From the first moment you see the test turn positive until you sit down with your doctor for the initial appointment, the waiting can sometimes feel like an eternity. Some of you will spend those weeks worrying if you really are pregnant since you feel so normal. For others, the pregnancy symptoms will be so severe that you will be desperate for some relief. The following is a list of common concerns that I get asked about at the first pregnancy appointment as well as some helpful hints for common symptoms.
If you are not already on a prenatal vitamin, then please start one as soon as you find out you are pregnant. Folic acid is the most important ingredient in a prenatal vitamin. We recommend 1 milligram of folic acid per day during pregnancy. Taking folic acid can significantly reduce the risk of birth defects like spina bifida. If someone in your family has had a baby with spina bifida you may need to take higher doses of folic acid, so talk to your doctor.
One common question of expectant mothers is “Do I need a prescription prenatal vitamin?” The main difference in over the counter and prescription prenatal vitamins is a higher dose of the all-important folic acid that is included in a prescription vitamin. They have 1 mg, whereas most over the counter prenatals have 600 micrograms. Other “extras” that come with a prescription strength prenatal vitamin are stool softeners, special coatings to help you swallow, DHA (for brain development) and a special form of iron that causes less stomach upset. It’s usually easier to take the prescription prenatal because it has everything you need and it’s easier on your stomach. If it’s too expensive you can take the over the counter prenatal and simply add a folic acid and DHA supplement. It is important to note that folic acid is best absorbed as a supplement rather than its natural source.
You can take too many of some vitamins (like vitamin A) so you should not add additional supplements in pregnancy without talking to your doctor first. I’ve heard lots of women say that their prenatal vitamins upset their stomach so they took ‘a few’ Flintstone’s chewable vitamins instead. This is probably not a great idea because as I said, you can have too many of some vitamins. A better option would be to take one Flintstone chewable and then an additional folic acid supplement if you really can’t tolerate prescription prenatals. Here is link to a company that sells prenatals by mailorder for less than you can usually get them at the pharmacy: http://www.vitamedmd.com
Pregnancy should be a time of very purposeful, deliberate eating. Look at how many calories your body needs, and fill those calories with the most high yield nutritious foods. There are several websites that will tell you the amount of calories you need for your height and activity level. www.choosemyplate.gov is a good site that will give you a sample food pyramid based on your caloric needs. The best strategy is to plan ahead. Focus on getting 5 servings of fruits and vegetables a day with at least one of those vegetables being a dark green or leafy vegetable (sorry pickles don’t count). Drink lots of water. Around 8 glasses a day is ideal. Also make sure at least half of your grains are whole grains. You only need an additional 100 calories a day in the first trimester, so you not need to increase the amount of food eaten at this point.
Meat. All meat should be well cooked. Raw sushi should be avoided as well as rare and medium-rare steak.
Alcohol. There is no known safe amount of alcohol during pregnancy so please discontinue all drinking.
Fish. Shark, swordfish, king mackerel, and tilefish contain high levels of mercury. It is recommended that they be avoided while pregnant. Salmon and tuna should be eaten in moderation. Please note that fish sticks and fast food fish sandwiches are in general made from low mercury fish. See the following link for a complete breakdown of fish safety. http://womenshealth.gov/publications/our-publications/fish-facts.pdf
Caffeine. Caffeine intake should be limited to 200 mg a day during pregnancy.
Unpasteurized food. Cheeses, milk and juices should all be fully pasteurized. Soft cheeses such as feta and bleu cheese are some times sold in the unpasteurized form, so read labels.
Listeria associated foods. Several different foods have been associated with outbreaks of Listeria bacteria, which can be associated with miscarriage and bad pregnancy outcomes. While the overall incidence of this bacteria is extremely low, precautions should be taken to make sure that all vegetables are thoroughly washed. If a food cannot be well cleaned (such as fresh sprouts) it should probably not be eaten. Deli meats should be eaten only if fresh and for added precaution can heated in the microwave until sizzling to kill any possible contaminating bacteria.
Smoking. Please stop smoking immediately when you find out you are pregnant. Smoking is associated with an increased risk of miscarriage, stillbirth, preterm delivery and fetal growth restriction. If you smoke more than a pack a day and are having difficulty quitting, talk to your doctor about whether the nicotine patch would be appropriate for you.
Cats. Toxoplasmosis is a parasite that can live in cat feces. If it is contracted during pregnancy it can cause severe pregnancy complications. You should avoid handling cat litter or being in the room when the cat litter is being changed. You can still pet your cat and be in the same room as the cat litter if needed.
Exercise. We recommend you stay active during pregnancy. This helps you maintain your overall stamina, avoid excess weight gain and decreases your risk for gestational diabetes. If you are not already active, then I recommend you start walking or swimming 30 minutes daily, or at least 5 times a week. As you exercise, you want to maintain your heart rate at under 150 beats per minute. This is an exertion level of about 6-7 (on a scale of 1-10). At this level you should still be able to talk.
If you are already active in an exercise routine such as running or aerobics, you can usually continue with the above modifications. Make sure to keep your heart rate under 150. It is also a good idea to maintain your flexibility and strength. A prenatal yoga or pilates class (or DVD) can help you maintain your core muscles to help reduce the back pain associated with mid-pregnancy. After 15 weeks, exercises that involve laying flat on your back should be avoided. Additionally weight lifting should be limited to under 40 pounds.
Heat. There are a few things that are known to cause malformations at this stage of development. One of them is extreme heat. This is a time when it is especially essential to avoid hot tubs or very hot baths (higher than body temperature). Having a high core temperature in early pregnancy has been shown to cause malformation of the spinal cord. If you have a fever at this time it is best to take acetaminophen (Tylenol) to help keep your temperature down. If that does not lower your temp, call your doctor.
Medications. Be cautious of taking any medications that might interfere with the development of the baby. Check with your doctor before taking any additional medication: prescription, over the counter, herbal supplements and/or additional vitamins. Thyroid medication and asthma medications are probably the most common medications that women can take in pregnancy. They are safe for the baby and can be harmful if discontinued suddenly. If you care taking any other mediation, then notify your doctor’s office to determine if it is safe to continue.
Medications that are generally accepted as safe in pregnancy:
Milk of magnesia
Other things that are considered safe:
Hair dye has not been proven to cause malformations because it is minimally absorbed by the skin. Coloring your hair is considered safe, but if you want to be overly cautious you can wait until you are 12 weeks along.
Self-tanning lotions are also minimally absorbed and are considered safe to use. We always recommend you stay away from tanning beds and this applies during pregnancy as well.
Regular cleaning supplies are fine (sorry, I can’t give you an excuse to get out of your housekeeping). Just make sure you keep all areas well ventilated while cleaning. Avoid solvents such as paint thinner. Use common sense, if a chemical requires specialized disposal, you probably shouldn’t handle it while you are pregnant.
Most cosmetics and lotions are safe. If you use Retin-A, you should probably discontinue use during pregnancy. If you have questions about any prescription lotions, ask your doctor.
Sex is safe as long as you are not having any bleeding or complications.
Cravings. If you are craving a specific fruit, then go with it. If you need a Hershey’s bar every afternoon then you may need to slow down. I tell patients to give into their ‘bad’ cravings once or twice a week, just not once or twice a day!
There are weird cravings that could be a signal that something abnormal may be going on. For instance if you crave plain ice all the time, you could be anemic. Also some women will crave dirt or laundry soap, as well as other non-foods. This could be a signal of specific vitamin deficiencies. If this is the case inform your doctor. Needless to say, don’t give in to these ‘bad’ cravings!
Fatigue. I think fatigue is the least discussed early pregnancy symptom. Everybody knows about the “morning sickness,” but sometimes fatigue can be the most debilitating symptom in early pregnancy. The source is thought to be a combination of the high levels of HCG and Progesterone. But whatever causes it, from about 6 weeks to 12 weeks most pregnant women just want to sleep. Like 12 hours a night…and then take a nap later. If you can get away with it, go for it. The good news is that fatigue and nausea seem to get better after 12 weeks.
Links to discussions on other symptoms:
In our book I go into greater detail on all these issues and symptoms, with Jessica adding a faith based perspective on how to journey through pregnancy without fear. If you are looking for additional resources, I also recommend the ACOG Pregnancy Guide.
Hopefully this post will help fill the information gap that may crop up during those weeks between peeing on the stick and your initial pregnancy appointment. As an obstetrician, I love seeing patients for their first pregnancy visit. The joy and excitement on their faces when they see that first tiny flicker of the heart beat on the sonogram, still melts my heart. Thank you for letting us be a part of your journey and congratulations during this exciting time in your pregnancy.