Is it possible to drink furadonin during pregnancy?

Double beauty

Pregnancy is a wonderful time in a woman’s life. But often expectant mothers, as well as young mothers breastfeeding, are upset by the presence of many restrictions in all areas of life - from nutrition to sports and recreation. In particular, there are many prohibitions in the matter of self-care. But you really want to be beautiful during this magical period of your life, and modern women are usually not ready to just give up going to a cosmetologist and using a variety of cosmetics for several years.

Fortunately, it is not at all necessary to wrap yourself in a burqa for this entire period and use exclusively baby cream and a cucumber mask. Let's, together with the cosmetologist of the EuroMed Clinic, Svetlana Mikhailovna Lexandrova, figure out what is actually prohibited during this period and what is not.

The role of vitamin D in human reproductive function

This collective term in medicine refers to two substances that are similar in chemical composition and structure:

• Ergocalciferol (D2) is a form of vitamin D that enters the human body exclusively with food;
• Cholecalciferol (D3) is a form that enters the body with food and is synthesized in it under the influence of ultraviolet radiation.

Regardless of the form of vitamin D, its physiological role is to regulate calcium-phosphorus metabolism. The most famous result of the “work” of this substance is the formation of bone tissue and the normal development of the musculoskeletal system in humans. However, in the human body it also performs a number of functions related to the female reproductive system:

• Streamlines the course of the monthly cycle, including ensuring timely formation of follicles and ovulation of the egg;
• Blocks the rejection of the embryo by the mother's immune system, which initially recognizes it as a foreign object (due to the father's genes);
• Increases the readiness of the uterine endometrium for implantation and fixation of the fertilized egg in it.

The effect of vitamin D on conception and subsequent pregnancy is significant. So, if conception was successful, but for some reason a woman lacks this substance in her body, the likelihood of premature birth or miscarriage increases sharply. The effect of vitamin D on the reproductive system of the father has also been recorded - in particular, it increases the number of active and morphologically correct sperm in the seminal fluid.

This substance also affects the body of the mother and child indirectly - through other systems and organs:

• ensures normal functioning of the immune system, reducing the risk of developing diseases such as ARVI and influenza, rubella, herpes, which can cause congenital pathologies in a child;
• regulates the development of fetal bone tissue - vitamin D deficiency leads to rickets, congenital osteoporosis and other problems with the musculoskeletal system;
• promotes the synthesis in the fetal body of pulmonary surfactant - a surfactant that prevents the adhesion of the pulmonary alveoli and thereby ensures normal breathing of the child after birth.

Take the first step

make an appointment with a doctor!

Vitamin D deficiency has a very negative effect on conception and subsequent pregnancy. In the mother during the period of preparation for pregnancy and its course, it can cause complications such as gestational diabetes mellitus, polycystic ovary syndrome, preeclampsia, etc. The normal concentration of this substance sharply increases the chance of successful conception during in vitro fertilization.

Hair care

There is an unusually persistent myth that pregnant women should not cut or dye their hair.

Where it came from is now difficult to understand, but nevertheless, in the antenatal clinic you will definitely meet several expectant mothers with noticeably grown hair roots and a haircut that has lost all shape. There is no scientific evidence that cutting or dyeing hair with modern gentle hair dyes can harm a pregnant woman or unborn child. Therefore, forget about grandma’s fears and feel free to go to the beauty salon! The only caveat is that don’t forget that after the birth of your baby, you most likely won’t have time for a hairdresser in the first months, so closer to the birth, get a haircut that will be easy to care for when you’re short on time.

Manicure and pedicure

Can! You can do a manicure, you can do a pedicure, you can paint your nails and remove polish - all this will not affect your baby’s health in any way. The only thing is to be doubly attentive to the sterility of the instruments that the master uses - because now you are responsible not only for yourself, but also for the health of the unborn child. Although, to be honest, it’s unlikely that you, even if you weren’t pregnant, would agree to catch any unpleasant infection because of unsterile instruments.

By the way, keep in mind that almost all maternity hospitals require that the woman in labor not have nail polish. This often surprises women, but in fact such a wish makes sense. During childbirth, a variety of unforeseen situations are possible, and one of the symptoms signaling a problem is the condition of the nails. If your nails begin to turn blue, this indicates problems with the cardiovascular and respiratory systems. Perhaps you shouldn’t risk your health for bright marigolds in such a situation.

Cosmetics

It is forbidden

Products with retinoids are strictly prohibited during pregnancy, breastfeeding and three months before a planned pregnancy - they can have a teratogenic and embryotoxic effect, that is, negatively affect the fetus and increase the risk of congenital malformations. Therefore, products with retinoids are prescribed only if there is a negative pregnancy test and reliable contraception.

It is undesirable to use drugs containing acids during pregnancy. These are quite aggressive agents, and during pregnancy they can cause an unpredictable reaction: irritation, pigmentation disorders (lightening of some areas or, conversely, the appearance of dark spots), etc.

You should not use creams containing hormones (usually these are cosmetics that fight the signs of aging), because the body already undergoes powerful hormonal changes during pregnancy and lactation; you should not additionally load it.

Need to!

Be sure to use sunscreen during pregnancy. This is due to the fact that hormonal changes in the body often provoke the development of hyperpigmentation. And the sun's rays make this problem worse.

Remedies against stretch marks. Striae or stretch marks are such an unpleasant phenomenon that it is much easier to prevent than to get rid of it later. Be sure to use good anti-stretch mark creams from the very beginning of pregnancy, applying them with massaging movements to problem areas: chest, shoulders, abdomen, hips, buttocks. By the way, stretch marks often appear after childbirth, during lactation - after all, a nursing woman’s breasts can increase by several sizes compared to their normal state. Therefore, do not forget about the prevention of stretch marks throughout the entire period of breastfeeding.

Symptoms of the disease

There are two forms of the disease - acute and chronic. Acute cystitis during pregnancy has the following symptoms:

• Cloudy urine (may have a pinkish tint).
• Painful sensations during urination.
• Constant feeling of a full bladder.
• Presence of drops of blood or mucus in the urine.
• Pain in the lower abdomen, aggravated by pressure.

It is important to distinguish cystitis from the physiological changes that occur during pregnancy. In the chronic form, the symptomatic picture is less pronounced, and exacerbation of the disease occurs periodically.

Treatment of cystitis in the 1st trimester

Treatment of cystitis involves an integrated approach to the problem. Several methods are used at once:

• taking medications;
• special diet;
• compliance with the drinking regime.

When treating pathology in the early stages of pregnancy, the most gentle methods are selected, since this period is the most dangerous for the baby. During the 1st trimester, future organs and systems of the fetus are formed, so any external influence can lead to a number of complications and pathologies.

At the initial stage, a diagnosis is carried out, which helps to choose the right treatment regimen. Tetracyclines and sulfonamides, which are most often used to eliminate cystitis, are prohibited, so the choice is made in favor of other, safer drugs.

Salon treatments

Many people forget the way to a cosmetologist as soon as they see two lines on the test. This is a completely unnecessary sacrifice! Yes, there are certain procedures that are not recommended during pregnancy, but most skincare programs are quite affordable and will help maintain your beauty during this wonderful period. Just remember to notify the cosmetologist about your interesting situation, and the doctor will offer you suitable care.

It would also be a good idea to consult with the obstetrician-gynecologist who is caring for your pregnancy.

It is forbidden

• Procedures associated with a sharp change in temperature: cryosauna, hot wrap, etc.
• Hardware stimulating procedures can provoke contraction of the uterine muscles.
• Laser procedures and photorejuvenation.
• Injection techniques.

Massage

There is a widespread belief that pregnant women should not receive massage. In fact, it is possible, but only if the massage therapist has the appropriate qualifications. Regular massage can cause undesirable consequences. But a special massage for pregnant women, on the contrary, will significantly improve your well-being and condition. During this difficult period, when increasing weight, swelling, increased stress on the back and legs can cause many unpleasant moments, an experienced massage therapist will be of great help.

The main thing to remember is to be less nervous, don’t let meaningless restrictions poison your life and enjoy every moment of your magical state!

Subclinical hypothyroidism and pregnancy

To determine the indications for the treatment of subclinical hypothyroidism, it is necessary to take into account the effect of different TSH levels on the course of pregnancy and its outcomes. Unfortunately, not all studies identify groups of pregnant women with varying degrees of increased TSH and take into account the titer of antithyroid antibodies, which also affect the course of pregnancy. A study by N. Benhadi [17] revealed a positive correlation between TSH levels, starting from normal values, and spontaneous abortion: with each doubling of TSH, the probability of miscarriage increased by 80%. An increase in TSH in the range of 2.5–5.0 mU/l in women without antithyroid antibodies is accompanied by an approximately 2-fold increase in the risk of miscarriage, both in early and late pregnancy [18, 19]. It should be noted that the effect of subclinical hypothyroidism on pregnancy increases when using local TSH standards. A study conducted in Australia showed that the risk of miscarriage increases by 3.66 times with TSH>95 percentile in early pregnancy, although TSH>95 percentile combines subclinical and overt hypothyroidism, which may affect the results of the study [20]. The risks of spontaneous abortion increase with a combination of elevated TSH and high titres of antibodies to thyroid peroxidase (TPO). In a study by C. Lopez-Tinoco et al. [21] demonstrated that the presence of antibodies to TPO in pregnant women with subclinical hypothyroidism increases the risk of miscarriage by more than 10 times. Researchers from China received similar data. The highest risk of miscarriage was identified in the group of pregnant women with subclinical hypothyroidism (TSH 5–10 mU/l) and elevated titer of antibodies to TPO (odds ratio (OR) 9.56; p<0.001). In a study by Y. Zhang [19], the risk of miscarriage at less than 20 weeks. pregnancy increased by 2.47 times with elevated TSH>2.5 mU/l and a high titer of antithyroid antibodies. However, not all studies have confirmed the negative effect of TSH>2.5 mU/l on the course of pregnancy. Thus, in a study by H. Liu [22], no statistically significant differences in the rate of abortion were found in the groups of pregnant women with TSH<2.5 mU/l and TSH in the range of 2.5–5.22 mU/l, although there was an increasing trend was observed in the group with elevated TSH (3.3% versus 2.2%, p=0.083). A Cochrane review compared pregnancy outcomes between total screening for thyroid dysfunction and screening based on risk factors. When TSH>2.5 mU/l, pregnant women received replacement therapy with levothyroxine. In the universal screening group, hypothyroidism was detected much more often (OR 3.15) and pharmacotherapy was prescribed more often, but despite better detection of hypothyroidism in the total screening group, no differences were found in pregnancy complications and outcomes. The authors concluded that total screening does not improve pregnancy outcomes [23]. However, the influence of weight cannot be excluded in this study, since healthy pregnant women significantly outnumbered patients with hypothyroidism in both groups. Conflicting data have been obtained from studies of the association of subclinical hypothyroidism and preterm birth. In a study by Casey et al. [24] revealed a connection between subclinical hypothyroidism and birth before 34 weeks. gestation, but no such association was found for periods less than 32 or less than 36 weeks. Subsequently, similar studies obtained conflicting data, partly due to the combination of pregnant women with subclinical and overt hypothyroidism into one group, as well as the inclusion in the study of pregnant women with antithyroid antibodies. As shown by T. Korevaar et al. [25], the complicated course of pregnancy depends on the degree of increase in TSH. Pregnant women were divided into groups depending on their TSH level: 2.5–4.0 mU/L or more than 4.0 mU/L. With TSH below 4.0 mU/L, no increase in the incidence of preterm birth was detected, while with TSH>4.0 mU/L the risk of delivery before 37 weeks. increased by 1.9 times, and earlier 34 weeks. - 2.5 times. But the primary analysis was carried out without taking into account the titer of antibodies to TPO. When pregnant women with elevated anti-TPO antibodies were excluded from the analysis, the difference between the groups disappeared, and even an isolated increase in TSH >4 mU/L did not affect the incidence of preterm birth. This study once again demonstrated the importance of distinguishing between pregnant women with normal and elevated titers of antibodies to TPO, since they are an independent risk factor for complicated pregnancy. The influence of subclinical hypothyroidism on the development of pregnancy-associated hypertension and preeclampsia appears to be questionable at this time. Previous cohort studies have found an association between subclinical hypothyroidism and preeclampsia, but only if screening for hypothyroidism was performed late in pregnancy. If thyroid function was studied before 20 weeks. pregnancy, no dependence was detected [26, 27]. It is assumed that in the initial stages of the development of preeclampsia, the placenta may produce factors that affect the function of the thyroid gland [28]. With elevated TSH (>2.15 mU/l) in the first trimester of pregnancy, there was no increase in the frequency of pregnancy complications, including preeclampsia, developing after 20 weeks. [29]. When studying moderately elevated TSH, from 2.5 mU/L to 97.5 percentile, and the population norm, an increase in the incidence of preeclampsia was detected only in pregnant women with highly normal free T4; in the rest, a highly normal TSH level did not affect the incidence of preeclampsia [11]. However, some studies did find an association between elevated TSH and high blood pressure during pregnancy. For example, a study by LM Chen [30] revealed an increased risk of gestational hypertension, as well as low fetal weight in pregnant women with subclinical hypothyroidism. That is, at first glance, diametrically opposite results were obtained. But in this study, subclinical hypothyroidism was diagnosed when TSH >3.47 mU/L, which was defined as the upper limit of normal in this laboratory, which is significantly higher than 2.5 mU/L. It is likely that it is the TSH level used to diagnose subclinical hypothyroidism that affects the results of studies of its effect on the course of pregnancy. Typically, when there is conflicting data, meta-analysis is used to identify the truth. A recent meta-analysis of 18 cohort studies found that subclinical hypothyroidism is associated with several adverse pregnancy outcomes, such as miscarriage (OR 2.01; 95% confidence interval (CI) 1.6–2.44), placental insufficiency (OR 2.14). ; 95% CI 1.23–3.7) and increased neonatal mortality (OR 2.58; 95% CI 1.41–4.73). There was no association with other adverse outcomes, such as preeclampsia [31]. It should be noted that the studies included in the meta-analysis used different TSH cutoff values ​​for the diagnosis of subclinical hypothyroidism. In only 6 of 18 studies, the threshold TSH value was 2.15–2.5 mU/L. Moreover, three studies included pregnant women with TSH≥2.5 mU/l and normal free T4 levels. That is, the degree of increase in TSH could be different, from 2.5 to 10 mU/l. And as we see from other studies, different degrees of TSH elevation have different effects on pregnancy outcomes. In most meta-analysis studies, subclinical hypothyroidism was diagnosed when TSH >3.5 mU/L. And this is precisely the upper limit of the TSH norm recommended today for pregnant women, if modified general population norms are used. The effect of TSH from 2.5 to 4 mU/l on the psychoneurological development of the fetus and other indicators of fetal health has not been identified [31, 32]. Taking into account the currently obtained data, it can be considered that TSH>2.5 mU/l is associated with spontaneous termination of pregnancy. Other adverse pregnancy outcomes are associated with higher TSH threshold values. Pregnant women with elevated TSH and antithyroid antibodies deserve special attention. In this case, the adverse effect on the course of pregnancy increases. But it is necessary to understand whether the situation will change for the better if we compensate for the function of the thyroid gland during subclinical hypothyroidism in pregnant women. Many researchers support the idea of ​​treatment, since it is quite safe and can have a positive effect on pregnancy [32]. Pregnancy outcomes did not differ between women taking levothyroxine sodium for overt or subclinical (TSH>2.5 mU/L) hypothyroidism and euthyroid women. This indicates the safety of treatment with sodium levothyroxine, at least regarding pregnancy [33]. Prescription of levothyroxine sodium to pregnant women with TSH above the norm determined in the local laboratory led to an overall decrease in pregnancy complications. Moreover, the effect depended on the timing of the start of treatment and the time spent to achieve the target TSH level. The incidence of complications decreased if treatment was started before 12 weeks. pregnancy and the treatment goal was achieved in less than 4 weeks. [34]. In a study by S. Maraka et al. [35] showed that the prescription of replacement therapy at TSH 2.5–5 mU/l reduces the risk of intrauterine growth restriction and low Apgar score of the fetus at birth. There were no differences in other pregnancy outcomes, including spontaneous abortion. In other studies, the positive effect of treatment with levothyroxine was detected only in groups of pregnant women with TSH>4.0–5.0 mU/l. However, one study showed a significant reduction in the incidence of preterm birth (OR 0.38; 95% CI 0.15–0.98). In pregnant women with TSH 2.5–4.0 mU/L, replacement therapy did not improve pregnancy outcomes [36–38]. Thus, at present, the positive effect of replacement therapy with levothyroxine sodium at a TSH level of 2.5–4.0 mU/l, especially with normal levels of antithyroid antibodies, has not been proven. However, with a more pronounced increase in TSH, the positive effect of treatment is beyond doubt. Perhaps the positive effect is manifested only when using local TSH norms, which increases the importance of their determination. Based on the latest data, it can be concluded that during pregnancy it is better to use local TSH norms to make decisions about prescribing treatment with levothyroxine sodium. In the absence of local norms, or with TSH>2.5 mU/l in pregnant women with antithyroid antibodies, or TSH>3.5 mU/l in women without antibodies, the appointment of replacement therapy at least reduces the likelihood of spontaneous abortion, and possibly has other positive effects, especially if initiated early in pregnancy. Subclinical hypothyroidism and fertility

An important question is what is the impact of subclinical hypothyroidism on a woman’s fertility. And this question gives rise to two more: 1) at what TSH level should treatment be started when planning pregnancy and 2) what is the target TSH level at the stage of pregnancy planning. If a woman at the planning stage of pregnancy has a TSH higher than the general population norm, the prescription of treatment is not in doubt. It is more difficult to decide on the need for treatment when TSH levels are normally high. Recently, more and more data have emerged on the effect of moderately elevated TSH on fertility. Indeed, it was found that in case of infertility, a woman’s TSH level is higher than in the control group, especially if the cause of infertility was ovarian dysfunction or the cause was unknown. [39]. In one study, the administration of levothyroxine sodium to infertile women with TSH>3 mU/l was accompanied by pregnancy in 84.1% of women, and spontaneous pregnancy in some women [40]. But earlier studies did not find an association between elevated TSH and decreased fertility in women [41]. A one-time elevated TSH level >2.5 mU/l at the stage of pregnancy planning can independently decrease after pregnancy. One small study showed that in 50% of pregnant women with TSH>3 mU/L at the planning stage after pregnancy, the TSH level independently normalized and became less than 2.5 mU/L. Unfortunately, this study did not examine differences between groups with elevated and normal TSH levels after pregnancy [42]. A larger study of 482 women undergoing in vitro fertilization (IVF) assessed the likelihood of pregnancy and pregnancy retention based on baseline TSH. In 55% of pregnant women, after pregnancy, TSH decreased from the initial level of 2.5–4.0 mU/l to 2.5 mU/l. The onset of pregnancy did not depend on the initial TSH level. The authors concluded that treatment for TSH levels between 2.5 and 4.0 mU/L may be delayed until pregnancy, when this level is confirmed [43]. On the other hand, a population-based study conducted in China revealed a dependence of the outcomes of spontaneous pregnancy on the TSH level determined within 6 months. before pregnancy. In women with TSH 2.5–4.28 mU/L, when compared with women with TSH below 2.5 mU/L (0.48–2.49 mU/L), a slight but still statistically significant increase in the frequency of spontaneous miscarriages (OR 1.1) and premature births (OR 1.09). More severe pregnancy complications, such as perinatal mortality, intrauterine fetal death, and cesarean section, were observed only with TSH levels >4.0 mU/L [44]. Many studies have assessed the impact of subclinical hypothyroidism and its treatment on the success of various assisted reproductive technologies (ART). Particular attention to this group of women is explained by the use of high doses of estrogens during stimulation, which can cause compensated thyroid insufficiency. There was no negative effect of TSH levels from 2.5 to 4.9 mU/L on the results of insemination. One study in euthyroid women found an inverse association between TSH levels at pregnancy and the rate of spontaneous miscarriage [45]. Another similar study did not find an association between elevated levels of antithyroid antibodies and/or TSH >2.5 mU/L on the rate of birth in women after insemination [46], although in a retrospective study the effectiveness of insemination increased when replacement therapy was prescribed to women with TSH levels >2 .5 mU/l [47]. The success rate of IVF with a TSH level <2.5 mU/L was even higher and the quality of the embryos was higher than in women with a higher TSH [48–50]. But not all studies have the same data. Thus, M. Aghahosseini et al. [51] did not reveal statistically significant differences in the incidence of pregnancy as a result of ART depending on the TSH level. A prospective study showed that prescribing replacement therapy to women with subclinical hypothyroidism (TSH 4.2–20.0 mU/L and free T4 normal) before IVF improves outcomes and they are comparable to euthyroid women. But in this study we are talking about a TSH level above the population norm, but not about a highly normal TSH. After prescribing replacement therapy, no differences in pregnancy outcomes were found depending on the target TSH level (0.5–2.5 or 2.5–4.0 mU/L); only its normalization was sufficient [52]. Thus, the prescription of replacement therapy at the stage of pregnancy planning, including for women planning ART, is indicated only when the TSH level increases above the general population norm. The use of standards for pregnant women at this stage is not justified. There is also an interesting question about the long-term risks of women with subclinical hypothyroidism detected during pregnancy. A study conducted in India showed that 2 years after pregnancy, 17.8% of women developed subclinical or overt hypothyroidism. Risk factors for the disease were age (23.6–25.5 years), goiter, degree of increase in TSH during pregnancy (7.9–5.1 mU/l), and increased titer of antibodies to TPO [53]. Thus, in the presence of such risk factors, periodic testing for hypothyroidism should be carried out; however, the frequency of testing has not been determined.

Conclusion

The data accumulated to date confirm the need to determine the local TSH norm for pregnant women. When deciding whether to prescribe treatment during pregnancy, it is necessary to take into account not only the increased level of TSH, but also the level of antibodies to TPO, since it is this group of pregnant women who has the greatest risk of a complicated pregnancy. At the pregnancy planning stage, treatment if TSH exceeds the general population reference values ​​is mandatory. But the advantage of replacement therapy in women planning pregnancy, including through reproductive technologies, with highly normal TSH levels has not been proven.