What pregnant women can do in the second trimester: the doctor spoke about safe medications, diseases and mandatory screening

The second trimester of pregnancy is a wonderful and at the same time responsible time. Toxicosis and worries were left behind. The expectant mother gets used to her “interesting” position and even enjoys it. The belly is already noticeable, but does not restrict movement yet. Skin and hair become amazingly beautiful, and your health improves.

Yes, and doctors do not particularly restrict either nutrition, lifestyle, or habits. It is believed that almost anything is possible in the 2nd trimester of pregnancy! Is it so? What should an expectant mother pay attention to? And what is actually possible for pregnant women in the second trimester, and what is still not allowed? Obstetrician-gynecologist at the Women's Medical Center, Candidate of Medical Sciences Evgeniy Petreikov these questions from FAN .

What are the dangers of colds and flu in pregnant women?

Respiratory infections pose two threats. Firstly, they may be accompanied by fever, which can lead to defects in fetal development. And secondly, influenza and ARVI during pregnancy can lead to the development of complications. During pregnancy, a number of changes occur in the immune response, as well as in the functioning of the heart and lungs, making the mother's body especially vulnerable. Therefore, colds and flu in expectant mothers are much more severe than in non-pregnant women and are often complicated by bacterial infections, including bronchitis and pneumonia.

The World Health Organization has included pregnant women at risk of developing severe and/or complicated influenza. It has been proven that pregnant women with the flu require hospitalization 4 times more often than non-pregnant women. Among patients in the third trimester, 8% require hospitalization in intensive care units [3].

Timely vaccination can prevent infection with the influenza virus during pregnancy. If infection has already occurred, the woman needs to begin treatment for ARVI or influenza during pregnancy as early as possible.

2nd trimester screening

Health control is extremely important for the expectant mother. Regular examinations and tests prescribed by the doctor are necessary to ensure that the pregnancy is proceeding normally and the child is developing correctly.

This is the purpose of the second screening during pregnancy. The optimal time for its completion is in the 18th week, the recommended time interval is from the 17th to the 20th week. During screening, a woman will need to undergo blood and urine tests and an ultrasound. Doctors focus on:

• hormonal examinations;
• monitoring the function and condition of the kidneys;
• hemoglobin level in the blood to eliminate the risk of iron deficiency anemia;
• anatomical ultrasound examination of the fetal anatomy.

“In the first trimester, we do an analysis of the level of glucocorticoid hormones,” explains Evgeniy Petreikov. — In the second, we take this hormone again and look at the dynamics. If abnormal glucocorticoid levels are detected, replacement therapy should be prescribed as early as possible to reduce the risk of developmental delays, late miscarriage and premature birth.”

To exclude the risk of developing diabetes mellitus in pregnant women, a glucose tolerance test is performed from the 24th to the 28th week. Even if a woman has no prerequisites for developing the disease, she still needs to be examined. The expectant mother is asked to drink a glucose solution and blood is taken after an hour and two hours. Based on the obtained blood glucose levels, a “sugar curve” is constructed. If it passes above normal values, gestational diabetes mellitus is diagnosed. It requires mandatory monitoring by doctors and the woman herself.

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Is it necessary to bring down a high temperature during pregnancy and what medications can be used?

It is important to manage fever in pregnant women in a timely manner, since high temperature can negatively affect pregnancy. It is especially dangerous in the first 12 weeks, when the formation of all organs and systems occurs. Hyperthermia in pregnant women during the first trimester doubles the risk of developing neural tube defects (future brain and spinal cord defects) and may also be associated with other birth defects and adverse outcomes in the baby [1].

It is not known for certain which temperature exceeding the greatest danger. Thus, data from a cohort study involving more than 77 thousand women showed that the incidence of malformations was approximately the same among those who reported a fever below 39 and above 39 degrees in the first trimester [1].

The drug of choice for reducing fever is paracetamol, which is approved for use throughout pregnancy [2]. In addition, ibuprofen is used as an antipyretic and analgesic in the first and second trimesters. Multivitamins containing folic acid can reduce the risk of developmental defects due to hyperthermia [1].

Fetus in the second trimester of pregnancy

The second trimester begins from the 14th week of pregnancy and lasts until the 28th week. At this time, the formation of the child’s internal organs ends. The baby already has all the organs and systems like an adult: the brain, spine, limbs, subcutaneous adipose tissue and even the papillary pattern on the fingertips - future imprints. The child grows and develops daily, and his internal organs develop along with him.

At week 14, the liver produces bile for the first time, and the pancreas begins to produce the hormone insulin. The activity of the endocrine glands increases. If until this time only her hormones were present in a woman’s body, then in the second trimester they are “supplemented” with the child’s hormones. They are produced by the baby’s maturing thyroid gland, pancreas, and adrenal cortex. For this reason, doctors closely monitor the hormonal levels of the expectant mother.

“If a woman’s body produces insufficient amounts of thyroid or pancreatic hormones, the fetus releases its hormones,” comments obstetrician-gynecologist Evgeniy Petreikov. — Disorders of the thyroid gland in the mother increase the risk of developmental delays in the fetus. If a woman has missed diabetes mellitus, it is not corrected with diet and medications, this increases the load on the child’s pancreas. There is a high probability that the baby will develop diabetes mellitus in the first or second year of life.”

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How to reduce a sore throat? What antiseptics can I take?

During pregnancy, it is allowed to use a number of antiseptics for sore throats, so it is not necessary to endure sore throat and other unpleasant symptoms during this period. Medications that expectant mothers can take include:

• ambazon, which has an antimicrobial effect against streptococci, daily dose 4–5 tablets 0.04–0.05 g;
• the combination of lysozyme + pyridoxine exhibits an antiseptic effect against gram-positive and gram-negative bacteria, fungi and viruses. Vitamin B6 in its composition has a protective effect on the oral mucosa. Prescribe 2 tablets 3-4 times a day.

In addition, warm drinks, which are indicated in unlimited but reasonable quantities, help reduce sore throat.

Can pregnant women take any expectorant medications?

Therapists and obstetricians-gynecologists recommend that pregnant women refrain from taking expectorant medications if possible. The vast majority of drugs in this group are prohibited for use during pregnancy, including herbal remedies, which are often considered “safe” by consumers. In fact, plantain syrup, preparations based on thyme and thyme extract, and other popular herbal remedies are contraindicated for pregnant women.

At the same time, the drug ambroxol is still approved for use by pregnant women in the second and third trimesters with the label “with caution.” The same applies to bromhexine - it is prescribed, but only after a careful assessment of the benefit/risk ratio, and only the attending physician can carry it out. Therefore, primary care providers who advise pregnant women with requests for expectorant medications should limit themselves to insistent advice to consult a doctor. And the only recommendation that should be given in such situations is to drink warm drinks and sufficiently humidify the air in the room.

What can a pregnant woman take for a debilitating dry cough?

Antitussive drugs, like mucolytics, are prohibited from taking during pregnancy at all or are allowed under the supervision of a doctor after assessing the risks and benefits. Thus, the popular centrally acting antitussive drug butamirate can be taken only in the second and third trimesters and only after consultation with a doctor. The peripheral drug prenoxdiazine is also used with caution during pregnancy. Thus, when counseling a pregnant woman with a dry cough, she should be advised to immediately visit a doctor.

Is it possible to be treated during pregnancy with infusions, decoctions of medicinal herbs or herbal teas?

Despite their natural origin, not all preparations based on medicinal plants, including herbal teas, are safe during pregnancy. Herbs may contain active substances that negatively affect the development of the fetus or increase the tone of the uterus. Herbs can cause miscarriage or stimulate premature labor. Medicinal plants that are unsafe during pregnancy include [4, 5]:

• chamomile - can promote uterine contractions;
• licorice root - may increase the risk of premature birth;
• laxative herbal teas based on senna and other plants - active intestinal peristalsis can stimulate the contractile activity of the uterus;
• common twig - stimulates the production of estrogen, may increase the risk of miscarriage;
• echinacea - activates the synthesis of oxytocin; aloe vera - stimulates the contractile activity of the uterus;
• calendula - has an abortifacient effect and many others.

However, there are also medicinal plants that have been proven safe during pregnancy. Among them [6]:

• raspberry leaves;
• peppermint leaves;
• plantain oval seed shell;
• garlic.

Since the list of medicinal plants that are unsafe during pregnancy is quite large, it is still better to take herbal medicines during this period after consulting with your doctor.

Ultrasound during pregnancy 2nd trimester

Ultrasound examination is carried out at 20-24 weeks. Its task is to clarify the anatomy of the fetus and its healthy development. During the study, the specialist records “anatomical elements”: structural features of the body, the development of arms and legs, the number of fingers. Looks at the condition of the brain, heart, and circulatory system.

During this period, a heart defect can be identified if it has not been diagnosed previously. As well as dilatation of the ventricles of the brain - hydrocephalus.

“Using ultrasound, we can see hemorrhages in the brain, brain cysts,” comments Evgeniy Petreikov. “These conditions will not necessarily lead to severe pathologies of fetal development. During pregnancy, they may go away, but it is important for the doctor to monitor this process and monitor the dynamics of the identified disorders.”

Are any antiviral drugs allowed during pregnancy?

The treatment regimen for influenza in pregnant women includes antiviral drugs from the group of neuraminidase inhibitors. They are active against influenza A and B viruses, and their effectiveness has been demonstrated in numerous clinical studies [7, 8]. Antiviral drugs of this group disrupt the ability of viral particles to penetrate into cells, which leads to localization of infection in the body, alleviation of the condition and reduction of the likelihood of complications during pregnancy [7]. According to international and Russian recommendations, neuraminidase inhibitors are the drugs of choice for influenza, including during pregnancy [8]. Their effectiveness is highest when taken within the first 48 hours after the onset of the disease, so when the first flu symptoms appear, it is very important to consult a doctor and begin treatment. Let us remember that neuraminidase inhibitors are prescription drugs ( also in this case it is necessary to make sure that the patient has the flu and not ARVI in pregnant women - editor's note.

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Well-being of the expectant mother and illnesses of the 2nd trimester

As the belly grows, the woman’s body also changes. The uterus increases in size, and after the 12-14th week it emerges from the pelvis. At the same time, the ligaments have not yet stretched, which is why abdominal pain may occur in the second trimester.

Ligamentous pains that seem to pull the uterus down are not dangerous. They do not threaten the healthy course of pregnancy. However, if your stomach feels tight and you experience discomfort and, even more so, painful sensations, you should definitely visit a doctor, even if the date of your next visit has not yet arrived.

Pain in the lower abdomen can have many explanations. In addition to sprains, they can be caused by harmless and natural Braxton Hicks contractions, which usually indicate a woman is overtired, needs rest or changes in body position.

Dangerous conditions can also manifest themselves as pain. For example, uterine tone in the 2nd trimester, in which there is a threat of premature birth. Or inflammatory processes in the kidneys or bladder, which requires specialist consultation and treatment.

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If you experience pain in the lower abdomen, it would be a good idea to visit a doctor. This must be done when:

• copious or unusual in color and consistency discharge in the 2nd trimester (white, greenish, cheesy);
• increased body temperature without signs of a cold or viral disease;
• bloody discharge;
• acute pain.

An enlarged uterus puts pressure on internal organs, which can lead to exacerbation of chronic diseases or the development of specific pregnancy conditions. The symptoms of hemorrhoids may increase, so to prevent constipation in the 2nd trimester, it is extremely important to follow a healthy diet rich in vegetables and fruits. And don’t forget about physical activity - it also stimulates intestinal motility.

Other problems may also be a concern.

Edema . They usually occur in the evening if a woman spends on her feet all day. Despite the fact that maternity leave goes on only after 30 weeks, already during this period the expectant mother needs to rest more. If you have the opportunity to lie down during the day, you need to put your feet on a pillow, raising them slightly above head level. If this is not possible, compression stockings will help get rid of swelling in the 2nd trimester. They also reduce the risk of exacerbation or development of varicose veins.

Cystitis . The inflammatory process in the bladder can develop due to anatomical changes, severe dietary restrictions, and hypothermia. It manifests itself as pain and pain when urinating, and there may be traces of blood in the urine. It is diagnosed by urine analysis, which reveals leukocytes. If microorganisms are found during urine culture, the doctor prescribes antibiotics. Cystitis during pregnancy in the 2nd trimester can lead to serious complications: chronic inflammation or the development of pyelonephritis - inflammation of the kidneys. To prevent it, you need to eat well and regularly, as prescribed by your doctor, take a urine test. This will prevent another serious disease in pregnant women - asymptomatic bacteriuria, which can go completely unnoticed. And result in the development of cystitis or pyelonephritis.

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Thrush . Abundant, cheesy or greenish vaginal discharge occurs against the background of the growth of fungal microflora. Despite the discomfort they cause, doctors do not consider thrush a disease. Rather, it is dysbacteriosis, which can occur both in the intestines, which is manifested by stool disorders and discomfort in the abdomen and in the vagina. This condition is typical for expectant mothers. Due to hormonal changes, the vaginal environment changes. From acidic, suppressing fungal microflora, it becomes alkaline, which allows fungi to actively reproduce.

“There are more than 800 types of microorganisms that can cause thrush during pregnancy in the 2nd trimester,” says obstetrician-gynecologist Evgeniy Petreikov. “And our options for treating this condition are minimal. There are only a few medications that can be used by pregnant women. And in this case it is necessary to treat not only the vagina, but first of all the intestines.”

To normalize the intestinal microflora, the drug “Pimafucin” is used. For topical use, the drugs Pimafucin, lactobacilli and bifidobacteria in the form of suppositories are prescribed. In 90% of cases, thrush in pregnant women goes away on its own, but after the 37th week, sanitization of the vagina is mandatory to prevent the fetus from becoming infected with a fungal infection when passing through the birth canal.

How to boost immunity during pregnancy?

The following help increase the body's defense against respiratory infections during pregnancy:

• a balanced diet that compensates for a woman’s needs for nutrients, vitamins, and microelements;
• healthy sleep;
• laughter – helps to activate the immune response [9];
• taking probiotics, which normalize the composition of the intestinal flora, which helps reduce the risk of respiratory infections and reduce the severity of cold symptoms [10];
• taking multivitamin complexes containing vitamin D, which helps relieve cold symptoms and reduce the incidence of infection [11].

In addition, to increase the immune response, the doctor can prescribe interferon alpha-2b drugs - intranasal or rectal (there may be restrictions on the duration of pregnancy, for example, some of them are prescribed only after 14 weeks - editor's note).

Is it possible for a pregnant woman to apply mustard plasters and pepper plaster?

Despite the fact that both mustard plasters and pepper plaster act externally and do not affect the development of the fetus, they are potentially dangerous for pregnancy. Heat treatments can increase uterine contractility, which is associated with an increased risk of miscarriage or premature birth. In addition, increased microcirculation, which occurs under the influence of mustard plasters or pepper patches, can change uteroplacental blood flow, which is also undesirable. The greatest danger is posed by thermal procedures in the first and last trimester of pregnancy - in the first they increase the risk of miscarriage, in the last - premature birth.

How are pregnant women treated?

In the previous article “Medicines during pregnancy,” we talked about the terrible and sometimes unpredictable effects that various medications have during pregnancy. And, of course, ideally, it is better for the expectant mother not to get sick. However, during pregnancy there are situations when prescribing medications is absolutely necessary:

• acute conditions (pain, fever, infections, cough, runny nose);
• chronic conditions not related to pregnancy (diabetes mellitus, epilepsy, bronchial asthma, rheumatoid arthritis, etc.);
• conditions characteristic of pregnancy (anemia, morning sickness, arterial hypertension, etc.);
• complications of pregnancy (threat of miscarriage or premature birth, gestosis, etc.).

Risk categories

When choosing drug therapy for a pregnant woman, doctors are guided by risk categories developed by the FDA

Category A

— no risk has been proven (folic acid, L-thyroxine). The drug is used by many pregnant women and women of childbearing age; there is no reliable evidence that the drug causes developmental defects, and no negative effects on the fetus have been found.

Category B

- no evidence of risk (amoxicillin). Animal studies have proven the safety of the drug, but there is no data from clinical trials on pregnant women, or animal studies have found side effects that have not been confirmed by clinical trials.

Category C

- the risk cannot be excluded (nifedipine, omeprazole). The drug can cause adverse side effects and also provokes developmental defects; side effects may be reversible, animal studies have proven the drug is dangerous, but there is no clinical trial data on pregnant women. Such drugs are prescribed only when the benefit is greater than the risk.

Category D

- there is evidence of risk (phenytoin, propylthiouracil). The drug may cause irreversible side effects, including birth defects, or studies have shown it is dangerous in humans. Use during pregnancy is possible only for health reasons, when all the safer options have not helped.

Category X

— contraindicated during pregnancy (warfarin, thalidomide). Animal studies or experience in humans demonstrate a great danger of the drug, exceeding any possible benefit from its use during pregnancy. Such drugs are contraindicated not only for pregnant women, but also for women who may become pregnant.

Unfortunately, this classification is rarely updated, does not take into account the dose of the drug and the clinical situation, and most of the data are obtained only from animal experiments, which automatically classifies the drug as category C. In addition, many drugs used in our country are not used in the USA , therefore they are not classified by the FDA.

New rules

In 2015, it was decided to make the information more accessible and understandable. According to the new FDA rules1, information will be structured into three sections:

• Pregnancy and childbirth - dosages and potential risks to the developing fetus.
• Lactation - information about drugs prohibited during breastfeeding, known metabolites in breast milk and their effects on the infant.
• Reproductive potential of men and women - the effect of the drug on fertility, the possibility of pregnancy or loss before, during and after completion of drug therapy

What to “see on the Internet”

Among Russian-language resources, we can recommend the international FetalRisk database or the Farmugroza service.

In addition, modern smartphones allow you to keep reference information at hand not only for specialists, but also for everyone interested. The “Medicines for Moms” cheat sheet app is aimed at expectant mothers and allows you to leave your own reviews about medications. I don’t know what the point is in this, but I think that people just like to share their impressions about everything: about vacations, about shopping, about doctors. Now we can talk about medications.

Doctors and anxious patients

Today, obstetricians and gynecologists are in a rather difficult position. On the one hand, the number of completely safe and effective drugs used during pregnancy is vanishingly small. On the other hand, pregnant women with a high anxiety index often require us to treat either an imaginary threat, or “gardnerellosis-urealasmosis,” or edema, or placental insufficiency. In order not to prescribe unnecessary therapy, the doctor sometimes needs real courage. From the point of view of some patients, a good doctor will be the one who prescribes not only pills, but also injections, and even better, IVs.

There is another side: an attempt to prescribe a life-saving drug (an antibiotic, or progesterone, or a corticosteroid drug to prevent respiratory distress in a baby during premature birth, or epidural anesthesia during childbirth) can meet with fierce resistance from those who want “everything to be natural.”

Of course, these are extremes, and like any extremes, they do not promise anything good. Pregnant women need to follow the recommendations of their doctor, believe me, we just want your baby to be born healthy.

Oksana Bogdashevskaya

Photo istockphoto.com

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1 Pregnancy and Lactation Labeling (Drugs) Final Rule