Now That You Are Pregnant

Be prepared for many of the body’s adaptive changes you will experience. The following list is a guide of the most common problems encountered and suggestions to help you during your pregnancy. If after trying these suggestions, the problems still persist, please call the office. Congratulations on becoming pregnant!

Unrestricted Activities

Traveling by car until 38 weeks is permitted; but not for long periods of time unless you can walk briefly every 1.5 hours.

• Walking
• Swimming
• Riding a stationary bicycle

Restricted Activities

• Smoking Water or snow skiing
• Skiing Riding horses
• Flying after 32 weeks of pregnancy Painting
• Spraying insecticides
• Using hot tubs or saunas
• Using an electrical blanket
• Using tanning booth
• Douching or using tampons
• Lifting more than 20 pounds
• Jumping on trampolines
• Riding in overland 4 wheel vehicles
• Bungee Jumping
• Scuba diving
• Parachuting
• Playing soccer

Suggested Reading Materials

• Your Pregnancy Week by Week…Glade B. Curtis, M.D.
• Your Pregnancy Every Woman’s Guide…GIad B. Curtis, M.D.
• What To Expect When You’re Expecting…Arlene Eisenburg, Heidi E. Murkoffand Sandee E. Hathway
• Working Woman’s…Pregnancy …Hilary Body
• New Pregnancy and Birth Book …Miriam Steppard
• Chicken Soup for The Expectant Mother’s Soul
• The Pregnancy Diet Eileen Behai
• Eat This, Not That When You’re Expecting…. Jennifer Ashton, M.D.
• Safe Medications During Pregnancy
• Pregnancy Sleep Help Guide

Recommended Medications

When you have any of the symptoms listed below, please try these medications before you call us for another medication. Please give these medications at least 24 hours to work. These medications are safely taken as directed on the bottle or box. Do NOT take Aspirin or Aspirin containing compounds, Ibuprofen (Motrin, Advil) or Aleve during pregnancy. Please call if you have a fever of 100.4 or greater and symptoms continue to persist.

Nausea and vomiting are common discomforts of early pregnancy. It may begin as early as 6 weeks and usually subsides around the 12^th-14^th weeks or pregnancy. It can happen at certain times of the day or last all day. Nausea is initiated by the production of increases amounts of estrogen and progesterone in pregnancy. It can be made worse and advance to when meals are missed and the amount of glucose (and other nutrients) in the blood fall to levels at the lower end of normal.

Morning Sickness

There are several strategies for minimizing these discomforts.

First: feed the nausea. When you begin to feel sick the last thing you probably want to do is eat, but; this could be the cure. Try making these changes in your diet:

• Eat a small snack every 1-2 hours: This will keep your blood sugar level more even and prevent highs and lows, which can worsen nausea.
• ¹/2 Banana
• ¹/2 slice cheese
• 4 crackers with cheese or peanut butter
• 1/2 popsicle
• ¹/4 cup yogurt or cottage cheese
• ¹/2 piece toast
• ¹/2 cup of soup broth 1 cup of potato chips
• I cup of dry cereal
• ¹/2 cup of peppermint or raspberry tea
• Keep crackers, dry cereal, and a glass of apple juice beside your bed. When you get up several times during the night to urinate, eat or drink a small snack.
• When you find foods that you can hold down-eat them several times a day. (Variety is not important, that will return later.)
• Avoid spices and sauces
• Do not eat solids and drinks liquids at the same sitting.

In addition, you might try:

• • Take Nestrex three times a day.
  • Chew TUMS or peppermint candy at the onset of nausea.
  • Sip carbonated water at the onset of nausea.
  • Take Emetrol 1-2 teaspoons at the onset of nausea (may be purchased over the counter at your local drugstore.)
  • If you are unable to hold down two meals worth of food and at least 240z of fluid per day or if you are vomiting persistently— Call the Office! !

Guidelines For An Anti-Nausea Diet

l. Eat small frequent meals, 5-6, throughout the day.

• Eat more carbohydrates (i.e. bread, cereals, crackers, jello, pasta, potatoes, rice, etc.)
• Avoid fatty foods such as fried, greasy food, pastries, and rich desserts. Prepare food by baking, broiling, roasting, steaming, or boiling.
• Liquids (juices, soft drinks, popsicles, fruit ices, broth, soup, etc.) should be taken between meals, one hour before or after a meal.
• Eat at the time you feel most like eating.

II. If you feel the best in the morning, eat a well-balanced breakfast. you are most nauseated in the evening, eat lighter meal.

• Eat a variety of foods, adding fruits and vegetables as tolerated.
• 7. Eat slowly in a relaxed environment and sit up 30-60 minutes after finishing a meal.
• Avoid brushing your teeth immediately after eating if it seems to cause nausea or gagging.
• Keep foods at the bedside (crackers, dry cereal, vanilla wafers) to ear when nausea occurs or before getting up in the morning.
• Eat a snack before going to bed or during the night.

SAMPLE MEAL PATTERN

Environmental Agents

Many environmental agents have unknown effects on the developing fetus and exposure should be avoided or at least minimized. Household spray cleaners, oil based paints, insecticides, hair coloring and artificial sugar sweeteners (3-4 servings a day).

At one time it was though that a “placental barrier” existed which protected the baby from foreign substances ingested by the mother. In recent years, however, it has been shown that most substances to which the mother is exposed to does, in fact, cross the placenta and enter the bloodstream of the growing fetus. This occurs during all three trimesters of pregnancy and the time of labor and delivery. In short, there is no barrier.

Ideally, no drugs should be used during pregnancy, even though widespread use of a drug without recognized adverse effects on the fetus does not guarantee the safety of the drug. [fa drug is administered during pregnancy, the benefit to be gained must clearly outweigh any risks inherent in its use. This is not to say, “No medicine is the best medicine” during pregnancy because there are certain medical conditions that require treatment even during pregnancy. Typically, the benefit/risk is favorable when we use medications to treat an illness (such as a bladder infection) or to relieve severe symptoms.

Prenatal vitamins are routinely prescribed to help assure that you meet the minimal requirements for pregnancy. The use of such supplements, however, does not negate the need for a well-balance diet that contains ample quantities of calories, meats. or other sources of protein, dairy products, fruits, and vegetables. If prenatal vitamins cause nausea, discontinue them for two weeks, as well as well-balanced meals are far more important.

There is no advantage to “megavitamin” usage. Please do not medicate yourself with extra vitamins/minerals. Vitamins are drugs too!

During pregnancy, some very commonly used drugs such as caffeine, alcohol, and cigarettes can be potentially harmful. Moderate consumption of caffeine (2-3 cups per day) is probably safe, but if used in excess, could pose potential complications. Caffeine crosses the placenta easily and reaches the developing fetus. Caffeine ingestion by the mother can cause an increase in fetal movement and can affect the fetal heart, resulting in a fast pulse and/or extra heart beats.

Alcohol is also readily absorbed into the mother’s bloodstream and reaches the developing fetus. It has been said that the mother’s drink is the baby’s drink because the level of alcohol to which the baby is exposed to, is directly proportional to the quantity ingested by the mother. There is good evidence that alcohol consumption has been clearly established. It does appear that alcohol must be tåken over prolonged period of time to have a measurable effect. The wisest advice is to avoid alcohol during pregnancy.

With respect to cigarette smoking, more than 5 cigarettes per day have been shown to have adverse effects on the developing fetus. The effects are more pronounced with increased cigarette consumption. These effects include, but are not limited to: low birth weight, miscarriage, stillbirth, infant death, prematurity, premature rupture of the water bag, and interference with the normal breathing movements in the fetus. It is obvious from the data that a pregnant woman should not smoke. With a history of long time smoker; this is easier said than done, but we encourage you to make every effort to quit. At that time we are unable to measure if fewer than 5 cigarettes is safe number. Current research is also showing that children who are raised in homes where they are exposed to “passive smoke” are known to have a greater number of respiratory infections.

Constipation

This is a very common problem. Daily fresh fruits, vegetables, and salads will help. Fluid intake should be 8-10 glasses of water per day. Mild laxatives such as Metamucil, Surfak, Milk of Magnesia, or Colace may be used if necessary. If this unsuccessful, please Miralax packets for relief of constipation.

Diarrhea

You may use Kaopectate or Immodium AD. A bland diet, 7-UP, crackers, etc. should be followed for 24 hours. Do not eat or drink dairy products for 24 hours.

Nausea and Vomiting

Do not skip breakfast. An empty stomach worsens morning sickness. Cracker, dry toast or slightly sweetened hot tea usually helps reduce morning sickness- Coffee, fruit juice, milk or sweet-rolls often increases the nausea.

Nausea later in the day usually responds to eating some bland food or drinking 7-UP or Ginger Ale. Fried foods, spicy. Or fatty foods usually worsen the nausea. Frequent small feedings usually work best than the three large meals per day.

Vaginal Discharge

An increase in vaginal secretions during pregnancy is normal. It is best that you do not douche during pregnancy. Daily baths or showers are usually sufficient for good perineal hygiene. Vaginal itching or irritation should be reported to us.

Sexual Activity

Sexual intercourse may continue throughout pregnancy with no harm to the fetus unless advised otherwise because of bleeding or other problems. Frequent uterine cramps are noted after intercourse.

Leg Cramps

These usually occur at night during the second half of pregnancy, Os-Cal, TUMS 500, or Caltrate taken daily will help relieve these cramps. Support pantyhose should be worn when you plan to be on your feet for several hours in order to reduce leg pain and/or varicose veins.

Dizziness and Fainting

Dizziness occurs to some extent during all pregnancies; however, fainting only rarely occurs. Higher bodily temperatures and warmer environments can worsen the potential for dizziness and increases the likelihood of fainting. In the event of dizziness, moving to a cooler room, sitting down or lying down in a cool room for a while should allow a rapid recovery. Also, increasing your intake of fluids will lessen these problems.

Headaches, Backaches, Etc.

Headaches can occur frequently during pregnancy. You may use Extra Strength Tylenol as needed for headaches. Do NOT use Aspirin or Aspirin containing compounds. Backaches and lower abdominal discomfort occur with all pregnancies. Bedrest, heating pad, warm tub baths along with Extra Strength Tylenol usually relieves these discomforts. A maternity sling will also be quite helpful in relieving backaches and abdominal pressure. Posture is important, and sensible shoes, not high heels, should be worn.

Spotting

Brownish discharge or spotting may occur in the first trimester. If it becomes bright red, bedrest is recommended If spotting increases and becomes heavy like a period, please call the doctors’ office.

Perms/Hair Color

Perming or coloring your hair is not a problem during pregnancy. Make sure the room is well ventilated to insure the fumes won’t nauseate you.

Extermination/Painting

Well ventilated areas are the key to pointing or extermination safely during pregnancy when possible use water based paints only.

Toxoplasmosis Precautions

DO NOT change the litter box. If you have an “inside” cat eating raw meat and fish wear gloves and wash hands thoroughly.

Now That You Are Pregnant, What Labs Are Next?

Some patients are quite eager to know exactly at which visit they will have prenatal labs submitted and look forward to their next appointment. It is almost like it is a sign of progression during the pregnancy. Others, on the other hand, despise having labs drawn and rely on their significant other to hold their hands during the lab collection. Therefore, it is always good to know which labs are expected and when they will be submitted to the lab throughout the pregnancy. Most routine labs are covered through your insurance carrier. However, there are other labs that we consider optional that may be helpful for you in making decisions regarding your pregnancy. We will step you this very important process each step of the way!

First Trimester

6-12 Weeks-Routine NOB labs

• ABO Blood type and RI-I, Antibody titer, Hepatitis, Syphilis, HIV, Rubella, Complete Blood Count, Sickle Cell testing, Drug screening, Gonorrhea, Chlamydia, Herpes culture
• Confirm Pregnancy Ultrasound

6-12 Weeks-optional labs

• Fetal Free DNA testing, first-trimester screening with ultrasound, Genetic Carrier Mutation screening

Second Trimester

15-20 weeks

• Second-trimester screening
• Maternal serum alpha feto-protein testing for defects of the brain and spinal cord
• QUAD screening for Downs Syndrome

24-28 weeks

• Gestational diabetes screening, complete blood count, antibody titer

Three-Hour Glucose Tolerance Test

About 3 to 5 percent of pregnant women develop diabetes for the first time during pregnancy. This type of diabetes, called gestational diabetes, occurs when pregnancy hormones interfere with the body’s ability to use insulin, the hormone that turns blood sugar into energy, resulting in high blood sugar levels. You are at increased risk if you are over age 30, obese, have a family or personal history of diabetes, or previously gave birth to a baby who weighed more than 9 pounds or was stillborn.

Initial screening for gestational diabetes is done at 24 to 28 weeks’ gestation with the one-hour glucose tolerance test. If this reading is too high, which occurs 15 to 23 percent of the time, you will need to return for a three-hour glucose tolerance test to see if you really do have gestational diabetes. The good news is that most women whose screening test shows elevated blood sugar don’t turn out to have gestational diabetes.

For 3 days before the test, you’ll be told to eat at least 150 grams of carbohydrate a day. If you eat a normal diet and have an extra piece of bread at each meal, you’ll likely be getting enough carbohydrates. For 12 hours before the test, you should not eat or drink anything other than sips of water. You should not smoke or exercise during this time. Schedule your test for the first thing in the morning.

You can also meet the requirement of the 150 grams’ carbohydrate diet by incorporating the following foods in your diet. Each item listed below contains approximately 15 grams of carbohydrates. Please include a minimum of 10 items from the list below each day for 3 days prior to your 3-hour test.

• 1/2 cup cereal 1/3 cup rice
• 1/2 cup pasta
• 1/4 cup baked beans 1/2 cup corn
• 1/2 cup peas I baked potato
• 1/2 cup mashed potato 1/2 bagel
• I slice bread 3 graham crackers
• 6 saltine crackers I slice pound cake I apple, orange or pear 19-inches banana 3/4 cup blueberries 1/4 cup strawberries 15 grapes
• 1/2 cup fruit juice

24 Hour Urine Collection Instructions

To obtain accurate laboratory test on a 24-hour urine sample, it is necessary that a complete collection be made. The following procedure must be carefully followed.

• Empty your bladder when you first get up in the morning. The first morning void is NOT collected, however, you must record the time and date of this void.

Record the time and date here:

AM

(Time of last void)(Date of first void)

• From this point forward and for the next 24 hours, collect all urine into the bottle provided to you. Refrigerate the bottle during the collection period.

3. Your final collection will be when you empty your bladder the next morning at the SAME hour as you recorded in step I above. Record the time and date of this last void.

Record the time and date here:

AM

(Time of last void)(Date of first void)

4. The specimen must be transported to the Lab as soon after the collection as possible. Continue to refrigerate the bottle until you are ready to transport it to the lab.