HIV and Pregnancy – Reducing Risk of Transmission to Your Child

hiv pregnancy transmissionPregnancy is a wonderful phenomenon. Those who are suffering from HIV/AIDS may still continue to undergo pregnancy and support offspring. The main issue against this, however, is the possibility of spreading the disease to your child. This possibility may occur during the pregnancy, while in labor, or even through breastfeeding.

You shouldn’t let this information scare you from trying to become pregnant.

Many Mothers have undergone pregnancy with HIV/AIDS, while managing their disease successfully. In fact, it has been reported that this incident occurs fewer than 2% of the time. In other words, it’s extremely rare.

Steps to Lower Your Risk of Transmitting HIV to Your Child During Pregnancy

There are certain steps you may take in an effort to dramatically decrease your chances of spreading the disease to your children:

1. Get tested.

Roughly 18% of all people with HIV do not know they have the disease. Before beginning pregnancy, get tested to make sure you may or may not have HIV.

2. Start HIV treatment either before or during your pregnancy.

If you are diagnosed with HIV, then talk to your doctor about beginning treatment right away in order to become healthy enough to support pregnancy. If you are currently on treatment, then schedule an appointment with your doctor to discuss what you should be doing. If you choose not to undergo HIV treatment through childbirth, then you are putting your baby at more risk of contracting HIV.

3. Make sure your child is tested immediately after delivery.

This will determine whether or not your child should be put on treatment in order to successfully manage and control the disease. Most of the time your child will have to undergo multiple tests and wait until 2-4 months before a diagnosis is made.

How is HIV Treated?

If you are recommended to undergo treatment, you will be given certain medications designed to slow the disease from progression, as there is currently no cure for HIV. The medication is known as antiretroviral (ARV). However, those who undergo medication treatment are able to live very happily with their HIV.

Flu Vaccines Highly Effective for Pregnant Women & Children

flu vaccine for pregnancyFlu is the leading cause of death from a vaccine-preventable disease in the US, responsible for 36,000 deaths and 200,000 hospitalizations. The greatest burden of disease is among expectant mothers, kids, elderly citizens, and people with certain medical conditions. The highest incidence of influenza-related hospitalization among children is for infants below the age of 1 year, especially those aged less than 6 months.

The WHO and CDC Recommend the Flu Shot

Consequently, the World Health Organization and the Centers for Disease Control and Prevention (CDC) recommends influenza vaccination for all pregnant women regardless of the trimester, as well as for children, except for infants aged less than 6 months and individuals with a severe allergy to egg protein. Since the flu vaccine is inactivated, it does not pose any safety concerns to pregnant women.

In addition, the vaccine has been found to be very successful in preventing flu and related complications in expectant women and the baby, for a short time (6 months) after birth. According to a study published in the Journal of General Virology, an infant’s concentration of flu antibodies at birth correlates with that of the mother. Higher concentrations of flu antibodies in the infant resulted in the delayed onset and lower severity of influenza infection.

Risks of Complications from Flu

Influenza is known to cause more severe complications in expectant mothers than in non-expectant women. Changes in their immune system, lungs, and heart during pregnancy make expectant mothers (as well as women up to two weeks post-partum) more susceptible to serious illness from influenza, resulting in hospitalization and even death. Flu-related complication can also cause serious problems before birth, like birth defects and premature labor and delivery.

Administering the influenza vaccine to expectant mothers during their second and third trimesters has been shown to increase seroprotection against all strains of flu for most women, and more than half of their newborns. However, the protective levels against the flu completely disappears within 6 months in the newborn; hence, the requirement by the CDC that all persons above the age of 6 months get an annual influenza vaccination.

Points to note about the flu shot:

  • The influenza shot is one of the most critical things for a pregnant woman during her prenatal care, irrespective of the trimester.
  • The inactivated flu shot, with or without the preservative thimerosal, is safe for pregnant mothers, and the protection extends to the newborn for a period of up to 6 months, protecting the baby against acute respiratory infections and bipolar disorder.
  • The flu shot is claimed to reduce the risk of stillbirths/miscarriages, as well as other birth complications like an underweight baby or preterm birth.

Early treatment for influenza is critical for pregnant women. So, if you notice flu-like symptoms, contact your doctor immediately for the safety of your child.

Best Holiday Maternity Clothing Styles

Holiday Maternity Clothing
Are you expecting? Congratulations. The holiday season is a great time to celebrate new life with style, and unlike the past when you were expected to conceal your pregnancy with shapeless fashion, many fashion outlets today feature maternity clothing sections that address all basic apparel needs.

What are you waiting for? Dive in to Dr. Torbati’s personal maternity clothing tips that he has gathered over the years practicing as a OBGYN in Tarzana.

Best Holiday Maternity Clothing Tips

1. Wear what you like.
Just because your tummy is expanding does not mean that you should transform your wardrobe. In the second trimester, when the bump is still not that visible yet, you can pair a loose blouse with a pair of skinny jeans. As the bump grows, you can easily accommodate the changes with skirts or pants with flexible waistbands designed to expand as you grow with your baby.

2. Wow them with your glowing self.
You will be the center of attraction during the holidays. So, you can impress the crowds by looking radiant in a one-shoulder dress or simple shirt paired with magnificent jewelry and a cute blazer or cardigan to portray that smart mommy-to-be look. For much cooler weather, consider a long-sleeve or sweater dress, accessorized with a scarf.

3. Embrace Lycra or wrap it up.
In your third trimester, your bump will be very noticeable. If you don’t want to look bigger, you can accentuate your sexy tummy with stretchy lycra dresses that show off your shape in a fantastic way. Alternatively, you flaunt your bump with a wrap dress. The cut is comfy, there are no annoying buttons, and the plunging necklines are incredibly sexy.

4. Look amazing in graphic prints.
Although graphic prints seem like a scary choice for a growing belly, you can look amazing by making the right selection. Choose items with straight lines that contour your body. For a laid-back vacation vibe, get a pretty tunic or one piece for a full body cover.

5. Keep it simple.
There are quite a few clothing options that don’t cost a lot, like pretty maternity dresses and comfy women’s jeans. You may want to avoid bright colors, like satin and loud prints. Consider dark, solid-color tops and dresses or neutral-colored stripe clothing. Also, get some staple maxi dresses. Other options include a swing dress, socialite dress, one-shoulder dress, sweatshirt dress, floral pencil dress, and body-conscious dress.

Final Note
When you’re still in the holiday shopping mood, you may want to get some items to make your life easier, like maternity belly supports that help to reduce back pain and lighten the stretch marks, and nursing bras to make breastfeeding a breeze. You also need to change your intimates as every part of your body will be expanding, in order to accommodate your new figure.

Stay away from your hubby’s closet! Instead of stealing your daddy-to-be sweats and shirts, stay fashionable with the options mentioned above. Having a baby is an amazing thing that you can only do once or a couple of times, so flaunt it this holiday.

New Report Finds Eating Light Meal During Labor is Beneficial

eating light meal during laborIt had traditionally been believed that fasting was necessary while a woman was in labor. The reason being to avoid aspiration that could lead to pneumonia. However, a new report has found that this actually may not be the case. The report, presented during the Anesthesiology 2015 annual meeting found that eating a light meal is beneficial for the labor process.

What The Researchers Found…

Researchers visited hundreds of cases on women who have had birth in a hospital. They found that the energy demands of a woman undergoing labor is similar to a marathon runner, whose body will use fat as an energy source if it cannot be found elsewhere (i.e. through adequate nutrition).

For laboring women, this phenomenon would lead to reduced uterine contractions, leading to longer, more strenuous labor and lower health scores for newborns.

Aspiration is a Very Rare Phenomenon

To re-emphasize, the main concern eating during labor was because of aspiration troubles.

Advancements in anesthesia have made the pain involved during labor a lot more manageable and safer, which reduces risks related to eating. Aside from this, the researchers also noted that aspiration is very rare citing only one case that had occurred between 2005 and 2013 of a woman suffering from obesity and pre-clampsia.

Benefits of a Light Meal During Labor

Provided you are in good health standing, which is to be determined by your doctor, a light meal during labor could provide benefits. Researchers note that light meals would “give expectant mothers more choices in their birthing experience and prevent them from being calorie deficient, helping to provide energy during labor”.

Always Follow Your Doctor’s Advice

Regardless of the findings, you should always follow the advice of your obstetrician or doctor. They will direct any laboring women as to whether a light meal would benefit them or not.

Dr. Torbati is a board-certified OB/GYN in Tarzana. He specializes in obstetrics, family planning, and other related services. He has been practicing for over 20 years, having delivered several newborns to happy Mothers. For more information, please contact our office @ (818) 575-6021.

In The News: “Female Viagra” for Women

addyi female viagra for women 2015Viagra is a little blue pill that quickly became popular as the ideal treatment for erectile dysfunction in men. Now, there is a little pink pill – dubbed the “female Viagra” – that is believed to have a positive effect on sexual dysfunction in premenopausal women.

It is estimated that 10 percent of the female population develops hypo active sexual desire disorder (HSDD) – a condition whose primary sign is low sexual drive – and up to 40 percent experience this condition at some point. There are a number of psychological factors that contribute to the low sexual desire, including stress, low self-esteem, and mental health problems, as well as hormonal changes and physical factors, such as lifestyle habits and fatigue.

How the “Female Viagra” Corrects HSDD

Flibanserin, also known by its brand name Addyi, was recently tested and approved by the FDA for the treatment of HSDD. The drug, which is manufactured by Sprout Pharmaceuticals, is believed to correct an imbalance of brain chemicals involved in stimulating sexual desire, though the actual mode of action is unclear.

According to the FDA, a 100-mg dose of Flibanserin should be taken once a day, just before going to bed. If there are improvements in sexual desire after taking the drug for 8 weeks, it is recommended that you discontinue.

Studies Leading to Approval of Viagra for Women

The FDA found the drug safe for use after conducting 3 randomized, double-blind placebo-controlled tests with a sample population of around 2,400 women of a mean age of 36 years and with HSDD.

For the duration of 24 weeks, the women were administered with a placebo or 100-mg dose of flibanserin every day before bedtime. The women who took the flibarensin dose reported a modest increase in both sexual desire and number of sexual events during the period of study, as well as a reduction in anguish resulting from low sexual desire.

Risks of Addyi – Women’s Sex Pill

With regard to the safety of the drug, the FDA reported that the most common adverse reactions noted were fatigue, dizziness, nausea, dry mouth, insomnia, and sleepiness.

addyi female viagra risksBefore the approval, the FDA has rejected the drug twice before, in 2010 and 2014, because it was associated with hypertension – extremely low blood pressure, as well as loss of consciousness especially when taken with alcohol.

Consequently, flibanserin was approved based on a risk evaluation and mitigation strategy (REMS) that requires prescribers to attend a training program before administering the drug to patients.

Additionally, the drug comes with a boxed warning alerting patients of the risk of concussion and hypertension if taken with alcohol. There is also a warning for women with liver impairment and those taking CYP3A4 inhibitors to stay away from the drug.

Motherhood Tips & Tricks – Managing Time

motherhood tips and tricksAll moms share the same problem: lack of enough time to do everything, let alone do them well. So, you’re either tripping over toys or having some other difficulty because you rarely have time to get things organized. Your spouse is also counting on you, exerting more pressure on you to rush through all duties, from doing laundry to scrubbing bathtubs to shopping for groceries.

Stay Organized With These Ideas

  • Keep things you use often in an obvious spot – don’t waste time looking for things like baby wipes, scissors, your phone, and other things you use often. Things like recipes, parenting information, and favorite articles from printouts or magazines should be organized in a binder where you can find them easily.
  • Keep your bills in a box – keep your files together and pay them online if possible. This will keep you from having to buy envelopes and stamps. You could even sign up to receive your bills electronically.
  • Keep things you don’t need in labeled boxes – to keep things from getting too disorganized, it is important that you routinely get rid of clutter and unused items. When you notice clothes, beddings, damaged toys, or other things that are unlikely to be used again, put them in boxes or storage bins labeled “donate”, “trash”, or “consign” and put them in your garage.
  • Stay on schedule – limit your personal email/computer time and stick to it, so you don’t compromise on other things. Also choose a single day to run all your errands, and schedule any doctor appointments in the mornings to avoid long waits.

Make Use of Time-Saving Apps

  • Volunteer Spot – this is a free web-based coordination tool designed for busy moms, teachers, or anyone else who needs to coordinate other people for activities. The system has automatic reminders so all scheduled people for activities don’t miss the event.
  • Ruckus Reader – this iPad learning program is a library of mobile applications offering narrated video books, digital storybooks, and a bunch of literary activities for kids. The app provides the parent or guardian with weekly feedback on the child’s reading experience and progress based on in-app reading skills, like word recognition and phonics, fluency, alphabet knowledge, story comprehension, print awareness, and sequencing.
  • Manila – a free web household account and bill organizer available on PC and mobile. It is designed to help you manage accounts, such as utility bills, credit cards, subscriptions, travel reward programs, and daily deals, among others.

There are many other ideas and apps you can use to make parenting easier, but most of them point to organizing yourself, identifying what needs to be done, and setting time frames. Start by creating a list of things that need to be done every day, every week, and every month, and then prioritize.

Does Tying Tubes Reduce Risk of Ovarian Cancer?

does tying tubes reduce ovarian cancerOvarian cancer is one the five main types of cancers that affect a woman’s reproductive organs. The others are cervical, uterine, vaginal, and vulvar cancers.

Unfortunately, there is no sure way to know if a woman will get ovarian cancer. Most women get it without being at high risk. That said, there are certain factors that could increase a woman’s likelihood of getting ovarian cancer, including:

  • Age – middle-aged and older women are at greater risk
  • Family – reports suggest that about 10 percent of ovarian cancer cases are hereditary, if close family members, on either the mother’s or father’s side have had the condition
  • Personal history of cancer – if the individual has had other types of cancer, like uterine, colorectal, or breast cancer
  • Ethnicity – people with an Eastern European – Jewish background are at greater risk
  • Successful conception and birth – women who have never given birth, or have had trouble getting pregnant are at greater risk of ovarian cancer
  • Endometriosis – a condition where tissue from the uterus lining grows elsewhere in the body can increase the risk

Women showing one or more of these factors are not necessarily destined to get ovarian cancer, though they should discuss with their doctor about the risk. Usually, women who have given birth, or have used birth control pills for over five years are less likely to get ovarian cancer. But if the risk is imminent, the doctor can recommend a few measures to lower your chances of getting ovarian cancer, including tubal litigation (getting the tubes tied), ovary removal, or hysterectomy (an operation to remove the uterus and cervix).

Dr. Torbati offers a non-surgical tubal litigation option at his OB/GYN office located in Tarzana.

How effective is tubal ligation?

Research suggests that some of the cells responsible for ovarian cancer originate from the fallopian tubes. Other researches claim that ovarian cancer starts from the tissue covering the outside of the ovary, in the ovary’s hormone-producing cells, or in the egg-producing cells within an ovary. When having your tubes tied, or undergoing a tubal ligation procedure, the fallopian tubes are blocked permanently or cut, preventing the ova from traveling from the ovaries to the uterus.

While this process has no direct impact on fimbria – where cancerous cells originate from on the surface of the ovary – research has consistently shown that tying the fallopian tubes significantly reduces the woman’s risk of ovarian cancer: perhaps because the ovaries are no longer exposed or connected to the external environment, or because the fallopian tubes undergo some sort of anatomical changes after a tubal ligation.

It is important that you see your doctor or health care professional if you notice any signs of ovarian cancer continuously for two weeks. Symptoms to watch for include: pain in the abdominal or pelvic area, back pain, upset stomach or heartburn and bloating, unusual vaginal discharge, and being tired all the time.

Smoking During Pregnancy – Dr. Torbati’s Thoughts

smoking and pregnancySmoking can cause serious problems for women trying to become pregnant, or those already pregnant, as well as the baby, both before and after birth.

Research suggests that cigarette smoke contains over 4,000 chemicals, including harmful substances such as lead and cyanide, as well as 60-plus cancer-causing elements. When a pregnant woman smokes, that toxic mixture is absorbed into your bloodstream, which is your baby’s only source of nutrients and oxygen.

In general, a fetus should not be exposed to any of the 4,000-plus chemicals, but even worse is the harmful effect of nicotine and carbon monoxide – two toxins that account for nearly every smoking-related pregnancy complication, with the most serious ones being premature delivery, stillbirth, and low birth weight.

Research suggests that nicotine narrows blood vessels throughout the body, including those in the umbilical cord, choking off oxygen supply to the fetus. As if this is not bad enough, the red blood cells that supply oxygen start to pick up carbon monoxide elements instead, further reducing oxygen supply to the mother’s tissues and the fetus.

So, how does this impact the fetus?

Lack of sufficient oxygen has tragic effects on your baby’s growth and development. In fact, research shows that smoking during pregnancy more than doubles the chances that your baby will be born too early, weigh less than 4.5 pounds, or be at risk of stillbirth. Other effects of smoking on the fetus include:

• Lifelong effects on the baby’s brain function, increasing the risk for learning disorders, low IQ, and behavioral problems

• Increased risk for a heart defect at birth, as well as infections and other health problems – especially if the mother smoked during her first semester

• Babies smaller in weight and size usually have underdeveloped bodies, and their lungs may not be fully functional at birth, requiring them to rely on a respirator for a few days or weeks.

Every cigarette a pregnant mother smokes increases the risks to the baby. The fewer cigarettes you smoke per day the lower the risk, though the difference may not be significant, since a smoker’s body is most sensitive to the first couple of nicotine doses each day.

It is hard to quit smoking, so ask for help from your spouse, family, friends, and a physician such as myself.

DGA Guidelines for Pregnant Women: What You Should Eat During Pregnancy

Learn what dietary recommendations are best during pregnancyThere is a lot of advice out there informing all kinds of people about how to choose what to eat, but all of them seem to agree that what is most important is that you consume a balanced diet containing the appropriate amount of calories needed to perform daily activities.

The Dietary Guidelines for Americans (DGA), 2010, which was released early 2011 emphasizes that Americans need to manage their weight by engaging in physical activities; consuming foods with less refined sugars, cholesterol, sodium, sugars, and fats; and consuming more fruits, vegetables, seafood, and general low-fat products.

DGA Guidelines for Pregnant Women

The guidelines also propose foods and nutrients recommendations for specific population groups, including women capable of becoming pregnant, and women who are already pregnant.

For the former group, the DGA recommends:

• Foods rich in heme-iron, because it is readily absorbed by the body; any other foods rich in iron; and iron absorption enhancers, such as foods rich in vitamin C
• Daily intake of 400 micrograms (mcg) of synthetic folic acid from supplements or fortified foods, as well as food forms of folate from a diverse diet.

For pregnant women and those breastfeeding, the DGA recommends:

• Weekly intake of 8 – 12 ounces of seafood from different seafood types
• Minimal intake of white tuna (6 ounces per week) because it is rich in methyl mercury
• That they avoid these four types of fish: swordfish, king mackerel, tilefish, and shark
• Iron supplements for pregnant women, as advised by a health care provider.

The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) encourage pregnant and nursing mothers to follow the DGA recommendations, especially with regard to the intake of seafood.

According to the FDA, seafood (fish and shellfish) is low in fat, high in protein, and a great source of vitamin D, iodine, and selenium, which are absent in many Western diets, but are necessary to ensure proper growth, development, and general health. Children born to mothers who took omega-3 seafood during pregnancy are also said to have better functioning brains and nervous systems, and perform better in school.

Top seafood choices for Omega-3 fatty acids include salmon, tilapia, canned tuna, catfish, Pollock, and cod.

Stick to the DGA’s advice and both you and your child will be happy!

A Decision All Mothers Have to Make: Breastfeed or Formula/Bottle Feed?

breastfeeding or bottlefeeding newbornWhen it comes to food for newborns, options are rather easy. During the first six months you should either be feeding your newborn breastfed milk or fortified formula.

What are reputable sources saying?

You can read tons of articles online and get almost nowhere with various sources saying to go one way or the other – or even do both.

The American Academy of Pediatrics is a very reputable source and here’s what they have to say on the matter: breastfeeding is the best choice for infants.

A few pointers to keep in mind before attempting to breastfeed your newborn child:

• Premature and sick babies should also be breastfed.
• Adoptive mothers should also breastfeed.
• Breastfeeding should be done anywhere from 8-12 times per day.
• Each session should last roughly 20-30 minutes, with 10-15 minutes on each breast.
• The advantages of breastfeeding far outweigh the negatives.
• Dr. Torbati can offer you personalized family planning advice in Tarzana tailored to your specific needs.

Advantages and Disadvantages to Breastfeeding

If you’re concerned with costs – did you know breastfeeding is the least expensive way to feed an infant? Well, it is. There are many other natural advantages to breastfeeding over the alternatives.

Visit our website to learn more about Dr. Torbati’s advantages and disadvantages to breastfeeding.