Progest-E Dosage For Pregnant Women

[catan]

I read that progest-e is beneficial during pregnancy and for the development of the baby. Can anyone shed light on the dosage?

I started taking progest-e 3 drops before bed after ovulation this cycle, and started feeling nausea and fatigue around a week before my period is due. I was confused because I thought progest-e should make me feel better! I've been nauseated for 4 days now.

Last cycle, I took progest-e the whole cycle, and my luteal phase was 13 days, which is normal. A few bouts of nausea but I was mostly pretty energetic until my period started.

It was mentioned on this forum that nausea during pregnancy is from insufficient progesterone. Does that mean I should increase progest-e dosage?

 

[HDD]

From "Once A Month" by Katharina Dalton

"Progesterone should be continued once pregnancy has been confirmed and continued if there are any unpleasant pregnancy symptoms, such as nausea, tiredness, headache, or depression. If necessary, the dose of progesterone can be increased until all pregnancy symptoms subside."

Dalton also recommends a 3 hourly starch diet that may be sufficient to relieve the symptoms of early pregnancy.

 

[catan]

haagendazendiane, thank you for that!

I increased my dosage and take a couple drops every time I feel nausea. I'm concerned if I take more than that during the day time, I would fall asleep.

Interestingly, even though I take double the dose now than I used to at bedtime, I don't get the same knock out effect like before.

 

[catan]

Since I last posted here, I've been taking about 5 drops progest-e every time I feel nausea, which on some days is every couple of hours, and some days only a few times. I also eat starch, mostly potatoes, or eat fruit every few hours. I still feel nauseated and tired most of the time. I'm not even 6 weeks yet, and according to my doctor, nausea in pregnancy doesn't usually start till 7-8 weeks. Makes me wonder what's going on...

 

[HDD]

I posted this in the email depository a while ago.


"Salt is often the most important thing for pregnancy nausea. Two quarts of milk daily, cheese, eggs, and orange juice, but with anything salty, even sips of salty water first thing in the morning, should stop it. Low thyroid function, with a low ratio of progesterone to estrogen, causes the kidneys to be unable to retain salt efficiently."

 

[catan]

From "Once A Month" by Katharina Dalton

"Progesterone should be continued once pregnancy has been confirmed and continued if there are any unpleasant pregnancy symptoms, such as nausea, tiredness, headache, or depression. If necessary, the dose of progesterone can be increased until all pregnancy symptoms subside."

Does this mean progest-e should be stopped after first trimester when nausea and fatigue is gone, or continued throughout pregnancy?

 

[aguilaroja]

...Does this mean progest-e should be stopped after first trimester when nausea and fatigue is gone, or continued throughout pregnancy?

I am only speaking anecdotally here. This is for discussion purposes only, with the forum disclaimers.

Since both estradiol and progesterone rise through pregnancy, it seem sensible to continue the supplementation until term, to support a favorable progesterone to estradiol ratio. Since hazards are greater in the first trimester, that period seems more important.

My recollection is that danger of miscarriage is highest in the first trimester. It peaks in healthy women with intact embryo at around 6-ish weeks. Morning sickness symptoms are also most frequent in the first trimester. If progesterone is used selectively, first trimester seems an especially important time.

http://www.medicine.mcgill.ca/physio/vl ... levels.gif

I have only read some of Katerina Dalton's papers, which emphasize the first trimester:

http://www.ncbi.nlm.nih.gov/pmc/article ... 4-0011.pdf

I have unofficially discussed Progest-E use with a small number of pregnant mothers. In each case, thankfully, the babies, now children, have had uneventful births and thriving & healthy childhoods. I have also observed persons use Progest-E to relieve infertility, but that is a different and maybe even more varied discussion.

Some of the Progest-E use might depend on the age and obstetric history of the mother, how the pregnancy and mother's health is going, and other determinants. Supplementing 3-4 drops, roughly paralleling the physiologic amount in a non-pregnant woman, seems like a baseline. The pregnant mothers I have known have felt comfortable using amounts in the 5-6 drops daily range. Based on Dalton's observations (in the Dalton paper mentioned, she says "the effect was dose dependent, with those receiving progesterone before the 16th week, and in the highest does showing the greatest advantage."), for instance, different quantities could be explored.

Most preferred to use a steady dose, rather than adjusting based on situation. .

For morning sickness/nausea (which they had few symptoms of compared to their friends) they preferred to make other adjustments. Two expectant mother that I know directly increased the Progest-E amount when morning sickness/nausea symptoms started. They appeared to have prompt relief of symptoms by adding a couple of drops once or twice a day to the baseline Progest-E amount.

http://www.easybabylife.com/miscarriage ... -week.html

http://en.wikipedia.org/wiki/Miscarriage

"Progesterone deficiency may be another cause. Women diagnosed with low progesterone levels in the second half of their menstrual cycle (luteal phase) may be prescribed progesterone supplements, to be taken for the first trimester of pregnancy.[12] No study has shown that general first-trimester progesterone supplements reduce the risk however, (when a mother might already be losing her baby),[14] and even the identification of problems with the luteal phase as a contributing factor has been questioned.[15]"

 

[catan]

Some of the Progest-E use might depend on the age and obstetric history of the mother, how the pregnancy and mother's health is going, and other determinants. Supplementing 3-4 drops, roughly paralleling the physiologic amount in a non-pregnant woman, seems like a baseline. The pregnant mothers I have known have felt comfortable using amounts in the 5-6 drops daily range. Based on Dalton's observations (in the Dalton paper mentioned, she says "the effect was dose dependent, with those receiving progesterone before the 16th week, and in the highest does showing the greatest advantage."), for instance, different quantities could be explored.

Most preferred to use a steady dose, rather than adjusting based on situation. .

For morning sickness/nausea (which they had few symptoms of compared to their friends) they preferred to make other adjustments. Two expectant mother that I know directly increased the Progest-E amount when morning sickness/nausea symptoms started. They appeared to have prompt relief of symptoms by adding a couple of drops once or twice a day to the baseline Progest-E amount.

Thank you for your response! This is informative.

This is my second pregnancy, I'm 32, and 11 weeks along. I've had nausea and fatigue since week 4, and taking progest-e since ovulation, upping the dose whenever I feel nausea/tired. My dose varies from 5 drops twice to five times a day depending on how nauseated I am. It seems like I'm mildly nauseated all the time regardless of the progest-e.

I didn't use progesterone at all in my last pregnancy, and the nausea went away in the second trimester. Pregnancy, labor, and delivery was uncomplicated. I was younger then, though.

It would be interesting to see how this pregnancy differs with the progest-e. How would I be able to determine whether or not to continue with progest-e, assuming an uncomplicated pregnancy?

 

[aguilaroja]

...This is my second pregnancy, I'm 32, and 11 weeks along. I've had nausea and fatigue since week 4, and taking progest-e since ovulation, upping the dose whenever I feel nausea/tired. My dose varies from 5 drops twice to five times a day depending on how nauseated I am. It seems like I'm mildly nauseated all the time regardless of the progest-e.

I didn't use progesterone at all in my last pregnancy, and the nausea went away in the second trimester. Pregnancy, labor, and delivery was uncomplicated. I was younger then, though....

Though there is reason to believe, particularly thanks to Katerina Dalton's work, that bio-identical progesterone is supportive throughout the pregnancy, there's no careful recent research I am aware of. (Full disclosure: I have not done a recent literature review.) So ideas are speculative. Something between three and six drops seems to approximate at and somewhat above the non-pregnant young female physiologic levels, and might be useful through the entire term.

There's the background of a previous good pregnancy and mid-range youth in the child-bearing years, that suggest keeping augmentation on the low side. Though bio-identical progesterone seems generally protective, it would also be understandable that someone wished to avoid adding anything to a process unfolding well.

I suspect that for the undernourished and indigent at-risk pregnant women in "third world" settings that progesterone's ("pro" "gestational") functions would be especially important. I have for years talked to researchers and health care providers with access to these groups, trying without success to get the notion tested, even anecdotally.

I suppose the general low metabolism issues might be clues about extra support. For any pregnancy, monitoring thyroid function formally and informally is wise. (Fatigue might be less of an indicator, since among other issues, a pregnant woman is carrying extra weight, and needs leeway to adjust energy for two.)

I would emphasize what probably goes without saying: Start with the clear, basic measures: Adequate rest, access to quiet/noise-free settings at times, good nutrition, supportive social network, enriched & engaging environment.

 

[HDD]

ammuc,

I posted this in the email section a while back, I am not sure if you saw it.. Might be helpful for your nausea.


In regard to nausea during pregnancy.


"Salt is often the most important thing for pregnancy nausea. Two quarts of milk daily, cheese, eggs, and orange juice, but with anything salty, even sips of salty water first thing in the morning, should stop it. Low thyroid function, with a low ratio of progesterone to estrogen, causes the kidneys to be unable to retain salt efficiently."

 

[HDD]

"I didn't use progesterone at all in my last pregnancy, and the nausea went away in the second trimester. Pregnancy, labor, and delivery was uncomplicated. I was younger then, though."


In "Nutrition for Women", it says that older women (not that you are old) usually have larger more precocious babies. Preventing low blood sugar is important. One of the reasons older women have larger babies is due to higher blood sugar. They also usually eat better.

 

[aguilaroja]

....In "Nutrition for Women", it says that older women (not that you are old) usually have larger more precocious babies. Preventing low blood sugar is important. One of the reasons older women have larger babies is due to higher blood sugar. They also usually eat better.

My recollection is that Dr. Peat has also returned to this point in some newsletters. Dr. Peat's views on diabetes mellitus are certainly contrarian. The orthodox view about diabetes appears to help people in life-threatening situations. If Dr. Peat is right, there is still a lot of room to help people more. "Gestational" "diabetes" is a unique situation, even in the diabetes perspective, since it can readily be seen that ample glucose/metabolic energy to a developing human might be an advantage.

http://raypeat.com/articles/articles/diabetes.shtml

"Normal pregnancy can be considered "diabetic" by some definitions based on blood sugar. I got interested in this when I talked to a healthy "diabetic" woman who had a two year old child whose IQ must have been over 200, judging by his spontaneous precocious hobbies. Old gynecologists told me that it was common knowledge that "diabetic" women had intellectually precocious children.)"

Some recent studies showed a different trend, and another showed differences due to maternal but not paternal age. Dr. Peat has often been helpful when the conventional wisdom has been in the other direction. I am simply saying on quick survey, some finding are different. These studies are not definitive work, but appear to be sincere:

http://www.ncbi.nlm.nih.gov/pubmed/24065154
"...maternal diabetes in pregnancy was associated with lower offspring cognitive ability even after adjustment for maternal age at birth, parity, education, early-pregnancy BMI, offspring birth year, gestational age and birthweight."

http://www.ncbi.nlm.nih.gov/pubmed/22927834
"Maternal diabetes in pregnancy is consistently associated with lower offspring cognition and educational attainment though confidence intervals were wide."

http://www.ncbi.nlm.nih.gov/pubmed/23467498
"advanced paternal age showed no association with offspring IQ; however, maternal ages above 30 years were inversely associated with offspring IQ"

(These full articles free at PubMed links)

 

[HDD]

My daughter gave birth last week to an 8 lb 4 oz. baby girl. Of course, I fretted throughout her pregnancy because she is a salmon/salad eating former vegan. She spoke about not getting too much sugar but then her cravings always trumped that. The same thing with salt. She avoided beans, IIRC, because they upset her stomach. So, without my interference (except getting her to take vitamin k for her nosebleeds) she delivered a healthy baby at home. Her baby Dr. said that babies are born heavier and stronger these days because the moms are more informed. I think that will be especially true with you, ammuc.

 

[LucyL]

http://www.ncbi.nlm.nih.gov/pubmed/24065154
"...maternal diabetes in pregnancy was associated with lower offspring cognitive ability even after adjustment for maternal age at birth, parity, education, early-pregnancy BMI, offspring birth year, gestational age and birthweight."

Here are some quotes from this study -

A recent report based on data from the UK-based Avon Longitudinal Study of Parents and Children (ALSPAC) found that exposure to pre-existing maternal diabetes and gestational diabetes were both associated with lower IQ measured in childhood (age 8 years) and that existing diabetes was also associated with lower educational achievement at 16 years [8]

and

In contrast to these two studies from Western populations, where diabetes in pregnancy is relatively uncommon (0.5% [7]), a recent study from India which reported a 7% prevalence of gestational diabetes [9], suggested that gestational diabetes was associated with higher cognitive achievement scores in offspring at a mean age of 9.7 years [10].

Since data in the Medical Birth Register does not distinguish between gestational or existing diabetes, we used the term ‘maternal diabetes in pregnancy’ for this exposure

Also the results section of the study had this:

Results

Among non-siblings, maternal diabetes in pregnancy was associated with lower offspring cognitive ability even after adjustment for maternal age at birth, parity, education, early-pregnancy BMI, offspring birth year, gestational age and birthweight. For example, in non-siblings, the IQ of men whose mothers had diabetes in their pregnancy was on average 1.36 points lower (95% CI −2.12, −0.60) than men whose mothers did not have diabetes. In comparison, we found no such association within sibships (mean difference 1.70; 95% CI −1.80, 5.21).

Since this is Sweden, I would go on the assumption that diabetes, whether pre-existing or gestational, was fully treated and "controlled" during the pregnancies, compared to a country like India where diabetes is rampant and control may not be as tight.

Type 1 diabetics already on insulin for blood sugar control are going to keep it under even tighter wraps while pregnant, begging the question of whether studies like this might actually indicate a negative result of tightly controlled diabetes?

The other thing that jumped out was the IQ disparity was an average of 1.36. Really? There are studies showing a IQ disparity of 2 points just by effect of being the second born sibling. And margarine, can produce a 3 point IQ drop. Margarine consumption is linked to lower IQs in children. Of course, diabetics of any stripe are told to avoid those horrible saturated fats. India, ironically, has the highest butter consumption rate in the world.

Go figure.

 

[catan]

My daughter gave birth last week to an 8 lb 4 oz. baby girl. Of course, I fretted throughout her pregnancy because she is a salmon/salad eating former vegan. She spoke about not getting too much sugar but then her cravings always trumped that. The same thing with salt. She avoided beans, IIRC, because they upset her stomach. So, without my interference (except getting her to take vitamin k for her nosebleeds) she delivered a healthy baby at home. Her baby Dr. said that babies are born heavier and stronger these days because the moms are more informed. I think that will be especially true with you, ammuc.

Congratulations Haagendazendiane! :)

The country where I'm going to deliver in is c-section-happy, the rates are high, 40% of women or more. Many women say their doctors worried their babies would be too big to deliver vaginally, although in most of these cases the babies are hardly 8 lbs (inaccurate estimate from ultrasound). Women with gestational diabetes are usually sent for c-sections. So I'm a bit concerned about this. My diet this time round is a lot higher in carbohydrates, fruits/sugar than before.

Among most of my peers with babies in the recent years, 6-7 lbs appear to be the norm, which seems far smaller than babies from my mother's generation. My mother delivered 5 babies, all over 9.5 lbs. At that time 8-10 lb babies was the norm (many of my cousins, etc were that large). But I don't find that we are particularly precocious given our birth weights

I've also observed some women gain a lot of weight yet have small babies, and some women gain little weight and have large babies.. does this have any relation to diabetes? When I mentioned to my obgyn that my mother gained 50+ lbs per pregnancy and had large babies, she immediately assumed my mother must have had gestational diabetes but just that they didn't diagnose as such 20-30 years ago.

 

[LucyL]

My second, when I had the diagnosed "gestational diabetes" was a whopping 7.4 pounds - my biggest baby. The other two, one with a "normal" pregnancy and the other I refused the test, were right at 6 pounds. I gained about 10-15 pounds total with each one.

The GD obgyn said they never let their patients go past their due date and other stuff like that. Thank God my regular obgyn was a very sensible doctor. That baby was allowed to arrive on it's own schedule about a week late. I think that played into the extra 1.4 pounds more than anything, as the smaller babies were about a week early.