2.

Contraindications to exercise during pregnancy include PIH, preterm rupture of membranes,

preterm labor during the prior or current pregnancy, incompetent cervix or cerclage placement,
persistent second- or third-trimester bleeding, placenta previa, and intrauterine growth
retardation.

3. Rapid eye movement sleep, or REM, is one of the five stages of sleep that

most people experience nightly. It is characterized by quick, random

movements of the eyes and paralysis of the muscles.
The amount of time spent in REM sleep varies significantly with age; it normally
makes up around 20-25% of an adult humans total time spent asleep (on average
about 90-120 minutes), and about more than half of an infant's.

This Medical News Today information article provides information on REM sleep
cycles, the physiology of REM sleep, its functions, and how it is linked to creativity.

REM sleep cycles

People usually experience REM sleep 4 or 5 times a night (it comes in cycles). The
first cycle - which occurs at the beginning of one's sleep - only lasts for a short time,
with each following cycle lasting a little longer.

It is common for some people to experience light sleep, or even to wake up after a
cycle. The amount of time one spends in REM sleep has a lot to do with certain
psychological factors - people with depression tend to be in the state for a longer
duration than those without it.

Infants spend more time in REM sleep than adults.

Studies have shown that people who go to sleep after being sleep deprived enter
REM sleep faster than those who weren't.

While in REM sleep, most of the muscles become paralyzed and the activity of the
brain's neurons becomes quite intense, similar to the activity during wakefulness.

This inactivity can affect the breathing muscles and is a cause of snoring and
other breathing problems in sleep.

REM sleep is also sometimes known as paradoxical sleep. It's during this stage of
sleep that most people are able to have especially vivid dreams.

Physiology of REM sleep

During REM, certain neurons in the brain stem, called REM sleep-on cells, become
especially active - these cells are most likely what trigger this phase in the sleep
cycle.

Once triggered and in a state of REM, the body stops releasing neurotransmitters called monoamines - that are responsible for stimulating the motor neurons; this
means that the muscles stop moving, essentially entering a state of temporary
paralysis.

Some people don't experience the paralysis, their muscles continue to move, even
while they are in REM sleep. They may act out their dreams in violent or dramatic
ways, this is a condition called REM behavior disorder (RBD).

Functions of REM sleep

Memory Consolidation
One theory states that REM sleep is important for the consolidation, or stabilization
of spacial and procedural memory.

Mitchison and Crick, in their hypothesis of sleep and neural networks, proposed that
REM sleep can help eliminate abnormal modes of interaction in the neural networks
of the cerebral cortex.

10

Stimulation of Central Nervous System (CNS) Development

Another theory states that this sleep stage is vital for the development of the human
brain in infants. It proposes that REM sleep is responsible for the neural stimulation
necessary to develop mature neural connections.

11

Supporting evidence for this is seen in how the number of hours spent in REM sleep
reduces as one ages, and how sleep deprivation in early life can be a cause of
behavioral problems, sleep disruption and decreased brain mass. This theory
suggests that REM sleep might not have any essential role in mature human brains.

Creativity and REM sleep

REM sleep facilitates the way creativity combines certain associative elements into
new combinations that are necessary or helpful for problem solving. This has been
attributed to the cholinergic and noradrenergic neuromodulation that occurs while
someone is in a REM state.
In fact, one study concluded that REM sleep, might foster the formation of
associative networks.

4.

12

Substance Use During Pregnancy

Tobacco, alcohol and drugs can have harmful effects on anyone's health. When a pregnant or nursing woman
uses these substances, her baby also is exposed to them, for all substances cross the placenta through the
umbilical cord and enter into the baby's bloodstream.
While pregnant, it is best to eat well, stay healthy and avoid ingesting anything that might be harmful to the
mother's or baby's health. A health care provider can give you more information about these issues.

"Street" Drugs
A pregnant woman who uses drugs like cocaine, crack, heroin and methadone may have a baby born addicted
to the substances she took during her pregnancy. Cocaine is one of the most harmful drugs to unborn babies.
Cocaine can cause a woman to miscarry and may cause preterm birth, bleeding, fetal death and fetal strokes,
which can lead to brain damage and death. After birth, a baby who has been exposed to cocaine prenatally
goes through withdrawal, signs of which include jitters and irritability. These babies are hard to comfort and are
often unable to respond to their mothers. Cocaine use during pregnancy also may be linked to an increased risk
of sudden infant death syndrome, or SIDS.
Amphetamines or "speed" also are harmful to unborn babies. One study showed that the fetuses of mothers
who used speed during pregnancy had decreased weight, length and head size. Another study showed that
these babies had more strokes, or bleeding into their brains.

Marijuana
Marijuana can affect fetal and infant development and may cause miscarriage. Although the effects of
marijuana on an unborn baby are still unknown, studies have indicated that prenatal marijuana use is linked to
premature births, small birth size, difficult or long labor and an increase in newborn jitteriness.
Marijuana smoked by a pregnant woman remains in the baby's fat cells for seven to 30 days. Smoking
marijuana can affect the amount of oxygen and nutrients the baby receives, which may affect growth. Marijuana
is never safe during pregnancy and it can harm the baby at any stage. In addition, marijuana can have longterm effects on infants and children, such as having trouble paying attention or learning to read.

Alcohol
Drinking alcohol can increase the risk of miscarriage, stillbirth, newborn death and fetal alcohol syndrome
(FAS). Babies with FAS have low birth weight, heart defects, facial defects, learning problems and mental
retardation. Since it is not known if there is a safe level of alcohol during pregnancy, the best advice is not to
drink at all. Even one drink a day has been shown to have effects on the growing fetus. The best time to stop
drinking alcohol is before you conceive. If your pregnancy is unplanned, you should stop drinking as soon as
you suspect you are pregnant.

Tobacco
Women who smoke during pregnancy are more likely to have babies who are too small. Smoking also
increases the risk of miscarriage, preterm labor, stillbirth and newborn death. Babies born weighing less than 5
pounds may have more health problems early in life and learning problems later in school. If you smoke, quit
now. Ask your health care provider for information about classes or support groups for pregnant women who
want to quit smoking.

Prescription Drugs
Some prescribed medications may be harmful to your unborn or nursing baby. If you are taking any prescribed
drugs, tell your health care provider as soon as possible so that your medications can be changed or adjusted
as needed.

Over-the-Counter Medicines and Vitamins

Avoid over-the-counter medicines such as antacids, laxatives, sleeping pills, cold medications and pain
relievers. While some are safe for pregnant women, many are not. If you feel you need any of these
medications, first check with your health care provider. This applies to large doses of over-the-counter vitamin
preparations as well, for taking large doses of extra vitamins can be harmful to you and your baby.

Caffeine
Caffeine is present in coffee, tea, cola drinks and some medications. For at least 10 years, there has been
controversy over whether caffeine is harmful during pregnancy. Some studies suggest caffeine is harmful,

pointing to an increased risk of miscarriage, early delivery or lower birth weight. Other studies have shown that
women who consume a moderate amount of caffeine do not experience these problems. Because results are
conflicting, no one knows the true risk. We recommend drinking as little caffeine as possible.
Ask your health care provider for more information about substances and their effects on pregnancy.
Remember -- your baby needs a healthy mom!

Mercury[edit]
Elemental mercury and methylmercury are two forms of mercury that may pose risks of mercury
poisoning in pregnancy. Methylmercury, a worldwide contaminant of seafood and freshwater
fish, is known to produce adverse nervous system effects, especially during brain development.
Eating fish is the main source of mercury exposure in humans and some fish may contain
enough mercury to harm the developing nervous system of an embryo or fetus, sometimes
leading to learning disabilities.[9] Mercury is present in many types of fish, but it is mostly found in
certain large fish. One well-documented case of widespread mercury ingestion and subsequent
fetal development complication took place in the 1950s in Minimata Bay, Japan. Used by a
nearby industrial plant in the manufacture of plastics, methyl mercury was discharged into the
waters of Minimata Bay, where it went on to be ingested regularly by many villagers who used
the fish living in the bay as a dietary staple. Soon, many of the inhabitants who had been
consuming the mercury-laden meat began experiencing negative effects from ingesting the
toxin; however, the mercury especially impacted pregnant women and their fetuses, resulting in
a high rate of miscarriage. Surviving infants exposed to mercury in-utero had extremely high
rates of physical and mental handicaps, as well as physical abnormalities from exposure in the
womb during key stages in fetal physical development.[10] The United States Food and Drug
Administration and the Environmental Protection Agency advise pregnant women not to eat
swordfish, shark, king mackerel and tilefish and limit consumption of albacore tuna to 6 ounces
or less a week.[9]
High mercury levels in newborns in Gaza are theorized to originate from war weaponry.[11]
Mercury exposure in pregnancy may also cause limb defects.[3]

Lead[edit]
Adverse effects of lead exposure in pregnancy include miscarriage, low birth weight,
neurological delays, anemia, encephalopathy, paralysis, blindness,[3][7]
The developing nervous system of the fetus is particularly vulnerable to lead toxicity.
Neurological toxicity is observed in children of exposed women as a result of the ability of lead
to cross the placental barrier. A special concern for pregnant women is that some of the bone
lead accumulation is released into the blood during pregnancy. Several studies have provided
evidence that even low maternal exposures to lead produce intellectual and behavioral deficits
in children.[12]

Dioxin[edit]
Dioxins and dioxin-like compounds persists in the environment for a long time and are
widespread, so all people have some amount of dioxins in the body. Intrauterine exposure to
dioxins and dioxin-like compounds have been associated with subtle developmental changes on

the fetus. Effects on the child later in life include changes in liver function, thyroid hormone
levels, white blood cell levels, and decreased performance in tests of learning and intelligence.[13]

Air pollution[edit]
Air pollution can negatively affect a pregnancy resulting in higher rates of preterm births, growth
restriction, and heart and lung problems in the infant.[14]
Compounds such as carbon monoxide, sulfur dioxide and nitrogen dioxide all have the potential
to cause serious damage when inhaled by an expecting mother.[15] Low birth weight, preterm
birth, intrauterine growth retardation, and congenital abnormalities have all been found to be
associated with fetal exposure to air pollution.[16] Although pollution can be found virtually
everywhere, there are specific sources that have been known to release toxic substances and
should be avoided if possible by those who wish to remain relatively free of toxins. These
substances include, but are not limited to: steel mills, waste/water treatment plants, sewage
incinerators, automotive fabrication plants, oil refineries, and chemical manufacturing plants.[15]
Control of air pollution can be difficult. For example, in Los Angeles, regulations have been
made to control pollution, by putting rules on industrial and vehicle emissions. Improvements
have been made to meet these regulations. Despite these improvements, the region still does
not meet federal standards for ozone and particulate matter. Approximately 150,000 births occur
every year in Los Angeles. Thus, any effects air pollution has on human development in
utero are of great concern to those who live in this region.[17]

Pesticides[edit]
Pesticides are created for the specific purpose of causing harm (to insects, rodents, and other
pests), pesticides have the potential to serious damages to a developing fetus, should they be
introduced into the fetal environment. Studies have shown that pesticides, particularly
fungicides, have shown up in analyses of infant's cord blood, proving that such toxins are
indeed transferred into the baby's body.[18] Overall, the two pesticides most frequently detected in
cord blood are diethyltolaumide ( a commonly used repellant) and vinclozolin (a fungicide).
[18]

Although pesticide toxicity is not as frequently mentioned as some of the other methods of

environmental toxicity, such as air pollution, contamination can occur at any time from merely
engaging in everyday activities such as walking down a pathway near a contaminated area, or
eating foods that have not been washed properly.[18] In 2007 alone, 1.1 billion pounds of
pesticides were found present in the environment, causing pesticide exposure to gain notoriety
as a new cause of caution to those wishing to preserve their health.[18]

7.

8. People with proteinuria have urine containing an abnormal amount of protein. The

condition is often a sign of kidney disease.

Healthy kidneys do not allow a significant amount of protein to pass through their
filters. But filters damaged by kidney disease may let proteins such as albumin leak
from the blood into the urine.
Proteinuria can also be a result of overproduction of proteins by the body.
Kidney disease often has no early symptoms. One of its first signs may be
proteinuria that's discovered by a urine test done during a routinephysical exam.

Risk Factors for Proteinuria

The two most common risk factors for proteinuria are:

Diabetes

High blood pressure (hypertension)

Both diabetes and high blood pressure can cause damage to the kidneys, which
leads to proteinuria.
Other types of kidney disease unrelated to diabetes or high blood pressure can also
cause protein to leak into the urine. Examples of other causes include:

Medications

Trauma

Toxins

Infections

Immune system disorders

Increased production of proteins in the body can lead to proteinuria. Examples
include multiple myeloma and amyloidosis.
Other risk factors include:

Obesity

Age over 65

Family history of kidney disease

Preeclampsia (high blood pressure and proteinuria in pregnancy)

Race and ethnicity: African-Americans, Native Americans, Hispanics, and

Pacific Islanders are more likely than whites to have high blood pressure and
develop kidney disease and proteinuria.
Some people get more protein into urine while standing than while lying down. That
is known as orthostatic proteinuria.

Treatment of Proteinuria
Proteinuria is not a specific disease. So its treatment depends on identifying and
managing its underlying cause. If that cause is kidney disease, appropriate medical
management is essential.
Untreated chronic kidney disease can lead to kidney failure.
In mild or temporary proteinuria, no treatment may be necessary.
Drugs are sometimes prescribed, especially in people with diabetes and/or high
blood pressure. These may come from two classes of drugs:

ACE inhibitors (angiotensin-converting enzyme inhibitors)

ARBs (angiotensin receptor blockers)

Proper treatment -- especially in patients with chronic disease such as diabetes and
high blood pressure -- is essential to prevent the progressive kidney damage that is
causing the proteinuria.
WebMD Medical Reference
View Article Sources
Reviewed by Varnada Karriem-Norwood, MD on March 27, 2014
2014 WebMD, LLC. All rights reserved.

9. What is GFR?
GFR - glomerular filtration rate is the best test to measure your level of kidney function and
determine your stage of kidney disease. Your doctor can calculate it from the results of your
blood creatinine test, your age, body size and gender. Your GFR tells your doctor your stage of
kidney disease and helps the doctor plan your treatment. If your GFR number is low, your
kidneys are not working as well as they should. The earlier kidney disease is detected, the better
the chance of slowing or stopping its progression.

What are the Stages of Chronic Kidney Disease (CKD)?

-->

Stage

Description

(GFR)

At increased
risk

Risk factors for kidney disease (e.g., diabetes, high blood

pressure, family history, older age, ethnic group)

More
than 90

Kidney damage with normal kidney function

90 or
above

Kidney damage with mild loss of kidney function

89 to 60

3a

Mild to moderate loss of kidney function

59 to 44

3b

Moderate to severe loss of kidney function

44 to 30

Severe loss of kidney function

29 to 15

Kidney failure

Less than
15

Your GFR number tells you how much kidney function you have.
As kidney disease gets worse, the GFR number goes down.

What happens if my test results show I may have chronic kidney

disease?

A GFR below 60 for three months or more or a GFR above 60 with kidney damage
(marked by high levels of albumin in your urine) indicates chronic kidney disease. Your doctor
will want to investigate the cause of your kidney disease and continue to check your kidney
function to help plan your treatment.

Typically, a simple urine test will also be done to check for blood or albumin (a type of
protein) in the urine. When you have albumin in your urine it is called albuminuria. Blood or
protein in the urine can be an early sign of kidney disease.

People with a high amount of albumin in their urine are at an increased risk of having
chronic kidney disease progress to kidney failure. (See chart below)

Your doctor may also suggest further testing, if necessary, such as:

Imaging tests such as an ultrasound or CT scan to get a picture of your kidneys and
urinary tract. This tells your doctor whether your kidneys are too large or too small, whether you
have a problem like a kidney stone or tumor and whether there are any problems in the
structure of your kidneys and urinary tract.

A kidney biopsy, which is done in some cases to check for a specific type of kidney
disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the
doctor removes small pieces of kidney tissue and looks at them under a microscope.
Your doctor may also ask you to see a kidney specialist called a nephrologist who will consult on
your case and help manage your care.
Glomerular Filtration Rate (GFR) Brochure
Calculate your Glomerular Filtration Rate (GFR)

If you would like more information, please contact us.

2015 National Kidney Foundation. All rights reserved. This material does not constitute
medical advice. It is intended for informational purposes only. Please consult a physician for
specific treatment recommendations.