High Blood Pressure in Early Pregnancy Raises Birth Defect Risk

A new study suggests that high blood pressure during early pregnancy is what raises the risk of major birth defects -- not the medicines used to control the condition, as previously thought.

Pregnant women have been warned for years to avoid drugs called ACE inhibitors during the later stages of pregnancy to avoid the possibility of birth defects. But whether it was safe to take them during the first trimester wasn't clear.

A 2006 paper concluded no, and two later studies found an increased risk with other blood pressure drugs as well.

Researchers behind a new, larger study suggest it's the high blood pressure itself that is responsible for the higher risk of birth defects, not the medications.

Compared to women without high blood pressure, those with the condition were more likely to have babies with congenital heart, brain or spinal cord defects regardless of whether they were taking ACE inhibitors, other medications, or getting no treatment at all, the study found.

Dr. De-Kun Li and colleagues from Kaiser Permanente in California examined data covering more than 460,000 pregnant women and their babies from 1995 to 2008 for the study, which was paid for by groups including the U.S. Agency for Healthcare Research and Quality and the Department of Health and Human Services.

Dr. James Walker, a spokesman for Britain's Royal College of Obstetricians and Gynaecologists who was not linked to the research, said it was reassuring that blood pressure drugs taken in early pregnancy probably weren't raising the risk of birth defects.

He said ACE inhibitors are not commonly prescribed to pregnant women because of past concerns, and that the main worry has been getting them off the drugs as soon as they are pregnant.

"What this study does is reassure us women can stay on the drug until they're pregnant and then stop," he said. "You never know how long someone is going to take to get pregnant and if they come off a blood pressure drug for too long, it could be bad for them."

ACE inhibitors are used mainly to treat high blood pressure and heart failure. They work by relaxing the blood vessels and improving blood flow.

The researchers looked at pharmacy databases to see whether the women took any blood pressure drugs during their pregnancy and medical records to look for birth defects. The scientists adjusted for potential confounders like diabetes and obesity.

The study, published online Tuesday in the journal BMJ, found similar rates of birth defects among children of pregnant women who took ACE inhibitors in their first trimester compared to women with untreated high blood pressure, those who took other blood pressure drugs, and those with normal blood pressure.

The numbers ranged from about five percent to eight percent and the differences could have been due to chance.

The researchers concluded that it was high blood pressure, not any medication, that was likely responsible for the problem.

Since earlier studies raised questions about the safety of taking ACE inhibitors once they were pregnant, it's unclear how many women are still commonly prescribed the drugs, among the most popular blood pressure medicines.

In the U.S., the Food and Drug Administration advises women to switch from ACE inhibitors to other drugs once they are pregnant, but there is no warning against using them, as there is for use in the second and third trimesters of pregnancy.

Scientists aren't sure why high blood pressure in pregnant women could result in birth defects, but suggest there could be physiological changes in mothers that affect fetal growth.

Women's Health -  Published October 19, 2011Associated Press

 

Frequently Asked Questions About High Blood Pressure

Answers to your frequently asked questions about hypertension, commonly called high blood pressure.

1. What Causes High Blood Pressure?

While the cause of high blood pressure in most people remains unclear, a variety of conditions -- such as getting little or no exercise, poor diet, obesity, older age, and genetics -- can lead to hypertension.

2. What Is Systolic and Diastolic Blood Pressure?

The blood pressure reading is measured in millimeters of mercury (mm Hg) and is written as systolic pressure, the force of the blood against the artery walls as your heart beats, over diastolic pressure, the blood pressure between heartbeats. For example, a blood pressure reading is written as 120/80 mm Hg, or "120 over 80". The systolic pressure is 120 and the diastolic pressure is 80.

3. What Is a Normal Blood Pressure?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified blood pressure measurements into several categories:

• "Normal" blood pressure is systolic pressure less than 120 and diastolic pressure less than 80 mmHg
• "Prehypertension" is systolic pressure of120-139 or diastolic pressure of 80-89 mmHg
• Stage 1 Hypertension is blood pressure greater than systolic pressure of 140-159 or diastolic pressure of 90-99 mmHg or greater.
• Stage 2 Hypertension is systolic pressure of 160 or greater or diastolic pressure of 100 or greater.

 4. What Health Problems Are Associated With High Blood Pressure?
Several potentially serious health conditions are linked to high blood pressure, including:

• Atherosclerosis: a disease of the arteries caused by a buildup of plaque, or fatty material, on the inside walls of the blood vessels. Hypertension contributes to this buildup by putting added stress and force on the artery walls.
• Heart Disease: heart failure (the heart can't adequately pump blood), ischemic heart disease (the heart tissue doesn't get enough blood), and hypertensive hypertrophic cardiomyopathy (enlarged heart) are all associated with high blood pressure.
• Kidney Disease: Hypertension can damage the blood vessels and filters in the kidneys, so that the kidneys cannot excrete waste properly.
• Stroke: Hypertension can lead to stroke, either by contributing to the process of atherosclerosis (which can lead to blockages and/or clots), or by weakening the blood vessel wall and causing it to rupture.
• Eye Disease: Hypertension can damage the very small blood vessels in the retina.

5. How Do I Know if I Have High Blood Pressure?

High blood pressure often doesn't have any symptoms, so you usually don't feel it. For that reason, hypertension is usually diagnosed by a health care professional on a routine visit. This is especially important if you have a close relative who has hypertension or embody risk factors for it.
If your blood pressure is extremely high, you may have unusually strong headaches, chest pain, and heart failure (especially difficulty breathing and poor exercise tolerance). If you have any of these symptoms, seek treatment immediately.

6. What Is the Treatment for High Blood Pressure

High blood pressure treatment usually involves making lifestyle changes and, if necessary, drug therapy.
Lifestyle changes for high blood pressure include:

• Losing weight.
• Quitting smoking.
• Eating a healthy diet, such as the DASH diet.
• Reducing the amount of salt in your diet.
• Regular aerobic exercise (such as brisk walking).
• Limiting alcohol drinking.

High blood pressure drugs include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, diuretics, beta-blockers, and calcium channel blockers.

7. What Are the Side Effects of High Blood Pressure Drugs?

As is true with any medication, high blood pressure drugs have side effects. Among the most common are the following:

• Diuretics: headache, weakness, joint or muscle pain, low potassium blood levels.
• ACE inhibitors: dry and persistent cough, headache, diarrhea, high potassium blood levels.
• Angiotensin receptor blockers: fatigue, dizziness or fainting, muscle pain, diarrhea.
• Calcium channel blockers: dizziness, trouble breathing, heart rhythm problems, ankle swelling.
• Beta-blockers: dizziness or lightheadedness, decreased sexual ability, drowsiness, low heart rate.

8. What Type of Diet Should I Follow if I Have High Blood Pressure

A healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, is very effective at lowering high blood pressure. The DASH diet calls for a certain number of daily servings from various food groups, including fruits, vegetables, and whole grains.
The following steps can also help:

• Eating more fruits, vegetables, and low-fat dairy foods
• Eating less of foods that are high in saturated fat and cholesterol, such as fried foods
• Eating more whole grain products, fish, poultry, and nuts
• Eating less red meat and sweets
• Eating foods that are high in magnesium, potassium, and calcium

9. When Should I Call My Doctor About High Blood Pressure?

If you are diagnosed with high blood pressure, it's important to see your doctor on a regular basis. He or she can answer your questions during these visits.
However, there may be other times when you may need to speak to your doctor. For instance:

• If you aren't responding to the prescribed treatment and your blood pressure is still high.
• If you are having any side effects from the blood pressure medication. If this happens, your doctor may wish to adjust the dosage of the medication or put you on another medication.

10. Are There any Drugs that Cause High Blood Pressure?

Some drugs that you take for another condition may cause high blood pressure. These include amphetamines, Ritalin, corticosteroids, hormones (including birth control pills), migraine medications, cyclosporine, and erythropoietin.

Also, many over-the-counter medications that contain pseudoephedrine and ephedrine (for example, allergy, cold, and asthma medications and appetite suppressants) can cause hypertension.
Don't stop taking any prescribed medication, including high blood pressure drugs, on your own without talking to your doctor.

© 2009 WebMD, LLC. All rights reserved.

Diabetes: 5 Steps to Total Body Care

If you have type 2 diabetes, you know that blood sugar control, a balanced diet, weight management, regular exercise, and checkups are vital to your health. Taking special care of every part of your body to avoid serious complications is just as critical.
Among some of your biggest concerns with diabetes care are:

• Foot infections
• Chronic skin infections
• Gum disease and tooth loss
• Vision problems
• Heart disease and blood circulation problems

Diabetes Body Care: It's for Everyone

The need to take care of yourself isn't just for adults; with the epidemic of childhood obesity, type 2 diabetes has also become more prevalent among children, teens, and young adults.

"In hospitals, we're seeing first-time patients in their late 20s and 30s who have uncontrolled blood sugar and severe skin infections that probably started as a boil or a spider bite," says Philip Orlander, MD, director of endocrinology at The University of Texas Medical School at Houston.

How can diabetes so dramatically damage the body? If blood sugar is uncontrolled, blood vessels and nerves become damaged, while the body becomes less able to fight infections.

Controlling blood sugar is the bottom line in preventing these problems, but personal care routines -- simple things you can do every day -- can dramatically reduce your risks, too.

5 Steps to Total Diabetes Body Care

Your feet, skin, eyes, heart, and teeth and gums need special attention if you have diabetes. Here are steps you can take to care for these parts of your body:

1. Foot Care and Diabetes 
Common foot problems can cause many complications, including athlete's foot, fungal infections in nails, calluses, corns, blisters, bunions, dry skin, sores, hammertoes, ingrown toenails, and plantar warts.

While anyone can have these problems, they're more critical for people with diabetes because:

• If you have nerve damage, you may not feel small wounds that need treatment.
• Poor blood flow can slow wound healing.
• If you're immune suppressed, you may be more prone to infection.
• Damaged foot muscle nerves may prevent your foot from aligning properly, causing you to put more pressure on one area of the foot, leading to foot sores and pressure point ulcers.

Prevention tips: Make time for foot care daily. Wash, dry and examine the tops and bottoms of your feet. Check for cracked skin, cuts, scratches, wounds, blisters, redness, calluses, and other changes. Use antibiotic creams recommended by your doctor and apply sterile bandages to protect cuts. Prevent ingrown toenails by cutting toenails straight across; don't cut corners. Don't go barefoot and always protect your feet.
Make sure you wear properly fitting footwear.

If you develop even minor foot problems, treat them right away or see a doctor. And see a foot doctor (podiatrist) every two or three months.

Checking your feet daily means you can catch small things and get them treated before they become serious. Make it part of your daily morning routine -- it doesn't take long.

2. Skin Care and Diabetes 
Bacterial infections, fungal infections, and itching are common skin problems anyone can develop, but they're especially problematic for people with diabetes because of poor blood flow and because the body may not be fighting infection well. Avoid extremely serious complications. Don't ignore these problems:

• Bacterial infections like boils (hair follicle infections) require antibiotic treatment.
• Fungal infections include the yeast-like fungus called Candida albicans, which often occurs in warm, moist folds of the skin: under the breasts, around the nails, between fingers and toes, and in the armpit and groin areas.
  
  • Jock itch(in the genitals and thighs), athlete's foot (between the toes), ringworm (on the feet, groin, chest, abdomen, scalp, and nails) and vaginal infections are very common when blood sugar isn't controlled. These may require treatment with prescription medications, though occasional over-the-counter antifungal treatments may work.
  • A fungal infection called mucormycosis (contracted from soil fungus and decaying plants) can become extremely serious, especially for those with out of control type 2 diabetes. It may start as a sinus infection that gets worse, and can spread to the lungs and brain. Symptoms are sinus infection, fever, eye swelling, skin redness over the sinus area; occasionally ulceration can occur with drainage. See a doctor immediately; this can be life-threatening.
  • Itching caused by dry skin, a yeast infection, or poor blood flow (in the legs especially) is often a result of diabetes. Using lotion or creams can provide relief.

Other skin conditions are caused by poor blood supply and some by your body's resistance to using insulin.

Rashes, bumps, and blisters can also occur; some require treatment, some don't. You need to know which is which and get them treated when necessary.

For instance, eruptive xanthomatosis, a skin condition, is caused by high cholesterol and fat levels in the blood. It appears on the backs of arms, legs, and buttocks as firm, yellow, waxy, pea-like bumps which are typically itchy and surrounded by red halos. Medication to control fat levels in the blood help, as does controlling blood sugar.

Prevention tips: Boost your body's ability to fight infection, and help prevent dry skin, by controlling you blood sugar. Use talcum powder in areas prone to infections and use moisturizing lotions and soaps when needed. (Don't put lotions between toes; extra moisture there can trigger fungus growth.)

And remember, see your doctor for treatment of skin problems that won't go away -- especially foot problems and fungal infections. These can be very serious, and require treatment with prescription medication.

3. Eye Care and Diabetes
Diabetes can damage the blood vessels in the eyes, leading to serious preventable problems like cataracts, glaucoma, and retinopathy.

• With a cataract, the eye's lens becomes cloudy, blurring vision. While anyone can get cataracts, they may develop at an earlier age -- and progress more quickly -- if you have diabetes.
• Glaucoma occurs when pressure builds inside the eye due to fluid not draining properly. The pressure damages the eye's nerves and blood vessels, harming vision.
• Retinopathy is caused by blood vessel damage in the eyes, and if not diagnosed and treated early, can lead to blindness.

Prevention tips: Prevent these problems from becoming serious by making sure your blood sugar is under control and see an eye doctor for an annual exam.

4. Teeth and Gum Care with Diabetes 
Most people develop gum problems during their lives but, if you have diabetes, your risks are higher for serious gum disease -- and for getting it at an earlier age.

That's because, with diabetes, your body is more vulnerable to bacteria and infection. High blood sugar levels can make gum disease worse, resulting in bleeding, tender gums, and gums that pull away from teeth. In time, you may need gum surgery to save your teeth.

Other mouth problems that are a risk:

• Gum inflammation
• Poor healing after dental treatment
• Dry mouth
• Burning mouth or tongue

Prevention tips: Brush after every meal, floss daily, and see your dentist twice a year. Be sure to tell your dentist you have diabetes and bring a list of the medications you take.

Discuss any mouth infections or difficulties in controlling blood sugar levels with your dentist, and make sure blood sugar is under control before routine dental procedures. If you're having dental surgery, your dentist should consult with your diabetes doctor about your medications and the need for an antibiotic.

5. Caring for Your Heart When You Have Diabetes 
Heart disease, heart attack, and stroke are very serious concerns for anyone with diabetes, but they can also be prevented.

Buildup of cholesterol on blood vessel walls (hardening of the arteries) is the most common cause of heart disease and stroke. When blood sugar levels are higher than normal, this damaging process escalates - reducing blood flow to the heart and brain and increasing heart attack and stroke risks. The heart's pumping ability can also be affected, leading to heart failure.

Prevention tips: Follow your doctor's advice in keeping blood sugar, blood pressure, and cholesterol in check.

If you have diabetes, your cholesterol and blood pressure levels must be lower than for the average person - so you must take your prescribed medications. Lose weight if you are obese, exercise regularly, and eat a heart-healthy diet low in fat and salt. Quit smoking and talk to your doctor about taking a daily aspirin.

And, finally, make sure you're getting good medical care for your diabetes. "If you're trying everything lifestyle changes, nutrition, medication but if blood sugar is not getting better, you may need a new doctor," says Orlander.

By Jeanie Lerche Davis
© 2008 WebMD, LLC. All rights reserved.

Visit out online store at http://www.goldeneramart.com for all of your  diabetes care products

Diabetic Nerve Pain: Descriptors & Possible Causes

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Understanding Diabetic Nerve Pain

Nerves allow your body to feel temperature, pain, and other sensations. Over time, diabetes can harm nerves in the feet and legs and less often in the hands and arms. The pain usually occurs in both feet and may seem to extend into the legs as time passes. Similarly, both hands would be affected, and this pain may travel up the arms. Healthcare providers call this diabetic nerve pain. The pain can develop on its own, or it may also be caused by light touch or movement.

Possible Causes of Diabetic Nerve Pain

The prevalence of diabetic nerve pain is estimated to be 20% to 24% among patients with diabetes, affecting both people with type 1 and type 2 diabetes. It is also estimated that 10% to 20% of patients with diabetic nerve pain have pain severe enough to require treatment. No one yet knows exactly what causes the nerve damage. Having high blood sugar (glucose) levels over time is likely to be involved. While diabetic nerve pain can occur at any time, those who have had diabetes for a long time may be more likely to develop pain. People who have had problems controlling their blood sugar levels, have high blood pressure, and/or are overweight may also have a greater risk of developing diabetes-related nerve damage.

Fortunately, research has shown that diabetic nerve pain may be prevented through improved control of blood sugar. Other measures to improve your overall health include maintaining a healthy diet, exercising, lowering your blood pressure, lowering your cholesterol, avoiding smoking, and reducing the amount of alcohol you drink. There are options to help manage diabetic nerve pain, such as Cymbalta or nonmedicinal treatments, like acupuncture. Ask your doctor what you can do.

Note: Before beginning or changing an exercise program, please consult your healthcare provider.

Diabetic Nerve Pain Descriptors

Diabetic nerve pain has been described by some patients as constant or that it comes and goes. Words commonly used to describe diabetic nerve pain can include burning or shooting pain in the feet and legs, and you may have increased sensitivity to touch. Everyday things that come into contact with the painful area may cause pain, such as bedsheets or socks that touch your feet. Some people diagnosed with nerve damage due to diabetes experience numbness and muscle weakness.
Do you suspect that you have diabetic nerve pain? Do any of these words describe your pain?

• Aching
• Burning
• Numbness
• Shooting
• Stabbing
• Throbbing
• Tingling

Fortunately there is help. Through a complete treatment plan prescribed by your doctor and support of family and friends, you can learn to help manage your diabetic nerve pain.

Treatment Options for Diabetic Nerve Pain

Prescription Treatment Is Available

Cymbalta may be able to help improve your diabetic nerve pain. Cymbalta is indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy. Cymbalta is not a narcotic and can be taken once a day. As with all medicines, results may vary from person to person. Learn more about Cymbalta and how it is believed to work.

Talk with Your Doctor about Pain You Believe Is Due to Your Diabetes

Even if you and your doctor have talked about your pain before, talk about it again if it continues to be an issue. You can help your doctor understand how much the pain is affecting your life and how it makes you feel. Only your doctor can diagnose diabetic nerve pain and determine if Cymbalta is right for you. Read more tips for talking to your doctor about diabetic nerve pain.

Put Together a Complete Treatment Plan

Work together with your doctor to create a plan to help manage your diabetic nerve pain. Along with medication, your plan may include lifestyle changes. Some healthcare professionals may suggest:

• Glucose control
• Relaxation techniques
• Acupuncture

• Blood pressure control
• Quitting smoking
• Avoiding alcohol

• Healthy diet
• Medication
• Exercise

WebMD does not endorse any specific product, service, or treatment. 
©2005-2011 WebMD, LLC. All rights reserved.

Managing Your Diabetes Care: When Low Blood Sugar Has No Symptoms

No one with diabetes welcomes signs of a low blood sugar, also known as hypoglycemia. These physical and emotional changes, such as shakiness, dizziness, sweating, moodiness, and anxiety, signal that your blood sugar is dropping and must be treated quickly.

But what if your body stops giving you these warning signs? Losing the ability to feel low blood sugar is known as hypoglycemic unawareness. If you have it, you could lose consciousness without ever knowing that your blood sugar has dropped.

Who Gets Hypoglycemic Unawareness?

Low blood sugars can happen to anyone with diabetes, whether you take insulin or other medications to control your blood sugars. Low blood sugars most commonly happen in people with type 1 diabetes. It impairs the body’s ability to respond to subsequent drops in blood sugar.


Losing the ability to feel low blood sugars is most common in people with type 1 diabetes, although it can happen in those with type 2 diabetes as well. The longer you’ve had diabetes, the higher your risk of hypoglycemic unawareness. Low blood sugar symptoms can start fading after you've had diabetes for as little as five years. By 20 years, they may be too faint to recognize or only occur after your blood sugar becomes severely low.

You may also be at higher risk for hypoglycemic unawareness if:

• You have neuropathy, or nerve damage.
• You have strict blood glucose control and you are on an intensive insulin regimen, have a history of severe low blood sugars, or a recent episode of low blood sugars.
• You take certain medications for your heart or high blood pressure.

What Causes Hypoglycemic Unawareness? 

When your blood sugar starts to drop too low, your body normally stops releasing insulin and starts releasing other hormones. These include glucagon and epinephrine. These hormones help stabilize blood sugars.

Epinephrine is the same hormone that helps us during our “flight or fight” reactions. It also causes the low blood sugar signs that people with diabetes usually recognize. But if someone keeps having low blood sugar reactions, their body may dampen the release of epinephrine. Without the symptoms of low blood sugar that epinephrine causes, someone with diabetes may not realize that their glucose levels are dropping.

If your blood sugar levels get too low, you may pass out and need emergency treatment.

Treatment for Hypoglycemic Unawareness

See your doctor if you start to lose the ability to feel your low blood sugars coming on. You may be able to regain that ability within weeks. Your doctor can develop the best treatment plan for you.

Set your targets for blood sugar higher than usual.
This is usually done for a few weeks.
Test your blood glucose levels as often as possible.
This should always include at bedtime and before and after exercise. Ideally, your blood sugar should also be checked before and after meals. Your doctor may advise you to test at other times.
Use a continuous glucose monitor (CGM).
Although this doesn’t replace the need to prick your finger, a CGM may be more convenient than having to step up your blood testing. A CGM can alert you to lows even during the night.
Modify your risks of hypoglycemia.
Review the risks for low blood sugar and take steps to reduce your risk. For example, you may need to adjust your insulin doses to better match your diet and exercise or to be more consistent with your meals and intake of carbohydrates.

Recognizing Other Symptoms of Hypoglycemia
Although it's possible that you could not have the physical and mood symptoms associated with hypoglycemia, the mental symptoms will still show up. These include:

• Trouble concentrating
• Slowed speech
• Slowed thinking
• Lack of coordination

When these symptoms start to appear, you'll be at a blood glucose level where you can still treat hypoglycemia on your own. Mental symptoms of low blood sugar are more subtle than the classic symptoms. But if you are aware of the times of day when your blood sugar normally drops, you can watch for them.

Preventing Hypoglycemic Unawareness

The only specific way to prevent hypoglycemic awareness from developing is to avoid low blood sugar episodes as much as possible. These steps may help:

• Check your blood glucose levels often.
• Talk with your doctor about your target blood glucose level.
• Recheck and treat low or dropping sugar levels, even if you feel OK. Avoid activities such as driving.
• Let your friends and family know about the possibility of hypoglycemic unawareness and teach them the signs they should watch for.

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© 2011 WebMD, LLC. All rights reserved.