Best wishes on a healthy baby and mom!

Q & A On CFS/FMS and Pregnancy

Dear Doctor Teitlebaum:

Thank you very much for agreeing to answer these questions for my Fibromyalgia Aware Magazine article on Pregnancy and Fibromyalgia. Parents (old, new or expectant) as well as parent hopefuls, have fears and concerns regarding the impact of FM/CFIDS on their pregnancy. I did receive today the ten tips – thank you for that.

On behalf of people with fibromyalgia, I thank you most sincerely – Catharine Shaner, MD

QUESTIONS

1. What is your specialty? How long have you been practicing? Do you care for many patients with fibromyalgia?
A -- I am a board-certified in internal medicine and have been practicing for 25 years. For the last 15 years or so my specialty has been CFS, fibromyalgia, and pain management. I have treated over 2000 CFS/fibromyalgia patients.
2. Please spell your name, including degree:
A -- Jacob E. Teitelbaum M.D.
3. Where is your practice located? Are you associated with any organization (i.e., spokesperson for _________, practices at _______ hospital)?
A -- Annapolis, MD. I am a medical director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies. I am a medical adviser for numerous groups. I have a policy of not accepting money from any group or any company whose products I recommend. I am an emeritus member of the Anne Arundel Medical Center

PRE-CONCEPTION:
1. Do you agree with the following advice for women with FM or CFIDS prior to conceiving (& do you give any other advice?)?
-get in the best shape possible physically
-wait to conceive until you are not in a flare
-reduce stress
A -- in terms of exercise, it is important to realize that people should not push to the point of crashing. Instead, they should slowly increase walking as is tolerated without causing next day flares. It is a good idea for fibromyalgia patients to reduce stress in general.

Most importantly, I think that the fibromyalgia should be treated with an integrated metabolic regimen for about a year before pregnancy, so that people have largely recovered before they get pregnant. Our randomized double-blind placebo controlled study showed that treatment can be very helpful (P. < .0001 versus placebo).
2. Would you agree that fertility problems with FM are no different than the general population?
A -- Although infertility is not a significant problem, I do find it to be more frequent in fibromyalgia than in the general population. On the other hand, when the nutritional deficiencies (especially iron) and subclinical hypothyroidism are treated, the infertility problems often resolve (as is also seen in the Non- fibromyalgia general population)
3. Do you see problems with irregular cycles, hormone imbalances, ovarian cysts, vaginosis, endometriosis, or other GYN problems in women with FM/CFIDS?
A -- yes, especially hormonal imbalances, irregular periods, and endometriosis. There is also an increased frequency of polycystic ovary syndrome associated with elevated DHEA -- S and testosterone as well as glucose intolerance. This can result in infertility, which responds well to treatment. In addition, elevated prolactin is common in associated with the hypothalamic dysfunction (and rarely pituitary adenoma). This can also result in infertility, and also responds excellently to therapy.
4. Should women stop all meds? (please list any acceptable ones to take, if known) particularly:
muscle relaxants
anti-depressants
guiafenesen
neurontin
medications for migraines
medications for irritable bowel
A -- I leave my pregnant patients on the Energy Revitalization System powder as this was also made to be an excellent support for pregnancy. They also need to be on a stabilized, mercury free fish oil (I recommend the Eskimo 3 Brand), calcium 1500 milligrams, and iron if needed (i.e. -- if the ferritin is less than 40). They can also stay on thyroid hormone, and if needed, Ultra low-dose Cortef -- both of which supports pregnancy. If critical, they can stay on Prozac, which has not been associated with increased birth defects. Besides for these, I stop almost all medications and herbals. I would note that in general, acetaminophen (Tylenol) is a poor choice for fibromyalgia patients as it depletes glutathione -- a critical antioxidant that is likely already deficient in CFS/fibromyalgia