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Pregnant With CFS/ME

Pregnancy when you have CFS/ME need not be anymore complicated than a 'normal' pregnancy. It will be a journey of many discoveries (especially if it is your first) and although it may be tough at times the end product will be more than worth any difficulties you experience.

The Effect of Pregnancy on CFS/ME

CFS/ME symptoms tend to improve in about one third of pregnant CFS/ME patients, are unchanged in about one third and worsen in about one third of them. Many mothers feel worse during their second and later pregnancies. Mothers with CFS/ME need extra rest during pregnancy and some may need bed rest most of the time. Improvement during pregnancy usually occurs after the first trimester and is thought to be due to the effect of pregnancy hormones.

Within weeks of delivery, at least half the mothers either relapse or feel worse than before the pregnancy. Symptoms are similar both before and after the pregnancy in about a third of mothers and symptoms are decreased in a minority. Relapse after delivery is likely to be due to the extra effort needed to take care of a young baby, coupled with the loss of the elevated pregnancy hormones.

Many CFS/ME patients use both over-the-counter and prescribed medications to relieve symptoms. Some vitamins, such as folic acid, are beneficial both before and during pregnancy. In healthy women, folic acid has been shown to reduce the occurrence of neural tube defects in the child. However some medications can damage the fetus, especially in early pregnancy. The effects of most herbal preparations are unknown. CFS/ME patients should discuss all their non-prescription and prescribed medications with their doctors, and stop any which are potentially dangerous before pregnancy begins. Symptoms may worsen as a result of stopping the medications.

Taking Care Of You And Baby

Now that you are pregnant it is especially important to make sure not to overdo things. It is now especially important to rest well as you will soon have another life totally dependant on you. If you find pregnancy has made your CFS/ME worse try and restrict yourself to the most essential tasks and get your partner to take as much of the load as possible. If necessary look into getting a cleaner or home help, even if you don't think you'll need one until after the baby's born you will have a lot more time now to find one you get along with.

If you are someone who finds it especially hard to let go of responsibilities and obligations remember that your baby's needs are far more important than those of relatives who want you to visit etc, and pacing yourself well now will not only keep your illness more stable but let your relatives know that you are not always able to do what they want. This will prove an especially important lesson for them once baby has arrived as you will certainly have a lot less time and energy for other peoples demands then.

You also need to try and follow the guidelines of avoiding alcohol, smoking, medications (unless your gp says they are ok for use during pregnancy) and eating as healthily as you can manage. See my article on preparing for pregnancy for more details on this.

Which Parts Of The Pregnancy Will Be Hardest?

As with any 'normal' pregnancy the hardest parts are the first and third trimester. During the first trimester hormone levels can cause high levels of fatigue and nausia. The fatigue you will experience in the first trimester will be unlike CFS/ME fatigue though in that it is more of a sleepy fatigue than a body fatigue, so extra sleep may be all you need to get your through this stage.

The third trimester, especially the last few weeks, is probably the hardest part of pregnancy. The extra demand on your body by your growing baby (not to mention the extra weight youll be carrying by then!) will cause more fatigue again, and it is this stage of pregnancy where you will be most likely to need extra support. It is also the most exciting stage of pregnancy, with your baby seeming more and more real as time passes, being able to see your tummy moving as your baby kicks and turns is truely incredible.

Of course the part of pregnancy that everyone both fears and looks forward to is the birth, but I shall cover that in another article.

If you are wanting to have a holiday or have some other major event try and plan it for during the second trimester when most people have more energy.

The Effect of Maternal CFS/ME on the Child

There is a theoretical possibility that a virus, which might cause CFS/ME, could be passed to the fetus during pregnancy or delivery, or to the child during breast-feeding and affect the child later in life. There is no scientific evidence for any of these scenarios. Most women with CFS/ME have normal healthy children, but CFS/ME can occur in both mother and child. A recent survey found that 5% of the children of mothers with CFS/ME also developed the illness. Half of the affected children developed the disease as adults, and 42% of the children recovered. Both genetic susceptibility and an infectious agent have been proposed as possible contributors to the risk of CFS/ME in these children. CFS/ME is thought to be very uncommon in infants and in children under the age of five.

No difference in the risk of major or minor birth defects was found in children who were born after, compared with before, their mothers developed CFS/ME. However, developmental delays and learning disabilities occurred in more than twice as many children who were born after compared with before their mothers developed the illness. Some parents have opted for adoption, because of possible risks to their child.

The Effect of CFS/ME on Pregnancy

Pregnancy is not recommended in the early stages of CFS/ME, when a woman is very ill and the diagnosis may be uncertain.

Many CFS/ME patients have problems, which reduce fertility, such as irregular periods, Endometriosis, or lack of libido. Infertility may be higher than the rate of 10% to 20% found in healthy couples.

First trimester miscarriage occurs in 10% to 20% of pregnancies. The miscarriage rate was higher, around 30%, in two groups of women with CFS/ME.

A common symptom of early pregnancy is morning sickness, which is usually limited to the first trimester. In women with CFS/ME, this symptom may be more severe, lasting throughout the day and even persisting into the later months of pregnancy. The severe form of morning sickness, hyperemesis gravidarum, appears to be commoner in pregnant CFS/ME patients than in healthy women. Bed rest usually helps morning sickness. Complementary therapies such as fresh ginger or Sea-bands™ worn around the wrists may be useful. Prescribed medications are sometimes necessary.

Other pregnancy complications including vaginal bleeding, gestational diabetes, hypertension, pre-eclampsia, premature rupture of membranes, premature labor and low birth weight of the baby were found to be no more frequent in the pregnancies of CFS/ME patients, whether the pregnancy occurred after or before the patient developed CFS/ME.

Prenatal care should start early in pregnancy. An early ultrasound scan will confirm the fetal age, the date of delivery and reassure the parents of the presence of a fetal heartbeat.

The Effect of CFS/ME on Labor and Delivery

Mothers with CFS/ME will tire more quickly in labor than healthy mothers. If she also has Fibromyalgia, which is a common co-illness with CFS/ME, labor pain may be felt as being more intense than normal. It is important that mothers with CFS/ME should be given adequate pain relief and kept well hydrated in labor. An epidural anesthetic can be useful. Prolonged labor can be avoided and the baby delivered before exhaustion occurs by using a C-Section in the first stage of labor, or using forceps or a vacuum extractor in the second stage. A C-Section before labor may be recommended. C-Sections require an epidural or a general anesthetic. CFS/ME patients often require a much smaller dose than normal, of drugs given for pain relief in labor and drugs used for epidural and general anesthetics.

The Effect of CFS/ME after Delivery

Many women with CFS/ME are exhausted by childbirth and need to stay in the hospital longer than normal. This is especially true for women delivered by C-Section. Arrangements for this possibility should be made before delivery.

Postpartum depression is two to three times more frequent in CFS/ME patients than in healthy mothers. Treatment with supplemental hormones may be as effective as antidepressants.

Previously healthy mothers can occasionally develop CFS/ME after delivery. Their CFS/ME could have been triggered by the effect of changing hormone levels on the immune system.

CFS/ME and Breast Feeding

Many mothers with CFS/ME successfully breastfeed their babies and it is a lot less trouble than preparing formula. Some mothers even feel better while they are breastfeeding. Other mothers find nursing their babies is exhausting and for them, someone else can help with bottle-feeding. Mothers should weigh the well-known benefits of breastfeeding against unproven risks of exposing their infant to a possible CFS/ME infectious agent in breast milk.

Many women feel better during pregnancy, but they relapse after delivery. If so, previously helpful CFS/ME medications may be beneficial. If these are medications that pass into the breast milk and could adversely affect the child, then bottle-feeding is recommended.

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