05/08/2025

LYFE TUESDAY | AUG 5, 2025

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Detecting abnormalities in pregnancy via anomaly scan o Ultrasound examination allows doctors to take closer look at physical structure of baby

GYNAE SAYS

A detailed scan or an anomaly scan is an ultrasound examination done to look at the anatomical or physical structure of the baby. It can be a diagnostic test to check the physical structure or abnormalities in the baby. It can also be used to screen for chromosomal abnormalities, but this will then require a diagnostic test such as amniocentesis. During the test, we look for soft markers that are not real abnormalities, but to show an increased risk of chromosomal abnormalities. It is recommended to be done between 18 to 22 weeks of pregnancy. However, with better training and machines, most of the major abnormalities can be detected at 14 weeks of pregnancy but it is still recommended to repeat at 18 to 22 weeks of pregnancy especially in the heart where only about 50% of abnormalities can be detected in the best hands. Here the whole structure of the baby that includes the head, brain, face chest, heart, stomach, kidneys, bladder, spine and all four limbs are checked to be anatomically normal. This scan is best done by a maternal fetal medicine specialist. However, an obstetrician and gynaecologist that is trained and credentialled can also do these scans. However, general practitioners are not trained to do these examinations. By law, they and the sonographers (not registered under the Private Healthcare and Facilities Act) are not allowed to perform these examinations as they are unable to provide the complete test. These examinations are not only about the scan, but also about counselling. Ideally, the patient should be counselled on the implications of the test in this case the ultrasound examination. They should be counselled on the implications of a finding when the scan shows an abnormality. Even when the scan does not show an abnormality, the patient needs to be informed that certain He said metformin, a medicine to treat type 2 diabetes, has many side effects when given to children under 10, such as stomachache, flatulence and discharge of oily stool. Yazid added that while metformin is “not popular for children under 12, we will consider it in certain cases”. “Metformin is used for type 2 diabetes and can be given to children aged 10 and above who show signs of insulin resistance or prediabetes. The aim is to reverse their health issues before they develop full-blown diabetes.” This medication is usually taken for up to a year for weight loss, but some patients may need to take it for more than a year to prevent extreme weight gain and their insulin resistance from worsening, he said, adding scientific data has shown the use of metformin can reverse prediabetes in 50–70% of cases. Liraglutide, bariatric surgery Referring to a study conducted and co-authored by him together with several of the world’s leading medical experts, titled Liraglutide for Children 6 to Less Than 12 Years of Age with Obesity – A Randomised

Some abnormalities may not be detected during the first scan.

vitamin A,” he said. Rampant sale of junk food Beyond hospitals and clinics, the everyday environments children are exposed to, especially at school, also play a critical role in shaping their eating habits and long-term health. Sharing their concerns over the increasingly rampant sale of sugary drinks, snacks and fast food, including outside school gates, several parents described the situation as a “threat” to their children’s health. Siti Balkis, 42, a government employee, said almost every day her children, particularly the two younger ones who are in primary school, would buy ice cream, snacks or “jelly balls” (colourful jelly candies) after school as the street vendors are just a few steps away from the school gate. “Sometimes, we don’t even know what our children are eating because many different types of snacks are available in the market these days,” said the mother of four. with all the risks and possible treatment plans will be discussed with the patient and her family. The plan after agreement and consent can then be carried out for the best interest of the baby and family. There are options available to patients and some of the treatment may even be initiated while the baby is still in the womb. These treatments include medications, intrauterine blood transfusion for fetal anaemia, pleural tapping or chest tube for babies who have fluid in the lungs and a suprapubic catheter in those that cannot pass urine. This article is contributed by consultant obstetrician & gynaecologist, maternal fetal medicine Datuk Dr H. Krishna Kumar.

Certain abnormalities may develop later in the pregnancy period.

recommended for children who have not reached puberty due to potential disruption to growth. “Bariatric surgery is not performed on children unless under very specific conditions, usually in cases of extreme obesity where obesity-related diseases have started to develop. It can be done for adolescents who have stopped growing and entered adulthood,” he said. The surgery is performed to reduce the size of the stomach, making the patient feel full quickly even with small meals. However, it also reduces nutrient absorption, which can lead to nutritional deficiencies if not properly managed. “Post-surgery, patients must continue to consult doctors and dietitians to ensure they get the right supplements. For instance, a lack of vitamin D can lead to osteoporosis, while vitamin K deficiency can cause bleeding and bruising. In the US, (there was a case of ) a patient (who) became blind after undergoing bariatric surgery due to a lack of baby is born. This ensures a smooth plan and execution of the treatment of the baby, in which care in the neonatal intensive care unit and the surgical management are done together. If there is a query about the cause of the abnormalities being due to a chromosomal abnormality, then an amniocentesis with an appropriate laboratory test will be chosen for the best identification of the problem. This could also shed on the risk of other problems in the baby that will be counselled to the patient and her family. After that, a proper counselling

Trial , Yazid said their research involved the use of liraglutide – an injectable medication suitable for obese children aged six to under 12, to help reduce their appetite. The study, published in The New England Journal of Medicine in September 2024, found treatment with liraglutide for 56 weeks, combined with lifestyle interventions, resulted in a significantly greater reduction in BMI compared with placebo combined with lifestyle interventions. “Liraglutide tends to be more effective in children and youth than adults, with fewer side effects compared with other medications. We only prescribe it after all other weight loss efforts fail,” he said, adding that liraglutide costs about RM1,900 per month, making it unaffordable for many families. He said bariatric surgery is seen as a last resort for extremely obese children at risk of developing NCDs. However, it is not abnormalities may develop later or not detected due to the fetal circulation such as an atrial septal defect and a persistent ductus arteriosus, which is normal in a fetal circulation but not after birth. The scan also does not detect chromosomal abnormalities and rare genetic syndromes. If there is an abnormality detected, the patient may require a referral to a neonatologist and a paediatric surgeon. Counselling can be done together by all of these professionals if the team approach is used. The plan for the management of the baby can be executed before the

Some treatment for abnormalities may be initiated while the baby is still in the womb. – PICS FROM PEXELS

Combating child obesity with joint effort

Father of two Muhammad Saufi, 39, meanwhile, said the presence of vendors selling food high in sugar, salt and other additives outside school premises calls for stricter action from the authorities. “The types of food being sold also need to be monitored because most of them are unhealthy,” he said, suggesting schools to work together with Parent-Teacher Associations and local councils to more closely monitor the sale of food outside school gates and promote healthier alternatives at affordable prices. Experts stressed treatment alone is not enough. Early prevention, public awareness and stronger enforcement of regulations are crucial to breaking the cycle before it burdens the nation further. From sugar-laden drinks sold outside school gates to inherited risks compounded by sedentary routines, this issue demands urgent, multi pronged actions – not just to manage weight but to safeguard the future health and productivity of the nation’s younger generation. – Bernama

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