Question: My partner is an alcoholic. I have had multiple miscarriages (more than
10). Is there a connection? B (UK)
Answer: My sincere sympathies for your quite incredibly bad obstetric history.
Proper studies on the subject of male excess alcohol intake and miscarriage/infertility
are very few. However, the little evidence available point to an increased risk of
miscarriage up to a factor of 5 (compared to the average). Of-course, it is an established
fact that excessive alcohol intake reduces sperm production and increases the proportion
of abnormal sperm. These may contribute to fertility problems including miscarriage.
However, I am struggling to reconcile this risk with that number of miscarriages.
This would point more to a genetic defect with one or both parents, something that
is unchanging and therefore not susceptible to chance. It may also point to a possible
severe case of anti-phospholipid syndrome.
I would like to think your doctors are doing all they can to help you through this
and my best wishes for the future.
Hypothyroidism and mental retardation in the child
Question: I am currently 5 months pregnant with hypothyroidism that was untreated
until late December 2008. I was then given synthroid, for my tsh level of 17.99.
Is there any documentation to support mental retardation, developmental delay or
low IQ ? K.G (USA)
Answer: There is, indeed, a great deal of evidence for many years now that uncorrected
underactive thyroid in pregnancy can result in delayed intellectual development in
the offspring. This is due to some degree of brain development impairment. What’s
more, the pregnancy phase that is most critical for this is the early trimester,
before the thyroid gland of the fetus starts functioning. This does not occur until
after about 12 weeks of gestation.
Only a small proportion of babies are so affected but some of these can be quite
profoundly affected with an IQ below 85. It is also important to be aware that this
problem has not been found where hypothyroidism is sub-clinical. The fact that yours
was undiscovered until so late may suggest that you fall in this category even though,
I have to say, your TSH was quite high. Your doctor is best placed to answer the
Potentially harmful Vitamin supplements in pregnancy
Question: I want to get pregnant and need to buy vitamin supplements but am confused
about the choice out there. For example, most pregnancy supplements include zinc,
which you say is best avoided. There is also an abundance of B12 included with most
tablets, as well as separate supplements with Omega-3 (E.G. Eye Q Mumomega). Could
you please provide some guidance? Currently, I'm thinking the best way forward is
to buy separate vitamin supplements for those you recommend, taking an appropriate
dosage of each on a daily basis. M.B (UK)
Answer: You are quite right. Most of the formulations of vitamin supplements are
made not with a pregnant woman in mind. Consequently, it is possible to take preparations
with some constituents that may pose some risk to the baby. If you feel that you
indeed need to take vitamin supplements, then pick the ones that you need and take
them individually. Most healthy women in the developed world do not really need to
take any supplements because their diet, in most cases, supply all they need. It
is clearly the case that those supplements where scientific evidence of harm is incontrovertible
should be avoided. There is general consensus that this advice should extend to those
supplements whose claimed benefits are questionable. I would therefore avoid combination
brands. The merit of taking Folic Acid pre-conception is established beyond doubt.
Vitamin B12 is essential but deficiency is quite rare so supplementation is unnecessary
for most women. The exception is in cases of coeliac disease (impaired absorption)
and strict vegetarians where the diet is likely to supply insufficient amounts.
Low-dose Aspirin in pregnancy
Question: Why is aspirin 75mg taken in pregnancy; to prevent what problems? S (UK)
Answer: Low-dose aspirin, typically at that dose of 75 mg is commonly used where
there is a suspected or confirmed condition of Thrombophilia. This is a condition
where there is an increased tendency to form blood clots in the very small blood
vessels in the body. Thrombophilia or antiphospholipid syndrome is associated with
early miscarriages which could be recurrent. We have discussed this in more details
Trying for a baby after a miscarriage
Question: How soon after a miscarriage can I start trying for a baby? A.C (UK)
Answer: Ovulation resumes, on average, within 2 – 4 weeks after a miscarriage. This
means, the body is then ready for another pregnancy. The implication is that you
can start trying for another baby as soon as you feel ready to do so. A previous
miscarriage usually has no bearing on the subsequent pregnancy, however recent it
Vitamin B12 deficiency and optic atrophy in the baby
Question: Could a B12 deficiency lead to sight problems in the unborn child? ....
(UK)[We have excluded the rest of the details of this question to protect privacy]
Answer: This is an interesting scenario. It is certainly true that severe prolonged
Vitamin B12 deficiency can lead to a variety of neuropathies and these include optic
atrophy. That is typically seen in adulthood with patients affected by such conditions
as pernicious anaemia.
The picture you paint for this individual suggest that hers is congenital optic atrophy.
Is this so? If that is the case then maternal Vitamin B12 deficiency is almost certainly
not to blame. Some neurological deficiencies have been reported with infants whose
mothers are strict vegans and who are exclusively breast-fed. These tend to be manifested
in tremors, abnormal limb movements (ataxia) and even respiratory difficulties. As
far as I am aware, no case of congenital optic atrophy has ever been reported resulting
from maternal B12 deficiency.
There are well-known causes of congenital optic atrophy with manifestations typically
starting during childhood or in the early teens. Leber’s is a case in point. These
are genetic (hence hereditary). If this lady’s optic atrophy developed later in life,
then there is no doubt that it has nothing to do with her mother’s B12 deficiency.