Bacteria & Flagyl, nutrition, and pregnancy

I had my first OB appointment today with an actual doctor (first was with a completely useless NP - not that all NPs are useless, but this one was). She said I have a minor bacterial infection and was going to put me on an antibiotic - I was sort of surprised when she handed the prescription, and it is for Flagyl! I have never taken Flagyl before. Do I continue taking my probiotics WHILE I'm taking the Flagyl? Or do I stop them during the course of the Flagyl and pick up again after? Or should I take more or less than I have been? I know the idea of the probiotic is to promote the growth of the "good" bacteria, but I wasn't sure if it was counterproductive to take it and an antibiotic at the same time.

I asked my OB today how often they normally run nutritional labs (vitamins & minerals) throughout pregnancy, expecting her to say maybe only twice, and then I would request more frequent. No, she says they don't run them AT ALL. Ever. She recommended I just stop raking everything and take JUST a prenatal. I looked at her and said no, that's not a good idea  :P   She told me to at least stop any A, D, E, and K I was taking, and I again said no, not a good idea. So she said, well, just don't take more than 100% of the normal RDA for each of them. Someone doesn't have a clue about malabsorption! And I just had a result of 32 on my vit D drawn in July, so, no, I will NOT stop my vit D. I get that vit A in particular can be scary to take during pregnancy, but I feel like if I just stop taking it completely, my levels will plummet. Luckily, my A was at 97 (98 being top of the normal range) at my last labs in June, so I have a little more leeway there than with my D.

She said I am "welcome" to have my regular doctor monitor my vitamins and minerals, but that they would not, and they have had other "gastric bypass" patients before who didn't have a problem with just the prenatals. Umm, how do you know they didn't have a problem if you don't TEST them for anything??

So, I will have to go to my PCP for labs throughout my pregnancy. Not a huge issue since my PCP's office is super close to my work, and she has been quite supportive of helping me with my labs. Just annoying that my OB was so clueless about it all. Not surprising, really, but annoying. I will likely be OB shopping in the next few weeks anyway since their location is nowhere really near my home OR office (was close to my office at my last job, but not anymore).

Any info on taking Flagyl is much appreciated. And anyone with suggestions/recommendations regarding supplements/labs during pregnancy is also very welcome!

Oh, and I ask these questions here instead of over on the pregnancy forum because the general consensus over there is to blindly follow doc's orders regarding supplements, so many have reduced to just prenatals. I just can't wrap my brain around that being a good idea - let's take FEWER supplements now that we're supporting an additional life! Umm, no.

I don't think there is hard and fast rules for taking or stopping your probiotics when you're on a round of antibiotics. I've hear both from docs, so I have a feeling they're just making stuff up. 

The post-DS moms will likely have some good info for you regarding vitamins. I can't imagine that it would be a good idea to reduce what you're currently taking. 

--gina
 

 Hi Jillybean,

I'm also post DS (3 yrs post-op) and pregnant (13 weeks)!... it's my 3rd baby, but my first one post-WLS.
I have always heard that you can stop probiotics while you're actively taking Flagyl and resume them when you have finished your course. I've never personally taken Flagyl.
And with regards to supplements, I just took my usual vitamin regimen until I got some labs, then I increased/ decreased things according to my labs. I have my PCP's office sending out a full lab requisition once a month so I can keep a close eye on everything during the pregnancy.
I know it's a good idea for all preggo ladies, DS or not, to increase iron and calcium. (I started liquid iron and added an additional dose of calcium citrate to my regimen... of course iron and calcium can't be taken together so you have to space everything out... and they both tend to constipate me, so I added additional magnesium and stool softener, plus miralax every other day!) And I try to have a protein shake once a day.
As far as ADEKs, I've continued everything except the A, I had noticed my A slipping on labs (prior to getting pregnant) so I'd increased the dose to bring it up.... but when I got my first set of pregnancy labs, my A had gone way too high... like 300-something. So, I completely discontinued the A. But if your current A, D, E and K are looking good, then just keep doing what you're doing! Congrats & Good luck!

-V

 HI Jill,

My doctors were concerned about the amount of A I take because it can be so risky.
The agreement that we made was that I would take it at half the dose and moniter every 6 to 8 weeks and adjust as needed. Having said that it is important for me to note, that my a levels are through the roof (above normal) and I don't think I  have any malabsortion left. (or very little)

If your doctor is on board for regular testing then why don't you cut back a little and watch the trends?

Goodluck

CNC

Not only did I not reduce my vites etc during pregnancy, I increased them and added a prenatal.  I had my hematologist run what he always runs every three months,  and my OB ran add'l stuff throughout my pregnancy.  I saw a high risk OB practice and they were very understanding (and informed) about malabsorption.

You need a new OB who gets it - maybe you should be seeing a high risk OB because perhaps it is more likely that they will appreciate the malabsorption issues and potential risks.

Never stopped the probiotic during pregnancy,  and you should especially take them when you're on an antibiotic.

It's ridiculous for the OB to tell you that no bypass patient had any deficiency issues for exactly what you state - how the hell would she know if they never run anything?

You especially need to watch your calcium,  D,  iron...

Thank you, everyone!

I was considering a high-risk OB as well, so I'll look into that in the area. I'm glad I at least have a PCP who "gets it" and is more supportive and helpful, but I would definitely prefer to also have an OB who is on board as well. Fingers crossed that the local DS surgeon's office has a recommendation for an OB (I will be emailing Dr. Elariny's office tomorrow to ask).

Oh, and I picked up my Flagyl prescription, and I read the little insert of warnings and whatnot, and it states that it should not be taken in the first 3 months of pregnancy. Awesome. Off to Google...

I would call the OB who prescribed the Flagyl and insist on speaking to a doctor...tell them about the warning,  and ask if there is another antibiotic that might work that is not contraindicated during pregnancy...

Dr. Elariny just wrote me a prescription today for Flagyl and I asked him specifically if I stop the probiotic and he says no. Take them together.

I evidently have some super gut bug I got while in Peru. Fun times. Not.

Super gut bug - eww! Hey, if you're gonna do it, go all out and do it right!  :P   I always end up with the worst possible scenario of things health-wise, so I'm super happy that my pregnancy seems to be relatively easy so far as far as symptoms and such.

and they have had other "gastric bypass" patients before who didn't have a problem with just the prenatals. Umm, how do you know they didn't have a problem if you don't TEST them for anything??

OMG, that's incredible.  I guess no one dropped dead on the office floor, so they didn't have a problem, huh?

On the probiotic thing, when I had researched this a while back, the answer I found was to take your probiotic at the mid point between your antibiotic doses.

How are you feeling?  any nausea or anything?

-Jenny