Category: pregnant

Polycystic Ovarian Syndrome: A lifestyle-related disease?

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Polycystic Ovarian Syndrome (PCOS) is common in South African women and affects about one in 10 women globally. It is caused by a complex imbalance of hormones in the ovaries.  Charlene Yared West spoke to Life Kingsbury endocrinologist, Dr Jocelyn Hellig and gynaecologist Dr Philip Zinn to find out more about this condition. 

So what is PCOS?

In a woman’s body, the ovaries release eggs each month as part of a healthy menstrual cycle.  However, with PCOS the egg is not released as easily, which leads to irregular ovulation and menstruation and can impact fertility. “The ovaries are described as polycystic because there is an excess of the fluid-filled, egg-containing sacs called follicles, all of a similar size, when seen on an ultrasound image,” says Dr Zinn. “This excess occurs due to disturbance of the growth of follicles – to the size required for ovulation.”

It’s all about the hormones… or is it? 

Dr Hellig explains that the exact cause of PCOS is unknown. “There is no one singular factor which causes PCOS. It is considered to be a complex trait arising from the interaction of genetic and environmental factors, usually first presenting when mature gonadotropin levels (hormones essential for reproduction)are achieved at puberty. It occurs naturally in primates as well as humans,” she says. “The disorder arises clinically by the presence of two out of three criteria: irregular periods or the absence of ovulation, features of high androgen levels (acne or excess hair growth) and a certain appearance of polycystic ovaries on ultrasound,” she says. 

You could be predisposed to PCOS if…

  • You have insulin resistance.
  • You have Type 2 diabetes.
  • You have unhealthy eating habits.
  • You do not exercise regularly.
  • You are overweight or obese.

Trying to fall pregnant?

If you are trying to fall pregnant, but it is proving difficult, PCOS might be the culprit, says Dr Zinn. “Many women are unaware that they even have PCOS until they start trying to have a baby. Once they start treatment and their symptoms are managed, then their chances of conceiving are increased.”

QUIZ: ✓Tick the boxes below to see if you might have symptoms of PCOS

  •  Irregular menstrual cycle 
  • Thinning hair or hair loss on the scalp (male-pattern baldness).
  • Acne on the face, back and chest. 
  • Too much hair on the face or areas where men usually have hair (hirsutism affects up to 70% of women with PCOS). 
  • Weight gain and difficulty losing weight. 
  • Darkening of skin pigmentation, along the neck, groin and under the breasts. 
  • Skin tags in the armpits or neck area. 

How is PCOS diagnosed? 

“If you think you have PCOS, make an appointment with your gynaecologist. There is no single test to diagnose PCOS, but we take your medical history and can conduct a physical exam with a pelvic ultrasound and do some blood tests,” says Dr Zinn.  Dr Hellig adds: “Of utmost importance is that PCOS is a diagnosis of exclusion and it is important for your medical professional to look for other causes of your symptoms before ascribing it to PCOS.”

  • Physical exam: Checks your blood pressure, BMI and waist size. Also checking for extra hair on the body, skin discolouration, hair loss and any other signs of excess testosterone such as an enlarged clitoris. It is important to exclude other health conditions. 
  • Pelvic ultrasound: A sonogram will examine the lining of the uterus and check the ovaries for the polycystic features. 
  • Blood tests: To check your androgen hormone levels, as well as other hormone checks, including your thyroid. 

Can I be cured from PCOS?

8Dr Hellig explains that there is no cure for PCOS, but symptoms can be effectively managed and therefore treated. “We take into account if you want to conceive, your risk of long-term health problems, especially diabetes and cardiovascular disease, and will help formulate an effective treatment plan through lifestyle changes and medication where necessary,” she says. 

What can I do to alleviate my symptoms?

Dr Hellig and Dr Zinn agree on the following steps that women can take to treat PCOS: 

  • Lose weight: This will help to stabilise your blood glucose levels and alleviate insulin resistance. Even a 5 – 10% loss in body weight can improve your chances of conceiving. 
  • Remove hair: Using facial hair removal creams, laser hair removal or electrolysis. Medication is not very effective for permanent hair removal. 
  • Hormonal birth control for women not wanting to conceive: Can help to regulate  menstruation cycles, stabilise weight, improve acne and reduce new hair growth on face and body. 
  • Anti-androgen medicines: Although not safe for pregnancy, can help reduce PCOS symptoms. 
  • Metformin: A drug used to treat type 2 diabetes and may help some women with PCOS symptoms in certain circumstances. 

Do you have the pregnancy glow?

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In pregnancy, your skin can exude a truly healthy glow because of a combination of factors, such as greater blood volume, which can give the cheeks a flushed look and more sebum on the skin, which can make the skin shine. While every woman experiences hormone changes in pregnancy, not every woman will get that pregnancy glow. It is well-documented that pregnancy brings with it a whole new set of skin concerns – not just the most common of problems, namely stretchmarks. Charlene Yared West spoke to Life Fourways Hospital Gynaecologist, Dr Abigail Lukhaimane, Life Mercantile Hospital Dermatologist, Dr Zinzi Limba and Genesis Maternity Clinic Maternity Coach & Spa owner, Tsholo Bless, to find out more about skin conditions in pregnancy.

Acne-oh-no!

What is it? “Acne is very common in pregnancy, especially in the first and second trimesters and in some cases can be quite severe. When your hormones settle by the third trimester it can subside for most women, but this is not always the case” says Dr Abigail Lukhaimane. “I do my best to reassure moms that it is a natural , cosmetic condition and that it will get better when hormones stabilise.” 

Primary cause: Dr Zinzi Limba explains that increased levels of androgen hormones, believed to be important for cervical ripening at full term, as well as for maintaining a healthy pregnancy, can cause acne. 

What can you do? “Managing acne in pregnancy can be tricky because many prescriptions and over the counter treatments are contraindicated for pregnancy and can cause birth defects,” says Dr Limba.  She encourages moms to talk to their doctor to plot the best and safest way forward before taking any acne treatment. 

Tsholo Bless recommends some easy drug-free options for managing zit outbreaks:

  • When washing your face, use an oil-free, alcohol-free cleanser, limiting washes to twice a day. Avoid over-cleansing as this stimulates the oil glands in the skin to produce more oil.
  • Change your pillowcases often – use cotton pillow cases which encourage the skin to breathe.
  • Keep your hands away from your face so that you do not spread bacteria from your fingers to your face. This goes for your mobile phone too – a device dripping in bacteria, even on the best days!
  • Avoid the temptation to squeeze or pop your pimples, as this can cause re-infection and scarring.
  • If you have clogged pores, treat yourself to a professional salon facial.

Chloasma: The Mask of pregnancy

Dr Lukhaimane explains that chloasma, also known as melasma, is a common skin problem where the condition causes dark, discoloured patches on your skin (hyperpigmentation).  Most common on the forehead, nose, cheeks and chin.  According to the American Academy of Dermatology, 90% of people who develop this condition are women.
Primary cause: “Estrogen and progesterone sensitivity often accompany this condition and can trigger it,” says Dr Lukhaimane. “Usually it is self-limiting and will fade after the pregnancy. Sun exposure can also predispose melasma. In addition, darker skinned people are more at risk than those with fair skin.” 

How do I know I have it? A visual exam of the area is often enough for your care provider to diagnose it, says Dr Limba. “However, dermatologists can perform a bed-side test using a Wood’s Lamp – a special kind of light that allows the doctor to check for any bacterial and fungal infections to determine how many layers of skin the melasma has affected.”

Living with melasma: Not all cases clear up with treatment, but there are methods of behavioural changes that can help minimise the worsening of the condition.  “Visit your doctor to discuss prescription options that are safe to use for pregnancy,” says Tsholo.

  • Use Paraben-free makeup if you are self-conscious to cover up areas of discolouration.
  • Wear Sunscreen containing Titanium Dioxide & Zinc Oxide – every day!
  • Wear a wide-brimmed hat and protective clothing when you are out and about in the sunshine.
  • Seek out support groups for your condition.

The Pregnancy Line

The pregnancy line is also known as linea nigra and is a normal and natural part of pregnancy. It is brown and darker than the skin tone of the woman and is a vertical line running down the middle of the belly, between the belly button and the pubis, explains Dr Lukhaimane. 

Primary cause: “It is understood that the linea nigra and the darkening around the nipples is caused by the hormones estrogen and progesterone, which stimulate the production of melanin, the pigment which darkens and tans the skin in pregnancy,” says Dr Limba. 

Does it fade? After pregnancy and birth  it goes away on it’s own – you do not need treatment. 

Stretchmarks? You earned your stripes mama! 

“Stretchmarks are very common in pregnancy, affecting about 8 out of 10 women –  and do not cause harm to the mother or baby, but can cause itching on the area for some women,” says Dr Lukhaimane. 

Primary cause: Dr Limba explains that skin is highly adaptable and can stretch and contract, but during pregnancy, the skin does not have enough time to adjust, which causes the skin to tear, which in turns results in a scar that forms – and this is known as a stretchmark. 

Who gets stretchmarks? “Lighter skinned women often get pink stretchmarks forming, while darker skinned women will have lighter stretchmarks than the surrounding skin area.  Stretchmarks can occur anywhere; on the hips, thighs, belly breasts, lower back and buttocks,” says Dr Limba. 

Treatment: Tsholo says that there is no absolute treatment for stretchmarks, but that women can be comforted to know that they will fade into paler scars and sometimes become less noticeable, but will not go away completely. “The best advice would be to make sure that you keep the skin well nourished and a cream or oil made from plant oils rich in Omega 3,6, & 9 can be very useful. A study published in International Journal of Molecular Sciences by T.Lin et al showed that the topical application of some plant oils can have anti-inflammatory and skin barrier repair effects. This also means that the itching is reduced. So it is wise to seek information from your skincare therapist,” she adds. 

TOP TIPS

Sunscreen is imperative. 

When pregnant, all medication should be cleared by your physician / gynaecologist. 

Own your birth: Why you need a birth plan

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The birth plan: a tool pioneered by childbirth activist and midwife, Sheila Kitzinger in the 1970s, who believed that women and not their caregivers, should be the focus of childbirth and be able to advocate for themselves with this document, which detailed their wishes for the delivery. In the wake of birth plans, the Better Births Initiative was formulated as a way of educating caregivers on the general care of women in labour. The initiative was also rolled out in South Africa and expected to be adopted by all hospitals by 2015. Amongst the guidelines, it encourages respect, privacy and companionship for women in labour, pointing out that women should be able to labour and birth in whatever position they feel most comfortable, with as many birth companions as they choose to have. By Charlene Yared West. 

Birth plans inform and educate 

“Birth plans have become common practice now, as expectant mothers are more informed about their birth choices,” says Marié van Heerden, midwife and hospital manager at Genesis Maternity Clinic. “It is a good exercise for each expectant parent to inform themselves of their options through compiling a birth plan, so that they understand what they can expect, as well as benefit and risk of procedures and medication – and know where they can make certain choices. This applies to any type of birth, whether it is for a natural or planned caesarean section.” Laura Sayce, doula and lactation consultant at Genesis agrees; “I help my clients to compile their birth plans as a way of helping them make informed decisions. It also encourages them to do their own research into each element of the birth and then to make choices based on this information.” 

What should a birth plan include? 

According to a research paper Birth Plans, the good, the bad and the future by J.Lothian (2006), the focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labour, and what will I need from them? “I encourage all my patients to write out their birth preferences and to make copies of it, one of which is placed into their file at the hospital and extra copies for the hospital midwife on duty for the day they go into labour,” says Dr Sean Drew, gynaecologist-obstetrician at Life Hilton Hospital. “It helps everyone onto the same page about what the parent’s intentions are for the birth, but it must also leave room for what happens in the event of having to resort to ‘plan b’ option, which is often not detailed in the plan, but should be.” Dr Drew explains that as medical professionals, their first obligation is to the safe and healthy delivery of baby and mother. “First we want to ensure life, then we can look at incorporating all the ‘quality of life’ elements from the birth plan. This is not to say we don’t observe what is written in the document. It is quite the opposite. We do try to fulfil the mother’s wishes to the best of our ability, within our scope of practice.”

Most important birth plan elements

Life Hospitals aim to work in an evidence-based way. Sister van Heerden points out that it is helpful to speak to your care provider and to do a hospital tour, so that you have a clearer insight into how the births are conducted at the hospital you have selected to birth at. “Once you have done that, you are ready to write your birth plan. There are so many templates on the internet, but here are some important factors to include,”: 

  • Labour and birth: freedom to eat and drink in labour, play music, dance, make labour sounds without inhibition, use aromatherapy oils (safe for labour and birth), have freedom to move into any position and birth in any position on the floor, or the bath or the bed. A mother should be allowed access to a doula or birth companion of her choice, who will provide non-medical pain relief options, including hypnobirthing, massage and general encouragement. Delayed cord clamping after the baby has emerged to allow for all the baby’s blood to be drained from the placenta to the baby. 
  • First hour: Uninterrupted, immediate skin-to-skin contact with the mother or the father (if the mom is unable to). Assistance with the first latch if requested, otherwise the baby should be allowed time to attempt a breast crawl. Weighing and measuring to be done after the first hour of bonding for the family. No separation of mother and baby unless absolutely medically necessary. 
  • Postnatal: Rooming in with your baby, no formula unless there is informed consent of the mother, provision of pain relief if medically necessary and assistance with breastfeeding. 
  • Plan B: In the event of an unexpected caesarean, there are still choices. The mother can request immediate skin-to-skin with the baby in the theatre after the initial checks by the paediatrician and no separation unless medically necessary. Early initiation and assistance with the first latch. If the baby has to go to the neonatal ICU, then the father may accompany the baby. 

What are the roles of each of the professionals present at a birth? 

  • Obstetrician-Gynaecologist: A medical doctor who is the primary caregiver for your birth and there to deliver the baby when it is time to push the baby out. He/She may also conduct vaginal examinations during labour, but this is more often performed by the hospital midwife on duty. It is also the role of the doctor to perform the caesarean sections either scheduled or emergency. 
  • Hospital Midwife: The hospital midwife performs nursing duties during labour and ensures the medical needs of mother and baby are taken care of by checking foetal heart rate, mother’s well being,blood pressure and other medical checks. She/he may also conduct the vaginal examinations, under the instruction of the primary caregiver, the doctor. In private hospitals in South Africa, the baby is delivered by the doctor and not by the midwife, unless the baby is born before the doctor’s arrival at the birth. The midwives at Life Healthcare hospitals are however trained to conduct normal deliveries. In government hospitals, the hospital midwives are permitted to conduct deliveries. 
  • Independent Midwife: She/he fulfils the same role as the hospital midwife, but may also deliver the baby and call on the obstetrician-gynaecologist in the event of an emergency. Independent midwives may also conduct homebirths, hospital births on low risk pregnant women, with confirmation and back up of a supporting gynaecologist-obstetricians. 
  • Doula: A doula is employed privately by the parents themselves and works independently of the hospital. She is non-medical and is there for the mother’s physical and emotional support throughout the labour process. She may not advocate on the mother’s behalf to her caregivers. Research supports the use of a doula for a more empowered and positive birth experience, no matter what turn the birth takes, whether the baby is born vaginally or abdominally.   
  • Anaesthetist: The anaesthetist is called in if the mother requests an epidural during labour and is also there for caesarean births to administer the spinal block and for ensuring adequate pain relief after the caesarean. 
  • Paediatrician: The paediatrician is called in after natural births to check on the wellbeing of the baby. They are also present during caesarean sections to ensure the health of the baby. 
  • Lactation consultant: Although the mother receives breastfeeding advice and assistance from the midwives in the maternity unit of the hospital, a lactation consultant is extremely helpful to ensure long-term breastfeeding success. 

Medication & pregnancy

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Knowing what medication is safe to take in pregnancy is very important when considering over the counter and prescription medications. There will be times in your pregnancy when you simply don’t feel well – and wonder if it’s safe to take the same medication you took before you got pregnant. Life Healthcare delves a bit deeper into this topic, making sure you and your baby stay safe during pregnancy. 

Why is it important to know the facts about what’s safe and what’s not?

In the late 1950s the drug ‘Thalidomide’ was released as a non-addictive sedative, which could also effectively treat morning sickness in pregnant women. It was distributed to 46 countries and what followed was a medical disaster where over 10,000 children were born with a range of severe debilitating malformations. “That was one of the most devastatingly tragic events in medical history – one that should never be repeated. However, it is rare for something like that to happen again in our day and age, where women are more informed about what’s safe and what’s not – and do question everything,” says Dr Billy Joseph Jacobs, gynaecologist and obstetrician at Life Glynnwood. “We encourage all our patients to clear the medications they were on with us – and if they are experiencing symptoms, to check with us what medications are safe to take now that they are pregnant,” he says. “The greatest risk to the baby is in the first trimester of pregnancy when all the organs are forming. Oral medication used for acne is especially dangerous then. It is best to avoid all medication in the first trimester, unless prescribed by your doctor.”

Clinical Practice Pharmacist at Life Eugene Marais Hospital Kashmiri Ganas, agrees; “During pregnancy, many medications and supplements can be passed via the placenta directly to the foetus,” she says. “Some medications and supplements can cause harm or birth defects to the unborn child, so it is of utmost importance to consult your doctor before taking any medication or supplement. The same holds true once your baby is born and if you are breastfeeding.”

Medication to avoid in pregnancy

According to Dr Jacobs, medication containing alcohol and pseudoephrine, which is found in common cold and flu preparations, as well as aspirin and anti-inflammatory agents such as Ibuprofen and Diclofenac are not safe in pregnancy and should not be taken, unless directed under the supervision of your treating doctor. “Each medication has a risk factor classification associated with it and it is on an individual basis that safety is established,” he says. 

Chronic medication in pregnancy

Pharmacist Kashmiri adds that it is very important to also inform your doctor of any chronic illness that you may have. “Your doctor will then decide on the risk benefit ratio when deciding whether to continue treatment or not. Conditions that require treatment such as epilepsy and depression must be treated adequately, as failing to do so may result in a risk to mother and baby,” she says. “The doctor will review all medication taken to treat the chronic condition and establish whether it is safe to take whilst pregnant, if it is deemed to be harmful during pregnancy an alternate drug may be prescribed or collaboration with a physician may ensue.” Dr Jacobs agrees, adding that it is imperative that all medication is taken as prescribed, at the correct dose, quantity and frequency as deviation in any way may cause harm to you or your baby. “Always read the label and look for allergic reactions, expiry dates and warnings – and be wary of side effects. In addition, be careful not to mix up your medications or skip medications when you should be taking them.” 

<Sidebar> Dr Jacobs and Pharmacist Kashmiri share their advice on how to alleviate some common pregnancy conditions from A to Z. 

Common Pregnancy ConditionsSafe medications and remedies Advice: 
Allergies-Allergex-Loratadine-Nasal decongestant spray-Nasal steroid sprayMay be used with caution in pregnancy, consultation with doctor is preferred. If allergic reactions last longer than a day or two, see your doctor.
Constipation-Movicol
-Glycerine Suppositories.		Increasing fibre and fluid intake may help relieve constipation, as well as adding dried fruit, prune juice and bran to your diet.
Common Colds and Flu-Salex Nasal Spray/Rinse-Prospan Cough Syrup -ParacetamolIf a respiratory infection is suspected, your doctor should be consulted.
Diarrhea-Kaolin-Pectin-Imodium-Smecta -RehidratContact your doctor if diarrhea is severe, if there is blood in the stools or if symptoms continue for longer than 24 hours. Most diarrheal illness last only a day or two without treatment. It is important to replace fluids lost with a rehydration solution.
Fatigue-Prenatal vitamins-Folic acid -Magnesium. Get plenty of rest, elevate feet, and eat a well balanced diet. If the problem is persistent, contact your doctor as this may also signal low iron levels. It is also very important to take folic to prevent a condition known as spina bifida in the baby.
Faintness and Dizziness-Don’t self treat. Fainting and dizziness that is not relieved by sitting down or lying down must best be assessed by your doctor. It may be a sign of either high/low blood pressure or glucose levels which may cause harm to the unborn baby.
Hemorrhoids-Anusol-Preparation HConstipation aggravates the symptoms of hemorrhoids, so ensure a high fibre diet and increase fluid intake. Don’t delay going to the bathroom. Sitting in a warm bath may help alleviate some symptoms.
Headache-ParacetamolIf pain is not alleviated, contact your doctor, as this may be a sign of elevated blood pressure. It might also be an indication of dehydration so increased fluid intake may also help. If you have a fever, contact your care provider immediately. 
Heartburn & Indigestion-Gaviscon-CitroSoda-Rennies-MaaloxSteer clear of foods which can exacerbate symptoms. 
Insomnia-Antihistamines listed above for allergies have a sedative effect.-Sleep eazeTake a warm bath before bed, try different sleeping positions or a maternity pillow, or ask your partner to give you a massage before bedtime. 
Muscle Strain-Slow Mag Slow Mag is considered safe and is especially effective for leg cramps that are common during pregnancy.Taking a warm bath may also help.
Nausea and Vomiting, morning sickness-Asic-After 8 weeks pregnancy; ZoferIdentify foods that may trigger these symptoms. Starting the day off with a dry bland meal such as toast may also relieve these symptoms. Eating smaller meals more frequently. Also easily digestible and less fatty meals.
Rashes-Allergies medication-Mild steroid creamsYour Pharmacist will be able to advise on a suitable topical treatment or consult with your doctor. Identify the cause, skin irritation, food allergy, contact dermatitis. Mild steroid creams for a day or two is safe.
Urinary Tract Infection (UTI)-CitroSodaContact your doctor as a UTI may cause harm to the unborn baby. Citro Soda relieves burning only. If persistent, see a doctor.
Yeast infection-Canesten CreamContact doctor as a Yeast infection may cause harm to the unborn baby. Use a probiotic like Interflora when recurrent.

‘Surrogacy gave us the gift of twins’

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Tasha and Wayne McKenzie wanted a baby even before they said their vows on their wedding day. After four years of trying to fall pregnant naturally and after six unsuccessful rounds of IVF, their friend Lee-Ann Laufs said she would be their surrogate. Charlene Yared West sat down with Tasha, Wayne and Lee-Ann to learn more about their surrogacy journey. 

Surrogacy chose us

Wayne and Tasha felt that they had exhausted all their options to have a baby, save the adoption route. Their friend, Lee-Ann Laufs worked closely with with a safe house for abused and abandoned children called Miracle Kids in Cape Town. “I emailed her to get the details and she called me back saying that she had been telling my wife Tash for months that she would be our surrogate – and that she really meant it. I was blown away by what she said and wanted to laugh and cry simultaneously. I knew this could finally be it… We could have our baby!” 

Tasha recalls how she got to know Lee-Ann in her beauty salon; “When she came for treatments, we got to know each other and would start chatting about where I was in fertility treatment. She always mentioned wanting to be our surrogate, but sometimes people say things they don’t really mean and I wasn’t sure if this was one of those times, so I left it at that. She gave birth to her second son and after the caesarean messaged me from the hospital saying she would do this for us. She told us to be patient and wait a little while longer until she had healed and was ready to be pregnant again. We left it at that and I still didn’t believe her!” 

It was only after Lee-Ann and Wayne had spoken that the offer of surrogacy became real to Tasha. “Unless you have been through the process, you will never know the heartache of infertility and I was terrified to allow someone else to carry my baby.” adds Tasha. “It was the best news to hear that both eggs survived and we were expecting twins. Prof Thinus Kruger from the Aevitas Clinic dealt with the embryo transfer and making us pregnant.”

Lee-Ann recalls how during the pregnancy, Wayne started calling her “Smeg”, which was a code word for oven. “That was exactly how I viewed the pregnancy; I was an oven for their babies. Simply put; their sperm and eggs, my uterus. The babies don’t receive anything from the surrogate mom except food and a warm comfy womb.This is known as gestational surrogacy,” explains Lee-Ann. “There were no feelings afterwards of ‘I wish they were mine.’ The joy it gives others is so worth it and helps erase all the heartache they went through to finally have their babies.”

The medical side

“The surrogate and the commissioning mother need to sync their monthly cycle,” says Professor Thinus Kruger from Aevitas Fertility Clinic in Cape Town. “Hormone injections are administered to the surrogate to stop her from ovulating at this time. Her uterine lining also needs to be a certain thickness so that the embryo can be transferred into the lining to grow.” He explains how the commissioning mother’s eggs are stimulated to get as many as possible and are then grown until they are mature enough to be harvested and then fertilized by sperm from the father. “The laboratory scientist selected eight eggs based on quality and and then fertilized those. They are then grown and allowed to undergo cell-division outside of the body between three and five days. Not all the eggs will go through these stages of cell division and then another selection process takes place where only two embryos are transferred into the surrogate’s uterus at this time. After the transfer, there is a waiting period of ten days before seeing if the pregnancy is viable.” Prof Kruger explains that there are variations to this process and it is not successful at every stage.

Gynaecologist and obstetrician Dr Gary Groenewald was chosen by Lee-Ann to continue his care as her primary caregiver. “Lee-Ann is an extremely giving person and to do this for friends – to undergo pregnancy and surgery via caesarean section – is a major sacrifice. It really takes a special, very generous person to do this for someone else,” he says.

Since the McKenzies’ case, Life Healthcare developed a very practical and sensitive protocol to deal with future surrogacy cases. Wayne shared how special the caesarean was at Life Kingsbury and that he and Tasha were allowed to be there as well as Lee-Ann’s husband, Shaun. “It was the best day of our lives and we are forever grateful to Lee-Ann for what she did for us. We are adjusting to life with our baby girls, Lea and Madi and being parents,” says Tasha. “It has been an amazing journey and all the pain and disappointment of infertility is slowly fading, but it still feels like a dream sometimes… but then I see my daughters and I am so proud and happier than I could ever have imagined possible.” 

Surrogacy Quick Facts 

  • According to Surrogacy.co.za, women who want to be a surrogate need to have had experienced pregnancy and birth and have at least one living child of their own. 
  • A surrogate also needs to be in good physical, emotional and mental health. A thorough medical and psychological examination is carried out to ascertain suitability of the surrogate and the parents. 
  • Since 2010, new laws about surrogacy were passed and women wanting to be surrogates may no longer gain financially from the process. However, all medical bills for the pregnancy must be footed by the commissioning parents. You may only be a surrogate for altruistic reasons. 
  • Commissioning parents opt for surrogacy because they are unable to conceive their own child via fertility treatment or otherwise. Many gay couples who want a child of their own often look for a surrogate to help them achieve this. 
  • As a surrogate you have no rights to the child after birth. 
  • A contract is drawn up with the Surrogate Lawyer so that your surrogate does not run away with your unborn child. In the contract it also states how many IVF processes the surrogate is willing to do and how many IVF processes the parents to be are able to afford before cancelling the contract. 
  • Check out www.surrogacy.co.za for more info. 

Multiples: A dream come true through IVF

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If you have been trying for a baby for more than a year, but have been unsuccessful, you are one of at least 50-million couples who experience infertility worldwide. The number of children being born in South Africa is also on the decline and according to the Recorded Live Births 2013 to 2015 report, the number of birth registrations decreased by 6.8% from 1.6-million in 2013 to 1.08-million in 2015.  As a result, many couples are turning to infertility treatment to fulfil their hopes of having a baby. If you’re a good candidate for In Vitro Fertilisation, it may be the only way to help you grow your family unit from husband and wife to three… or even four… or more! 

Multiples and IVF

“IVF treatment can result in multiple births because, often, more than one embryo is transferred into the uterus of the mother,” says Dr Henk Burger, gynaecologist and obstetrician at Life Carstenhof in Gauteng. “The chance of having multiple births can be reduced considerably by only putting one embryo back into the womb.” The cost of IVF ranges from R30k to R50k per attempt, which explains why many couples opt for implanting more than one embryo to increase their chances of a successful pregnancy the first time around, explains Dr Burger. He notes that sometimes a termination of one of the embryos is requested after implantation, but this is very difficult and dangerous for the embryo that stays behind. 

Multiples and risk

We all know how adorable twins are – and they make for an instant family unit, but they also come with a certain level of high risk in pregnancy. “Around 30% of multiples are prone to prematurity – and born before their due date. There is also the risk of intrauterine growth retardation, birth defects and miscarriage. The mother is also five times more likely to get pre-eclampsia and six times more likely to have polyhydramnios and antepartum haemorrhage,” says Dr Burger. “Mothers carrying multiples must ensure they attend each and every antenatal consult; every four weeks up to 20 weeks, every two weeks up to 28 weeks and every week up to birth thereafter. The aim is to get the mother to carry her baby to at least 36 weeks, but this is often not the case.” He also advises mothers to eat a  balanced diet, not to smoke and to take antenatal supplements. “Simple things like positioning of the safety belt in the car when driving are also important to remember to reduce risk,” he adds. 

Natural or Caesarean birth for multiples

According to Dr Burger, birth by caesarean section is the safest for multiples, because of the risk, especially for the babies born after the first one. “There is positional risk such as breech or transverse positioning, especially for the second baby. There is also the risk of premature labour, placental abruptia, fetal distress and even early closure of the cervix,” he says. “There was a case reported where the cervix closed after the mother had naturally birthed the first of her twin babies. Her cervix remained closed for 56 days before she birthed the second one! It is the longest reported period between delivery of the two babies.” 

Breastfeeding your babies

Dr Rebecca Makate is a paediatrician at Life Carstenhof and is experienced in helping parents adjust to life with their new babies. “Breastfeeding for any baby offers major health advantages such as less infections and better neurodevelopment. The breast can make enough breastmilk for two or more babies as breastfeeding is based on supply and demand,” she says. “In other words, the more you breastfeed the more milk your breast produces. It is also possible to breastfeed twins at the same time on different breasts. Having said that, having more than two babies can come with huge challenges during feeding time.Even if you breastfeed, occasional supplementing your babies formula will give you some much needed freedom and sleep.”

<Sidebar> So what is life like with multiples?Despite some challenges and drawbacks, having multiples is a great joy, says Dr Makate. “There is a level of convenience and efficiency in parenting children simultaneously; some of the unpleasant aspects are sleepless nights, feeding times, potty training and teenage troubles which all have to be endured at once. Mostly though, there is a great pleasure and enjoyment in parenting multiples, every moment is multiplied and every simple joy is magnified,” she says. Dr Makate lists the following challenges couples should consider before IVF:-Pregnancy and birth risks when carrying multiples.-Fetal complications and time in the NNICU.-Lack of sleep.-Difficulty bonding.-Economic impact on the family unit.-Relationship with your spouse is put under pressure.-The need for extra help with caring for the babies. 
<Sidebar> What are Monozygotic and Dizygotic multiplesMonozygotic multiples: In monozygotic multiples, the embryo splits and the babies are born identical. In utero, they share one placenta and one amniotic sac. Dizygotic multiples: In dizygotic multiples, there are two separate embryos, each with their own placenta. Monozygotic multiples are higher risk for a few reasons: Placenta abruptia: where the placenta tears away from the uterus during birth and deprives one or more of the babies from it’s life source of oxygen and blood. Cord prolapse: where the umbilical cord of the second baby born prolapses out of the mother’s vagina. Twin-to-twin transfusion syndrome: where the babies share a joint blood circulation through the placenta, which contains abnormal blood vessels, where blood is transfused disproportionately from one twin (the donor) to the other twin (the recipient).
Lindy and Michael’s* story
We fell pregnant after many, many years of trying to conceive – almost ten years. Initially we tried naturally, then Artificial Insemination and then only In vitro Fertilisation. As I am an older mom it was necessary to go this route. It’s a very drawn out process with lots of steps and checks and balances. One needs to eliminate the options that are not viable first and the doctors are all very cautious and considered in how they approach IVF in South Africa. It is a very expensive process, but we were committed to being parents, and I was not willing to give up, so we just kept on trying until we had a positive outcome. We first attended the Cape Fertility Clinic but after no luck there, we moved to Aevitas which is based at Life Vincent Pallotti. Prof Kruger and Prof Siebert from Aevitas were absolutely amazing, as were all the sisters that worked with them in their team. A number of eggs were fertilised and the best quality eggs were implanted and we were very lucky that two fertilised eggs resulted in our gorgeous twins, Jacques and Stella. It was a very long and stressful process. We lost a baby at full term, Ruby Mae, who was stillborn at 41 weeks.  Soon after this loss, we tried again to conceive and with the help of Aevitas got pregnant with the twins who were born on 1 May 2015. It was amazing and unbelievable to find out we were pregnant with twins after losing our previous baby.  We were elated and also scared as twins are a major change in one’s life. On the 13th of January we felt our first big kick after steak strips with Szechuan pepper and salad for dinner, it was wonderful! We made it through to 38 weeks and delivered them with the help of Dr Marie Pienaar and her team and Panorama Mediclinic. We love them to bits and they entertain, inspire and motivate us each day to be better, kinder parents. Its tough with two but the highlights are by far in excess.  It is stressful and one learns how to cope. Support makes all the difference, whether it is grandparents, siblings, night nurses, nannies or friends. Also each baby is so unique and has their own personality and it’s such a joy to experience the gift of twins.*Names have been changed. 
Vanessa and Philipp’s storyWe had been trying to conceive for a long time, but I knew that with my pre-existing conditions of Polycystic ovarian syndrome and Hashimoto’s Thyroiditis, it would not be without some challenges. In 2015 I had a molar pregnancy – very rare – where a non-viable fertilised egg implants in the uterus and grows as abnormal tissue.In that time, we had been in touch with an adoption agency to come ‘kangaroo parents’, which are like safety parents for babies under 3 months old, where we would care for them for up to 90 days until they were transferred to their forever homes. When we started the paperwork, I found out I was pregnant and we felt it might be too much to go through with the adoption agency, but then later that year, I miscarried and this broke me on so many levels. After that I left for Europe and shortly after we received a call from the adoption agency to know if we were perhaps keen to foster twins who were 6.5 months old. We slept on it and the next morning we decided that we would do it and eight days later they arrived. We lost our hearts completely to the babies and decided to start the process of legally adopting them. We still kept our sights on having our own biological child one day, so we kept on trying naturally at first and then decided on IVF at the Aevitas Clinic at Life Vincent Pallotti. On the day of the transfer they implanted two eggs and at the 9 week scan we heard three heartbeats! The two boys shared one placenta, but each had their own sac and the girl had her own placenta and sac. I honestly felt as though I lost the ground under my feet and the world was spinning… we would be parents to five children now, the twins included! My pregnancy was easy until 26 weeks when I started having contractions and had to have bedrest at Life Vincent Pallotti until my caesarean birth on the 24th of April at 30 weeks pregnant with Dr Jacky Searle at Life Vincent Pallotti. My precious babies weighed 1290g, 1220g and 1540g at birth and now we are a beautiful family of seven. I am thankful for blessings in abundance and the good health of all my children. 

Dealing with infertility, when he has the problem

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It’s not just a women’s issue

Struggling to fall pregnant? Usually women are the first to seek help when trying to conceive. However, if the woman has been thoroughly examined and it is not due to her that she is unable to fall pregnant, it falls to the male partner to be tested. According to a study published in 2015, infertility affects about 15 per cent of couples globally, amounting to about 48.5-million couples. The study also found that males are found to be solely responsible for 20-30 per cent of infertility cases and contribute to about 50 per cent of cases overall. Furthermore, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. If a male factor is what’s making it tough for a woman and her partner to conceive, it’s important to understand what may be causing his infertility and what the couple’s options are. Charlene Yared West speaks to the experts to find out more… 

Infertility and feelings of inadequacy and impotence

“Research indicates that the male partner is not willing to seek medical advice about infertility. They feel embarrassment for not being able conceive naturally and suffer guilt, self-blame and shame,” says Dr Liezel Anguelova, Counselling Psychologist at Life Roseacres Hospital. “Many men do not feel comfortable with the testing procedure as it includes the examination of their testicles and penis and the production of a sperm sample. As such, men often associate infertility with impotence, when they are actually unrelated.” Dr Anguelova explains how infertility can be devastating to the man who experiences the failure of his procreative nature, as it is so intrinsically linked to his sexuality. “It is often an assault on the masculinity of the male partner and it is not uncommon for him to develop sexual problems such the loss of sexual desire or erectile dysfunction, which can leave him feeling that he is ‘less of a man’,” she says. 

What causes male infertility?According to Dr Sulaiman Heylen, Specialist in reproductive medicine at Life Kingsbury Hospital, male infertility is diagnosed by an abnormal semen analysis. “We always start at the beginning of the fertility testing with the semen analysis. We don’t want to do a lot of testing on the female without knowing what the male factor is. Semen analysis is very easy and inexpensive.”
There are three parameters important in the semen analysis according to 2010 WHO criteria:
1. sperm count: must be over 15 million sperm per milliliter.
2. sperm motility (how they move): 50% of sperms cells must be motile.
3. sperm morphology (their shape): at least 4% of the sperm cells must have a normal morphology.
“If one of these parameters is abnormal we speak of male infertility in combination with an inability to conceive,” he explains. Dr Heylen lists the following as possible causes of male infertility;Varicocele: These are varicose veins of the testis, they can contribute to up to 30% of all cases of male infertility. Trauma of the testicles; related to accidents or sports injuries.Sexual transmitted disease which can lead to infections of the testis and blockage of the epididymis (tubes of the testis)Mumps of the testis.Pollution and environmental factors (estrogen like factors in the environment): These are called xenoestrogens. Estrogen is the normal female hormone. Xenoestrogens are chemical compounds that mimic estrogen. There is more and more evidences that pollution and environmental factors can contribute to male infertility.Unhealthy lifestyle: Obesity, excessive alcohol, smoking and drugs. Anabolic drugs are well known to cause low sperm counts. Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.Undescended testes: During fetal development one or both testicles sometimes fail to descend from the abdomen into the scrotum. Genetic: there are genetic defects in the chromosomes or small defects of the Y-chromosome. Unknown: We not always can identify the cause of the low sperm count. 

How is male infertility uncovered?

Urologist, Dr Dap Louw from Life Beacon Bay Hospital explains how the physical examination entails a general exam, evaluation of the testes ( volume, masses, varicocele, infections, etc) and a prostate exam if needed. “The basis of the evaluation starts with taking  a thorough medical history. We normally do a pelvic and scrotal ultrasound as well, to evaluate the testicular tissue and to look for signs of sperm transport blockage. Other more invasive diagnostic methods can be used especially when there is little or no sperm seen in the ejaculate. This would then be aimed at distinguishing between abnormal sperm production or blockage of sperm transport,” he says. 

What treatment is available? 

Dr Louw explains that treatment is aimed at the underlying problem whether it is advice on a healthier lifestyle, surgical correction of a testicular abnormality or medically treating an underlying infection, sexual dysfunction or hormonal abnormality. “When there is no urological correctable contributing cause to the infertility, I then like take a multidisciplinary approach and get the infertility specialists and/or gynaecologists involved,” says Dr Louw. “Together we can then decide on further optimal treatment, according to their hormonal levels, semen analysis and then also female factors. These can then vary from medical treatment, sperm washing with artificial insemination, IVF (in-vitro fertilization) or ICSI (intracytoplasmic sperm injection).” Dr Louw always emphasises to his patients that 20-30% of sub-fertile couples end up falling pregnant without any further help, which is positive – as nature is on their side! “Anxiety about infertility also plays a significant role and it is important to explain the normal conceiving time of 6-12 ovulatory cycles,” he says. “It does unfortunately happen where our patient is not able to have children and the couple would need to discuss alternate options like sperm donation or adoption.” 

Can a couple survive infertility treatment?Infertility can be a relationship maker or breaker depending on how it is managed says Dr Anguelova. “It will put your relationship to the test, but if you focus on the importance of your relationship, it could be used as a opportunity to make your relationship stronger.” She shares some tips for surviving infertility;Stay in the moment, because it can be very overwhelming.  Wait for each doctor’s visit to gather information on the process before making decisions and planning ahead.  Communicate openly and honestly to address unmet expectations, fears, frustrations and  stress. Find professional assistance and counselling if you are not communicating effectively.  Do not get caught in a blame game of resentment, but rather become committed as a team. Remain positive about yourself and your partner.Keep your sexual relationship spontaneous and full of fun and nurture intimacy by touching, hugging and kissing outside of a sexual connotation.Do not let your entire life be merged into the fertility treatment process. Continue with other hobbies and keep other dreams alive.Build a support system. Support each other and include friends and family in the process.

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Prenatal Surgery: Saving a baby’s life in utero

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In July 2015, Eunice and Nathi Motha finally became pregnant via in-vitro fertilisation and their joy at the news turned to pure elation when they found out they were pregnant with twins; a boy and a girl. After an uncomplicated pregnancy until 18 weeks, the couple readied themselves for the arrival of their babies. Sadly, however, the amniotic sac of the boy foetus ruptured and his leg protruded through the cervix. This made life in the womb for the boy unviable and the pregnancy needed to be terminated – or did it? According to gynaecologist obstetrician, Dr Deon Van der Merwe at Life Midmed Hospital, the girl foetus could be saved and the pregnancy for one of the twins could continue, the boy however, had to be removed from the uterus either vaginally or via caesarean birth.  

Not just another day at the hospital

It was the second time in 15 years that Dr van der Merwe performed an operation of this nature and he consulted with colleagues to gauge their informed opinions. “It is not an operation that is taken lightly as the dangers are immense; there is the risk of uterine rupture to carry the second twin to term after a caesarean at 19 weeks, there is also the risk of bleeding and sepsis and lastly, miscarriage, as the cervix was already dilated to 3 cm,” said Dr van der Merwe. “Even with all these risks, I had to help Eunice, as she had conceived under trying circumstances through IVF and she wouldn’t entertain me terminating the pregnancy.” 

Eunice relates how Dr van der Merwe explained the termination procedure and how she refused to listen to his words. She believes that after seeing their desperation and sadness in addition to her husband Nathi’s pleas to save one of the babies, he decided to do the work. “Even before Dr van der Merwe saw that my son’s leg was protruding through my cervix, I just knew something was wrong. For me his little leg kicking felt like a wriggling worm – a feeling I would never wish on anyone. It broke my heart to know that he would not make it,” says Eunice. “When they did the scan, I could still hear his heartbeat and I was so worried about if he would be hurt when the procedure was done; either vaginally or via caesarean. There was also no time for me to process all of these thoughts and we had to make the decision to save one baby or risk losing both babies… We chose to save our daughter.” The membranes were already ruptured for one week and the decision could not be delayed any longer. 

Emphasising that the operation was not an everyday procedure, Dr van der Merwe set to work, trying to remove the male foetus vaginally, but it was not possible and so a caesarean was performed. “We put the patient under general anaesthetic and after trying to remove the foetus through the cervix, which would not open enough, we knew the only way to save the second foetus’s life was to remove the first one via caesarean.” he said. 

Eunice remembers how she felt after the first operation. “I did not expect to have the burning sensation in my belly, as I assumed they would be able to remove him vaginally. I was denied pain medication so that they could do a scan after the operation was done to make sure my daughter was ok,” she says. “I knew I could endure anything for her well being, so that when I heard her heartbeat on the scan I was so happy, but it was also mixed with a deep sadness for the loss of my son, who I had never met, but who I had only felt – in my cervix. I still wish I had had the opportunity to see him with my own eyes, just to say goodbye – and that I was sorry.” 

A challenging caesarean section

Dr van der Merwe explained how the incision was made only after carefully ascertaining where the girl foetus’s placenta was. It was imperative not to accidentally rupture the amniotic sac of the second baby, as that would mean a complete termination of the pregnancy. “There would be no way to save the female baby if the membranes ruptured, so we had to be extremely careful. The incision was followed by removing the male infant with the ruptured sac and then putting the undamaged sac back into the the mother’s uterus to enable her to continue with the pregnancy,” he added. A stitch was also made around the cervix, as the pregnancy needed to continue – and because she had already dilated to 3 cm. “The risk of preterm labour of the other baby increased, as well as the chances of infection and so we had to be very cautious after the operation too. The longer the foetus could stay in the mother’s womb the better for it’s overall health and development,” said Dr van der Merwe. 

D-day for the girl twin to be born

Eunice’s pregnancy progressed to 35 weeks when she went into natural labour. She proceeded to go to the hospital immediately and underwent a second caesarean in the space of 17 weeks after her first caesarean. “The second caesarean was far less complicated; as the baby was ready to be born, although five weeks premature,” said Dr van der Merwe. “There was absolutely no way we could allow for an attempt at natural birth either, because of the danger of uterine rupture as a result of the very recent previous caesarean earlier in her pregnancy.” Eunice remembers meeting her daughter a day after she was born, as she was admitted to the neonatal unit for what became 13 long days after the birth. 

“After the caesarean, I was so confused and exhausted, so I slept a little while. On that same evening, I got up, had a shower and felt better. After getting dressed, I took a wheelchair up to see my baby girl… and I could not stop staring at her beautiful face,” says Eunice. “She was so amazing and just so beautiful and I will always be grateful to Dr van der Merwe who saved my baby’s life. My husband and I cannot be more thankful than we will always be to him. We named her Thembelihle, which means Good Hope; as she gave us hope when we almost lost everything.”

Pregnancy and Diabetes

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Have you been diagnosed with gestational diabetes? While that might sound overwhelming at first, it turns out the condition is more common than you may think. / Recent studies indicate that gestational diabetes is on the rise. How can you protect yourself and your baby during pregnancy from this condition? 

Gestational diabetes only happens during pregnancy and affects about three to five out of every 100 pregnant women. Even women who have not have diabetes before can experience gestational diabetes in pregnancy. So, what are the risks and how can they be overcome to ensure a healthy mom and baby throughout the nine months of pregnancy? Charlene Yared-West speaks to Dr Bandile Masuku and Dr Gaontebale Matlhaga, two obstetrician/gynaecologists from Life Suikerbosrand. 

What causes gestational diabetes?

Pregnancy can affect the normal way a woman’s body processes sugar. In normal circumstances, explains Dr Gaontebale Matlhaga, obstetrician/gynaecologist from Life Suikerbosrand, food is ingested and digested and glucose from the food enters the bloodstream. “In response to this increase of sugar in the blood, the pancreas releases the hormone insulin, which helps to move the sugars from your bloodstream and into your body’s cells, where it is used as energy,” he says. “In pregnancy however, the placenta produces pregnancy hormones, which impair the action of insulin, which automatically then raises the blood sugar levels.” As your pregnancy progresses and your baby grows, the placenta, he says, produces even more insulin-blocking hormones, which create a cycle of  increased blood sugar levels. He adds that the condition is most common from around 20 weeks of pregnancy, but generally not earlier than that. “It isn’t always easy to notice signs or symptoms – which are non-specific and so it is usually picked up in the urine test, which is then followed up with a fasting blood test to ascertain if the woman has this condition,” he says. 

<Sidebar> What are the different types of Diabetes Mellitus?
Diabetes mellitus, otherwise known as diabetes is a metabolic condition where there are uncontrolled high blood sugar levels over a long period of time. Symptoms can include increased hunger and thirst, as well as frequent urination. 

Type 1 Diabetes: An autoimmune disease, where the pancreas produces very little or no insulin at all. It is most common in people under the age of 20. 

Type 2 Diabetes: A disease found in people who are overweight as they get older, where the pancrease does not produce enough insulin, or the body does not use it properly. It can be considered a lifestyle disease which is usually triggered by little or no exercise and being overweight. 

Type 3 Diabetes: A condition otherwise known as gestational diabetes, which occurs in pregnancy.

<Sidebar>Who is at risk of gestational diabetes? 

  • Women older than 25 years of age are more prone to metabolic conditions.
  • Women with polycystic ovary syndrome. 
  • Family or personal history and pre-pregnancy diabetes. 
  • Women with a body mass index of 30 or higher. 
  • Women who are black, of indian origin or Asian are more likely to develop gestational diabetes. 

What are the complications of developing gestational diabetes? 

If left undiagnosed, the complications for mother and baby can be dire, explains Dr Bandile Masuku, obstetrician/gynaecologist from Life Suikerbosrand. “Babies are born with a high birth weight, because of the extra glucose in the bloodstream, which crosses the placenta and triggers the baby’s own pancreas to make extra insulin – and this causes the growth rate to speed up. As a result, many of these babies with this condition known as macrosomia, are born via Caesarean because of their size,” he says. “Preterm labour is also a risk, which also means that the baby’s lungs are not fully developed and the baby will not be able to breathe on its own. In addition, babies can also develop low blood sugar, because their insulin production is so high, which can also lead to seizures. As a result the blood sugar levels in the baby must be closely monitored after birth to help normalise the baby’s blood sugar level. Babies of mothers who have gestational diabetes also have  an increased risk of developing obesity and type 2 diabetes later in life,” Dr Masuku adds gestational diabetes can also increase the risk of high blood pressure and preeclampsia, which are also dangerous to mother and baby. Furthermore, women with gestational diabetes also often develop future diabetes; whether in a future pregnancy or type 2 diabetes later in life.

Why is it challenging to fall pregnant when you have diabetes?

Women suffering from Type 1 or Type 2 diabetes usually face challenges when trying to fall pregnant as the “conception environment” can be compromised, explains Dr Matlhago. Type 1 Diabetes sufferers also tend to have higher incidences of miscarriage or have a baby born with a birth defect. In a healthy person, food is digested with the help of the hormone insulin – and in diabetics, there are flaws in this metabolism system. Hormones and hormone production are an essential part of the reproductive process – especially for a person wanting to conceive – and diabetics have a compromised system of hormonal control. “In addition, diabetic men may also want to consult their doctor about problems that can arise such as erectile dysfunction and damaged nerves, which can cause the sperm to enter the bladder during ejaculation,” he adds. 

Getting ready for pregnancy: Consult your ob/gyn

“It would be beneficial for all women who want to fall pregnant to see their obstetrician/gynaecologists before conception, for counselling and to develop a plan – especially if they have diabetes as an existing condition. It is important for all women to gain control of their blood sugar levels before pregnancy, which can also help to avoid the onset of gestational diabetes,” says Dr Masuku. “It is also more challenging for women who have pre-existing diabetes to fall pregnant, so a consultation can help to see where the problem is and also to create a programme, which includes dietary advice and exercise guidelines. It even helps if a woman can lose extra weight before conception to also help achieve a healthier pregnancy and lower her chances of getting gestational diabetes.” 

Managing gestational diabetes

According to Dr Masuku, it can be psychologically challenging and inconvenient to be diagnosed with gestational diabetes, because of the lifestyle and dietary changes that come with the treatment strategy. “Daily checking of the sugar levels, before and after meals is necessary to make sure the levels are within a healthy range,” he says. “In addition, eating the right kinds of food in healthy portions is one of the best ways to control the sugar levels and help to avoid weight gain. Exercise also plays an important role and can help lower your blood sugar by encouraging your body to move glucose into your cells where it will be burned for energy – and less insulin will be necessary.” He adds that if diet and exercise are not impacting your sugar level, medication might be necessary, which is assessed on an individual basis. “Medication in the form of oral drugs and injectible insulin might be necessary to control the condition.” 

<Case Study>Millicent Ndlovu 

“I was 30 weeks pregnant, on the highway and driving to work one winter’s morning in June, when I suddenly felt extremely hot, so I opened the car window and then felt terribly nauseous. I started vomiting and moved over into the slow lane. Luckily I was close to the office, but the nausea wouldn’t go away and I started vomiting some more. My colleague took me to hospital, where I was kept for observation. They measured my sugar levels and they were exceedingly high and wouldn’t go to normal levels even that evening when the levels were taken again. It was decided to put me on insulin, which brought my levels back to normal. I also had to speak to a dietician who advised me on diet and exercise. Diabetes is hereditary in my family; both my parents and sister have it, but I did not – and I thought I was having a healthy pregnancy; no morning sickness or nausea, I only had fatigue.  It was very frustrating for me to have this condition and of course I was worried about the health of my baby too. Thankfully, through diet and injectible insulin I controlled my sugar levels well and my 4.5kg baby girl, Humelelani was born on July 22, last year, via caesarean section. The gestational diabetes cleared after I had given birth, but after a health screening at work about a year later, it was determined that I had diabetes type 1, which I now manage with medication and a strict diet.”