Group 4: Pregnancy and breastfeeding

1. Explain the pathology (symptoms, signs, global/national involvement), condition, or

situation in terms of the chosen topic.
Pregnancy is the physiological condition of a woman that begins with the conception of the
fetus and continues with its development until delivery. This period is divided into weeks (40)
and lasts more or less 280 days: under special conditions, delivery may occur before the due
date (premature birth) or after the due date.
The duration of pregnancy is calculated in weeks, starting from the date of the last
menstruation, which is why it is important to know this date with certainty. A pregnancy is
defined as:
- full-term that whose delivery occurs between 37 and 41 weeks
- preterm (or premature birth) when delivery occurs before 37 weeks
- protracted (beyond term) when delivery occurs at 42 weeks or later.
Breastfeeding is a fundamental gesture to ensure the healthy development and growth of a
child after birth.
Breast milk is, in fact, a more natural and complete food for the newborn, as it contains all
the nutrients it needs in the first phase of life. In addition, breastfeeding boosts the baby's
immune system and promotes intestinal development, strengthens the mother-child
relationship and protects women from breast and ovarian cancer and osteoporosis in old
age.

2. Explain non-pharmacological treatments

The majority of treatments mainly fall in the scope of non-pharmacologic treatment to match
up with the nutritional requirements that may arise during pregnancy. Non-pharmacological
treatments of the developing fetus are also taken into account during pregnancy. Treatment
methods are also applied for breastfeeding mothers, taking into account the requirements of
both the mother and child, mainly through micronutrient and omega-3 fatty acid
supplementation. Micronutrient treatment during breastfeeding can be used to compensate
for vitamin deficiencies in the mother and omega-3 fatty acid supplementation can be used
for proper development of the brain of the child. For pregnant women, examples include
supplementation with iron for maternal anemia, zinc for protein synthesis and growth,
magnesium for hypertensive disorders, iodine and various vitamins that aid the health of the
mother and child.
3. Explain pharmacological treatments
A common use for pharmacological treatments in these cases are generally directed towards
for hypertensive patients to relieve symptoms and the potential draw-backs for the baby.
Treatments for fetal supraventricular tachycardia may also be carried out through the
administration of digoxin. In the case of postpartum depression, although subjective for each
patient, we often look towards the use of SSRIs, as it is generally considered safe. In the
case of the potentiation of depressive and anxious thoughts, the patient can opt to cut out
the drug completely (if administered for under 2 weeks) or the patient can taper down the
dose. For symptoms of pain during delivery, we mainly look to administer an epidural block
(vaginal delivery) and a spinal block (C-section) as well the injection of numbing agents or
opiods to the area of pain. In the case of breastfeeding, the treatments are generally varied
but mainly arise due to diseases on the mothers side.

4. Possible drug-drug, drug-food, drug-food, drug-food supplement, etc. interactions.

The physiological and anatomical changes that begin in early pregnancy have an impact on
a broad portion of the body throughout pregnancy. The pharmacokinetic (absorption,
distribution, metabolism, and excretion) and pharmacodynamic aspects of various
medications are greatly impacted by many of these changes. To ensure the safety of the
mother and fetus during pregnancy, it is crucial to utilize medications during therapy that
contain only a small number of active substances. The physicochemical, physiological, and
pathological links between a drug and one or more nutritional elements, nutrients, and
components, or the nutritional status in a more general sense, are referred to as
drug-nutritional element interactions. Extracellular bioinactivation, decreased/increased
absorption, decreased/increased effectiveness, and decreased/increased excretion are the
four possible drug-nutritional element interactions (elimination). To ensure that
pharmacotherapy is effective, it is crucial that medical practitioners take into account the
physiological changes and factors impacting the distribution of the drug in the body during
pregnancy.

5. Implication in dental pathology.

Effective and sufficient care are required to maintain oral and dental health for the rest of
one's life. Whether a woman is pregnant, nursing, or menopausal, dental care is
considerably more crucial. Being pregnant is an indication of health rather than a sickness
state. It is not typical for a healthy person to lose their teeth suddenly. Pregnant women must
follow the same guidelines. They won't have tooth loss or other dental issues if they take a
few easy precautions. Yet, moms are known to have gingival and tooth deterioration during
pregnancy. Premature birth, low birth weight, pre-eclampsia, gingival tissue ulcerations,
pregnancy granulomas, gingivitis, and pregnancy tumors are all possible side effects of poor
oral health during pregnancy (epulis gravidarum),dry mouth(xerostomia), dental erosions,
and loose teeth. Pregnancy hormone changes have a direct impact on gum issues and
indirectly on tooth decay.
6. Relationship of nutritional habits and diet to the maintenance of health.
It is important for a pregnant woman to acquire all the needed nutrients during pregnancy,
since the woman not only needs to feed herself but also the fetus. But also, it's important to
understand that during breastfeeding the woman's body is under a lot of pressure/stress and
since she is feeding the baby it's important that the woman gets all the needed proteins and
minerals to be able to fill the needs that her body and the baby needs.
7. Prevention of oral-dental diseases, also at the level of diet/nutrition.
Talking about dental prevention in pregnancy is very important. In fact, oral health problems
are quite common in pregnant women and can lead to various problems. From tooth pain in
pregnancy to real complications.
Throughout the pregnancy period there are a few small precautions to keep in mind to avoid
unpleasant complications.
- Always floss after meals
- Use mouthwash with chlorhexidine 0.05 and fluoride if indicated by the dentist

Pregnancy is a special time, on the borderline between the discomforts that this state entails
and the serenity and joy of carrying one's child. At this time, a woman is no longer alone and
needs more than ever to follow a correct diet, for her own health and that of her child.
Pregnancy should therefore be seen as the ideal opportunity to improve one's lifestyle, if one
has not already done so; it should not be experienced as a period of 'indulgence' during
which one can indulge all one's desires and food 'cravings'.

8. Dietary/nutritional recommendations.
What kind of food is appropriate and not appropriate to eat during pregnancy and
breastfeeding and why. Nutritional recommendations for pregnant women, for example, what
to avoid to eat during pregnancy and why.
9. Other possible recommendations
There is little scientific evidence on how best to treat pregnant or breastfeeding women with
suspected or confirmed Ebola virus disease (EVD). Historical reports indicate increased
mortality and morbidity among women who develop Ebola virus disease during pregnancy,
with rates of adverse pregnancy outcomes approaching 100%.

To save the lives of mothers and their infants, mitigate complications, and limit the spread of
disease, it is critical to make recommendations for the prevention, treatment, and monitoring
of women exposed to EVD, while pregnant or breastfeeding or acquiring or surviving EVD
EVD in pregnancy. These guidelines are the first to offer such advice.

Jouanne M, Oddoux S, Noël A, Voisin-Chiret AS. Nutrient Requirements during

Pregnancy and Lactation. Nutrients. 2021;13(2):692. Published 2021 Feb 21.
doi:10.3390/nu13020692
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926714/

Pharmacological treatments:
Pinheiro, Emily A.; Stika, Catherine S. (2020). Drugs in Pregnancy: Pharmacologic and
Physiologic Changes that Affect Clinical Care. Seminars in Perinatology, (), 151221–.
doi:10.1016/j.semperi.2020.151221
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883753/
Ede G, Nergiz Unal R. Physiological and pharmacokinetic alterations and drug-nutrient
interactions during pregnancy. İstanbul Med J 2017; 18: 1