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Vitamin D Key After Pregnancy Loss

Among women planning to conceive after a pregnancy loss, sufficient preconception levels of vitamin D was associated with increased likelihood of pregnancy and live birth, compared to women with insufficient levels of the vitamin. Researchers performed a secondary analysis of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial, which sought to determine if daily low-dose aspirin (81 mg) could prevent miscarriage in women with a history of pregnancy loss. Blood levels of vitamin D were tested for ~1,200 women aged 18 to 40 years before pregnancy and again at the eighth week of pregnancy.

They found:

  • Women who had sufficient preconception vitamin D concentrations were 10% more likely to become pregnancy and 15% more likely to have a live birth.
  • Among women who became pregnancy, each 10 nanogram per milliliter increase in preconception vitamin D was associated with a 12% lower risk of pregnancy loss.
  • Vitamin D levels in the eighth week of pregnancy were not linked to pregnancy loss.

In 2010, the Food and Nutrition Board at the Institute of Medicine of the National Academies established that an adequate intake of vitamin D during pregnancy and lactation was 600 units per day. Most prenatal vitamins contain 400 units of vitamin D per tablet. So we encourage you to incorporate some of the following foods into your diet in addition to supplements.  Foods that contain high levels of vitamin D include:

  • Fatty fish like tuna, mackerel, halibut, trout and salmon
  • Foods fortified with vitamin D like some dairy products, orange juice, soy milk and cereals.
  • Beef liver
  • Cheese
  • Butter
  • Egg yolks
  • Mushrooms
  • Soy products
  • Oatmeal

If you are concerned about your vitamin D levels, please contact Coastal Carolina OB/GYN for further testing.

Why is Sex Painful for Some Women?

Let’s talk about everyone’s favorite subject: sex.

Sex is supposed to feel great—mind-numbingly great. After all, isn’t that the kind of sex people write novels about? It can be devastating when it isn’t like that at all, but it’s important to remember it’s not your fault.

Painful intercourse is also called dyspareunia, and can be due to medical or psychological causes. It affects more women than women—about 20 percent of all American women—and is treatable. But what causes it in the first place?

There are a variety of reasons your vagina doesn’t feel its best after sex, and it all depends on you and your body.

The First Time: The first time you have sex, it is fairly common to experience mild pain and discomfort. Your hymen, or the thin piece of tissue that partially covers the external vaginal opening, may still have been intact. Or you may not have been fully aroused before penetration, which could lead to dryness or too-tight muscles.

After Baby: Your vagina just went through a large change, and it’s understandable to experience discomfort or even a lack of sex drive. Six weeks after giving birth is typically when your doctor will clear you for intercourse, although that doesn’t mean you should expect your sex drive to return to normal on that schedule.

Post–menopause: Many women may experience painful intercourse after experiencing menopause. This is mainly due to significant hormonal changes, medical and nerve conditions, as well as depression or emotional issues. A typical condition of post-menopausal women is vulvovaginal atrophy, where dryness and thinning of tissues in and around the vagina is apparent.


Even if those situations don’t apply to you, painful sex isn’t uncommon, and there’s a variety of names for the pain you may be experiencing.

The most common problem is lubrication. Vaginal dryness can be caused for a variety of reasons, including the Pill and some over-the-counter drugs, but is easily treatable. If your vagina is too dry to accommodate intercourse painlessly, then just give it a little help: a spoonful-sized amount of lube can be all that’s in between you and a pleasurable night.
A yeast infection could be another reason why sex is painful. Studies show that women on the receiving end of oral sex may be more prone to a yeast infection, although it’s a common condition for all women. If your downstairs itches like crazy, and penetration only makes it worse, then you may need to visit your doctor. Treatment is as simple as antibiotics and a correct diagnosis.
Sometimes, curing painful sex is as easy as learning the art of arousal: women need a good twenty minutes of warm-up before they are ready. Your body needs time to lift the uterus out of the way and allow the vagina to expand, and only a little time can do that. Sit back and enjoy, ladies!

Birth Control Options For Your Age Group

Let us walk you through the many options for birth control tailored specifically to your age group.  Starting with women in their 20s to women over 40, we discuss a variety of options that may work best for your age, lifestyle, and your body.  Your Walnut Hill physician will also help you pick the birth control solution that is right for you and your body during your appointment. Click the button below to download.


Pregnancy Risks You Should Know About

High-Risk Pregnancy: What You Need to Know
Many conditions affecting a mother or her baby before, during or after pregnancy can designate a pregnancy as high risk. Learn what causes a high-risk pregnancy and how maternal-fetal medicine specialists can help.

Whether it’s your first pregnancy or your third, hearing your obstetrician, nurse practitioner or midwife say that your pregnancy is high risk can feel concerning. High-risk pregnancy is a term that can denote a wide variety of common conditions. Many of them are related to pre-existing conditions you may have had before becoming pregnant or conditions you may have developed while pregnant or during delivery.

A high-risk pregnancy does not necessarily mean that your pregnancy will be more difficult or challenging than a low-risk pregnancy. However, it does sometimes mean that you will need to consult a maternal-fetal medicine specialist and undergo more monitoring than someone with a low-risk pregnancy.

Learn more about high-risk pregnancy from Janice Henderson, M.D., a Johns Hopkins maternal-fetal medicine specialist and the coordinator of the Johns Hopkins Nutrition in Pregnancy Clinic.
Q: What’s the difference between a maternal-fetal medicine specialist and an obstetrician?

A: A maternal-fetal medicine specialist (perinatologist) receives a traditional obstetrics and gynecology education but with an additional three years of training to learn how to treat medical complications that are related to pregnancy. In addition, the maternal-fetal medicine specialist has extensive training in assessment and treatment of fetal problems. Most perinatal ultrasound is interpreted by maternal-fetal medicine specialists.

You may be referred to a maternal-fetal medicine specialist if you have a pre-existing medical condition prior to pregnancy, develop a medical condition during pregnancy or have problems during delivery. Additionally, you will see a maternal-fetal medicine specialist during pregnancy if your baby has an anomaly. In this case, the maternal-fetal medicine specialist will coordinate your care as well as your baby’s care during pregnancy and at delivery with the help of a pediatric care team.
Q: Should I see a maternal-fetal medicine specialist before pregnancy?

A: It can be beneficial to consult with a maternal-fetal medicine specialist before pregnancy if you have one (or more) of the following:

Pre-existing medical condition. There are many pre-existing medical conditions that may need to be monitored in relation to pregnancy, e.g., diabetes, lupus, renal disease and hypertension (high blood pressure). In some instances, a maternal-fetal medicine specialist may alter the type of medication you’re taking to maintain your health and prevent any adverse effects to your future pregnancies. If you have diabetes, a maternal-fetal medicine specialist can help you optimize your blood sugar control prior to conception to help reduce the risk of fetal anomalies. If you struggle with obesity, a maternal-fetal medicine specialist can review the benefits of weight loss before pregnancy. According to Henderson, “Losing weight in a healthy manner can reduce your risk of developing conditions such as hypertension and gestational diabetes during pregnancy.”
Genetic risks. Preconception genetic screening has become more common in recent years as technology has advanced and testing has become more accessible. If you have family members with a certain disease or if you belong to an ethnicity that has a greater risk of developing specific conditions (such as sickle cell disease or Tay-Sachs disease), genetic screening can be used to assess your and your partner’s risk of being a carrier. Also, common genetic conditions, such as cystic fibrosis or spinal muscular atrophy, can be screened for with a blood test.

Additionally, if you have a child affected by a genetic disorder or syndrome, a maternal-fetal medicine specialist can provide counseling and management to consider how the condition may impact your future pregnancies. Always speak with your health care provider to determine what’s best for you and your pregnancy.
Q: What conditions may lead to a high-risk pregnancy?

A: The following list represents the most common conditions that can lead to a high-risk pregnancy, but note that not all women with these conditions will have a high-risk pregnancy.

Diabetes. If you have diabetes before you become pregnant, you will likely be referred to a maternal-fetal medicine specialist to monitor your condition and determine the proper medications. Preconception counseling is ideal. Developing diabetes during pregnancy (gestational diabetes) is very common, and your obstetric provider will likely be able to care for you without a maternal-fetal medicine consult. If a maternal-fetal medicine specialist is consulted for gestational diabetes, he or she will follow your baby’s growth and well-being, and manage your health with nutrition counseling, glucose monitoring and, possibly, medications.
Pre-eclampsia. Pre-eclampsia is a condition unique to pregnancy where you have high blood pressure in conjunction with protein in your urine and edema (swelling of the skin). In some women with pre-eclampsia, liver or platelet abnormalities are present. You may be referred to a maternal-fetal medicine specialist depending on the severity of your disease or if you are preterm. “The only treatment for pre-eclampsia is delivering your baby,” explains Henderson, “so this is a condition that requires very close monitoring to balance maternal complications against the risks of delivering your baby early.”
Hypertension. If you have hypertension before pregnancy, a maternal-fetal medicine specialist will monitor your baby’s growth and may be consulted if problems arise. Some medications commonly used outside of pregnancy to treat hypertension are contraindicated in pregnancy.
Multiples. Pregnancies with twins or higher-order multiples have a greater risk of complications. Women with multiple pregnancies are more likely to develop pre-eclampsia or go into preterm labor. Twin pregnancies have a higher risk of fetal anomalies and growth problems, especially if they share a placenta. If you have a multiple pregnancy, a maternal-fetal medicine specialist will closely monitor the pregnancy by performing additional ultrasounds. The maternal-fetal medicine specialist will recommend how and when your babies should be delivered. “If you remain healthy and the growth of your babies is normal and without complications, you may continue to see your Ob/Gyn,” says Henderson, “or you may prefer to be seen in a specialty multiples clinic.”
Sexually transmitted diseases (STDs). In general, your obstetric provider can treat you for sexually transmitted diseases that may occur during pregnancy or if there is a pre-existing STD, such as herpes. In certain cases, consultation with a maternal-fetal medicine specialist will be required. For example, if you are being treated for syphilis and an ultrasound shows that your fetus may be affected, a maternal-fetal medicine specialist will provide further care and management. Women with HIV are also generally cared for by maternal-fetal medicine specialists because the medication regimens are complex.
Obesity. Women who are obese have a greater risk of developing diabetes, hypertension and pre-eclampsia during pregnancy. “Obesity is the one of the only health conditions affecting pregnant women that can be changed before pregnancy, which is why maternal-fetal medicine specialists encourage women to lose weight through healthy strategies,” explains Henderson. “The Johns Hopkins Nutrition in Pregnancy Clinic works with obese women during pregnancy to optimize the health of mothers and their babies.”

Q: Will all my future pregnancies be high risk?

A: Having one high-risk pregnancy does not mean that all your future pregnancies will be deemed high risk as well. You may have a fetal complication occur in one pregnancy that wouldn’t in another, and certain health conditions may change over time.

However, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy. If this occurs, your obstetric provider will manage your pregnancy using medication, and a maternal-fetal medicine specialist will monitor your cervical length with ultrasound surveillance.

Ultimately, the most important thing to remember about having a high-risk pregnancy is that your maternal-fetal medicine specialist and Ob/Gyn have the knowledge and experience required to keep you and your baby as healthy as possible.