Now what? You might be equal parts thrilled and terrified, and will likely have a lot of questions when it comes to nutrition, activity, the latest dos and don’ts, and everything else surrounding pregnancy, labor and delivery — never mind parenting. We’re here to help with some of the top questions we see in our practice:
Q What vitamins and supplements should I be taking?
A We encourage women trying to get pregnant, who are pregnant or who are breastfeeding to take a daily prenatal vitamin for women. The most important component of this vitamin is folic acid or folate, which is a B vitamin needed to support normal development of a baby’s brain and spinal cord.
Folate is the natural form of this vitamin, which doesn’t require extensive metabolism and is more fully absorbed. It’s found in leafy green vegetables and beans as well. Most prenatal vitamins also contain DHA, another important element for the baby’s brain development. DHA can also be found in fish and some milk and eggs.
If your prenatal vitamin doesn’t contain iron (most gummy versions do not), make sure you’re taking an additional iron supplement.
Finally, it’s important to consume an adequate amount of calcium for development of your baby’s bones, teeth and muscles. This is a component of prenatal vitamins and can be found in dairy products, dairy alternatives, broccoli and kale.
Q What products should I avoid?
A Many products we use every day contain chemicals, and we don’t have enough good research that assesses exposure to all of these chemicals in pregnancy. For most chemicals, high levels of exposure — that go beyond a typical person’s level of use — would be required to cause birth defects.
It can be helpful to limit use of some items out of caution and opt for more “natural” alternatives.
- Talk with your health-care provider about all medications you’re taking as soon as you know you’re pregnant. Bisphenol-A (BPA) is found in many plastic food containers and may increase rates of miscarriage and birth defects.
- Parabens, phthalates and phenols — which are found in many soaps, lotions and hair products — can disrupt fetal hormones, so much so that a recent study showed a correlation with early onset of puberty in female offspring.
- Excess vitamin A is linked to birth defects. Isotretinoin (also known as Accutane) is a vitamin-A-derived medication used for skin conditions, including severe acne and is associated with significant birth defects and developmental problems.
- Do not smoke during pregnancy, and avoid second-hand smoke as much as possible.
- Do not use illicit drugs in pregnancy.
- Do not consume alcohol during pregnancy. Because it’s extremely difficult to create a controlled study of alcohol use in pregnancy, no one can recommend any safe amount at any time during pregnancy.
- Caffeine consumption of about 200 mg daily (think one to two measuring cups of coffee) is thought to be generally safe. If you can avoid it altogether, that’s likely best, since more recent evidence suggests smaller amounts may have some effects on the growth of a baby.
- If you have a cat, someone else should be in charge of managing the litter box. Taking on that role may expose you to a parasite called toxoplasma, which can damage a baby’s organs, especially the brain and eyes, and lead to stillbirth.
- If your job or home life exposes you to lead, pesticides or radiation, discuss precautions with your health-care provider.
Q What vaccinations should I receive?
A During flu season, a flu shot is recommended for pregnant women at any stage in pregnancy. Pregnancy makes a person more susceptible to the flu in general and to much more severe complications from the virus. Pregnant women and their babies can die due to severe illness from the flu.
The Tdap (tetanus, diphtheria and pertussis) vaccine is also recommended for all pregnant patients between 27–36 weeks of pregnancy. The most important component of this is protection against pertussis, most commonly known as whooping cough, which can be deadly for babies. A mother’s vaccination provides some passive immunity to the baby, so the baby has some protection from the condition in the vulnerable newborn period. This vaccination is recommended for patients regardless of when they last received a “booster” shot (typically every 10 years for non-pregnant adults).
Q How should I change my diet?
A Avoid large fish (think swordfish and tilefish) as they can contain large amounts of mercury, which in excess can contribute to developmental problems for the baby. Smaller fish like salmon are OK and can be helpful for a baby’s brain development.
A dangerous bacterium called listeria can be found in deli meats and hot dogs. If you have extreme cravings and cannot avoid these foods completely, make sure you cook them either in a frying pan or in the microwave until they’re visibly steaming hot.
Make sure all dairy products you consume are pasteurized (versus raw). During pregnancy, it’s important to wash all foods and vegetables thoroughly and cook all meats completely.
Q Can I travel by air?
A Most airlines will allow pregnant passengers to fly until about 36 weeks. On flights and long car rides, make sure you get up frequently to stretch your legs to prevent blood clots. Nobody (including yourself!) wants you to have a baby in the air, so be safe and don’t board a plane if you’re having labor symptoms.
Be aware there’s still a high risk of Zika virus in many countries. Exposure to this virus can be severely detrimental to a baby’s growth and development, particularly brain development. Refer to the Centers for Disease Control website for country-specific information and recommendations regarding potential Zika exposure.
Note that Zika exposure among male partners throughout the pregnancy can also affect the baby.
Q How should I sleep?
A By around 20 weeks of pregnancy, you should avoid sleeping flat on your back. By this time, your uterus is large and pushes down on the big vessels in your belly, which can interrupt blood flow — and thus oxygen delivery — to your heart, your brain and the placenta. Try using body pillows to help position yourself so you don’t roll onto your back while you’re asleep.
Q How many ultrasounds will I get?
A Although it can be fun to see images of the baby, frequent ultrasounds aren’t medically necessary for most pregnancies. Often an ultrasound will be obtained midway through the first trimester to confirm the timing of the pregnancy and assess the number of fetuses: You’ll likely want to know if you have twins — or more — early in the pregnancy!
A heartbeat is first typically visible after six weeks and often better assessed after seven weeks. Obtaining an ultrasound earlier is generally not helpful unless you’re experiencing significant pain or bleeding that requires assessment. An ultrasound at the end of the first trimester is optional depending on what (if anything) you decide you’d like to do for genetic screening.
Midway through pregnancy, an ultrasound is recommended between 18 to 22 weeks to assess growth and anatomy as well as the position of the placenta and the amount of amniotic fluid. This is also when many people choose to learn the sex of their baby.
In a normal, healthy pregnancy, no further ultrasounds would be needed after that point. Patients with medical problems or pregnancy complications sometimes require more ultrasounds to evaluate the baby’s growth and wellbeing throughout the pregnancy.
Of course, it’s important to have a thorough discussion with your health-care provider about any questions or individual concerns. Your personal circumstances may lead to specific recommendations to keep you and your baby as healthy as possible!
Dr. Erin Stevens sees patients at the Edina location of Clinic Sofia, an OBGYN clinic known for its personalized approach to women’s health care. Learn more at clinicsofia.com.