Leg Cramps and Group B Strep Testing

Q: I am 30 weeks pregnant and having extreme leg cramping at night. It is made worse by, when I try to stretch them out, my muscles contract so painfully that my legs ache for a day or so after. What do you recommend?

A:

Leg cramps during pregnancy can occur when the calcium and magnesium ratio is either not in proper balance or there is a lack of these minerals in your overall diet. A lack of these can also cause an increase in uterine contractions. During pregnancy, your calcium/magnesium and vitamin D requirements are increased. The following combination of calcium, magnesium and vitamin D are recommended during pregnancy: Calcium 1200mg, Magnesium 600mg, Vitamin D 400 iu.

Unfortunately many prenatal vitamins or multi-vitamins in general either don’t have the proper balance of these or the amounts are not adequate or include iron in the mix. Iron taken at the same time as any calcium supplement or taken with foods which are high in calcium such as cheese, yoghurt, milk should be avoided as these can interfere with absorption. It is best to obtain a multi vitamin that does not include iron. This means that any recommended iron supplement should be taken separately from calcium supplements or foods high in calcium.

Your health care provider can prescribe a specially formulated prenatal supplement where the calcium and iron components are taken separately. Although vitamins are often recommended during pregnancy, for optimal absorption it is always best to obtain as much calcium through eating a diet high in calcium rich foods. There are also many foods on the market that are fortified with calcium which can be very important for lactose intolerant women.

For a comprehensive list of calcium rich foods please visit the following resource or see the table in the link from Health Link BC below:

http://www.healthlinkbc.ca/healthfiles/hfile68e.stm

 

Q: My OB just told me that I needed to take a Group B Strep test. What is Strep B? Why do I need the test? What happens to the baby if I have it and don’t take the test?

A:

I would like to start off by saying that Group B strep is a fairly complex topic, and I would recommend thorough communication with your care provider to determine which approach is most appropriate for you. I would invite you to go back and look at the previous ‘Ask A Midwife’ column to learn how to have a thorough informed choice discussion with your careprovider.

Group B streptococcus (GBS) is a type of bacteria that is commonly found colonizing the digestive tract of all humans. It is considered a normal part of the gastrointestinal flora of the gut. The GBS bacteria can migrate out of the digestive tract and into the vaginal canal, and even into the urethra and colonize the bladder. It is very important to know that this migration is not a result of poor hygiene, nor is it transmitted sexually. In adults, this bacteria will not cause an infection or illness. However, this bacteria can cause some potentially devastating complications for the newborn infant, such as sepsis, pneumonia and meningitis.

The newborn can pick up the bacteria from a GBS positive mother during a normal vaginal delivery. The Center for Disease Control estimates the following:

  • Between 10 and 30% of women are colonized with GBS at the time of birth.
  • 50% of infants born to GBS positive mothers will be colonized with the bacteria after vaginal delivery.
  • Of the 50% of colonized infants, 98% will show no symptoms of infection.
  • the remaining 2% of infants will suffer from early-onset invasive GBS disease which can be quite serious (sepsis, pneumonia, meningitis and death) It has been demonstrated that, through the use of screening and treatment of GBS positive mothers, there has been a significant reduction in the number of babies contracting invasive GBS disease.

So what is the screen test?

  • The screen test is a simple swab taken from the vagina and rectum. Most women are able to swab themselves (after instruction from their care provider)
  • the swab is usually collected between 35 and 37 weeks gestation.

Although this bacteria can be transient in the vagina, if the bacteria is present at the time of screening, it is believed that it will be present for 5 weeks after the screen.

What are the recommendations if you screen positive? Some risks and benefits?

  • The first recommendation is for GBS positive mothers to receive antibiotics in labour. This has been shown to significantly reduce GBS infected infants from developing GBS related diseases. Recommendations are to begin treatment as soon as you waters break or in active labour (3-4 cm dilated) if your waters are not broken.
  • The second recommendation is for women who have not been screened to be treated with antibiotics in labour based on risk factors. The risk factors are: fever, prolonged labour, “water broken” for longer than 18 hours, or a previous infant with invasive GBS disease.
  • The risks associated with taking antibiotics include: anaphylactic reaction to the antibiotics-which is extremely rare- and more commonly: yeast infections in the postpartum period, digestive upsets, and newborn thrush.
  • The risk associated with not taking the antibiotics is for your newborn to become infected with GBS and become seriously ill. It is important to note that this occurrence is still extremely rare

Are there any natural ways to eliminate the bacteria without taking antibiotics?

Unfortunately, there is not a lot of success with alternative and natural treatments for GBS, because the bacteria itself is normal for our body. Natural medicines work in harmony with our body, so they will be unsuccessful in destroying the bacteria. There has been some positive support for using pro-biotics throughout pregnancy to reduce colonization of the vagina with GBS. Taking pro-biotics is a healthy choice regardless, but as of yet, they have not been clinically shown to reduce GBS infections.

This is a general overview of what GBS is, and how the use of screening and treatment can reduce infection in the newborn. Hopefully it can provide you with a foundation to explore this topic confidently with your care provider and determine what the best choice is for yourself and your family.

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