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Common Questions of First-Time Mothers
Fatigue is a very common sign of pregnancy in the first trimester, but it usually resolves after that. If you have continuing or extreme fatigue, check with your doctor—it may be a sign of a problem such as anemia. Toward the end of pregnancy, women may be fatigued because they are uncomfortable or not sleeping well.
Poor weight gain is a risk factor for problems with pregnancy. Don’t skip meals and always eat a well-balanced breakfast with proteins and carbohydrates. With an average size baby, women gain about 25-35 pounds total. Doctors may recommend that women who are overweight gain less weight during their pregnancy, perhaps 15 pounds.
If your pregnancy is uncomplicated, you can continue physical activity at your accustomed level. Talk with your doctor or midwife before starting new activity and start slowly. If you have any medical complications such as high blood pressure, check with your practitioner about exercise. Use common sense about your level of activity. It is okay to get moderately overheated as long as you can sweat freely and stay well hydrated. However, avoid hot tubs and other places where you are immersed or can’t sweat freely—this is dangerous for your baby.
If you are in good health, your pregnancy should not be high risk, although there is a greater chance for some problems, including maternal diabetes and chromosomal (genetic) abnormalities. You should talk with your doctor or midwife about whether you wish to be screened for chromosomal abnormalities in your baby. Several screening options are available. These include ultrasound at 10 to 14 weeks to evaluate the nuchal transparency (neck fold) of your baby. Blood tests, such as multiple marker screens, are done at 10-13 weeks or 15-20 weeks to evaluate the risk of spinal defects and some chromosomal abnormalities. Some centers offer a combined nuchal transparency ultrasound together with serum markers (blood tests for BHCG and PAPP-A). This combination of testing yields an 80% detection rate for Down Syndrome and must be performed late in the first trimester.
The gold standard for evaluating your baby for chromosomal abnormalities is done through invasive genetic tests such as chorionic villus sampling (CVS) or amniocentesis. In CVS, done at 10½ to 12½ weeks, the doctor takes a tiny tissue sample from the placenta. In amniocentesis, usually performed at the 15th week, the doctor takes a sample of the amniotic fluid surrounding the baby and examines fetal skin cells in the fluid. There may be a small risk of miscarriage and other complications with invasive tests.
Beyond age 40, there begins to be a higher risk for other pregnancy complications, but your doctor or midwife can evaluate and advise you.
It is fine to sleep in whatever position you are comfortable in until the 24th week. After that, don’t sleep on your back, because your uterus may compress arteries and affect your blood pressure.
You should feel free to call with any question or concern. However, you should call immediately with any of these symptoms:
It is safe to have sex during pregnancy as long as there are no serious complications of pregnancy, including bleeding, premature labor, or ruptured membranes, and as long as it is physically comfortable. However, you should not have sex with multiple partners during pregnancy.
It is fine to dye or highlight your hair after the first trimester. Exposure to the baby from the solutions used for perms or dying is not significant. However, hair may not take to the perm solution during pregnancy.
Be careful handling raw, uncooked meat and fish. As always, wash your hands, any equipment, and the work area thoroughly after preparing raw poultry or meat. As you may know, there have also been pasteurization issues recently with some poultry. Generally, however, it is all right to eat meats as long as they are fully cooked.
Be careful about raw eggs. Questions have also been raised about eating unpasteurized soft cheeses. Cheeses made in the United States are made with pasteurized milk, but be cautious about imported cheeses.
Fish is an excellent source of protein, but larger fish—shark, mackerel, and tuna (including canned tuna)—have higher concentrations of mercury. Stick to other fish during your pregnancy. Stay away from processed lunch meats, which contain high levels of nitrates. And, of course, avoid alcohol and tobacco and have only small amounts of caffeine.
With over-the-counter medications, use acetaminophen (Tylenol) rather than aspirin or ibuprofen. In the first trimester, weigh the benefit of the medicine before deciding whether to take it. After that, over-the-counter medications are generally safe, but read the label to make sure they don’t contain alcohol or iodine. Check with your doctor or midwife if you’re not sure whether something is safe.
You and your practitioner should also discuss any chemicals you handle at work to make sure they are not hazardous during your pregnancy.
Finally, pregnant women should not handle kitty litter—changing or scooping the cat box. Cats may have a parasite that can cause an infection that would be dangerous for you and your baby.
Editorial provided by Jane Porcelan, MD, and Maureen Murphy, CNM, of the Department of Obstetrics and Gynecology, Main Line Health System.