder, which makes getting a UTI easier.

Cranberry juice is a traditional natural remedy for UTIs — but is it safe for you and your baby during pregnancy? And will it help treat or prevent a UTI while you’re pregnant? Or maybe you just enjoy drinking this tart berry juice for its flavor!

Here’s what you need to know about drinking cranberry juice when you’re pregnant.

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Safety of cranberry juice in all 3 trimesters

ResearchTrusted Source has shown that drinking cranberry juice during pregnancy is safe for you and your little one.

Foods that Can Prevent a Miscarriage

You can safely drink cranberry juice in all trimesters of pregnancy.

As an herbal remedy, cranberries are linked to UTIs because they may help prevent bacteria from sticking to the sides of the bladder and urinary tract. This is important because if bacteria can’t find a suitable place to live, they can’t grow too much.

However, drinking cranberry juice can’t treat or stop a UTI once you have an infection, even if you don’t have symptoms.

You must get medical treatment for a UTI during pregnancy. Not getting the right treatment for a UTI can lead to serious complications if you’re pregnant.

Research on cranberry juice and pregnancy

Cranberry juice has been researched for treating UTIs during pregnancy, though not extensively.

For example, one older 2008 pilot study compared the effects of cranberry juice with a placebo in preventing UTIs in 188 pregnant women who were less than 16 weeks along.

The researchers found that participants who drank at least 240 milliliters (a little over 1 cup) of cranberry juice every day had a 57 percent reduction in bacteria in their urine and reported 41 percent fewer UTIs.

A larger study in 2013Trusted Source that included more than 68,000 women found that 919 of them had used cranberries while pregnant.

All those who used cranberries were healthy, and there was no risk to them or their babies due to drinking cranberry juice or other cranberry products.

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Potential benefits of cranberries

Cranberries and cranberry juice can give you plenty of other health and nutritional benefits. These bright red berries are rich in antioxidants called polyphenols that may be brain-boosting and heart-healthy.

Like other berries, whole cranberries are high in fiber. However, the juice doesn’t contain any fiber.

Cranberries are also a good source of vitamins and minerals, like:

vitamin C

vitamin E

vitamin K1

copper

manganese

One study (in non-pregnant people) also found that adding cranberry supplements to acid reflux treatment helped reduce the bacteria H. pylori in the stomach. This type of infection can lead to stomach ulcers.

Side effects and risks of cranberry juice

Talk with your doctor if you think you have a UTI.

It’s important to treat a UTI during pregnancy even if you don’t have any symptoms. This is because any kind of bacterial infection in the bladder can increase the risk of a kidney infection during pregnancy.

In fact, up to 30 percentTrusted Source of pregnant people with bacteria in their urine develop a kidney infection in later trimesters if it’s not treated. This can be very serious.

Your doctor might recommend a short course of antibiotics to treat a UTI. Cranberry juice may help prevent UTIs, but it won’t treat them.

Most cranberry juices also have large amounts of sugar added — they’re mixed with other kinds of juice to sweeten.

Check the sugar content of your cranberry juice. Balancing how much sugar you eat (or drink) is especially important during pregnancy to prevent and treat gestational diabetes. (Though gestational diabetes isn’t always preventable.)

Look for pure, unsweetened cranberry juice without added sweeteners.

If it’s too sour or bitter for you, sweeten with natural stevia or monk fruit sweeteners. You can also add pure, unsweetened cranberry juice to fruit and vegetable smoothies.

Precautions about taking cranberry supplements while pregnant

A small study in 2015 suggests that taking cranberry capsules may have the same effect on UTIs during pregnancy as drinking lots of cranberry juice.

Still, more research is needed and you should take precautions when taking any supplements while pregnant.

Although cranberry capsules and other natural supplements are monitored by the Food and Drug Administration (FDA), they’re not strictly regulated like medications are, meaning they may not always be safe and effective.

This is why it’s important to choose high quality supplements that are third-party tested for purity. You’ll also want to speak with your doctor before starting a new supplement.

You may want to just avoid taking cranberry supplements — including capsules and powdered forms — while you’re pregnant, unless they’re an exact brand and type recommended by your doctor. You may not know exactly how much cranberry extract they contain or what else is in them.

The takeaway

You can safely drink cranberry juice while you’re pregnant. It’s safe for you and your baby, and may even help prevent a UTI.

It can also keep bacteria overgrowth down there in check. However, you can’t treat a UTI with cranberry juice.

If you do have bacteria in your urine (even without symptoms) or you have a UTI, antibiotics are the first line of treatment. Without treatment, a bacterial infection in the bladder can lead to serious complications including a kidney infection.

Go to all your pregnancy check-ups and tell your doctor about any UTI symptoms you might have, right away.

Can Allergex pills cause miscarriage?

It isn't advisable to take medication during early pregnancy, but Allergex (chlorphenamine) has a very good safety record, so if required can be safely taken in early pregnancy,

Can amoxicillin terminate pregnancy?

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What are they?

Amoxicillin (Amix®, Amoram®, Amoxident®, Galenamox®, Rimoxallin®), co-amoxiclav (Augmentin®), and penicillin V are from a group of antibiotics called penicillins. Penicillins are used to treat a wide range of infections and are commonly prescribed during pregnancy.

Is it safe to use amoxicillin, co-amoxiclav, or penicillin V in pregnancy?

Numerous studies of use of these antibiotics in pregnancy have found no evidence of risk to the developing baby. Treatment of bacterial infections during pregnancy may be crucial to the health of both mother and baby.

When deciding whether or not to take amoxicillin, co-amoxiclav, or penicillin V during pregnancy, it is important to weigh up how necessary this is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are. Your doctor is the best person to help you decide what is right for you and your baby.

What if I have already taken amoxicillin, co-amoxiclav, or penicillin V during pregnancy?

Amoxicillin, co-amoxiclav, and penicillin V are often used in pregnancy and would not be expected to harm a baby in the womb. However, if you are pregnant and have taken any medicines it is always a good idea to let your doctor know in case you need any additional monitoring or treatment.

This leaflet summarises the scientific studies relating to the effects of amoxicillin, co-amoxiclav and penicillin V on a baby in the womb.

Can taking amoxicillin, co-amoxiclav or penicillin V in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

Large studies of women using amoxicillin or penicillin V in early pregnancy do not suggest an increased chance of birth defects in their babies. Studies investigating co-amoxiclav have produced reassuring findings, but were based on fewer women. Further research is required to confirm these results.

Can taking amoxicillin, co-amoxiclav, or penicillin V in pregnancy cause miscarriage or stillbirth?

No increased chance of miscarriage or stillbirth has been seen in large studies of pregnant women taking amoxicillin or penicillin V. Studies of co-amoxiclav have also produced reassuring findings, but are based on fewer women. Further research is required to confirm these results.

Can taking amoxicillin, co-amoxiclav, or penicillin V in pregnancy cause preterm birth or my baby to be small at birth (low birth weight)?

Studies have not shown an increased chance of preterm birth or low birth weight in babies born to mothers taking co-amoxiclav or penicillin V. A small study found an increased chance of preterm birth and low birth weight for babies exposed in the womb to amoxicillin, however, larger, more reliable studies have not agreed with these findings.

Can taking amoxicillin, co-amoxiclav or penicillin V in pregnancy cause learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

No studies have investigated learning and behaviour of children born to mothers who took amoxicillin or penicillin V during pregnancy. Most studies that have investigated co-amoxiclav are reassuring. Antibiotics are often given to women in pre-term labour. Children born prematurely have a higher chance of learning and behavioural problems. Research that accounts for the effects of preterm birth, and also investigates the learning and behaviour of children exposed in the womb to amoxicillin and penicillin V is required.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

There is no evidence that taking amoxicillin, co-amoxiclav, or penicillin V during pregnancy causes any problems that require extra monitoring of your baby.

Are there any risks to my baby if the father has taken amoxicillin, co-amoxiclav, or penicillin V?

There is no increased risk to your baby if the father took amoxicillin, co-amoxiclav, or penicillin V before or around the time you became pregnant.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your healthcare provider. They can access more detailed medical and scientific information from www.uktis.org

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General information

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

Can a urine infection cause a miscarriage?

Antibiotics are standard treatment for asymptomatic and symptomatic urinary tract infections (UTIs) in pregnancy. Their overuse, however, can contribute to antimicrobial resistance (AMR) and expose the foetus to drugs that might affect its development. Preventative behaviours are currently the best option to reduce incidences of UTIs and to avoid the use of antibiotics in pregnancy. The aim of this study was to explore women’s experiences of UTIs in pregnancy to develop an understanding of their concerns and to optimise and encourage behaviours that facilitate appropriate use of antibiotics.

Is Apple Cider Vinegar Good During Pregnancy | Can We Take Apple Cider Vinegar During Pregnancy?

Methods

An online pregnancy forum in the United Kingdom (UK) was used to collect data on women’s discussions of UTIs. A total of 202 individual threads generated by 675 different usernames were selected for analysis. The data was organised using NVivo 11® software and then analysed qualitatively using inductive thematic analysis.

Results

Women’s perceptions of UTIs and antibiotic use in pregnancy were driven by their pre-natal attachment to the foetus. UTIs were thought to be common and high risk in pregnancy, which meant that antibiotics were viewed as essential in the presence of suspected symptoms. The dominant view about antibiotics was that their use was safe and of little concern in pregnancy. Women reported an emotional reaction to developing a UTI. They coped by seeking information about behaviour change strategies to assist with recovery and through emotional support from the online forum.

Conclusions

Women face dual risks when they experience UTIs; the risk from the infection and the risk from antibiotic treatment. Pre-natal attachment to the foetus is highlighted in the decision making process. The focus is on the shorter term risk from UTIs while undermining the longer term risks from antibiotic use, especially the risk of AMR. A balanced view needs to be presented, and evidence-based infection prevention strategies should be promoted, to women to ensure appropriate antibiotic use in pregnancy, to address the global challenge of AMR.

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Background

Pregnancy can increase the susceptibility of urinary tract infections (UTIs) in women because of physiological changes [1]. The vast majority of primary care antibiotic prescriptions issued to pregnant women in the UK are for UTIs [2] which suggests a high prevalence. Evidence from studies shows that asymptomatic infection alone can affect 2–12% of women [3]. The current management of UTIs in pregnancy is with a short course of antibiotics whether or not the infection is symptomatic. Asymptomatic bacteriuria (ASB) is diagnosed and treated through routine screening during the first trimester [4] which is in contrast to non-pregnant women where asymptomatic infections are not treated with antibiotics [5]. ASB is treated in pregnancy because studies have shown that bacterial colonisation of the urinary tract in pregnancy can cause adverse health outcomes e.g. there are risks of kidney infection, intra-uterine growth retardation and pre-term birth [6, 7]. The authors of a recent randomised control trial however have questioned the benefit of routine screening for ASB in the first trimester of pregnancy [8]. Kazemier et al. (2015) [8] found no association between ASB and growth retardation or pre-term birth and although an association was observed between ASB and kidney infection, the absolute risk was found to be low.

Excessive and unnecessary use of antibiotics is strongly associated with a rise in antimicrobial resistance (AMR) which is the ability of bacteria to survive in spite of antibiotic treatment leading to life threatening infections [9]. There is evidence from the UK and internationally which suggests that antibiotics to treat UTIs are overprescribed in pregnant women [10, 11]. Although AMR is a global public health threat to everyone, in pregnancy it can be particularly concerning due to the risk of resistant bacteria passing on to the neonate during birth which can be a vulnerable stage of life with regards to contracting infections. In addition to this, antibiotic use in pregnancy may also carry the risk of potentially teratogenic effects including spontaneous abortion [12] . Therefore, in light of AMR and the risk of adverse effects from the use of antibiotics, it is important that maternal antibiotic use is appropriate without compromising the health of women if they experience a UTI.

While a number of non-antibiotic options for UTI management have been studied, research has mostly focused on non-pregnant populations. A systematic review by the authors of the current study reported that preventative hygiene behaviour, such as washing the genitals after sexual intercourse, is the only evidence-based intervention linked to a reduced incidence of UTIs in pregnancy and therefore the most effective method of avoiding antibiotics [13]. Therefore women need to be encouraged, through effective communication, to adopt these preventative behaviours to minimise antibiotic use. Qualitative exploration of women’s perceptions can assist healthcare professionals by informing an in-depth understanding of their beliefs and concerns about experiencing UTIs during pregnancy. As this has not been researched before, this study aims to explore women’s perceptions about UTIs specifically during pregnancy.

Method

Design

Research has shown that searching for information online increases during pregnancy and women find online communities useful because of their accessibility [14, 15]. The website www.mumsnet.com was used to access naturally occurring data with regards to women’s perceptions about UTIs during pregnancy. Mumsnet is a popular parenting website in the UK and consists of conversational threads in a designated space called ‘Talk’ where users have discussions on a wide array of topics. A Mumsnet census from 2009 showed that subscribers to the website are mostly white British women, 30–40 years old, with a degree qualification [16]. Although the demographic data is difficult to ascertain precisely and may have changed over the years, using the website as the medium for data collection provides access to naturalistic data where participants are open about their views due to the anonymous nature of posting on an online forum under a username. The data was analysed qualitatively using inductive thematic analysis [17].

Procedure

Conversation threads on the website were searched using the search tool and limited to ‘thread title only’ under the topic of ‘pregnancy’. The search terms ‘urinary tract infection or UTI’, ‘cystitis’, ‘kidney infection’, ‘bladder infection’, ‘E.coli’, ‘antibiotic’, ‘antimicrobial resistance’, ‘amoxicillin’, ‘co-amoxiclav’, ‘ciprofloxacin’, ‘nitrofurantoin’ and ‘trimethoprim’ were used to extract comprehensive data about UTIs. The search was conducted between 01-01-12 to 30–11-17 to explore recent views. All relevant threads were selected and downloaded to a Microsoft Word® document and then organised using the qualitative analysis software, NVivo 11®. A total of 202 individual threads generated by 675 different usernames were downloaded and analysed as seen in Table 1.

Table 1 Number of threads per search term

Full size table

Data analysis

The data was analysed using inductive thematic analysis, using the guide recommended by Braun and Clarke (2006). Thematic analysis is a method used to analyse qualitative data that provides flexibility in identifying, analysing and reporting patterns in data. Inductive thematic analysis is directed by the content of the data and was chosen to allow collective exploration and interpretation of women’s perceptions of UTIs in pregnancy. The data was read by FG multiple times to achieve familiarisation and to generate detailed codes. Codes were then organised and developed by FG into themes by examining and reflecting on broader patterns in the data. Themes were reviewed by all authors and refined by referencing back to the data. A thematic map was generated which shows how the themes are linked. Illustrative quotes from the data have been used to evidence each theme. Quotes have been edited for clarification where appropriate.

Ethical consideration

Mumsnet is a website that provides a forum for discussions where users are required to create a username to post a comment and they are informed that their posts are visible to anyone on the internet. The terms of use of www.mumsnet.com explicitly state that the website and its content are copyright to Mumsnet and any submission of data by users can be edited or published by Mumsnet for any purpose, commercial or otherwise, that the website considers appropriate. Therefore Mumsnet was contacted to explore whether they deemed this study an appropriate use of their data. Mumsnet confirmed approval and gave permission for the researchers to download the data to conduct the study. Individual users could not be informed about the study or contacted for explicit consent to use the content that they have posted on the website as users post under a username and no contact details are provided. To ensure scientific rigour ethical approval was sought and obtained from the University of Reading’s Research and Ethics Committee (Ref 17/30).

Public attitudes with regards to conducting research using social media are conflicting [18]. The rationale behind proceeding with the research was that data was not collected from a restricted space but an online open public forum accessible to anyone with an internet connection. There was a low risk of harm or distress because users had voluntarily shared their views. No identifiable information was collected or analysed during the conduct of this study protecting the identity and confidentiality of users. Users on the website posted using fictional usernames which were further changed to pseudonyms to anonymise quotes as an additional precaution to protect anonymity and confidentiality. Upon balancing the harms and benefits of this study, the authors believe that the study meets the British Psychological Society’s guidelines for internet-mediated research [19] and the Association of Internet Researchers’ recommendations for ethical decision making and internet research [20]. Exploring and voicing the experiences of women would lead to better understanding of healthcare needs by healthcare professionals and benefit women during pregnancy thus justifying this research ethically.

Results

Analysis of the data led to construction of three subthemes and an overarching theme as shown in Fig. 1. The primary theme relates to women’s pre-natal attachment to the foetus which is reflected in the subthemes that describe women’s perceptions of UTIs in pregnancy, the safety of antibiotics and coping mechanisms employed to deal with the impact of the illness. The themes with illustrative quotes are described below.

Fig. 1

figure 1

Thematic map

Full size image

Pre-natal attachment

The primary overarching theme describes the pre-natal attachment or bond that women feel towards the foetus during pregnancy. Cranley (1981, pg. 282) described prenatal attachment as ‘the extent to which women engage in behaviours that represent an affiliation and interaction with their unborn child’ [21]. Analysis of the data in this study strongly demonstrated women’s attachment to their baby which was visible in the types of questions they asked each other and the language that they used in the discussion on the forum. The findings also show that while women discussed a range of issues, the main concern for most, with regards to experiencing a UTI, was concern for their baby.

I’m just worried for my little nugget, think I’ll ask to check the heartbeat when I go back for peace of mind. (Luna).

Hi I’m 6 + 4 and had a scan today…got to see a little heartbeat: -) only problem was traces of blood in my urine so they gave me antibiotics for what they suspect is a UTI…just worried now after seeing the heartbeat that taking the antibiotics will do something to baba?? (Sally).

The following section describes women’s perceptions of UTIs and antibiotics in pregnancy and shows how pre-natal attachment is reflected in the three subthemes.

Illness perceptions

The risks of UTIs were viewed in terms of how the infection could impact the mother’s health e.g. developing a kidney infection, and the risks to the pregnancy in terms of effects on the foetus e.g. pre-term birth or miscarriage. The majority of discussions, however, focused on the impact on the foetus.

I’m really worried as I’m aware UTIs if left untreated can cause miscarriage, I feel like a sitting duck! I’m obviously glugging away at the water and cranberry juice but the pains are worrying me. (Rachel).

Untreated UTIs can lead to permanent kidney damage for you and premature labour. I’m not trying to scare you and I’m sure you’ll be fine but could you get in touch with your MW [midwife] and get their opinion. (Jane).

For most women it was the diagnosis of a UTI rather than the difficult symptoms per se that made them anxious, as even those who had an asymptomatic infection shared similar concerns about the UTI impacting pregnancy and harming the foetus.

Had no symptoms but told I had a bad UTI, I’m now absolutely petrified that I’ve found out too late and my baby will be harmed (Shadane).

Most women also viewed UTIs as being very common in pregnancy. As Stella described, “Never had one outside of pregnancy, you are more prone to them unfortunately!” In fact, it was thought that pregnancy caused UTIs to the extent that any troubling symptom could be the sign of a UTI.

“I always find in pregnancy that everything is put down to a UTI.” (Linda).

At the same time UTIs in pregnancy were also viewed as harder to diagnose and more difficult to treat compared to when not pregnant. The reasons were thought to be due to an overlap between normal pregnancy symptoms and those characteristic of UTIs. For example, as Jane indicated, “symptoms of UTI are quite difficult in pregnancy as you have a lot of them anyway”. Biochemical changes in the body due to pregnancy were also attributed to making diagnosis more difficult.

I also had trouble getting diagnosed when pregnant and was told by the midwife that it’s because there are so many things present in your pee and altering what’s in your pee when pregnant that it can be hard to get a dip result indicating a UTI. (Bella).

Ultimately, a desire to protect their baby, arising from pre-natal attachment, led most women to view UTIs to be so risky that urgent treatment with antibiotics was considered an absolute necessity and delaying or ignoring any symptoms was deemed “irresponsible”.

I’m surprised they haven’t given you any antibiotics straight away as it can cause early labour or a small baby if left untreated. Mine’s been in my kidneys, the pain has been horrendous. Don’t suffer if you need to ring and ask for antibiotics. (Aria).

If you weren’t pregnant you could maybe take your friend’s advice to drink water and cranberry juice and wait it out, but given that you are pregnant it’s irresponsible advice to be honest. (Nikita).

In summary, the majority of women perceived UTIs to be more dangerous in pregnancy compared to when not pregnant due to the risk of serious consequences such as miscarriage or pre-term birth. They also considered UTIs to be a fairly common occurrence with diagnosis and treatment of the infection more problematic in pregnancy. Pre-natal attachment to the foetus meant most women considered antibiotics to be absolutely essential for treatment and avoiding them, or a delay in seeking help was seen as irresponsible behaviour.

Safety of antibiotics

A few women expressed reluctance and questioned the use of antibiotics in pregnancy for the treatment of UTIs. The reasons varied from concerns about teratogenicity, effects on long term immunity or personally experiencing antibiotic side effects. For example, Liza was fearful about the effects on the foetus, “I’m petrified that taking amoxicillin will harm baby!” while another website user was concerned about longer term effects such as the development of allergies in the child.

Personally I would be wary of it [antibiotic] because there is a link between taking antibiotics in late stage pregnancy and the baby having eczema and allergies. I took antibiotics in late pregnancy and my daughter has multiple food allergies and eczema (Tania).

In spite of these concerns, which were expressed by only a small proportion of women, most considered antibiotics to be generally safe.

Antibiotics are one of the few things they are really sure about giving to pregnant women, precisely because we get infections. (Tula).

The majority of women compared the risks of a UTI with the risks of using antibiotics and viewed antibiotics as the safest option for normal progression of their pregnancy. They drew on their personal experiences of using antibiotics or viewed a prescription as proof that antibiotics were not dangerous. As Carey suggested, “Doc wouldn’t prescribe if dangerous. It’s more dangerous to leave a UTI, as at its worst it can cause kidney issues and miscarriage”. This view also meant that some women thought that it was better to take antibiotics “just in case”.

The doc said it wouldn’t do me any harm and better than not taking them just in case I had needed them (if that makes sense). I don’t think you should feel guilty as the doc will have given you antibiotics that wouldn’t affect your baby. (Usha).

What to Do After a Miscarriage (MUST WATCH)

Thus when discussing the safety of using antibiotics to treat UTIs, whether or not they viewed them as safe in pregnancy, women’s primary motivation was to protect the foetus owing to pre-natal attachment. For a small proportion of women it was the uncertainty of how the antibiotic might affect the foetus or their child’s immunity in the long term that led them to be wary but for the remaining majority, antibiotics were perceived as the safest and most effective management option.

Coping mechanisms

Pregnancy can understandably be an emotional time and unsurprisingly women on the forum described it in similar terms. Experiencing painful and frustrating symptoms of a UTI, coupled with a fear of how the infection might impact the pregnancy, had a considerably enhanced emotional impact on many women. Throughout the data, highly emotive language featured quite strongly to express discomfort and frustration. For example,

I just really worry about taking things when pregnant and feel so emotional atm [at the moment]!! Tia [thank you in advance] x (Serena).

One particular quote highlights strong feelings of guilt alongside the frustration,

I don’t know why but it makes me feel like such a failure each time the results come back with an infection still present. I get angry with myself that I can’t get my body to do its job to fight it and I’m putting my baby at risk. Stupid I know but I can’t help it xx (Nadia).

The majority of women therefore used the forum as a way of coping via two main functions; by using the forum for emotional support or by seeking information and advice. Some women coped by expressing their thoughts and feelings and seeking people with similar experiences whereas others sought advice on the forum about measures they could take to ease their symptoms and clear the UTI.

Using the forum as an online social support system to cope emotionally was seen throughout the data. For example, as one person posted, “Not sure why I’m posting, may just need a bit of hand holding …” (Hope) and another person while consoling someone stated, “It’s such a lonely illness try [to] get some company or people to talk [to] on the phone/text or Mumsnet of course” (Rachel). The emotional impact of the illness was particularly strong in women who experienced recurrent or resistant infections requiring multiple courses of antibiotics. They expressed frustration and feeling a lack of control as emphasised in the exchange below.

Now dreading getting another UTI as it will prove difficult to treat according to my GP. Only 19 weeks along, so this better not happen again (Veda).

I feel your pain - aside from the physical symptoms it was the “how will I ever get rid of this without Abs [antibiotics]?” question that really dragged me down (Response by Lynn).

As mentioned above, many women also used the forum to seek and give advice on measures to cope actively with their illness, especially if they experienced recurrent infections. Preventative measures such as drinking cranberry juice, using over-the-counter (OTC) cystitis relief remedies or following certain hygiene behaviours, like wiping the genitals from front to back etc., were some of the measures that women discussed. Perceptions around these measures, however, were varied and the suitability of some of the remedies was also often questioned. For example, one woman advised avoiding cranberry juice while another found it be effective and a better option than antibiotics especially for milder infections.

As much water as you can drink. Mix some bicarb in water and have that if you have some, tastes awful but helps. Avoid cranberry juice. Avoid caffeine. I am a UTI veteran! (Alia).

Cranberry juice is good as well. If it is mild this may flush the infection out and is gentler than antibiotics which will be likely to cause thrush… (Marina).

Similarly, there were differing views regarding the suitability of over-the-counter cystitis relief treatment.

I can’t have the sachets I normally drink to ease symptoms as they are unsuitable for pregnant women (Delia).

My doctor said it was safe to use the cystitis relief sachets along with drinking plenty of water and cranberry juice and apparently it should go within 48 h (Irene).

To summarise, UTIs in pregnancy had an emotional impact on most women which left them feeling frustrated at a time when they were already going through physical changes in their bodies. They used the online forum to find ways to cope either through exchange of information and advice or for emotional support. The discussions, both when exchanging tips and when venting emotionally, centred significantly on the impact on the pregnancy which again highlights women’s pre-natal attachment to the foetus.

Discussion

This study explored women’s perceptions of experiencing a UTI during pregnancy as discussed on an online forum. The results indicate that women view UTIs in pregnancy primarily from the lens of being an expectant mother and pre-natal attachment to their unborn baby drives them to put the safety of the foetus at the very core of how they view the illness and how they behave at the onset of a UTI. Pre-natal attachment is a theoretical construct drawn from John Bowlby’s theory of Human Attachment [22]. Its relevance to antenatal care lies in the fact that it is useful in motivating women to adopt practices that facilitate good health for themselves and their unborn child [23].

Previous studies [24, 25] exploring women’s perceptions of UTIs report that the condition can significantly affect women’s quality of life. The current study supports these findings, as described in the first subtheme relating to illness perceptions, and highlights how the state of being pregnant means that women view UTIs to be more common and linked to serious consequences compared to when not pregnant. The high risk perception and the view that UTIs are common in pregnancy encourages women to seek antibiotic treatment at the onset of any probable symptom even though it may be a normal pregnancy occurrence such as increased frequency of urination. The second subtheme, which relates to the safety of antibiotics, highlights that apart from a small proportion, most women on the forum favour antibiotic treatment which is in contrast to a study conducted with non-pregnant women [26]. The perception that antibiotics are generally safe in pregnancy is also unusual in light of other studies that report that women view antibiotics to be moderately harmful [27] and that women overestimate teratogenic risk from exposure to medicines [28]. The last subtheme, which describes coping mechanisms, highlights the negative impact that UTIs can have on women and how they cope by adopting two distinct approaches. These approaches are seeking advice on actions to take to cope with the UTI or using the forum for emotional support. Both of these approaches are reflected in health psychology literature and correspond to problem-focused or emotion-focused coping respectively which are two styles that people might adopt to cope with stressors [29].

Implications of study

The findings from this study have implications for how women should be encouraged to take care of their health during pregnancy with regards to urinary infections and the use of antibiotics. The data highlights how pregnant women are faced with dual causes of risk when they experience UTIs; the risks arising from the infection and the risks from using antibiotics. This duality of risks leads most women to perform a cost-benefit analysis and pre-natal attachment means they prioritise safeguarding the foetus against the short term risks of a UTI while overlooking the longer term risk of AMR from using antibiotics. This might lead to increased demand and overuse of antibiotics and contribute to the problem of AMR, which can affect not just the foetus but women themselves and society at large.

Current data on the incidence and outcomes of UTIs in pregnancy in the UK along with improved diagnostics is needed to ensure antibiotics are not being overused. As well as this, women need balanced information from healthcare professionals not only about the risks of UTIs but also of excessive antibiotic use. Future research can investigate the usefulness of emphasising pre-natal attachment in interventions designed to promote responsible use of antibiotics.

Although pregnancy can increase women’s susceptibility to a UTI, prevention measures can protect against it [13, 30, 31]. Information about prevention through hygiene behaviours needs to be standardised and emphasised as the best way of preventing UTIs in pregnancy. In addition, the perception that pregnancy causes UTIs, as seen in this study and promoted by the National Health Service [32], requires challenging as it reflects a medical model of illness that attributes the cause of illness to external factors beyond individual control. Instead, women should be encouraged to use a problem-focused coping style through the adoption of preventative hygiene behaviours so that they can appreciate the controllability of this illness rather than rely solely on a medical solution i.e. antibiotics. Promoting such a behavioural model of illness, which sees the individual’s behaviour as the solution to a health problem, has also been reported to lead to practise of healthier behaviours and outcomes that are sustained over a long period of time [33]. Lastly, the emotion-focused coping seen on the forum highlights women’s need for emotional support and a sensitive approach to their care during pregnancy in relation to UTIs.

Strengths and limitations of study

The strengths of this study lie mainly in the method used for data collection. The advantage of using an online forum to collect data was that it provided access to a wide range of participants across the UK. Online forum postings increase the perceived sense of anonymity in participants, which can increase disclosure compared to face-to-face interviews. Data was also immediately available for analysis and circumvented transcription errors arising from interviews.

Using an online forum, however, also contributed to the limitations of this study. Women used descriptive text and emoticons to express their feelings, but using an online forum could result in a loss of insight that facial expressions or verbal tone can offer to exploring perceptions. It was difficult to characterise the exact demographics of website users and only views of women who had access to the internet and had subscribed to the forum could be analysed. Different cultural groups in the UK may also have different norms of behaviour in pregnancy and the views of women from varying backgrounds may differ from what was captured from the forum. Therefore, the interpretation and transferability of the results should be made within this context and broad generalisations may not be appropriate.

Conclusion

UTIs are prevalent in pregnancy and can cause women considerable stress and anxiety. Their primary concern stems from how the infection or the antibiotics might affect their baby. Although some women question the safety of antibiotics, most women adopt a risk appraising process which leads them to regard antibiotics as absolutely essential and safe for use in pregnancy if they experience any suspected symptom of a UTI. Pre-natal attachment may cause women to focus solely on the risks of a UTI while under-appreciating the risks of antibiotics, particularly the threat from AMR, which is a major global challenge.

Availability of data and materials

All datasets supporting the conclusions of this article were collected from www.mumsnet.com and are available from the corresponding author on reasonable request.

Abbreviations

AMR:

Antimicrobial resistance

ASB:

Asymptomatic bacteriuria

E.coli :

Escherichia coli

UTI:

Urinary tract infection

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Acknowledgements

We would like to thank www.mumsnet.com for their permission to collect and analyse the data used in this study.

Funding

This work was supported by the University of Reading as a PhD studentship for FG. The study design, collection, analysis and interpretation of data and writing of the manuscript was conducted independent of the funding body, with AH and KR acting as PhD supervisors.

Author information

Affiliations

School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6UR, UK

Flavia Ghouri, Amelia Hollywood & Kath Ryan

Contributions

The data was collected and organised by FG. All authors developed and reviewed the themes. The final manuscript was prepared by FG, then edited and approved by AH and KR. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amelia Hollywood.

Ethics declarations

Ethics approval and consent to participate

Consent to use the publicly available data was obtained from Mumsnet, as the website has licence to use the content as they deem appropriate. Individual users could not provide consent due to the anonymity of the posts. Ethical approval was obtained from the University of Reading’s Research and Ethics Committee (Ref 17/30).

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Not applicable.

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Can antibiotics cause miscarriage in early pregnancy?

A large study yesterday in the Canadian Medical Association Journal (CMAJ) suggests that the use of certain antibiotics taken early in pregnancy raises the risk of miscarriage.

Apple Cider Vinegar, Can It Harm You?

In a nested case control study of more than 95,000 pregnant women in Quebec, Canada, researchers from the Universite de Montreal found that the use macrolides (excluding erythromycin), quinolones, tetracyclines, sulfonamides, and metronidazole was associated with increased risk of miscarriage in early pregnancy, with the increased risk ranging from 65% to a more than twofold increase. Use of the quinolone antibiotic norfloxacin was associated with a nearly fivefold increase in risk.

Although the study established only an association and not a causal effect, and it is unclear how antibiotics increase the risk of miscarriage, the authors suggest the results could alter treatment guidelines.

"Our findings may be of use to policy-makers to update guidelines for the treatment of infections during pregnancy," the authors write.

Large, population-based study

In the study, the authors analyzed data from the Quebec Pregnancy Cohort, an ongoing population-based system with prospective data collection on all pregnancies covered by the Quebec Public Prescription Drug Insurance Plan from 1998 through 2009.

The study included women who were 15 to 45 years old on the first day of gestation, were continuously covered by the province's drug plan, and had a diagnosis or procedure related to clinically detected spontaneous abortion before the 20th week of gestation. For each case of miscarriage, the authors selected 10 control cases and matched them by gestational age and year of pregnancy.

Antibiotic exposure was defined as having filled at least one prescription for any type of antibiotic either between the first day of gestation and the date of miscarriage, or before pregnancy but with a duration that overlapped the first day of gestation.

Out of a total of 182,369 pregnancies, the authors identified 8,702 pregnancies that ended with a clinically detected miscarriage with a mean gestation age of 14.1 weeks and compared them with 87,020 matched controls. The women who had miscarriages were more likely to be older, live alone, and have comorbidities and infections. A total of 1,428 of the women who had miscarriages (16.4%) were exposed to antibiotics during early pregnancy compared with 11,018 (12.6%) of the control patients.

After adjusting for potential confounding factors, such as age, socioeconomic status, and comorbidities, the authors found increased risk of miscarriage associated with azithromycin (adjusted odds ratio [AOR], 1.65), clarithromycin (AOR, 2.35), tetracyclines (AOR, 2.59), doxycycline (AOR, 2.81), minocycline (AOR, 2.48), quinolones (AOR, 2.72), ciprofloxacin (AOR, 2.45), norfloxacin (AOR, 4.81), levofloxacin (AOR, 3.28), sulfonamides (AOR, 2.01), and metronidazole (AOR, 1.70).

Exposure to nitrofurantoin, erythromycin, penicillins, and cephalosporins was not linked to increased miscarriage risk.

Further sub-analyses of women with urinary tract infections and respiratory tract infections, and comparisons of the women treated with the risk-associated antibiotics to a comparator group who received penicillins and cephalosporins, produced similar results.

The authors say their findings are consistent with the findings of previous studies that have indicated an association between antibiotic exposure and increased risk of miscarriage, including a Medicaid cohort study that showed metronidazole was linked to a 70% increased risk of miscarriage. But they acknowledge that one confounder they could not fully adjust for was severity of infection; in other words, the severity of the infection, more so than the antibiotic used, could have been a factor in the miscarriage.

"Residual confounding by severity of infection cannot be ruled out," they write.

In addition, the Quebec Pregnancy Cohort does not include data on tobacco use, alcohol intake, folic acid use, and body mass index—factors that could also play a role in miscarriage.

Weighing risks, benefits

Use of antibiotics is common in pregnant women, with some estimates indicating as many as one in four women will be prescribed an antibiotic during pregnancy. Although the science on how pregnancy affects the immune system remains unsettled, some expecting mothers are more prone to infections, and pregnancy can make some infections more severe.

"During pregnancy, there's a certain amount of dampening of the immune system, and that's in place so that the mother does not reject the fetus," Yvonne Butler Tobah, MD, an obstetrician/gynecologist at Mayo Clinic in Rochester, Minn., told CIDRAP News. "Because of that, when pregnant women get infections, it's easier, for example, for influenza to become pneumonia…or a urinary tract infection to become a kidney infection."

Because of this potential for infections to worsen in pregnant women, Butler Tobah said, proper treatment of bacterial infections with antibiotics is essential for maintaining maternal and fetal health. She was not involved in the study.

While most antibiotics have been considered safe for pregnant women, there have been concerns about a potential link to birth defects. A 2009 study by the US Centers for Disease Control and Prevention and the National Center on Birth Defects and Developmental Disabilities found that the antibiotics most commonly used for urinary tract infections—penicillins, erythromycins, and cephalosporins—were not associated with birth defects.

The study did, however, find an increased risk of birth defects among women taking sulfonamides and nitrofurantoins, though it was impossible to determine a causal relationship.

A 2015 study led by the same researchers that conducted the current study found no meaningful link between the use of azithromycin and clarithromycin and birth defects. That study also used data from the Quebec Pregnancy Cohort.

Butler Tobah said that taking into account the potential complications of antibiotic use in early pregnancy is a valid message, but she noted the several limitations of the current study, including confounding by infection severity and the fact that antibiotic exposure was based on filled prescriptions—not always a reliable measure of exposure. In addition, Butler Tobah explained that some of the antibiotics included in the study, such as doxycycline and minocycline, are not recommended for use in pregnant women except in the case of life-threatening infections, because of concerns about potential adverse effects on the mother and fetus.

Butler Tobah said she doesn't think the finding should affect guidelines for the use of antibiotics in pregnant women, but said the study is a good reminder that clinicians should use antibiotics only when indicated and should be aware of possible risks associated with the antibiotic of choice.

"In general, providers caring for obstetric patients must understand that much is unknown about the effects of antibiotics in early pregnancy, that antibiotics must only be prescribed if the benefits clearly outweigh the risks, and the general safety profile of each medication must be taken into consideration," she said.

Can jumping cause miscarriage early pregnancy?

what can cause a miscarriage?

A miscarriage, or early pregnancy loss, is the expulsion of a fetus from the uterus before it has developed enough to survive. Miscarriages are called spontaneous abortions and they occur in 15 percent to 20 percent of all pregnancies. Most miscarriages happen during the first trimester (first 12 weeks) of pregnancy.

Many miscarriages are caused because of an anatomic or genetic abnormality in the fetus. Therefore, when a fetus is not developing normally, certain hormone levels drop, and the lining of the uterus begins to shed. The pregnancy separates from the uterus and passes out of the body.

Miscarriage is not caused by the activities of a healthy pregnant woman, such as jumping, vigorous exercise, and frequent vaginal intercourse. Trauma causes miscarriage only very rarely. Stress and emotional shock do not cause miscarriage either.

Tags: miscarriage, pregnancy

Can getting hit in stomach cause a miscarriage?

Have you heard stories about when teachers used to send their students home with egg “babies” as a lesson in just how hard it is to keep a fragile little thing safe and protected?

You might have laughed and laughed because it was obviously not the same — except now you’re pregnant, and you’re wondering if waddling around with a baby sticking out from your center of gravity isn’t so different from carrying that egg around all day.

There’s a fragile little one that needs protecting from the big bad world out there, and you’re the only thing standing in the way.

Or are you?

There’s actually a lot of padding between the outside of your stomach and the cozy bubble that baby is floating around in. But your abdomen isn’t bulletproof, no matter how badass growing an entire human makes you feel — there’s a limit to how much pressure and impact it can withstand.

So just how safe is your baby when it’s inside you? Here’s what you need to know.

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Why your baby is (relatively) safe

Admit it: You went home with your egg baby, all confident and carefree, and then before the weekend was over you dropped it on the kitchen floor — because taking care of an egg baby is hard, folks.

Thankfully, taking care of your real baby while they’re in your belly is way easier.

People have been growing and carrying babies for… well, all of life on Earth. Traveling long distances on foot, toiling in the fields, taking care of other children, tending to animals — the pregnant body is actually designed to withstand a lot.

There are a few reasons, specifically, why your body can handle some roughing up without injury to your baby:

your uterus, aka the strong muscular organ housing your wee one

your amniotic fluid, which absorbs pressure like a waterbed would

the extra body weight you’re carrying, which acts like a protective fat layer

One thing to note is that contact (like bumping into a wall) is different from trauma (like a car accident).

Your belly can handle day-to-day abdominal contact. Trauma is a different story, but it’s also much less common.

Is a certain trimester more dangerous than others?

Because baby is so tiny in the first trimester, there’s virtually no risk to them with abdominal contact or trauma. It’s not impossible to have a negative outcome, but it would be rare unless the injury was severe.

The risk increases a bit in the second trimester, as your baby and stomach start growing more. Even still, the chances of harm to the baby are low.

The third trimester, though, is different. At this point, baby is getting pretty big and filling up a lot of the available real estate in your belly.

This means you may have less cushioning from amniotic fluid and body fat.

It also means you’re at a higher risk of placental abruption, which is most common in the third trimester. Placental abruption isn’t always caused by trauma — but trauma can cause it, leading to bleeding, pain, and even premature delivery.

All these factors combined make the third trimester the most dangerous when it comes to abdominal impact.

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Common sources of impact to the belly

Kids and pets

Little kids, dogs, and cats either don’t know or couldn’t care less that you’re pregnant, and their exuberance can result in some uncomfortable leaps into your arms or onto your lap.

For the most part, this won’t hurt your baby; after all, expectant moms have been living with older children and pets forever, mostly without incident.

It does make sense to do some training, though (of your pet and your kid, if necessary!) so it’s not a repeated thing. If your child or pet is over 40 pounds, they could — in theory — accidentally hit you hard enough to cause an injury.

Discourage larger dogs from jumping to greet you and teach your toddler to “hug gently” to avoid any issues.

Fender benders

In general, minor car accidents pose more of a risk to you than to baby. This is especially true in the first and second trimesters. Even in the third trimester, the risk to your baby is low as long as the accident is one all parties can walk away from.

But regardless of how far along you are or how serious (or not) the crash is, always get checked by a doctor right away.

While a little fender bender around the corner from your house isn’t likely to cause any problems, any kind of car accident falls into the “needs medical attention” category of pregnancy impacts.

Housework

Whether you were a klutz pre-pregnancy or not, you aren’t likely to escape those 9 months without banging your bump into doors, cabinets, drawers, and furniture.

Why? Because your center of gravity is all messed up, and you may be in a constant state of distraction thanks to pregnancy brain.

If you’re constantly bumping your belly while you vacuum, wash dishes, put away laundry, or just generally go about your daily biz around the house, you don’t need to worry — baby is nice and safe in there.

Sex positions

The good news is that you don’t have to change up your intimacy routine with your partner very much during pregnancy. There aren’t any sex positions that are actually unsafe.

Some positions might simply be uncomfortable for you, like ones where you have to lie on your back.

Although it isn’t dangerous to be on the bottom for the length of a normal sexual encounter, you might want to try new sex positions during pregnancy that aren’t only more comfortable but maximize the experience for your changing body.

Trips, slips, and falls

Again, your center of gravity isn’t the same as it used to be, so tripping and slipping isn’t unusual during pregnancy. As far as whether these foibles need to be evaluated by your doctor, that depends on if there was any impact to your back or stomach.

In other words, if you trip on a wayward shoe or slip on a patch of ice but don’t hit the floor or ground, you should be good to go.

If you do fall down, though, and it’s hard enough to hurt or knock the wind out of you for a sec, you should give your doctor a call to see what they say. (They might want to examine you or they might just tell you to monitor yourself for signs of injury.)

Any serious falls — like taking a tumble down a flight of stairs or while getting out of the shower — should receive medical attention right away, either with your doctor or through an emergency or urgent care facility.

Common abdominal strains

Lifting

Per the Centers for Disease Control and Prevention (CDC)Trusted Source, heavy lifting can not only result in more injuries for you, but could increase your risk for preterm birth.

But what does “heavy lifting” actually mean? Can you carry that box of new baby items up the stairs? Pick up your 5-year-old? Exercise with hand weights?

Well, it depends.

Guidelines published in 2013Trusted Source suggest that certain factors play into the overall amount you can safely lift. These factors include:

how far along you are

how heavy the item or person you’re lifting is

how often you need to be doing the lifting

To sum it up: The more often you need to lift things, the lighter in weight they should be. Heavier objects can be lifted as long as it’s done infrequently. (And those numbers vary based on whether you’re fewer than 20 weeks or more than 20 weeks pregnant, FYI.)

Also make sure you’re using safe lifting techniques, like bending from the knees and not raising items over your head.

Signs and Symptoms of Miscarriage that You Should Know About

Getting up using your abdominal muscles

If you’re the type who used to jump out of bed first thing in the morning and hit the ground running, you won’t do any harm to your baby with that habit — but you might want to consider a more moderate approach for your own sake.

Repeated abdominal strain during pregnancy can cause or worsen diastasis recti, a common pregnancy and postpartum condition that can be difficult to fully resolve (even with months and months of specialized exercise).

Instead of using your abs to get into a standing position from a prone or seated one, turn onto your side and push off with your arms and legs, or grab onto something — yes, your partner counts — and gently pull yourself up.

Exercises that use your abdominal muscles

You use your core for the vast majority of exercises, even when they’re focused on your arms, butt, or legs.

But there are definitely some exercises, like crunches, sit-ups, and leg lifts, that work your abs the hardest — and these should generally be avoided after the first trimester.

While there’s no direct harm to your baby with these exercises, there are a few reasons why it’s better to skip them.

Lying flat on your back can interfere with your blood flow, and can also cause you to accidentally strain other muscle groups, like the ones in your back, to overcompensate for the weight in your front.

If you want to keep strengthening your core during pregnancy, you can do planks, standing crunches, and yoga poses that position you on your hands and knees.

When to contact your doctor

There are three scenarios where you should call your doctor ASAP, no matter how small they might seem in the moment:

You’re in a car accident. It doesn’t matter if it’s a head-on collision or a small tap in a parking lot — contact your doctor if you’re involved in any kind of motor vehicle accident.

You fall. Flat on your face, hard on your butt, turtle-style onto your backside — it doesn’t matter where you land or what you injure. If there’s impact, you should call your doctor.

You experience an intentional blow to the stomach. There will always be rogue limbs flying when you have a toddler around, and that’s fine. But if anyone hits or kicks you in the stomach on purpose, you should contact your doctor (and if necessary, the police or a domestic violence hotline, depending on the situation).

If you have a minor abdominal strain or impact like the ones we outlined before (e.g., your dog jumped on you or you lifted something unexpectedly heavy), you most likely won’t need to call or see your doctor.

You still should be on the lookout for any concerning symptoms, such as:

vaginal bleeding or bloody discharge

consistent pain or cramping

frequent contractions that don’t get better when you rest

a decrease in fetal movement

If you notice any of these symptoms, call your doctor, regardless of how mild you think the impact or strain to your belly might have been.

The bottom line

The vast majority of contact your belly has with the outside world every day won’t hurt your baby — they’re very well protected in there!

The risk increases a little during the third trimester, when baby is bigger and the risk of placental abruption is higher. Even then, it takes a traumatic event (not your 5-year-old climbing into your lap) to be cause for concern.

That said, any traumatic event should prompt a call to your doctor, along with any symptoms of pain, bleeding, contractions, or changes to your baby’s movement.

How long does the vinegar pregnancy test take?

When you’re unsure whether you’re pregnant or not, it can be tempting to try homemade pregnancy tests you’ve found described online or heard about from well-meaning friends. These tests often use readily available household ingredients.

While there are many online resources about homemade pregnancy tests, very few of them look at whether these tests are scientifically accurate.

Let’s look at some common homemade pregnancy test types, how they supposedly work, and what the research says.

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Types of pregnancy tests

Pregnancy tests check blood or urine for human chorionic gonadotropin (hCG). Your body makes hCG after implantation of an embryo in your uterus. Your doctor can order either a blood or urine test; urine tests are also available over the counter.

Homemade tests, though, claim to work due to chemical reactions between hCG and common household items. There are a number of homemade pregnancy test types.

Shampoo

How to use it, according to popular opinion:

Collect urine in a plastic container. In another container, mix a little shampoo with water to make a soapy mixture. Add your urine to the mixture, and keep an eye on it. If it froths and foams, it’s a positive result.

How it’s said to work:

The hCG hormone is said to react with shampoo, making it fizz. There is no chemical scientific basis for believing this is actually the case.

Sugar

How to use it, according to popular opinion:

Put 1 tablespoon of sugar in a plastic bowl and add 1 tablespoon of your urine. Take a look at how the sugar reacts. If it dissolves quickly, the result is negative, but if it forms clumps, the result is positive.

How it’s said to work:

The hCG in urine supposedly doesn’t allow the sugar to dissolve. Again, scientific evidence that this works is completely lacking.

Toothpaste

How to use it, according to popular opinion:

Squeeze 2 tablespoons of white toothpaste into a container and add your urine. If the toothpaste color turns blue, it’s a positive result.

How it’s said to work:

The ingredients in the toothpaste are said to change color when they come into contact with hCG. However, this test doesn’t account for the fact that toothpaste comes in various colors already. There’s no proof that this is accurate.

Bleach

How to use it, according to popular opinion:

Collect 1/2 cup of your urine in a small container and add 1/2 cup of bleach to it. Wait 3 to 5 minutes. If it foams and fizzes, it’s a positive result.

This test can be dangerous if you inhale the fumes or get the mixture on your skin. Use gloves when handling bleach and be sure to avoid the fumes. Do not urinate directly over a cup of bleach, as the fumes can irritate your skin.

How it’s said to work:

It’s believed that the hCG hormone in urine reacts with the bleach and cause it to foam and fizz. As with the other tests, you’re probably better off using this household product for one of its intended purposes. Furthermore, urine from nonpregnant women can cause the same reaction.

Soap

How to use it, according to popular opinion:

Add about 2 tablespoons of urine to a small piece of soap and mix it. If it froths or foams, the result is positive.

How it’s said to work:

As with shampoo, the hCG hormone is said to make soap fizz and bubble. And as with shampoo, there are no studies verifying this works.

Vinegar

How to use it, according to popular opinion:

Add 1 cup of white vinegar to 1/2 cup of urine. Wait 3 to 5 minutes. A change in color indicates a positive result.

How it’s said to work:

As with toothpaste, the hCG in urine supposedly reacts with the vinegar, causing a change in color. Once again, there is no evidence that this is true.

Baking soda

How to use it, according to popular opinion:

Collect urine in a plastic container, and add 2 tablespoons of baking soda to it. If the mixture bubbles, it could be a positive result.

How it’s said to work:

As with bleach and soap, it’s said that any hCG in the urine will make baking soda fizz and bubble. No scientific evidence, yet again.

Pine-Sol

How to use it, according to popular opinion:

Pine-Sol, a pine-scented antibacterial household cleaner, is another popular ingredient in homemade pregnancy tests. Mix 1/2 cup urine with 1/2 cup of Pine-Sol and mix it well. Wait at least 3 minutes. If it changes color, the result is positive.

How it’s said to work:

Allegedly, the hCG reacts with the pine and changes the color. Science doesn’t agree.

What does the research say?

The homemade pregnancy tests described above have no scientific basis. No research suggests that they’re accurate methods for detecting pregnancy. They’re based on anecdotal evidence only.

Furthermore, there’s also anecdotal evidence that urine from nonpregnant people can cause the positive reactions described.

Fortunately, there are more accurate pregnancy tests available!

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Tried and true pregnancy tests with proven accuracy

Because of the lack of scientific research, we can’t determine the accuracy of the above homemade pregnancy tests. They are urban myths.

When it comes to a subject as emotive and potentially life-changing as pregnancy, you’re better off using one of the accurate pregnancy tests out there. These include drugstore-bought urine tests and blood tests at your doctor’s office. Pregnancy tests are also available online.

In general, home pregnancy tests can be used the day after you miss your period. Some early detection pregnancy tests can be used earlier than that. Drugstore home pregnancy tests claim to be about 99 percent accurate.

Pregnancy tests are more accurate when the first urine of the day is used. Your pregnancy test won’t be very accurate if it has expired, so it’s important to check the expiry date. It’s best to use multiple pregnancy tests for a more accurate result. If the results are conflicting, call your doctor.

By using scientifically sound pregnancy tests, you’ll be saving yourself the potential heartbreak and anxiety of a false result.

What Are Miscarriage Warning Signs

Early pregnancy symptoms

Wondering if you’re indeed pregnant? Consider some of these early symptoms of pregnancy:

a missed period

nausea and vomiting

constant need to urinate

tender, sore breasts

fatigue

bloating

Since these symptoms can be caused by other health conditions, you’ll want to take a legit pregnancy test before drawing any conclusions.

Related: Weird early pregnancy symptoms

Pregnancy Symptoms: 10 Early Signs That You May Be Pregnant

The takeaway

While it’s tempting to opt for a simple homemade pregnancy test made with cupboard ingredients instead of a store-bought variety, the truth is they aren’t scientifically proven to be accurate.

They may be fun to try before using a proven method, but don’t take results seriously and certainly don’t base your health decisions on them.

If you think you might be pregnant, call your doctor right away so that you can take a pregnancy test and begin prenatal care. If you are trying to get pregnant you should be taking a prenatal vitamin with folic acid.

Detecting pregnancy early will help ensure you’re able to get the care you need.

What is the most common week to miscarry?

MISCARRIAGE

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KEY POINTS

Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Some women have a miscarriage before they know they’re pregnant.

We don’t know all the causes of miscarriage, but problems with chromosomes in genes cause most.

It can take a few weeks to a month or more for your body to recover from a miscarriage. It may take longer to recover emotionally.

Talk to your health care provider about having medical tests before you try to get pregnant again.

Most women who miscarry go on to have a healthy pregnancy later.

What is miscarriage?

Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.

As many as half of all pregnancies may end in miscarriage. We don’t know the exact number because a miscarriage may happen before a woman knows she’s pregnant. Most women who miscarry go on to have a healthy pregnancy later.

What are repeat miscarriages?

If you have repeat miscarriages (also called recurrent pregnancy loss), you have two or more miscarriages in a row. About 1 in 100 women (1 percent) have repeat miscarriages. Most women who have repeat miscarriages (50 to 75 in 100 or 75 percent) have an unknown cause. And most women with repeat miscarriages with an unknown cause (65 in 100 women or 65 percent) go on to have a successful pregnancy.

What causes miscarriage and repeat miscarriages?

We don’t know what causes every miscarriage. But some miscarriages and repeat miscarriages can be caused by:

Problems with chromosomes

About half of all miscarriages are caused when an embryo (fertilized egg) gets the wrong number of chromosomes. This usually happens by chance and not from a problem passed from parent to child through genes. Chromosomes are the structures in cells that holds genes. Each person has 23 pairs of chromosomes, or 46 in all. For each pair, you get one chromosome from your mother and one from your father. Examples of chromosome problems that can cause miscarriage include:

Blighted ovum. This is when an embryo implants in the uterus but doesn’t develop into a baby. If you have a blighted ovum, you may have dark-brown bleeding from the vagina early in pregnancy. If you’ve had signs or symptoms of pregnancy, like sore breasts or nausea (feeling sick to your stomach), you may stop having them.

Intrauterine fetal demise. This is when an embryo stops developing and dies.

Molar pregnancy. This is when tissue in the uterus forms into a tumor at the beginning of pregnancy.

Translocation. This is when part of a chromosome moves to another chromosome. Translocation causes a small number of repeat miscarriages.

Problems with the uterus or cervix.

The cervix is the opening to the uterus that sits at the top of the vagina. Problems with the uterus and cervix that can cause miscarriage include:

Septate uterus. This is when a band of muscle or tissue (called a septum) divides the uterus in two sections. If you have a septate uterus, your provider may recommend surgery before you try to get pregnant to repair the uterus to help reduce your risk of miscarriage. Septate uterus the most common kind of congenital uterine abnormality. This means it’s a condition that you’re born with that affects the size, shape or structure of the uterus. Septate uterus is a common cause of repeat miscarriages.

Asherman syndrome. If you have this condition, you have scars or scar tissue in the uterus that can damage the endometrium (the lining of the uterus). Before you get pregnant, your provider may use a procedure called hysteroscopy to find and remove scar tissue. Asherman syndrome may often cause repeat miscarriages that happen before you know you’re pregnant.

Fibroids (growths) in the uterus or scars from surgery on the uterus. Fibroids and scars can limit space for your baby or interfere with your baby’s blood supply. Before you try to get pregnant, you may need a surgery called myomectomy to remove them.

Cervical insufficiency (also called incompetent cervix). This is when your cervix opens (dilates) too early during pregnancy, usually without pain or contractions. Contractions are when the muscles of your uterus get tight and then relax to help push your baby out during labor and birth. Cervical insufficiency may lead to miscarriage, usually in the second trimester. To help prevent this, your provider may recommend cerclage. This is a stitch your provider puts in your cervix to help keep it closed.

Infections

Infections, like sexually transmitted infections (also called STIs) and listeriosis, can cause miscarriage. An STI, like genital herpes and syphilis, is an infection you can get from having sex with someone who is infected. If you think you may have an STI, tell your health care provider right away. Early testing and treatment can help protect you and your baby. Listeriosis is a kind of food poisoning. If you think you have listeriosis, call your provider right away. Your provider may treat you with antibiotics to help keep you and your baby safe. Having certain infections may cause miscarriage, but they’re not likely to cause repeat miscarriages.

Are you at risk for a miscarriage?

Some things may make you more likely than other woman to have a miscarriage. These are called risk factors. Risk factors for miscarriage include:

Having two or more previous miscarriages

Being 35 or older. As you get older, your risk of having a miscarriage increases.

Smoking, drinking alcohol or using harmful drugs. If you’re pregnant or thinking about getting pregnant and need help to quit, tell your provider.

Being exposed to harmful chemicals. You or your partner having contact with harmful chemicals, like solvents, may increase your risk of miscarriage. A solvent is a chemical that dissolves other substances, like paint thinner. Talk to your provider about what you can do to protect yourself and your baby.

Some health conditions may increase your risk for miscarriage. Treatment of these conditions before and during pregnancy can sometimes help prevent miscarriage and repeat miscarriages. If you have any of these health conditions, tell your health care provider before you get pregnant or as soon as you know you’re pregnant:

Autoimmune disorders. These are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake. Autoimmune disorders that may increase your risk of miscarriage include antiphospholipid syndrome (also called APS) and lupus (also called systemic lupus erythematosus or SLE). If you have APS, your body makes antibodies that attack certain fats that line the blood vessels; this can sometimes cause blood clots. If you have APS and have had repeat miscarriages, your provider may give you low-dose aspirin and a medicine called heparin during pregnancy and for a few weeks after you give birth to help prevent another miscarriage. Lupus can cause swelling, pain and sometimes organ damage. It can affect your joints, skin, kidneys, lungs and blood vessels. If you have lupus, your provider may treat you with low-dose aspirin and heparin during pregnancy.

Obesity. This means you have too much body fat and your body mass index (also called BMI) is 30 or higher. BMI is a measure of body fat based on your height and weight. If you’re obese, your chances of having a miscarriage may increase. To find out your BMI, go to cdc.gov/bmi.

Hormone problems, like polycystic ovary syndrome (also called PCOS) and luteal phase defect. Hormones are chemicals made by the body. PCOS happens when you have hormone problems and cysts on the ovaries. A cyst is a closed pocket of that contains air, fluid or semi-solid substances. If you’re trying to get pregnant, your provider may give you medicine to help you ovulate (release an egg from your ovary into the fallopian tubes). Luteal phase defect can cause repeat miscarriages. It’s when you have low levels of progesterone over several menstrual cycles. Progesterone is a hormone that helps regulate your periods and gets your body ready for pregnancy. If you have luteal phase defect, your provider may recommend treatment with progesterone before and during pregnancy to help prevent repeat miscarriages.

Preexisting diabetes (also called type 1 or type 2 diabetes). Diabetes is when you have too much sugar (also called glucose) in your blood. Preexisting diabetes means you have diabetes before you get pregnant.

Thyroid problems, including hypothyroidism and hyperthyroidism. They thyroid is a butterfly-shaped gland in your neck. Hypothyroidism is when the thyroid gland doesn’t make enough thyroid hormones. Hyperthyroidism is when the thyroid gland makes too many thyroid hormones.

Having certain prenatal tests, like amniocentesis and chorionic villus sampling. These tests have a slight risk of miscarriage. Your provider may recommend them if your baby is at risk for certain genetic conditions, like Down syndrome.

Having an injury to your belly, like from falling down or getting hit, isn’t a high risk for miscarriage. Your body does a good job of protecting your baby in the early weeks of pregnancy.

You may have heard that getting too much caffeine during pregnancy can increase your risk for miscarriage. Caffeine is a drug found in foods, drinks, chocolate and some medicine. It’s a stimulant, which means it can help keep you awake. Some studies say caffeine may cause miscarriage, and some say it doesn’t. Until we know more about how caffeine can affect pregnancy, it’s best to limit the amount you get to 200 milligrams each day. This is what’s in about one 12-ounce cup of coffee.

What are the signs and symptoms of miscarriage?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of miscarriage include:

Bleeding from the vagina or spotting

Cramps like you feel with your period

Severe belly pain

If you have any of these signs or symptoms, call your provider. Your provider may want to do some tests to make sure everything’s OK. These tests can include blood tests, a pelvic exam and an ultrasound. An ultrasound is a test that uses sound waves and a computer screen to show a picture of your baby inside the womb.

Many women have these signs and symptoms in early pregnancy and don’t miscarry.

What treatment do you get after a miscarriage or repeat miscarriages?

If you’ve had a miscarriage, your provider may recommend:

Dilation and curettage (also called D&C). This is a procedure to remove any remaining tissue from the uterus. Your provider dilates (widens) your cervix and removes the tissue with suction or with an instrument called a curette.

Medicine. Your provider may recommend medicine that can help your body pass tissue that’s still in the uterus.

Do you need any medical tests after a miscarriage or repeat miscarriages?

If you miscarry in your first trimester, you probably don’t need any medical tests. Because we don’t often know what causes a miscarriage in the first trimester, tests may not be helpful in trying to find out a cause.

If you have repeat miscarriages in the first trimester, or if you have a miscarriage in the second trimester, your provider usually recommends tests to help find out the cause. Tests can include:

Chromosome tests. You and your partner can have blood tests, like karyotyping, to check for chromosome problems. Karyotyping can count how many chromosomes there are and check to see if any chromosomes have changed. If tissue from the miscarriage is available, your provider can test it for chromosomal conditions.

Hormone tests. You may have your blood tested to check for problems with hormones. Or you may have a procedure called endometrial biopsy that removes a small piece of the lining of the uterus to check for hormones.

Blood tests to check your immune system. Your provider may test you for autoimmune disorders like, APS and lupus.

Looking at the uterus. You may have an ultrasound, a hysteroscopy (when your provider inserts a special scope through the cervix to see your uterus) or a hysterosalpingography (an X-ray of the uterus).

How long does it take to recover from a miscarriage?

It can take a few weeks to a month or more for your body to recover from a miscarriage. Depending on how long you were pregnant, you may have pregnancy hormones in your blood for 1 to 2 months after you miscarry. Most women get their period again 4 to 6 weeks after a miscarriage.

It may take longer to recover emotionally from a miscarriage. You may have strong feelings of grief about the death of your baby. Grief is all the feelings you have when someone close to you dies. Grief can make you feel sad, angry, confused or alone. It’s OK to take time to grieve after a miscarriage. Ask your friends and family for support, and find special ways to remember your baby. For example, if you already have baby things, like clothes and blankets, you may want to keep them in a special place. Or you may have religious or cultural traditions that you’d like to do for your baby. Do what’s right for you.

Certain things, like hearing names you were thinking of for your baby or seeing other babies, can be painful reminders of your loss. You may need help learning how to deal with these situations and the feelings they create. Tell your provider if you need help to deal with your grief. And visit Share Your Story, the March of Dimes online community where you can talk with other parents who have had a miscarriage. We also offer the free booklet From hurt to healing that has information and resources for grieving parents.

If you miscarry, when can you try to get pregnant again?

This is a decision for you to make with your partner and your provider. It’s probably OK to get pregnant again after you’ve had at least one normal period. If you’re having medical tests to try to find out more about why you miscarried, you may need to wait until after you’ve had these tests to try to get pregnant again.

You may not be emotionally ready to try again so soon. Miscarriage can be hard to handle, and you may need time to grieve. It’s OK if you want to wait a while before trying to get pregnant again.

Natural Pregnancy Remedies: How to Use ACV During Pregnancy

More information

From hurt to healing (free booklet from the March of Dimes for grieving parents)

Share Your Story (March of Dimes online community for families to share experiences with prematurity, birth defects or loss)

Centering Corporation (grief information and resources)

Compassionate Friends (resources for families after the death of a child)

Journey Program of Seattle Children’s Hospital (resources for families after the death of a child)

Lupus Research Alliance: Pregnancy and family planning

Share Pregnancy & Infant Loss Support (resources for families with pregnancy or infant loss)

What kind of infection can cause a miscarriage?

Miscarriage is the spontaneous loss of a pregnancy before 12 weeks (early miscarriage) or from 12 to 24 weeks (late miscarriage) of gestation. Miscarriage occurs in one in five pregnancies and can have considerable physiological and psychological implications for the patient. It is also associated with significant health care costs. There is evidence that potentially preventable infections may account for up to 15% of early miscarriages and up to 66% of late miscarriages. However, the provision of associated screening and management algorithms is inconsistent for newly pregnant women. Here, we review recent population-based studies on infections that have been shown to be associated with miscarriage.

METHODS

Our aim was to examine where the current scientific focus lies with regards to the role of infection in miscarriage. Papers dating from June 2009 with key words ‘miscarriage’ and ‘infection’ or ‘infections’ were identified in PubMed (292 and 327 papers, respectively, on 2 June 2014). Relevant human studies (meta-analyses, case–control studies, cohort studies or case series) were included. Single case reports were excluded. The studies were scored based on the Newcastle – Ottawa Quality Assessment Scale.

RESULTS

The association of systemic infections with malaria, brucellosis, cytomegalovirus and human immunodeficiency virus, dengue fever, influenza virus and of vaginal infection with bacterial vaginosis, with increased risk of miscarriage has been demonstrated. Q fever, adeno-associated virus, Bocavirus, Hepatitis C and Mycoplasma genitalium infections do not appear to affect pregnancy outcome. The effects of Chlamydia trachomatis, Toxoplasma gondii, human papillomavirus, herpes simplex virus, parvovirus B19, Hepatitis B and polyomavirus BK infections remain controversial, as some studies indicate increased miscarriage risk and others show no increased risk. The latest data on rubella and syphilis indicate increased antenatal screening worldwide and a decrease in the frequency of their reported associations with pregnancy failure. Though various pathogens have been associated with miscarriage, the mechanism(s) of infection-induced miscarriage are not yet fully elucidated.

CONCLUSIONS

Further research is required to clarify whether certain infections do increase miscarriage risk and whether screening of newly pregnant women for treatable infections would improve reproductive outcomes.

Keywords: miscarriage, infection, female tract, pregnancy

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Introduction

Miscarriage is one of the most common yet under-studied adverse pregnancy outcomes. In the majority of cases the effects of a miscarriage on women's health are not serious and may be unreported. However in the most serious cases symptoms can include pain, bleeding and a risk of haemorrhage. Feelings of loss and grief are also common and the psychology and mental health of those affected can suffer (Engelhard et al., 2001).

For the purposes of this review ‘miscarriage’ is defined as the spontaneous loss of a pregnancy during the first 24 weeks of gestation (Fig. (Fig.1).1). For most women, a miscarriage is an individual event and will be followed by a successful pregnancy (‘spontaneous miscarriage’, termed ‘miscarriage’ from this point onwards). A small number (0.5–1%) of women wishing to have children may experience three or more successive miscarriages, a condition known as ‘recurrent miscarriage’ (Bulletti et al., 1996). ‘Early miscarriage’ is defined as pregnancy loss during the first trimester of pregnancy (less than 12 weeks of gestation) and occurs in up to one in five pregnancies. ‘Late miscarriage’ occurs during the second trimester (12–24 weeks of gestation) and is less common, occurring in 1–2% of pregnancies (Hay, 2004). Fetal death from the 25th week of gestation onwards is defined as stillbirth, an outcome taken into consideration in some of the studies included here, however it is not the main focus of this review.

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Figure 1

Adverse pregnancy outcomes across the three trimesters of pregnancy.

Although miscarriage is considered the most common adverse pregnancy outcome, worldwide figures are not available. In 2012–2013 there were 729 674 live births recorded in England and Wales (Office for National Statistics, 2012). Loss of one in five pregnancies suggests that this figure is accompanied by ∼200 000 miscarriages. Statistics from England and Wales for 2012/13 report that 39 800 miscarriages resulted in a hospital stay (Office for National Statistics, 2012). In an Australian prospective cohort including 14 247 women aged 18–23 years, the rate of miscarriage varied from 11.3 to 86.5 per 100 live births amongst different groups; overall, miscarriage occurred in 25% of the women in the study when the women were 31–36 years old (Hure et al., 2012).

Aetiology of miscarriage

The causes of miscarriage are often unknown. However, in ∼50% of early miscarriages the fetus exhibits chromosomal aberrations such as a structural alteration or abnormal chromosomal numbers (Eiben et al., 1990; Suzumori and Sugiura-Ogasawara, 2010). Several other factors have been associated with increased risk of miscarriage. The age of both parents has a significant role as the risk of an adverse pregnancy outcome is increased if the parents are 35 years old or older and it is 50% higher if the mother is 42 years of age (Fretts et al., 1995; Nybo Andersen et al., 2000; de la Rochebrochard and Thonneau, 2002; Slama et al., 2005; Maconochie et al., 2007). In addition, factors such as ethnic origin, psychological state of the mother, very low or very high pre-pregnancy BMI, feelings of stress, use of non-steroidal anti-inflammatory drugs, smoking and alcohol consumption have also been associated with significantly higher rates of miscarriage (Coste et al., 1991; Nielsen et al., 2001; Sopori, 2002; Lashen et al., 2004; Maconochie et al., 2007). Moreover, it has been reported that women whose first pregnancy resulted in miscarriage are at a higher risk of the second pregnancy resulting in miscarriage compared with women who had a live birth (Kashanian et al., 2006). Finally, a number of infections have been linked to miscarriage (Benedetto et al., 2004) and to other adverse outcomes, such as stillbirth (Goldenberg and Thompson, 2003) and preterm delivery (Garland et al., 2002). Specifically, 15% of early miscarriages and 66% of late miscarriages have been attributed to infections (Srinivas et al., 2006; Baud et al., 2008). In a recent study, 78% of 101 tissue samples from miscarriage were infected with bacteria (chorioamnionitis), whereas all the control samples from medically induced abortions were uninfected (Allanson et al., 2010).

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Methods

The aim of this review is to summarize present knowledge regarding the role of infection in miscarriage. In order to combine the most recent findings regarding infection and a potential association with miscarriage, we focused on studies published in the past 5 years. Our aim was to investigate current evidence regarding high-risk pathogens and scientific research trends. In PubMed, using the key words ‘miscarriage’ combined with ‘infection’ and ‘infections’, with ‘human’, ‘English language’ and ‘2009-present’ filters, articles published in the past 5 years were identified. The search returned a total of 292 and 327 papers for ‘miscarriage infection’ and ‘miscarriage infections’ respectively (up to 02/06/2014). From these, single case reports and studies in animals were excluded. A total of 44 studies investigated the association of different pathogens with miscarriage and the findings are presented in this review. The studies were also scored by two individuals independently based on the Newcastle - Ottawa Quality Assessment Scale for case control studies. The score of random studies was further evaluated by two more individuals.

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Results

Infections associated with miscarriage

An overview of all the studies analysed is presented in Supplementary Table SI, including pathogen(s) investigated, outcome of the study and an estimation on the strength of each study, as described in Methods. Some of the most common caveats addressed in this review were variation in sample size and detection techniques, whether multivariate analysis was implemented or not and variation in study design.

Bacterial infections

Bacterial vaginosis In healthy women, the normal genital tract flora consists for the most part of Lactobacillus species bacteria (Lamont et al., 2011). Other potentially virulent organisms, such as Gardnerella vaginalis, group B streptococci, Staphylococcus aureus, Ureaplasma urealyticum (U. urealyticum) or Mycoplasma hominis (M. hominis) occasionally displace lactobacilli as the predominant organisms in the vagina, a condition known as bacterial vaginosis (BV) (Eschenbach, 1993; Casari et al., 2010). BV is present in 24–25% of women of reproductive age (Ralph et al., 1999; Wilson et al., 2002) and causes a rise in the vaginal pH from the normal value of 3.8–4.2 up to 7.0. It is usually asymptomatic but may result in a vaginal discharge, which can be grey in colour with a characteristic ‘ﬁshy’ odour. BV is diagnosed using microscopic examination of vaginal swab samples for ‘clue cells’ and/or Nugent criteria and is commonly treated with antibiotics, such as metronidazole (Donders et al., 2014). Change of sexual partner, a recent pregnancy, use of an intrauterine contraceptive device and antibiotic treatment have been identified as plausible causes of BV (Hay, 2004; Smart, 2004). BV has been associated with premature delivery (Hay et al., 1994) and with miscarriage (Donders et al., 2009; Rocchetti et al., 2011; Tavo, 2013).

In a retrospective study from Albania, U. urealyticum and M. hominis were present in 54.3 and 30.4% of the patients (150 hospitalized women, presenting with infertility, who had had a miscarriage or medically induced abortion, Tavo, 2013). The prevalence of both pathogens was significantly higher among women with a history of miscarriage (U. urealyticum: P = 0.04 and M. hominis: P = 0.02) and women who reported more than one miscarriage (P = 0.02 for both pathogens). This study however has some weaknesses, as it is not clear whether the comparisons made were with non-infected women with a miscarriage history or non-infected women with no miscarriage history and the method by which prevalence of microbes was tested is not specified.

Data on the prevalence of group B streptococci and pregnancy outcome in 405 Brazilian women with gestational age between 35 and 37 weeks was published in 2011 (Rocchetti et al., 2011). Overall, 25.4% of women were positive for Streptococcus agalactiae and infection was associated, among other factors, with a history of miscarriage (odds ratio (OR) 1.875; 95% confidence interval (CI) 1.038–3.387).

Association of BV and particularly M. hominis and U. urealyticum was reported from a study from Turkey (Bayraktar et al., 2010). In total 50 pregnant women with BV symptoms were tested for M. hominis and U. urealyticum and observed until end of pregnancy. The pregnancy outcomes of 50 asymptomatic pregnant women were used as controls. Miscarriage was reported in 12 symptomatic women, in 8 of which M. hominis and/or U. urealyticum infection was confirmed. However, the definition of miscarriage used in this study was ‘less’ than 36 weeks. Furthermore, comparative analysis between the two groups was not carried out.

Ureaplasma urealyticum was also detected in 25% of 101 gestational tissue samples (chorion, amnion, umbilical cord) from miscarriage cases that were otherwise normal. Second most common pathogens were M. hominis and group B streptococci at 11.1%, whereas all controls were not infected (Allanson et al., 2010).

In a further study using a cohort of 759 Belgian pregnant women following microbiological evaluation of vaginal flora, 8.4% of participants in the cohort presented with BV and were not treated (Donders et al., 2009). BV was positively correlated with miscarriage, as 2% of positive women miscarried before 25 weeks gestation; with an OR of 6.6 (OR 6.6; 95% CI 2.1–20.9). An absence of lactobacilli was also associated with miscarriage (less than 25 weeks; OR 4.9; 95% CI 1.4–16.9, Donders et al., 2009).

These studies indicate an association of BV with miscarriage. As BV is treatable, screening programmes for pregnant women can be used to prevent adverse pregnancy outcome. Current guidelines from the USA advise against screening asymptomatic pregnant women (U.S. Preventive Services, 2008). The same principle is applied in Canada (Yudin and Money, 2008) and the UK as of November 2014 (UK National Screening Committee, 2014). A recent Cochrane review, including 7847 women in 21 trials, found decreased risk of late miscarriage when antibiotic treatment was administered (relative risk (RR) 0.20; 95% CI 0.05–0.76; two trials, 1270 women, fixed-effect, I² = 0%). As the authors highlight, further studies are required to establish the effect of screening programmes to prevent adverse pregnancy outcomes (Brocklehurst et al., 2013).

Brucellosis Bacteria of the genus Brucella can infect a variety of wild and domesticated mammals. Cattle and deer are susceptible to Brucella abortus (B. abortus) whereas Brucella melitensis affects goats and sheep, causing fever and abortion; a disease known as brucellosis (Atluri et al., 2011; Moreno, 2014). Humans can contract infection via consumption of unpasteurised dairy products (Corbel, 1997). Infection is detected via bacterial isolation from blood samples or serology (CDC—Centre for Disease and Prevention, 2012a).

Kurdoglu and colleagues in Turkey (Kurdoglu et al., 2010), conducted a case–control study examining the miscarriage rate of 342 pregnant women with brucellosis compared with 33 936 uninfected women of similar socioeconomic status treated in the same hospital. The researchers concluded that 24.14% of infected pregnant women miscarried versus 7.59% of the controls. This result however could be influenced by statistical power, as the cases are ∼100 times smaller than the control group.

The seroprevalence of brucellosis among 445 miscarriage cases and 445 control pregnant Jordanian women with no history of miscarriage consecutively recruited, matched for age, socioeconomic status and area of residence, was not significantly different (Abo-shehada and Abu-Halaweh, 2011). In the paper the researchers state that a sample of 441 was adequate as the prevalence of brucellosis is 8% in high-risk patients in contact with livestock (Abo-Shehada et al., 1996), though their reference for statistical power could not be reviewed. The overall prevalence was similar in both groups; 1% in controls and 1.8% in cases.

The evidence suggests brucellosis is still a risk factor for miscarriage in areas where the infection is endemic in farm animals. This is in accordance with older studies that have reported high miscarriage rates among women with brucellosis (Lulu et al., 1988; Khan et al., 2001).

Chlamydia trachomatis Chlamydia trachomatis, an obligate intracellular bacterium, is the most common sexually transmitted bacterial disease worldwide (Howie et al., 2011). The prevalence of the disease is high, estimated at 101 million new cases in 2005 worldwide (World Health Organisation, 2011). Though in women it is often asymptomatic, untreated C. trachomatis infection can result in mucopurulent cervicitis (Brunham et al., 1984), acute urethral syndrome (Stamm et al., 1980) and pelvic inflammatory disease (PID) (Paavonen and Lehtinen, 1996). Chlamydia trachomatis infection is a known risk factor for ectopic pregnancy and preterm birth (Martin et al., 1982; Hillis et al., 1997; Egger et al., 1998; Kovács et al., 1998; Bakken et al., 2007; Shaw et al., 2011). Diagnosis is carried out by PCR on vaginal swab samples and treatment includes the administration of antibiotics, such as tetracyclines, azithromycin or erythromycin (Brocklehurst and Rooney, 2000; MedlinePlus, 2014).

The most recent case–control study investigating a potential association of C. trachomatis and miscarriage was published in 2011 (Baud et al., 2011). Using an enzyme-linked immunosorbent assay (ELISA) to detect C. trachomatis antibodies in sera, as well as a standard vaginal swab for C. trachomatis detection by PCR, on 145 cases and 261 controls, a positive association with miscarriage was observed. Immunoglobulin (Ig)G antibodies against C. trachomatis were present in higher levels in the miscarriage group (15.2%) than in the controls (7.3%; P = 0.018). The same pattern was observed for IgA antibodies only after adjustment for age, origin, education and number of sexual partners. Furthermore, C. trachomatis was detected using PCR in the placentae from cases more often than those from controls (4.0 and 0.7% respectively, P = 0.026). Subsequently, an observational study from Finland on 4920 women with genital tract infections has suggested that late complications can occur in C. trachomatis infected pregnant women (Kortekangas-Savolainen et al., 2012). However there was no control group in this study and neither were the terms ‘early’ or ‘late’ pregnancy defined, therefore limiting extrapolation of the findings.

In a study from Serbia, 21.3% of 54 miscarriage cases were shown to have persistent C. trachomatis infection as determined by levels of sera IgA against C. trachomatis major outer membrane protein (Arsovic et al., 2014). The authors suggest an association between persistent C. trachomatis infection and miscarriage, however these cases were compared only against patients with tubal infertility and not uninfected pregnant women.

Chlamydia trachomatis has been studied extensively and a lot of data are available for this infection from over three decades of research. Contradicting studies have been published, resulting in conflicting evidence regarding the role of C. trachomatis in miscarriage (Feist et al., 1999; Wilkowska-Trojniel et al., 2009). Taking into account the most recent findings and the increase in screening programmes worldwide, such as the screening offered to all pregnant women in the USA (CDC, 2014), public awareness of the possible risk of C. trachomatis infection to a future pregnancy might be advisable.

Mycoplasma genitalium Mycoplasma genitalium is a sexually transmitted bacterium, known to cause urethritis, cervicitis and PID, but infection can also be asymptomatic (Taylor-Robinson and Jensen, 2011). It has been suggested that M. genitalium can enhance human immunodeficiency virus (HIV) infection and transmission (Napierala Mavedzenge and Weiss, 2009); diagnosis is via PCR on urine samples (CDC, 2012b) and treatments include azithromycin and doxycycline (Horner et al., 2014). The only published study of this infection, is a case–control study from the USA on 392 women with miscarriage before 22 weeks of gestation and 802 healthy pregnant controls, and used data from participants originally enrolled in another study. Overall, M. genitalium had a prevalence of 5.9% but no association with miscarriage was found (Short et al., 2010).

Q fever Q fever is a zoonotic infection, caused by the bacterium Coxiella burnetii (Maurin and Raoult, 1999). Infection is most commonly observed in humans who come into close proximity to livestock. Coxiella burnetii is usually transmitted via inhalation of infectious aerosols from animal fluids (Maurin and Raoult, 1999; van der Hoek et al., 2010). Infection is asymptomatic in half of all cases in adults but can present as an unspecific illness combined with pneumonia or hepatitis. Q fever is confirmed via PCR on blood samples (CDC, 2013). Recommended treatment in symptomatic adults and children is doxycycline administration. In pregnant women, Q fever infection has been associated with adverse pregnancy outcomes, as in a recent report from the United States Centres for Disease Control and Prevention (CDC) (Anderson et al., 2013). However, as the authors note, studies investigating serological evidence of infection and miscarriage have produced contradictory results. Screening of pregnant women is not currently recommended in the European Union (Munster et al., 2012).

Two Danish studies, one in 2012 and the second in 2013, concluded that C. burnetii is not linked to miscarriage (Nielsen et al., 2012, 2013). Both used randomized sera samples from the Danish National Birth Cohort. The first study was powered to detect whether infection could be associated with miscarriage. The presence of infection was investigated in a case group of 218 women with miscarriage (loss of pregnancy prior to 22 weeks of gestation) compared with 482 healthy pregnancies. The second study focused on pregnancy outcomes of 397 women exposed to cattle and sheep (high risk of exposure to C. burnetii infection) versus 459 women that had no contact with animals. Coxiella burnetii prevalence was 5% in cases and 6% in controls of the first study, whereas in the second study 19.5% of all women were positive, however 87% of these women had contact with livestock. Nielsen and colleagues (Nielsen et al., 2012) reported one positive miscarriage case (0.46%) and 3 (0.67%) seropositive among controls whereas in the second study two miscarriages were positive (Nielsen et al., 2013). These results suggest that, despite presence of C. burnetii infection especially in pregnant women in proximity with cattle and sheep, this bacterium does not seem to be widely associated with adverse pregnancy outcome, although individual cases have been reported.

9 Common Foods That can Cause Miscarriage in Early Pregnancy

Syphilis Syphilis is a bacterial infection that can be transmitted sexually or via contact with the blood of an infected person. It is caused by Treponema pallidum, diagnosed using PCR, and is treated with antibiotics (Cohen et al., 2013). Stage one symptoms include a highly contagious sore that develops during stage two to a rash accompanied by sore throat. The third and final stage is tertiary syphilis, which is not contagious but is very harmful.

Casal and colleagues (Casal et al., 2012) assessed risk factors associated with syphilis and pregnancy outcomes in a Brazilian population. The cases consisted of women positive for syphilis, 169 with live births and 68 who had an adverse pregnancy outcome. This included miscarriage, stillbirth and neonatal death grouped together. The control group of women negative for syphilis included 219 women who had live births and 83 with adverse pregnancy outcome. Syphilis was significantly associated with history of miscarriage (OR 3.31; CI 2.20–4.99; P < 0.0001) after testing using a multiple regression model. Most of the pregnancies resulting in live births were not completely asymptomatic when infection was present, resulting in outcomes such as prematurity, low birthweight and respiratory problems, among others. They also observed that maternal syphilis was associated with illegal drugs, alcohol, no counselling on syphilis, sexual activity initiation at 16 years of age or younger, two or more sexual partners during the preceding 1.5 years, life in a household with a low income and poorer sanitation; all factors that may also have a detrimental impact on reproductive outcome.

A study from China reported that, following a screening programme aiming to prevent mother-to-child syphilis transmission, the adverse pregnancy outcomes including miscarriage were reduced from 27.3% in 2003 to 8.2% in 2011 (Hong et al., 2014).

The effect of syphilis on pregnancy has been a subject of interest for almost 100 years; general consensus is that syphilis can have a devastating effect on fetuses resulting in miscarriage, stillbirth and congenital transmission (Temmerman et al., 1992; Oswal and Lyons, 2008). Syphilis screening programmes are in effect in the USA and EU (CDC, 2014; Janier et al., 2014).

Viral infections

Herpes virus infections The Herpes family of DNA viruses includes a number of pathogenic viruses of humans (Human Herpes Viruses/HHV) that can remain latent in the host and can reactivate (Whitley and Roizman, 2001). Two members of this family, HSV-1 (HHV1) and HSV-2 (HHV-2) establish latency in neuronal cells and on reactivation can cause herpes genitalis or labialis (Margolis et al., 2007). Cytomegalovirus (CMV) (HHV-5) is also a very common virus, acquired by most people during childhood (Chisholm and Lopez, 2011). CMV infects mostly myeloid cells and is never eradicated from the body (Koch et al., 2006). Herpes viruses can be diagnosed using PCR in sera samples (Singh et al., 2005).

HSV-1 and HSV-2 HSV1 and/or HSV2 DNA were detected in 43.5% of 95 frozen trophoblastic tissue samples from Greek women with spontaneous pregnancy loss compared with 16.7% of women undergoing elective abortion (n = 35, P = 0.03, Fisher's exact test) (Kapranos and Kotronias, 2009). Using in situ hybridization HSV DNA was detected in the trophoblast of 18 out of 25 HSV positive cases. The authors concluded that HSV seems to have a role in early miscarriage, although they did not distinguish between the two types of HSV.

These data are supported by a more recent study from Korea (Kim, et al., 2012b). The authors of this study tested sera of 500 pregnant women for HSV-2 and 85 (17%) were seropositive. Most of the women in both groups also tested positive for rubella, varicella zoster (HHV-3) and hepatitis B (HEPB), however the authors adjusted for this. Of HSV-2 seropositive women, 38.8% had a history of miscarriage compared with 29.6% of the control group (P < 0.05).

A possible association of HSV1 and HSV2 with miscarriage cannot be ascertained from these reports and further studies are required.

Human CMV/HHV-5 Hadar and colleagues studied a group of seropositive 59 women with peri-conceptional CMV infection, which occurred between 4 weeks prior to the last reported menstrual period and up to 3 weeks after the expected date of the period. Out of these women, four had miscarriages before undergoing amniocentesis to confirm intrauterine infection. The remaining patients either elected to terminate the pregnancy or gave birth to live infants. No conclusion could be drawn with regards to miscarriage association as no controls were included in this study (Hadar et al., 2010).

Data from a Malaysian study (Saraswathy et al., 2011) showed that anti-CMV IgG antibody was detected in 84% of healthy pregnant women as well as women with adverse pregnancy outcome, including 17 cases of miscarriage.

Despite the lack of recent studies supporting an association of CMV with miscarriage, in vitro studies have shown that CMV infection can result in placental dysfunctions (see below). However, further studies are required to elucidate the true role of CMV in adverse pregnancy outcomes.

Human papillomavirus Human papillomaviruses (HPV) comprise a group of over 150 different types of small DNA viruses some of which cause common sexually transmitted infections (Cutts et al., 2007). Sexually transmitted HPV infection has a prevalence rate of 11.7% in the general female population of reproductive age (Bruni et al., 2010). According to CDC, sexually transmitted HPV prevalence nationwide in the USA among women 14–59 years old was 42.5% in 2003–2006, an estimation based on positive servicovaginal swab tests (Hariri et al., 2011). Persistent infection with high-risk types of HPV (the most prevalent being HPV 16/18 worldwide) have been associated with cervical cancer, and others (HPV 6/11) with genital warts (Cutts et al., 2007; Crosbie et al., 2013). The vast majority of infections are asymptomatic and clear naturally without causing long-term disease and a vaccine is now available for types 6, 11, 16 and 18 (Cutts et al., 2007). HPV infection cannot be diagnosed by blood tests, however PCR on cervical cell samples is used to determine specific viral genotypes following a positive Papanicolaou (PAP)-test (Molijn et al., 2005).

The results of recent studies into the effects of HPV infection upon miscarriage are contradictory (Perino et al., 2011; Skoczyński et al., 2011; Yang et al., 2013). A study in China on the effect of HPV on the pregnancy outcome of IVF treated patients found no difference in miscarriage rates between women with abnormal cervical cytology who had a positive high risk HPV test (n = 56) and those who tested negative for high-risk HPV (n = 56, Yang et al., 2013). A second study from Poland tested for 33 HPV genotypes and also for specific HPV 16/18 DNA presence in placentae from miscarriages (n = 51) and from term deliveries from women who showed no signs of systemic infection (but were not tested, n = 78). They found HPV DNA in 17.7% of miscarriage cases and in 24.4% control placentae. A total of 11.8% of miscarriages and 12.8% of normal placentae were positive for HPV 16/18, but none of these differences reached statistical significance (Skoczyński et al., 2011). Both of these studies suggest that HPV infection in women has no effect on pregnancy outcome, although no more than 150 women were examined in either study.

Conversely, results from a 2011 study significantly associated male partner HPV infection with miscarriage rate in 199 couples attending IVF clinics in Italy (66.7% in HPV infected couples versus 15% of controls with no HPV infection, P < 0.01, Perino et al., 2011). The researchers also identified that all pregnancies in couples where both partners were infected resulted in miscarriage (n = 9).

These studies present contradictory data, however the first two examined infection in female partners whereas the second one investigated male partners. Interestingly, an older study (Hermonat et al., 1997) reported HPV DNA presence in 15/25 early miscarriage samples compared with 3/15 first trimester elective abortion samples. Further well-designed, adequately powered studies are required to fully elucidate the role of HPV as a potential risk factor for miscarriage, whilst considering the role of an infected male partner as there are indications of a potential role in early miscarriage (Garolla et al., 2011).

Parvovirus infection Parvoviruses belong to the Parvoviridae family and are very small single stranded DNA viruses that infect invertebrates and vertebrates (Cotmore et al., 2014). Of interest to studies of miscarriage are Adeno-associated virus (AAV), Parvovirus B19 (B19V) and Bocavirus (BC).

AAV Antibodies against several serotypes of AAV show infection in various tissues, but it is asymptomatic (Gao et al., 2004). AAV needs the help of a helper virus, adenovirus, to replicate. Despite this, 80% of the human population is seropositive for AAV, as diagnosed by PCR (Gonçalves, 2005).

No association of AAV infection with serotypes 2, 3 and 5 with recurrent miscarriage (defined as two or more) was found in couples with subfertility (Schlehofer et al., 2012). A total of 146 semen samples as well as 134 endocervical samples from couples attending a fertility clinic were tested for the presence of AAV DNA and 14.9% of female and 19.9% of male samples were positive. No associations with other infectious pathogens, semen quality or subsequent fertility issues were indicated.

In another study (Pereira, 2010), the presence of AAV was examined in 81 patients, divided into three groups: 13 medically induced abortions, 29 miscarriages and 39 ‘undetermined’ (including 66 decidua and 52 ovarian biopsies from the same patients). AAV DNA was detected in 23/81 (28.4%) of cases for at least one of the decidual or ovular fragments. Furthermore, 22/68 (32.3%) of spontaneous and 7.7% (1/13) of elective abortions (classified according to patient information) tested positive. The authors grouped cases with confirmed type of abortion and observed 28.6% (12/42) and 2.4% (1/42) AAV positive ‘for spontaneous and medically induced abortion, respectively (P < 0.05)’. The classification of samples used as well as definition of the various groups compared in this study are unclear from the paper description, thus interpretation is challenging. The authors suggest a ‘casual association’ of AAV to miscarriage.

Despite the detection of AAV DNA in some miscarriage cases, there is inconclusive evidence for a role for this virus in miscarriage.

Parvovirus B19 (B19V) Parvovirus B19 (B19V) is a small virus capable of causing different diseases in humans, such as ‘Fifth disease’ during childhood (Young and Brown, 2004). It is estimated that ∼50% of young men and women have antibodies against B19V, determined via serology tests (Broliden et al., 2006). The remaining 50% of women are at risk of developing infection during pregnancy, which can lead to non-immune hydrops fetalis, a well-established cause of fetal death (Silingardi et al., 2009).

A recent study from Northern Ireland examined 3921 women of reproductive age and 33.5% of them were at risk of infection as they had no antibodies against B19V (Watt et al., 2013). Though fetal loss was reported in infected women with confirmed presence of the virus in miscarried fetuses, no increased association with miscarriage was observed. However, the authors reported ‘inadequate follow-up’ of pregnancies potentially associated with B19V infection.

In an earlier study of 72 pregnant women with B19V, it was noted that the risk of vertical transmission is higher if infection occurs by gestational week 20. Six out of eight cases of fetal loss observed were ‘attributed to B19V infection’ without further elucidation. No conclusions regarding the association were reached by the researchers (Bonvicini et al., 2011).

A higher percentage of IgM antibodies indicating recent infection was observed in women with adverse pregnancy outcomes (22.72%, n = 88) compared with 4.5% observed in 88 control healthy pregnant women (Brkic et al., 2011). Interestingly, anti B19V IgG antibodies were higher in controls than cases (70.5 and 53.4% respectively, P = 0.046). An important limitation of this study is that the adverse pregnancy outcome included miscarriage, non-immune hydrops fetalis and intrauterine fetal death, thus the association of miscarriage alone with B19V is not clear.

In a study from Nigeria, B19V prevalence among pregnant women was estimated at 40.7%, as 111 out of 273 patients in the study had detectable levels of either IgG or IgM antibodies, however these were not associated with a history of miscarriage (Emiasegen et al., 2011).

From the above, it is evident that a case–control study on women with miscarriage versus healthy pregnant controls, statistically powered to elucidate the role of B19V in miscarriage is required, as there are indications of high prevalence in pregnancy and fetal infection.

Bocavirus (BC) The human BC is a newly discovered member of the parvovirus family detected in 93% of sera of children older than 3 years old (Karalar et al., 2010). In a study on 535 fetal biopsies (120 miscarriages, 169 intrauterine fetal deaths and 246 induced abortions), even though only 10% of women were seronegative, none of the fetuses tested positive and the authors concluded that BC could not have a possible role in miscarriage (Riipinen et al., 2010).

HIV HIV is a retrovirus, and is most commonly transmitted via unprotected sexual intercourse or sharing of equipment for intravenous drug use. There are two types of HIV, HIV-1 and HIV-2, with the first being the most common (Gnann et al., 1987). The virus infects several cell types of the host immune system, such as CD4+ T lymphocytes (Miedema et al., 1988; Embretson et al., 1993), macrophages (Orenstein et al., 1997) and dendritic cells (Gringhuis et al., 2010). Worldwide, the World Health Organization (WHO) estimates that 34 million people are living with HIV, diagnosed by HIV viral load blood tests (PCR) (World Health Organisation, 2013a). Anti-retroviral treatment delays the onset of severe symptoms and protects the patient from opportunistic infections, which are the main cause of death among HIV-positive patients (Dybul et al., 2002).

A 2013 study from Nigeria examined 2381 pregnancies in 1702 women positive for HIV compared with 2381 pregnant non-infected women from the same hospitals. Following preterm delivery, miscarriage was significantly associated with HIV positivity (OR: 1.37; CI: 1.1–2.3). This association was retained after adjustment for several confounding variables such as age, parity, history of miscarriage and others. The infected women in this study were all receiving anti-retroviral treatment, however different regimes were used during the years in which the study was conducted. Limitations of this study include the number of controls not being clearly stated and lack of testing for other sexually transmitted diseases (Ezechi et al., 2013).

In a study in Zambia 1229 HIV-positive pregnant women were followed up (Kim et al., 2012a, b). The ratio of miscarriages to live births was 3.1/100 and CD4 counts less than 350 cells/mm2 were significantly associated with miscarriage. The women were recruited during both first and second trimesters and none of the women who miscarried had received anti-retroviral treatment. The study did not compare the cases with uninfected pregnant women.

In a study of 382 Ugandan/Zimbabwean HIV-infected pregnant women undergoing multiple anti-retroviral therapies (Gibb et al., 2012), miscarriage and medically induced abortions occurring prior to 22 weeks of gestation were assessed as one factor, not separate outcomes. Of note, fetal death after 22 weeks was classified as stillbirth. Therefore, no conclusions regarding miscarriage specifically can be drawn from this study. A study from India on 69 HIV-infected and 345 non-infected women demonstrated higher miscarriage/stillbirth risk amongst the infected group, however again there was no distinction between medically induced abortions and miscarriages (Darak et al., 2011). In a retrospective analysis from Germany, 42% of HIV-positive women attending an outpatient clinic for preconception counselling became pregnant and only one miscarried (Gingelmaier et al., 2011).

HIV status was associated with miscarriage in a study of 1,218 pregnant women from Uganda (De Beaudrap et al., 2013). However, they defined stillbirth as the delivery of a non-living fetus ≥28 weeks gestation; and miscarriage as the delivery of a non-viable fetus either at <28 weeks gestation or weighing <500 g. Furthermore, as stillbirth and miscarriage were grouped together as one outcome, no definite conclusions regarding miscarriage can be drawn from this study.

To summarize, evidence suggests that HIV infection negatively affects pregnancy; however, anti-retroviral treatment can reduce the risk of adverse outcomes (Zolopa et al., 2009; Friedman et al., 2011). Furthermore, HIV has been associated with BV which could have a detrimental role on pregnancy outcome (Ledru et al., 1997). The presence of multiple diseases could further compromise a pregnancy. As most of the studies suggest, consultation and monitoring of HIV-positive women who wish to become pregnant is desirable. Women during their first antenatal visit are offered HIV tests in the UK, USA and EU (European Centre for Disease Prevention and Control, 2010; UK National Screening Committee, 2013; CDC, 2014).

Polyomavirus BK Polyomavirus BK infects up to 90% of the general population via an unknown transmission route and is usually asymptomatic with the exception of immunocompromised individuals (Hirsch and Steiger, 2003). Antibodies against the virus can be detected using sera samples and PCR, urine cytology and viral immunostaining (Masutani, 2014).

Recent studies have investigated a potential role of BK virus infection on adverse pregnancy outcomes. A study on patients with unexplained villitis (infection of the placental villi associated with adverse pregnancy outcomes) detected no BK in placenta from miscarriages (Cajaiba et al., 2011). The authors state that ‘For cases with diffuse villitis, the gestational age ranged from 31 to 41 weeks (average 37.2 weeks)’. It seems therefore more suitable to address these cases as stillbirths, not miscarriages. In another study from Italy, samples from five miscarried fetuses with chorioamnionitis and miscarriages due to chromosomal abnormalities (controls), BK was detected in fetal organs (Boldorini et al., 2010). Though this provides possible proof of vertical transmission of the virus, as it was detected in four out of five chromosomally abnormal controls and three out of five cases, the authors concluded that BK infection does not have a role in miscarriage. In accordance with the first study, the fetuses were between the 15th and the 28th week of gestation, so some of them were stillbirths according to our review's classification. Moreover, the fetuses were not matched for gestational age. In both studies, the numbers were small and no early miscarriages were tested. The question whether BK virus could be associated with miscarriage requires therefore further investigation.

Using Apple Cider Vinegar While Pregnant

Dengue fever Dengue fever is a disease caused by four viruses of the single stranded RNA flaviviridae genus (DEN1-4), transmitted via mosquito bites usually in tropical and sub-tropical climates worldwide. WHO estimates 40–50 million new cases every year. Dengue is a flu-like illness with no vaccination and treatment currently available. Diagnosis is difficult as symptoms resemble other diseases, however usual approaches include DNA and antibody detection in serum samples using PCR and ELISA, respectively (CDC, 2012).

The role of dengue fever in miscarriage was examined in a prospective study from Malaysia on 115 women with miscarriage up to 22 weeks of gestation and 296 healthy pregnant controls. This study found significant association of recent dengue fever infection with miscarriage after adjusting for confounders such as maternal age, gestational age, parity and ethnicity (5.3% in cases versus 1.7% in controls, adjusted OR 4.2, 95% CI 1.2–14, P = 0.023, Tan et al., 2012).

In a case series report from Sri Lanka, two out of fifteen pregnant women experienced fetal death at 24 and 35 weeks of gestation, however the study provides no evidence of vertical transmission to the fetuses (Kariyawasam and Senanayake, 2010). In another case series report from French Guiana the authors reported two late miscarriages in 53 pregnant women with dengue fever. However, the infection could not be connected to the adverse pregnancy outcome (Basurko et al., 2009).

A systematic review on 30 studies concluded that it is unclear whether dengue fever is associated with adverse pregnancy outcomes (Pouliot et al., 2010). Based on recent evidence however, we can conclude that dengue fever seems to be a risk factor for miscarriage; therefore it is advisable to raise awareness regarding protective measures in high-risk areas and for people travelling to those areas.

HEPB and HEPC The HEPB virus is a member of the Hepadnavirus family of small DNA viruses and the HEPC virus is a member of the flaviviridae genus of single stranded RNA viruses. Both viruses cause liver inflammation and disease and are both found in body fluids. HEPB is often resolved within a couple of months, however HEPC can develop into a chronic disease. Both diseases are diagnosed using blood serological tests (Gretch, 1997; Krajden et al., 2005).

In a case–control study from China, 75 couples that received assisted reproduction treatment were followed up, divided into a group with one partner diagnosed with chronic HEPB infection and a control group with both parents seronegative for HEPB (Ye et al., 2014). The early miscarriage rate (gestational week range not specified) was 44% in the case group compared with 9.1% in the control group (P = 0.043, Fisher's exact test). Highest miscarriage rates (60%) were observed when mothers were seropositive and fathers seronegative (P = 0.03). Using PCR, HEPB DNA was detected in 6/62 ‘abandoned embryos’ from the case group, whereas all embryos of the control group were negative. These results suggest a possible role of chronic HEPB infection in miscarriage.

Conversely, a cross-sectional study from Yemen examined the association of miscarriage with HEPB and HEPC infection in pregnant women, and found that 10.8% of women were positive for HEPB (95% CI: 8.0–14.0%) and 8.5% for HEPC (95% CI: 6.0–11.5%). No association of infection with miscarriage was apparent after multivariate analysis (Murad et al., 2013).

These studies raise questions regarding the role of persistent HEPB infection during pregnancy. At the moment, screening programmes of pregnant women for HEPB and HEPC during their first antenatal visit in the USA and UK aim to prevent adverse pregnancy outcome (UK National Screening Committee, 2013; CDC, 2014).

Rubella Rubella is a mild childhood disease that, if acquired during the first 16 weeks of gestation, can result in miscarriage and serious fetal defects (Banatvala and Brown, 2004). A vaccine has been available for several years resulting in significant reduction in new cases according to the latest WHO progress report (Reef et al., 2011). Regardless of this progress, it is important to be aware that there remain a number of unvaccinated pregnant women in Europe and worldwide that do not have access to vaccination and who are still at risk of adverse pregnancy outcome due to rubella (Metcalf et al., 2011; Muscat et al., 2014).

Influenza virus A study of the 1918 Influenza pandemic concluded that it resulted in a decrease of live births due not only to high mortality but also to an increase of early miscarriages in pregnant women who were infected by the virus (Bloom-Feshbach et al., 2011). In a case series report regarding the H1N1 Influenza A pandemic, six women were admitted to intensive care and had adverse pregnancy outcomes, however only one seriously ill patient had a spontaneous abortion as four cases occurred during the third trimester (Oluyomi-Obi et al., 2010).

Protozoan infections

Malaria Malaria is caused by infection with protozoa of the genus Plasmodium (P. falciparum, P. vivax, P. malariae, P. ovale), is transmitted via mosquito bites and is endemic in more than 100 countries in Africa, Asia and South America (World Health Organisation, 2013b). In 2012 there were an estimated 207 million cases of malaria resulting in an approximately 627 000 deaths (90% of all malaria deaths occur in sub-Saharan Africa) (World Health Organisation, 2013b). Symptoms include fever, sweats, headache and diarrhoea and can be treated using different drugs depending on the symptoms and the specific pathogen causing the disease such as atovaquone plus proguanil or doxycycline (Kar and Kar, 2010). Malaria parasites are identified by microscopit examination of patients' blood samples. In 2007, 54.7 million pregnancies occurred in areas with endemic P. falciparum malaria and a further 70.5 million in areas with exceptionally low malaria transmission or with P. vivax only (Dellicour et al., 2010). Plasmodium can bind chondroitin sulphate A expressed on trophoblast and this is what causes local parasitaemia in the placenta (Agbor-Enoh et al., 2003). Maternal disease is most severe in primigravida women, and it reduces with each pregnancy as immunity builds up to those parasites that target the placenta (Fried et al., 1998).

Women with asymptomatic and symptomatic malaria (single episode before 14 weeks of gestation) are at a higher risk of miscarriage (adjusted OR 2.70, 95% CI 2.04–3.59 and 3.99, 95% CI 3.10–5.13, respectively). This study included 3527 women with miscarriage and 14 087 women that gave birth to live babies in Thailand. The risk ratios were not different for both P. falciparum and P. vivax (McGready et al., 2012).

De Beaudrap et al. (2013) also studied malaria during pregnancy in Uganda. In 1218 pregnant women no association of malaria with adverse pregnancy outcome was shown but an association with HIV status was demonstrated, as described above.

An association of malaria with adverse pregnancy outcomes, and more specifically miscarriage, is evident from the above studies. Prevention measures and screening of pregnant women at risk of malaria infection are advised.

Toxoplasmosis Prevalence of Toxoplasmosis differs across the world, from 20–40% in the UK and USA (Food Standards Agency, 2012) to ∼70% in tropical countries (Klaren and Kijlstra, 2002). In a recent study from London, 17.32% of 2610 samples tested were seropositive (Flatt and Shetty, 2013). Even though most patients are asymptomatic, immunocompromised individuals are susceptible to developing severe disease and women who become infected whilst pregnant can pass the infection vertically (Jones et al., 2001). The presence of T. gondii is confirmed by antibody detection.

Alvarado-Esquivel et al. (2014) showed that 6.7% of 326 women with a history of miscarriage had been exposed to T. gondii. This study however did not include a control group with no history of miscarriage. Miscarriage or stillbirth occurred in 28 out of 190 pregnant cases with toxoplasmosis presenting in England and Wales between 2008 and 2012, however these are data from the surveillance programme currently in place and not part of a study (Halsby et al., 2014). In a study on serum samples from 100 women who had miscarried, 86% of which were during the first trimester of pregnancy, 55% were seropositive for IgG against T. gondii (Vado-Solis et al., 2012), however, no comparison to uninfected pregnant women was made. A meta-analysis of several Mexican studies also indicates that infection rates are higher in women with miscarriage (Galvan-Ramirez et al., 2012). Despite this, as the authors highlight, only three out of the 132 studies included in their systematic review, were focused on women who had a miscarriage.

The likelihood of association of T. gondii infection resulting in miscarriage is highlighted by the present review of recent studies. Taking into account the significant worldwide prevalence of this protozoan infection, screening of pregnant women is recommended if it is established that this infection presents a significant risk for adverse pregnancy outcome.

How do infections lead to miscarriage?

Pregnancy is a complex process involving multiple cell types and regulated by several sophisticated mechanisms, which are still not fully clarified despite years of research. To examine the negative impact of infections to pregnancy, we first need to understand how a normal, successful pregnancy is established.

Maternal-fetal interface: morphology, implantation process and the role of the immune system The human endometrium is composed of several different cell types, including luminal and glandular epithelial cells, stroma with stromal fibroblastic cells, immune cells and blood vessels. During every menstrual cycle, in response to ovarian estrogen and progesterone via a process called ‘decidualisation’, the endometrial stromal compartment undergoes morphological and structural transformation to become receptive to implantation. Prior to implantation, the trophoblast differentiates into the growing blastocyst as it travels from the Fallopian tube to the uterus. The ‘implantation window’, during which the uterus is receptive to the embryo, is usually between 6 and 12 days after ovulation (Rashid et al., 2011). The blastocyst attaches to the receptive endometrium utilizing adhesion proteins, called integrins, during the implantation window (Fig. (Fig.2A,2A, Merviel et al., 2001). Placenta formation begins as the trophoblast comes into contact with the epithelium and differentiates further into syncytiotrophoblast that invades the epithelial layer. Various other molecules, both from the maternal and fetal side, are involved in this process (reviewed in Dimitriadis et al., 2005; Tranguch et al., 2005; Achache and Revel, 2006; Chen et al., 2009). Syncytiotrophoblasts, supported by the decidualised stroma (Godbole et al., 2011), penetrate the endometrium and surround the embryo, whilst it embeds itself in the decidual stroma. A second trophoblast layer, the cytotrophoblast, is an inner layer without contact with the maternal cells. During the trophoblast invasion, cavities called lacunae develop, which, as they get filled with maternal blood, bring the maternal circulation into contact with the placental villi, thus marking the onset of placental circulation that includes exchange of nutrients and waste between the embryo and mother. At days 10–12 of gestation, the embryo is completely embedded in the endometrium, the epithelium has grown over it and the implantation process is complete (Fig. (Fig.2B).2B). The three placental zones are now distinguishable: the early chorionic plate near the embryo, the intervillous space with the villous trees and the primitive basal plate in contact with the maternal endometrium (Pijnenborg et al., 1980, 1981). Simultaneously, endovascular trophoblast cells stemming from the basal plate invade the walls of the spiral arteries, replacing the maternal muscular and endothelial cells with trophoblast cells, transforming the arteries into large diameter and low resistance blood vessels (Lyall, 2005).

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Figure 2

Implantation of blastocyst in the maternal endometrium. (A) During the implantation window (Day 6–12 post conception), the blastocyst adheres to the endometrium, and the placenta formation commences as the syncytiotrophoblast develops and invades the endometrium. (B) On Days 10–12 the implantation is completed as the embryo is encapsulated within the maternal tissue and the endometrial spiral arteries have been transformed into low resistance blood vessels, thus marking the onset of the placental blood flow.

The role of the immune system in a successful pregnancy is crucial (Fig. (Fig.3A).3A). Whilst the immune tolerance of the semi-allogeneic fetus is maintained, several components of the immune system fulfil their designated roles in preparation for implantation as well as during gestation (Entrican, 2002; Chaouat et al., 2004). Natural killer (NK) cells, macrophages and dendritic cells have all been detected in the feto–maternal interface (Guleria and Pollard, 2000; Moffett-King, 2002; Gardner and Moffett, 2003). Cytokines such as interleukin (IL-10), colony stimulating factor (CSF-1) and transforming growth factor-β among others have been linked with the implantation process and are expressed in uterine cells (Altman et al., 1990; Guleria and Pollard, 2000; Thaxton and Sharma, 2010). Implantation induces an inflammatory response because of invasion and damage of maternal tissue, with many cells undergoing apoptosis (Jerzak and Bischof, 2002; Joswig et al., 2003). Conversely, inflammatory cytokines such as interferon-γ and tumour necrosis factor alpha (TNF-α) are not usually expressed in the placenta and have been associated with abortion in mouse models (Entrican, 2002).

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Figure 3

Healthy and infected feto–maternal interface. (A) During a healthy pregnancy, the interaction between maternal decidua, vasculature and immune cells (macrophages, uterine natural killer cells and dendritic cells) with fetal trophoblast and syncytial cells is the cornerstone of establishment and progression of pregnancy. Molecules such as interleukin (IL-10), colony stimulating factor (CSF-1) and transforming growth factor-β are essential for trophoblast invasion during the implantation process and are expressed by uterine cells. (B) Infections can disrupt the balance of feto–maternal interactions. Plasmodium falciparum can infect trophoblast cells entering via the maternal bloodstream. Cytomegalovirus and Listeria monocytogenes are examples of viral and bacterial infections known to interfere with trophoblast cells.

Abnormal implantation, placentation or blood vessel transformation are thought to result in miscarriage (Michel et al., 1990; Ball et al., 2006). An active infection could interfere with the pregnancy by affecting any of the above-mentioned processes as well as disrupt the immune balance, whether it resulted in placental and fetal infection or not.

Examples of where we understand the mechanism of infection-induced miscarriage For most of the pathogens where an association has been demonstrated, the exact mechanism that leads from infection to miscarriage is unknown. Bacteria, protozoa and viruses utilize different mechanisms to infect their host and each one seems to induce a unique cascade of events in the feto–maternal interface, most of which remains to be determined. Our knowledge is derived mostly from animal studies and data on human pregnancies are scarce.

Multiple mechanisms can be utilized by pathogens to cross the placental barrier. Plasmodium, as mentioned previously, enters the host via the maternal circulation and can infect and multiply in the trophoblast (Fig. (Fig.3B),3B), even though its natural target cells are red blood cells (Agbor-Enoh et al., 2003; Moreno-Pérez et al., 2013). However, this mechanism of crossing the placental barrier is specific to malaria. Listeria monocytogenes uses two bacterial surface proteins called internalin A and B to invade the placenta, after passing from the intestinal barrier to the maternal circulation (Fig. (Fig.3B,3B, Vázquez-Boland et al., 2001; Lecuit et al., 2004; Disson et al., 2008). The presence of pathogenic organisms in the placenta induces a maternal immune response to infection that could result in miscarriage.

The susceptibility of placenta and fetus to several viruses has been investigated, as trophoblast cells have been identified as targets and viruses such as AAV and CMV have been detected in fetal tissue. CMV has been shown in vitro to replicate in trophoblast cells (Fig. (Fig.3B),3B), in addition to epithelial, stromal cells and macrophages that are known target cells of the virus (Minton et al., 1994; Fisher et al., 2000; Sinzger et al., 2008). In trophoblasts, CMV can induce an inflammatory response that increases apoptosis (Chou et al., 2006). CMV has also been shown to activate TNF-α, again leading to cell death (Chan et al., 2002). TNF-α is normally expressed in low levels by the placenta (Entrican, 2002); in the mouse CBA × DBA/2 model TNF-α was shown to increase fetal resorption via activation of NK cells, macrophages, and Th1-type cytokines (Clark et al., 1998). Furthermore, decreased levels of implantation-associated matrix metalloproteinases 2 and 9 (MMP2 and MMP9) in the early pregnancy villi of women with CMV indicate compromised invasive capability, that could result in miscarriage (Tao et al., 2011). These results suggest that CMV infection could lead to placental dysfunction as well as suggest possible routes of fetal infection resulting in miscarriage.

Bacterial infections initiate different responses from the immune system compared with viruses but gram-negative and gram-positive bacteria are both capable of activating the innate immune system (Takeuchi et al., 1999; Yoshimura et al., 1999). Most of our knowledge regarding bacterial infections and pregnancy comes from studies in mouse models. Nitric oxide and prostaglandins produced in the presence of bacterial lipopolysaccharides (LPS) were shown to be associated with embryonic resorption, as inhibition of this pathway reversed the effect in mice (Aisemberg et al., 2010). Poor uterine receptivity and implantation failure due to exposure to bacterial LPS was also reported in another study in mice (Deb et al., 2005).

Bacteria, viruses and protozoa utilize various mechanisms to infect fetal and maternal tissues (Fig. (Fig.3B),3B), a few of which have been elucidated yet several remain unknown. These pathways are possibly implicated in miscarriage caused by infection. Further research is however required, as understanding the exact mechanisms behind infection-induced miscarriages could lead to effective treatment and thus prevention.

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Conclusions

A plethora of bacterial, viral and protozoan infectious agents have been investigated to determine whether they are associated with an increased risk of miscarriage. The evidence presented in this review shows that infections such as BV, malaria, CMV, dengue fever, brucellosis and HIV may adversely affect pregnancy outcome. In contrast, there is no current evidence to suggest that C. burnetii, adeno-associated virus, Bocavirus, Hepatitis C and M. genitalium are associated with miscarriage. More importantly though, the lack of consensus regarding the effects of C. trachomatis, T. gondii, HPV, HSV1, HSV2, Polyomavirus BK, Hepatitis B and B19V infection reveals a gap in knowledge that future research should address, as these pathogens could potentially be harmful to early pregnancy development (Table (TableI).I). This issue is of particular importance for public health practitioners as it could alter current policies of prevention of infection, diagnosis and treatment in pregnant women.

Table I

Summary of pathogens and their association with miscarriage.

Bacteria Viruses Protozoa

Associated with miscarriage

Bacterial vaginosis (including Mycoplasma hominis and Ureaplasma urealyticum)

Brucellosis

Syphilis

Cytomegalovirus

Dengue fever (Flavivirus)

HIV

Rubella

Malaria (Plasmodium)

Little or no evidence for association with miscarriage

Coxiella burnetii

Mycoplasma genitalium

Adeno-associated virus

Bocavirus

Hepatitis C

None

Conflicting evidence for association with miscarriage

Chlamydia trachomatis

Human papillomavirus

Herpes simplex virus 1 and 2

Parvovirus B19

Polyomavirus BK

Hepatitis B

Toxoplasma gondii

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HIV, human immunodeficiency virus.

Even in diseases such as malaria and rubella, where a causative role is established, the underlying molecular cause of miscarriage is still unknown. The mechanism that has been proposed to explain how CMV infection could undermine a pregnancy could apply to other intracellular pathogens. Chlamydia trachomatis and U. urealyticum have been detected in placental cells, therefore they could cause a similar response (Joste et al., 1994; Baud, et al., 2011). It is well established that pregnancy is a balance between tolerance and rejection, as the maternal immune system is re-programmed to tolerate the allogeneic (paternal) fetal antigens (Thellin and Heinen, 2003). An active infection could destabilize this balance resulting in rejection, especially if it leads to a serious illness of the mother. Evidently, further research is required to understand the causes of pregnancy failure.

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In severe maternal infection, such as with influenza, HIV, dengue fever and malaria, the maternal response may result in miscarriage instead of a direct placental infection effect. However, pathogens such as Plasmodium parasites and Dengue fever's Flavivirus are known to be detected in fetal tissue and placenta, as are a plethora of other pathogens (Table (TableII).II). This is of particular importance, as proof of vertical transmission that could interfere with an ongoing pregnancy is more likely to result in miscarriage than a maternal infection. Examination of fetal tissues from infected mothers is essential to clarify whether vertical transmission is possible for pathogens as this has not yet been elucidated and it is evident from recent studies that an association is likely: for example, brucellosis, Mycoplasma genitalium and Coxiella burnetii infections. A very significant issue is fetal specimen contamination in cases with presence in the vagina of common viruses, such as HPV and HSV, as this does not equate to causation of miscarriage.

Table II

Summary of the sites of detection of pathogens in the studies in the review.

Microbe Site of detection

Fetus/placenta Vagina/cervix Serology/maternal blood/maternal urine Paternal sample

Adeno- associated virus Pereira (2010) Schlehofer et al. (2012)

Pereira (2010) Schlehofer et al. (2012)

Bacterial vaginosis (including M. hominis and U. urealyticum) Allanson et al. (2010) Rocchetti et al. (2011)

Bayraktar et al. (2010)

Donders et al. (2009)

Bocavirus Riipinen et al. (2010) Riipinen et al. (2010)

Brucellosis Kurdoglu et al. (2010)

Abo-shehada and Abu-Halaweh (2011)

Chlamydia trachomatis Baud et al. (2011) Baud et al. (2011)

Kortekangas-Savolainen et al. (2012)

Arsovic et al. (2014)

Coxiella burnetii Nielsen et al. (2012, 2013)

Cytomegalovirus Hadar et al. (2010)

Saraswathy et al. (2011)

Dengue fever (Flavivirus) Basurko et al. (2009) Tan et al. (2012)

Kariyawasam and Senanayake (2010)

Basurko et al. (2009)

Herpes simplex virus 1 and 2 Kapranos and Kotronias (2009) Kim, et al. (2012a, b)

Hepatitis B Ye et al. (2014) Ye et al. (2014)

Murad et al. (2013) Ye et al. (2014)

Hepatitis C Murad et al. (2013)

HIV Ezechi et al. (2013)

Kim et al. (2012a, b)

Gibb et al. (2012)

Darak et al. (2011)

De Beaudrap et al. (2013)

Human papillomavirus Skoczyński et al. (2011) Yang et al. (2013) Perino et al. (2011)

Malaria (Plasmodium) De Beaudrap et al. (2013) McGready et al. (2012)

De Beaudrap et al. (2013)

Mycoplasma genitalium Short et al. (2010)

Parvovirus B19 Brkic et al. (2011)

Emiasegen et al. (2011)

Polyomavirus BK Cajaiba et al. (2011)

Boldorini et al. (2010)

Syphilis Casal et al. (2012)

Hong et al. (2014)

Toxoplasma gondii Alvarado-Esquivel et al. (2014)

Halsby et al. (2014)

Vado-Solis et al. (2012)

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One interesting outcome of our review was that studies regarding infections and pregnancy outcome were conducted worldwide. Despite this, it seems that most of the studies were from countries in the developing world where the prevalence of specific diseases is higher.

A commonly observed limitation of the studies presented in this review was that few studies tested for the presence of other pathogens except for the one of interest. Several pathogens are often associated with one another, such as HIV with BV and malaria (Ledru et al., 1997; Taha et al., 1998; De Beaudrap et al., 2013).

Furthermore, the definition of terms, such as miscarriage and stillbirth, may differ from the ones generally accepted in some studies, as mentioned previously. For example, loss of pregnancy up to 36 weeks was considered miscarriage (Bayraktar et al., 2010), or in other cases less than 22 gestational weeks (Nielsen et al., 2012). Universal terminology guidelines are required to establish effective scientific communication.

The impact of immunization, if a vaccine is available such as in the case of HPV, could be detrimental in cases of infection-induced miscarriage. However, vaccine development for some of the pathogens of interest in this review is a complicated process and has been unsuccessful so far (Hafner et al., 2008; Mouquet and Nussenzweig, 2013).

To our knowledge, there are no EU guidelines regarding screening for infectious diseases in pregnancy. Current screening guidelines in the UK include offering tests for HepB, HIV, rubella (testing for susceptibility) and syphilis to pregnant women (Public Health England, 2015). Systematic screening for infections such as BV or CMV is not currently recommended in the UK. Without accounting for cost, screening for pathogens highlighted as high risk for miscarriage in this review should be reconsidered as an option worldwide.

New policies including public education to raise awareness and screening programmes for appropriate pathogens associated with adverse pregnancy outcomes could result in a decrease in the number of miscarriages.

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Supplementary data

Supplementary data are available at http://humupd.oxfordjournals.org/.

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Authors' roles

S.G. drafted the manuscript, substantially contributed to conception and design, analysis and interpretation of data. N.W. contributed to manuscript preparation and critically revised important intellectual content. K.C. critically revised important intellectual content. G.E. critically revised important intellectual content. S.E.M.H. substantially contributed to conception and design, and critically revised important intellectual content. A.W.H. substantially contributed to conception and design, and critically revised important intellectual content.

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Funding

S.G. is funded by the MRC Centre for Reproductive Health and Tommy's Charity. N.W. is funded by the Biotechnology and Biological Sciences Research Council (BBSRC)/Zoetis Industrial Partnership award. G.E. is funded by the Scottish Government Rural and Environment Science and Analytical Services Division (RESAS). Funding to pay the Open Access publication charges for this article was provided by RCUK UK Open Access Fund.

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Conflict of interest

The authors have no conflict of interests in relation to this work.

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Supplementary Material

Supplementary Data:

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Acknowledgements

The authors would like to acknowledge Sharon Cameron's critical review of the manuscript and suggestions, Ronnie Grant for the electronic drawing of the figures in the present review, Dr Colin Duncan for his expert opinion on statistics and Miss Eleni Fitsiou for proofreading the manuscript.

Apple Cider Vinegar During Pregnancy (Benefits & Risks)- Pregnancy Care

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Which painkiller can cause miscarriage?

Women who take even a small dose of painkillers such as ibuprofen early in their pregnancy more than double their risk of suffering a miscarriage, research shows.

18 Foods That Can Cause Miscarriage in Early Pregnancy😱

The findings prompted medical experts to advise mothers-to-be to avoid taking the drug and instead to use paracetamol for pain relief. Taking any painkillers from the class of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen, naproxen and Diclofenac – in the first 20 weeks after conception increases the risk of miscarriage by 2.4 times, the study found. The paper, published in the Canadian Medical Association Journal, found that pregnant women taking any type of NSAID, and any dose of one, ran that scale of extra risk of spontaneous abortion.

Researchers examined 4,705 cases of miscarriage, of which 352 (7.5%) had taken a non-aspirin NSAID.

The women in the study, aged from 15 to 45, were compared with 47,050 women of a similar age who had not lost a baby during pregnancy, of whom 1,213 (2.6%) had used an NSAID.

They identified the drug with the highest risk of miscarriage as Diclofenac when used on its own, and the lowest as rofecoxib, which was taken out of use in 2004 because of safety concerns. "The use of non-aspirin NSAIDs during early pregnancy is associated with statistically significant risk (2.4-fold increase) of having a spontaneous abortion," said Dr Anick Berard, from the University of Montreal, one of the study's Canadian and French co-authors.

"We consistently saw that the risk of having a spontaneous abortion was associated with gestational use of Diclofenac, naproxen, celecoxib, ibuprofen and rofecoxib alone or in combination, suggesting a class effect."

The authors concluded: "Women who were exposed to any type and dosage of non-aspirin NSAID during early pregnancy were more likely to have a spontaneous abortion.

"Given that the use of non-aspirin NSAIDs during early pregnancy has been shown to increase the risk of major congenital malformations and that our results suggest a class effect on the risk of clinically detected spontaneous abortion, non-aspirin NSAIDs should be used with caution during pregnancy." Previous studies of use of NSAIDs in pregnancy have produced mixed results.

But the Royal College of Midwives (RCM) and Royal Pharmaceutical Society (RPS) advised that, in order to ensure safety of the mother and her unborn child, they should be avoided in pregnancy altogether. "We need to advise women, as midwives often do, to avoid buying over the counter medication for pain relief. If a pregnant woman does need to take any analgesia, then paracetamol would be appropriate," said Janey Fyle, the RCM's professional policy adviser. "The most important advice to pregnant women is to report any pain to the midwife and avoid buying over the counter medication, as it may be contraindicated in pregnancy."

Jane Bass, the RPS's women's health spokeswoman, said: "This study reinforces current advice that women should avoid ibuprofen and other non-steroidal medicines in pregnancy. For most women, paracetamol is the safest painkiller to take at any stage of pregnancy. In certain circumstances, it may be appropriate for women to take medicines like these in the first six months of pregnancy, but only under close medical supervision."

But Dr Virginia Beckett of the Royal College of Obstetricians and Gynaecologists, a consultant at Bradford Royal Informary, said that while it was safe for women to take paracetemol in pregnancy "if a woman takes a NSAID the risk of miscarriage is still very low".

About a quarter of women who become pregnant will miscarry at least once, and at least one in eight of pregnancies in England and Wales in 2009 ended that way, official figures and studies suggest.

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Can hot water miscarriage?

Nothing is more relaxing and soothing than soaking yourself in a hot water bath at the end of a long day. The hot bath acts as an antidote, reduces stress and relaxes your mind and body. The feeling of just laying down in a bathtub filled with warm water is divine, especially when you are pregnant. But it is widely believed that taking a hot water bath is not good when you are expecting. Is this really true or is it just an old wives' tale? Read on to know the truth.

The reality

It is alright to take a hot water bath when you are expecting, but the water should not be too hot. Water should not be hot enough to raise your core body temperature to102°F for more than 10 minutes. Taking a bath in excessively hot water can cause several health issues like:

-It may cause a drop in blood pressure, which can deprive the baby of oxygen and nutrients and can increase the risk of miscarriage.

-Studies also suggest that taking a hot water bath, especially in the first trimester increases the chance of birth defects like spina bifida. -You might feel a little dizzy and weak

-You might suffer from hyperthermia (A condition in which the body starts to absorbs more heat than it repels.)

So, to avoid any pregnancy-related complications, it is advised to avoid taking a bath with extremely hot water. That's why saunas, hot tubs or steam baths are not considered safe during pregnancy. You can still opt for a hot shower but avoid long and steamy ones.

Try to keep the temperature of the water warm enough to be comfortable. You should not sweat or your skin should not turn red when you are in the bathtub. If that happens, then immediately get out of the tub and let the water cool.

Tip

While preparing your warm bath, skip the bubbles and scented oils and salts. They can alter your vagina’s acidic balance and can cause a yeast infection.

Can you drink apple cider vinegar with the mother while pregnant?

Alongside green smoothies and kombucha, apple cider vinegar is one of the most popular drinks among wellness enthusiasts these days.

Many claim that drinking apple cider vinegar prevents indigestion and leg cramps, which, if you are pregnant, may sound all-too-familiar.

But is it safe to drink apple cider vinegar during pregnancy?

In this article, we’ll outline our position on apple cider vinegar during pregnancy. We’ll explain the reasons for our stance and list its benefits, risks, and the science behind it all, to help you make an informed decision.

What Is Apple Cider Vinegar?

Apple cider vinegar (ACV) is essentially apple juice or cider mixed with yeast, which ferments the naturally occurring sugars in the fruit, forming alcohol.

After the initial fermentation, more bacteria are mixed with the alcohol, turning it into acetic acid (1).

Types Of Apple Cider Vinegar

There are two basic kinds of ACV – unfiltered and filtered. ACV can also be pasteurized or unpasteurized.

Processing removes sediment and bacteria to make filtered and pasteurized apple cider vinegar, respectively. Typically, filtered ACV is also pasteurized. The product is a clear, amber-toned liquid.

Pasteurization refers to mildly heating the ACV to destroy live bacteria (2). The process of filtration, though, involves removing sediment.

Unfiltered apple cider vinegar does not undergo additional filtration, so it may be cloudy due to the sediment and “the mother.” And often, unfiltered ACV is also unpasteurized — just raw.

“The mother” is a mixture of acetic acids and beneficial bacteria that occurs naturally in the fermentation process. It’s a strand-like residue in the vinegar and is believed to be responsible for most of the health benefits.

One of the most well-known brands of unpasteurized apple cider vinegar is Braggs. It is widely available in health stores and on Amazon.

What To Know About ACV

Health and wellness enthusiasts believe apple cider vinegar is beneficial for a variety of ailments.

Keep In Mind

Some of these claims are more stories than anything else as they haven’t been proven in scientific studies, but others are backed by medical research. So, take ACV information with a grain of salt, and don’t hesitate to check with your healthcare provider when in doubt.

Diabetes: Scientific studies have shown ACV can lower blood sugar levels and improve insulin sensitivity when consuming certain foods. Still, you should only use it for blood sugar control under the guidance and supervision of your doctor. This is especially important if you are already taking blood sugar-lowering medications. ACV can help with blood sugar control but not replace the therapy your doctor prescribes (3).

Digestion: When consumed regularly, apple cider vinegar can also help detoxify your body. It contains probiotics that support gut health, improve bowel function, and balance your body’s pH levels. Optimal pH balance and gut health can relieve conditions such as constipation and acid reflux. It is thought that taking 1-2 tablespoons of ACV in a big glass of water can help with morning sickness or nausea, but there is no scientific proof for this (4). Nevertheless, there’s a possibility that ACV can actually cause heartburn and trouble with digestion, especially digestion of starch-rich ingredients like potatoes. Either way, make sure to avoid unpasteurized ACV during pregnancy.

Weight Loss: When consumed before meals, ACV helps you feel full, so you may eat less and keep your calorie intake down. However, pregnancy isn’t the time to diet or try to lose weight. Instead, focus on eating a diet of well-balanced, nutritionally dense foods to nourish yourself and your growing baby.

Common Cold: Many pregnant women are uncomfortable taking over-the-counter medications for cold and sore throat symptoms. Since ACV has immunity-boosting and antibacterial properties, it could be an option to fight these symptoms. You can make a soothing drink by mixing one part ACV, five parts warm water, and 2-3 tablespoons of honey. Still, make sure to avoid unpasteurized ACV during pregnancy, and if you want to avoid drinking it altogether, you can try making an ACV gargle for your sore throat (5).

Leg Cramps: Sleep disruption due to leg cramping is common in pregnancy. This may be caused by low potassium levels and pressure on the circulatory system from the growing uterus. ACV is high in potassium can help alleviate this discomfort.

How to Prevent Miscarriage in Early Pregnancy - Early Pregnancy Symptoms

In addition to consuming apple cider vinegar, many people also use the substance topically — for everything from dandruff treatment to foot deodorizers!

Thanks to its antibacterial and anti-inflammatory properties, these common pregnancy skin concerns might benefit from a small amount applied topically:

Warts.

Varicose Veins.

Eczema and Acne.

If you have varicose veins, you can use ACV as an add-on to conservative treatment, such as elevation. Just make sure you don’t apply it to broken skin (6).

Still, ACV is a weak acid, and it can cause skin irritation. So, if you decide to apply it to your skin, make sure you use small doses (always use it diluted: two parts ACV to one part water). Apply it first to a small part of your skin (this also helps check for an allergic reaction), and don’t keep it on too long. If it starts feeling uncomfortable beyond a slight burning sensation, remove it right away. Never use it on open wounds or genital warts (7).

While there is a lot of talk about the health benefits of ACV, it’s worth noting that ACV can interact with certain medications (including laxatives, which some moms with constipation might be taking). It can make symptoms of a pre-existing ulcer worse and can affect teeth enamel. Consuming too much can also cause serious electrolyte disbalances.

Headshot of Dr. Irena Ilic, MD

Editor's Note:

Dr. Irena Ilic, MD

A Word Of Caution

Healthcare professionals recommend pregnant women should avoid consuming unpasteurized foods due to the risk of food poisoning. No proven or assumed health benefits can outweigh the possible health risks for you and your baby.

Unpasteurized apple cider vinegar — which is often unfiltered — still contains the “mother,” along with potentially beneficial enzymes and bacteria.

Important To Remember

Pregnant women are at a higher risk for foodborne illnesses due to hormonal changes and lowered immune system function. This is one reason to avoid unpasteurized foods. Remember that while you are pregnant, your baby still does not have a fully developed immune system, and some of the bacteria can cross the placenta.

Symptoms of food poisoning can be flu-like, including fever, muscle aches, nausea, vomiting, and diarrhea. Headaches, stomach pain, and dehydration can also occur.

However, there are foodborne illnesses such as listeriosis, toxoplasmosis, or salmonellosis, which not only affect mom but can cause serious complications for the unborn baby (8). The bacteria causing listeriosis, toxoplasmosis, or salmonellosis might not be in all unpasteurized apple cider vinegar, but the risk is present.

That’s why it is important for mom-to-be to consult her doctor or midwife to decide if she should consume ACV during pregnancy and get advice on the product choice.

You may wonder whether pasteurized ACV still has the potential to aid with the above-listed health issues. The truth is, research studies have not been able to confirm whether all potential benefits of ACV are lost after pasteurization.

Headshot of Dr. Irena Ilic, MD

Editor's Note:

Dr. Irena Ilic, MD

ACV Use In Pregnancy

Apple cider vinegar may be a hot wellness trend, but it might not be right for you, especially during pregnancy.

Claims that apple cider vinegar can cure a wide variety of ailments are promising. However, many have yet to be scientifically proven. We need more research to confirm all of its risks and benefits.

Until then, rest, try to enjoy your pregnancy — despite the discomforts, and take the cure-all apple cider vinegar claims with a grain of salt.

How do I know if Im pregnant with vinegar?

Homemade (DIY) pregnancy test to try

For many women, becoming a mother is the most desirable feeling. Missing your period is the first sign that can indicate pregnancy. While one can always find test kits available in the market, homemade pregnancy kits have been used by women for decades. A lot of them are based on folk remedies and can deliver good results, as they work by detecting the level of HCG (human chorionic gonadotropin ), pregnancy hormones in the urine.

With the advancement of medicine, we have a plenty of options in the form of readily available pregnancy kits, there are a lot of simple, safe and super cheap options available right in the comfort of our homes.

The best part of these do-it-yourself pregnancy tests is the privacy that they provide. So, if you are fretting over an unplanned pregnancy or want to retain the secrecy, we are listing down 8 DIY natural pregnancy tests.

02/13Are there any benefits to the tests?

Homemade tests do have some benefits to them. If you have an unplanned pregnancy and want to hide it from your close ones, homemade supplies won't doubt suspicions. Plus, since most of these ingredients are easy to find, you can take it in the comfort of your home without having to step out. Many of the supplies do not even have an expiry date so can be used safely.

03/13Bleach pregnancy test

This method is said to give the most accurate and quicker result than any other method.

Take a clean container and collect urine in it. Now add some bleaching powder to it and mix it properly to avoid lumps. If the mixture forms a foam or fizz, it means you are pregnant and if there is no foam, you are not pregnant.

04/13Sugar pregnancy test

The easiest of all tests, this method was most widely used when there were no scientific pregnancy kits available.

Take one tablespoon of sugar in a bowl and add one tablespoon of urine to it. Now notice how sugar reacts after you pour urine on it. If the sugar starts forming clumps, it means you are pregnant and if the sugar dissolves quickly, it means you are not pregnant.

The hCG hormone released from the urine does not allow the sugar to dissolve properly.

How to Prevent Miscarriages - What no one else will tell you about preventing miscarriages

05/13Toothpaste pregnancy test

You can use any toothpaste but make sure it should be white in colour.

Take two tablespoons of white toothpaste in a container and add the urine sample to it. If the toothpaste changes its colour and becomes frothy, you are pregnant.

06/13Vinegar pregnancy test

Yes, even vinegar can help you test your pregnancy. Remember, you will need white vinegar for this particular test.

Take two tablespoons of white vinegar in a plastic container. Add your urine to it and mix it properly. If the vinegar changes its colour and forms bubbles, you are pregnant and if there is no change you are not pregnant.

07/13Salt pregnancy test

This DIY pregnancy kit works just like the sugar test. Instead of the sugar, salt is used. The same steps are to be followed. Urine and salt are to be mixed in equal parts. Wait for a minute. If the salt forms a creamy white clump of sorts, it means a positive result. If no such effect is seen, it might mean you are not pregnant. This again is based on tradition and there is no scientific evidence to support the same.

08/13Soap pregnancy test

You can use any type of bathing soap for performing this test. Take a small piece of soap and pour your urine on it. If it forms bubbles, it means you are pregnant and if not, you are not pregnant.

09/13Baking soda pregnancy test

Take two tablespoons of baking soda and add two tablespoons of urine to it. Now observe the reaction. If you see bubbles like you see when you open a soda bottle, you are pregnant.

10/13Wine pregnancy test

A little expensive and time taking but wine test is another reliable method to test pregnancy at home.

Take half a cup of wine and add an equal amount of urine to it. Mix it nicely and wait for 10 minutes to observe the reaction. If the original colour of the wine changes, that means you are pregnant.

11/13Tip

If you try one of the above tests and it turns positive, try another method to be sure. If the second method also gives a positive result, consult your doctor as soon as possible.

12/13How to increase the accuracy of the homemade pregnancy test

- Use the first urine of the day as it has concentrated hCG levels.

- Make sure to use a clean plastic container to collect the urine.

- Collect a considerable amount of urine for the test. If it is too little, it may not be sufficient to give the correct result.

- Wait for five to 10 minutes for the reaction to occur.

- You can also repeat the method or use the second method to be double sure.

13/13Are these tests scientifically reliable?

Even though homemade tests have been used by generations and there's a lot of history behind their usage, there is no conclusive proof or scientific evidence that any of these tests work to deliver a 100% positive result. A good result can be resultant of coincidence as well.

Apart from homemade tests, certain fertility monitoring tools and awareness methods(such as measuring basal body temperature, tracking ovulation dates) can make a woman aware of her pregnancy. While they are reliable, they take a longer time to process and need prior knowledge.For proper detection, using a store-bought kit, or getting a test done from the doctor's clinic is the safest.

What causes miscarriage?

Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 10 to 20 percent of known pregnancies end in miscarriage. But the actual number is likely higher because many miscarriages occur very early in pregnancy — before you might even know about a pregnancy.

The term "miscarriage" might suggest that something went wrong in the carrying of the pregnancy. But this is rarely true. Most miscarriages occur because the fetus isn't developing as expected.

Miscarriage is a relatively common experience — but that doesn't make it any easier. Take a step toward emotional healing by understanding what can cause a miscarriage, what increases the risk and what medical care might be needed.

Products & Services

Book: Your Guide to Miscarriage and Pregnancy Loss

Symptoms

Most miscarriages occur before the 12th week of pregnancy.

Signs and symptoms of a miscarriage might include:

Vaginal spotting or bleeding

Pain or cramping in your abdomen or lower back

Fluid or tissue passing from your vagina

If you have passed fetal tissue from your vagina, place it in a clean container and bring it to your health care provider's office or the hospital for analysis.

Most women who have vaginal spotting or bleeding in the first trimester go on to have successful pregnancies.

Can you drink apple cider in early pregnancy?

Apple Cider Can Be a Healthy Addition to a Pregnant Woman's Diet

Apple cider is nothing more than apple juice before it has been filtered to remove the crushed apple pulp from which is it made. Leaving the pulp in the juice gives it a heartier flavor and its distinctive, cloudy look. It's absolutely possible for pregnant women to enjoy the earthy taste and thick, velvety texture of apple cider, with one important caveat: the apple cider must be pasteurized to ensure that it carries no harmful bacteria.

Natural Heartburn Prevention During Pregnancy

Pasteurization vs. Organic

Pasteurized juices have been heated to a high temperature for a very short amount of time. This kills most harmful bacteria without changing the texture or taste. The bacteria most often found in unpasteurized apple cider is Escherichia coli or E. coli. This can find its way into apple cider if it's made from ground apples which have been exposed to the manure of pasture animals or made from apples handled by people exposed to manure. It can also happen after apples are washed in contaminated well water. E. coli is of particular concern to people with compromised immune systems, such as pregnant women. Apple ciders labeled as organic are generally not pasteurized.

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Benefits vs. Concerns

The benefits of drinking apple cider are many. It's naturally high in vitamin C and antioxidants, which help fight the damage caused by free radicals. Apples and fresh apple products, such as applesauce, apple juice and apple cider, are soothing and rarely allergenic. Drinking cider helps keep you hydrated, while the fiber in the cloudy pulp can help keep you regular. The lush sweetness of apple cider can also help tame sugar cravings, making it good not only for you but for the children you already have. Most important is making sure that what you drink is pasteurized.

Apple Cider vs. Apple Cider Vinegar

Apple cider vinegar, or ACV, is apple cider that has been fermented twice; once into alcohol and then into acetic acid. Acetic acid helps break down foods, so folklore tells us that a spoonful of apple cider vinegar every day will help your digestion. All of the nutritional value in apple cider vinegar resides in the mother, which is the traditional name for the sediment that forms in the bottom of any container of unpasteurized ACV. Pasteurization removes the mother and thereby any rumored benefits. The acetic acid in pasteurized apple cider vinegar can interact with certain medications, and unpasteurized apple cider vinegar may not be safe to drink, so it's best to simply avoid ACV while pregnant.

When to Call Your Doctor

If you think you may have consumed unpasteurized apple cider either before you knew you were pregnant or unknowingly afterward, contact your doctor. Food poisoning can feel like the onset of the flu, with muscle aches, nausea, dizziness and vomiting. The sooner you see your doctor, the sooner you can begin a course of treatment to protect yourself and your baby.

Tips

If you've purchased or have been given apple cider and don't know whether it is pasteurized, you can do so at home. Heat the apple cider to 161 F for at least 15 seconds. Any longer and the heat will change its flavor. Store your cider at 40 F or lower to keep it fresh.

What is apple cider vinegar?

Apple cider vinegar (ACV) is a food, condiment, and very popular natural home remedy.

This particular vinegar is made from fermented apples. Some kinds may contain beneficial bacteria when left unpasteurized and with the “mother”, while others are pasteurized.

Unpasteurized ACV, because it’s rich in probiotic bacteria, has many health claims. Some of these may appeal to women who are pregnant.

Consumption of bacteria might be a concern for some pregnant women, however. This article explores these concerns, as well as the safety and benefits of using ACV while pregnant.

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Is ACV safe for pregnancy?

There’s no research proving that ACV specifically is either safe or unsafe for pregnancy.

Generally speaking, authorities and research suggest that pregnant women should be cautious when consuming certain unpasteurized products. These may harbor bacteria such as Listeria, Salmonella, Toxoplasma, and others.

Since the immune system is slightly compromised during pregnancy, pregnant women may be at higher risk for foodborne illness. Some of these illnesses can be deadly.

The fetus is also at higher risk to miscarriage, stillbirth, and other complications from these same pathogens.

On the other hand, all kinds of apple cider vinegar contain acetic acid. Acetic acid is known to be antimicrobial, favoring growth of only certain beneficial bacteria over others.

Studies show acetic acid can kill Salmonella bacteria. It may alsoTrusted Source kill Listeria and E. coli as well as Campylobacter.

According to this research, certain harmful pathogens that develop may not be as dangerous in apple cider vinegar as in other unpasteurized foods. Still, the jury is out on ACV’s safety until more definitive and specific research is done.

Pregnant women should only use unpasteurized apple cider vinegar with great caution and knowledge beforehand of the risks. Talk to your doctor before using unpasteurized vinegars while pregnant.

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Pregnant women may instead use pasteurized apple cider vinegar safely and with no concerns. However, it may lack some of the health benefits you seek, especially ACV’s claimed probiotic benefits. Keep in mind, however, that there are safer probiotic supplements available, which don’t carry these potential risks.

Does ACV help certain symptoms of pregnancy?

Though the safety of apple cider vinegar is unproven, many pregnant women still use it as a remedy for many things. No harm or other complications have yet been reported or connected with its use during pregnancy, whether pasteurized or unpasteurized.

ACV may especially help certain symptoms or aspects of pregnancy. Remember that pasteurized apple cider vinegar is considered the safest to use.

Apple cider vinegar may help with morning sickness

Some people recommend this home remedy for morning sickness.

The acids in ACV are known to possibly help certain other gastrointestinal disturbances. As such, it may help some women with nausea brought on by pregnancy.

However, there aren’t any studies to support this use. What’s more, taking too much apple cider vinegar may cause or worsen nausea, too.

Pasteurized and unpasteurized vinegar may apply for this symptom, as it has more to do with the vinegar’s acidity than its bacteria.

To use: Mix 1 to 2 tablespoons ACV in a tall glass of water. Drink up to twice per day.

Apple cider vinegar may help with heartburn

Though it’s unclear if ACV helps morning sickness, it may help with heartburn. Pregnant women sometimes experience heartburn during their second trimester.

A study in 2016 found that ACV may help people with heartburn who didn’t respond well to over-the-counter antacids. The unpasteurized kind was specifically tested.

To use: Mix 1 to 2 tablespoons ACV in a tall glass of water. Drink up to twice per day.

Apple cider vinegar may improve digestion and metabolism

Another interesting study in 2016 showed that apple cider vinegar could alter digestive enzymes. The study was on animals.

It specifically appeared to improve the way the body digested fats and sugars. Such effects may be good, especially for type 2 diabetes, however no human studies were conducted. This raises the question if ACV may help reduce the risk of gestational diabetes.

It was unclear whether unpasteurized or pasteurized ACV was used in the study.

To use: Mix 1 to 2 tablespoons apple cider vinegar in a tall glass of water. Drink up to twice per day.

Apple cider vinegar may help or prevent urinary tract and yeast infections

ACV may often be recommended for helping clear up urinary tract infections (UTIs). The same has been said about yeast infections.

Both of these can be a condition that pregnant women experience often. However, there aren’t any studies proving this works with apple cider vinegar specifically. Learn about proven ways to treat a UTI during pregnancy.

A study in 2011 did show rice vinegar helped clear up a bacterial urinary infection, though it may not be the same as apple cider vinegar.

Pasteurized or unpasteurized ACV may be used, since the most evidence for any vinegar helping with urinary tract infections was with a pasteurized rice vinegar.

To use: Mix 1 to 2 tablespoons apple cider vinegar in a tall glass of water. Drink up to twice per day.

Apple cider vinegar may help with acne

Due to hormonal changes, some pregnant women may experience acne.

Some studies suggest that acetic acids, which are found in high amounts in ACV, may help fight acne. These were only effective when used in combination with certain light therapies, however.

Pasteurized or unpasteurized apple cider vinegar may be used as a topical method of treatment. This poses less of a threat of foodborne illness.

Though no studies are strong enough yet to support ACV for acne, some pregnant women report beneficial results nonetheless. It’s also safe and cheap to use. Note that there are other all-natural pregnancy acne remedies you may want to try.

To use: Mix one part ACV to three parts water. Apply to skin and acne-prone areas lightly with a cotton ball.

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The bottom line

Some people may recommend or use apple cider vinegar as a home remedy for many things during pregnancy.

A lot of these uses aren’t supported by much scientific evidence. Some show more support and effectiveness from research for certain symptoms and conditions than others.

As far as we know, there are no current reports of harm from using ACV of any type during pregnancy. Still, pregnant women may want to talk to their doctors first about using unpasteurized apple cider vinegars.

For the utmost safety, avoid using vinegars with the “mother” while pregnant at all. Using pasteurized vinegars can still provide some useful health benefits during pregnancy.

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