Recently, the InfantRisk Center was asked to comment on the use of a new, extended-release bupivicaine product called Exparel. This drug is applied to surgical wounds and provides local anasthesia over then next 3-4 days. Some doctors are beginning to use it with C-sections and have some concerns about its safety profile in breastfeeding mothers.

Tobacco use during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes. Research has shown that smoking during pregnancy causes many health problems for both mothers and babies, such as infertility, placental rupture, abnormal placental implantation, preterm premature rupture of membrane (PPROM) or early rupture of the amniotic sac membrane, premature birth, stillbirth, low-birth-weight infant, and sudden infant death syndrome (SIDS).

Celiac disease is an autoimmune enteropathy triggered by components of the gluten protein found in many cereal grains. Also known as “non-tropical sprue” and “gluten-sensitive enteropathy,” this condition afflicts about 1% of the US population with cramping, bloating, and mal-absorptive diarrhea upon exposure to gluten. Many more people likely have atypical or subclinical presentations that remain undiagnosed.

For most women, pregnancy is generally considered a period of emotional well-being for the woman and her family. However, many women suffer from an increased vulnerability to psychiatric conditions during pregnancy and after delivery. It is important to evaluate mothers for psychiatric disorders such as antenatal depression, postpartum blues, postpartum depression, and postpartum psychosis before and after delivery, because they are common and may be undiagnosed or hidden from the physician.

Gestational diabetes mellitus (GDM) is defined as the state of carbohydrate (glucose) intolerance that has its onset or first recognition during late pregnancy and has many similarities to non-insulin dependent diabetes mellitus (NIDDM). GDM presents in two forms. The terms “overt” and “gestational diabetes” are used to describe the type of GDM, and are based primarily on gestational age at diagnosis.

Thyroid diseases are among the most common endocrine disorders encountered during pregnancy. An overall incidence including overt and subclinical hypothyroidism (underactive thyroid) during pregnancy is about 2.5 percent.1 When dietary iodine supplementation is adequate (as in the United States), the most common cause of hypothyroidism during pregnancy is chronic autoimmune (Hashimoto’s) thyroiditis.

Thyroid diseases are among the most common endocrine disorders encountered during pregnancy. The prevalence of hyperthyroidism (overactive thyroid) during pregnancy ranges from 0.05 to 0.2%. The most common causes of hyperthyroidism during pregnancy are Graves’ diseaseand hCG-mediated hyperthyroidism such as gestational transient hyperthyroidism, hyperemesis gravidarum (intractable nausea and vomiting), and gestational trophoblastic disease.

Clinical depression is more than just sadness. Although there are clear patterns, the symptoms can be very different from person to person. The most common symptom is called “anhedonia,” or no longer taking pleasure in fun activities. Some people become insomniacs, some sleep most of the day. Other people start abusing drugs and alcohol, while some simply get irritable and short-tempered. No lab or imaging tests can help diagnose depression, only the clinical judgment of a health-care practitioner. There are several clinical tools available to help diagnose depression.

Inflammatory bowel disease (IBD) is an umbrella term encompassing ulcerative colitis and Crohn’s disease. These two syndromes of chronic inflammation commonly affect women of childbearing age. About 1 in 250 people in the United States has IBD, with most of the cases beginning between ages 15 and 40.