Women's Medical Care, PC

Pregnancy

Prenatal Care

Prenatal care is the care a woman gets during pregnancy. Prenatal care should begin as soon as a woman knows for certain or suspects she is pregnant. Early and regular prenatal visits with a health care provider are important for the health of both the mother and the fetus.

During your first prenatal visit, your health care provider will probably talk to you about the following steps you can take to help ensure a healthy pregnancy:

Take folic acid.

Begin or continue to get at least 400 micrograms of folic acid by taking vitamin supplements and eating enriched foods every day to reduce your child’s risk of neural tube defects. Folic acid is found in enriched foods, such as bread, cereal, pasta, and other grain-based foods. A related form, called folate, occurs naturally in leafy, green vegetables and orange juice, but folate is not absorbed as well as folic acid. Also, it can be difficult to get all the folic acid you need from food alone. Most prenatal vitamins contain 400 micrograms of folic acid.

Avoid alcohol and tobacco.

Drinking alcohol and smoking during pregnancy can increase your child’s risk for problems such as fetal alcohol spectrum disorders (FASDs) and sudden infant death syndrome (SIDS, also called "crib death.").

FASDs are a variety of effects on the fetus that result from the mother drinking alcohol during pregnancy. The effects range from mild to severe, and they include intellectual disabilities; behavior problems; abnormal facial features; and disorders of the heart, kidneys, bones, and hearing. FASDs last a lifetime although early intervention services can help improve a child’s development. FASDs are completely preventable. If a woman does not drink alcohol while she is pregnant, her child will not have an FASD.

SIDS is the sudden, unexplained death of an infant younger than 1 year old. It is the leading cause of death in children between 1 month and 1 year of age. Most SIDS deaths happen when babies are between 2 months and 4 months of age. Drinking or smoking during pregnancy increases the risk of SIDS; also, infants exposed to secondhand smoke are at greater risk for SIDS.

Your health care provider can be a source of help if you find it hard to quit smoking or drinking on your own.

Talk to your health care provider about medications.

As many as half of women take four or more medications during pregnancy. Although many are safe, talk to your health care provider before taking any over-the-counter or prescription medication or herbal supplement. Certain medications to treat acne and epilepsy and some dietary or herbal supplements are not safe during pregnancy.

Avoid exposure to toxic substances.

During pregnancy, exposure to radiation, pesticides, some metals, and certain chemicals can cause birth defects, premature birth, and miscarriage. If you’re not sure if something might be harmful to you or your fetus, avoid contact with it until you check with your health care provider.

If you work in a job on a farm, a dry cleaner, a factory, a nail or hair salon, you might be around or come into contact with potentially harmful substances. Talk to your health care provider and your employer about how you can protect yourself before and during pregnancy. You may need extra protection at work or a change in your job duties to stay safe.

A few examples of exposures that are known to be toxic to the developing fetus are:

  • Lead: Lead is a metal that may be present in house paint, dust, and garden soil. Any home built before 1978 may have lead paint. Exposure can occur when removing paint in old buildings (or if the paint is peeling) and working in some jobs (for example, manufacturing automotive batteries). Lead is also present in some well water and in water that travels through lead pipes. High levels of lead during pregnancy can cause miscarriage, stillbirth, low birth weight, and premature delivery, as well as learning and behavior problems for the child. Women who had exposure to lead in the past should have their blood levels checked before and during pregnancy. Call the National Lead Information Center for information about how to prevent exposure to lead at: 800-424-LEAD.
  • Radiation: Radiation is a form of energy. It can travel as rays through the air, or it can be attached to materials like dust, powders, or liquids. Low exposures to radiation from natural sources (such as from the sun) or from microwave ovens or routine medical X-rays are generally not harmful. Because the fetus is inside the mother, it is partially protected from radiation’s effects. Nuclear or radiation accidents can cause high radiation exposures that are extremely dangerous, especially to the developing fetus. Pregnant women or women who may be pregnant should make sure their dentists and doctors are aware of this so appropriate precautions can be taken with X-rays or medical treatments that involve radiation. Pregnant women who may be exposed to radiation in the workplace should speak with their employer and health care provider to make sure the environment is safe during their pregnancy.
  • Solvents: Solvents are chemicals that dissolve other substances. Solvents include alcohols, degreasers, and paint thinners. Some solvents give off fumes or can be absorbed through the skin and can cause severe health problems. During pregnancy, being in contact with solvents, especially if you work with them, can be harmful. Solvents may lead to miscarriage, slow the growth of the fetus, or cause preterm birth and birth defects. Pregnant women who may be exposed to solvents in the workplace should speak with their employer and health care provider to make sure the environment is safe during their pregnancy. Whenever you use solvents, be sure to do so in a well-ventilated area, wear safety clothes (such as gloves and a face mask), and avoid eating and drinking in the work area.

Many chemicals are commonly found in the blood and body fluids of pregnant women and their infants. However, much remains unknown about the effects of fetal exposure to chemicals. It’s best to be cautious about chemical exposure when you are planning to get pregnant or if you are pregnant. Talk to your health care provider if you live or work in or near a toxic environment.

Follow a healthy diet.

Choose a variety of fruits, vegetables, whole grains, and low-fat dairy products to help ensure the developing fetus gets all the nutrients it needs. Make sure you also drink plenty of water. 

Maintain a safe diet.

Avoid certain foods such as raw fish, undercooked meat, deli meat, and unpasteurized cheeses (for example, certain types of feta, bleu cheese, and Mexican-style soft cheeses). Always check the label to make sure the cheese is pasteurized.

Some pregnant women are concerned about the amount of fish they can safely consume. Certain fish contain methylmercury, when certain bacteria cause a chemical change in metallic mercury. Methylmercury is found in foods that fish eat, and it remains in the fish’s body after it is eaten. Methylmercury in fish eaten by pregnant women can harm a fetus’s developing nervous system. According to the U.S. Food and Drug Administration (FDA), pregnant women can eat up to 12 ounces a week of fish and shellfish that have low levels of methylmercury (salmon, canned light tuna, and shrimp). Albacore (“white”) tuna has more methylmercury than canned light tuna; pregnant women should consume 6 ounces or fewer in a week. Avoid fish with high levels of methylmercury (swordfish, king mackerel, and shark). 

Limit caffeine intake.

Some studies suggest that too much caffeine can increase the risk of miscarriage. Talk to your health care provider about the amount of caffeine you get from coffee, tea, or soda. Your health care provider might limit you to 200 milligrams (the amount in about two 8-ounce cups of coffee) per day. Keep in mind, though, that some of the foods you eat, including chocolate, contain caffeine and contribute to the total amount you consume each day.

Talk to your health care provider about getting physical activity.

Most women can continue regular levels of physical activity throughout pregnancy. Regular physical activity can help you feel better, sleep better, and prepare your body for birth. After your child is born, it can help get you back to your pre-pregnancy shape more quickly. Talk to your health care provider about the amount and type of physical activity that is safe for you.

Talk to your health care provider about taking vitamin B12 and iron supplements.

Iron supplements can help reduce your risk for anemia, an iron deficiency common during pregnancy. Your health care provider may also recommend a vitamin B12 supplement if you are a vegetarian or vegan.18

Get regular dental checkups.

Your gums are more likely to become inflamed or infected because of hormonal changes and increased blood flow during pregnancy.19 Make sure you tell your dentist if you think you could be pregnant.

Prenatal Visits

What happens during prenatal visits varies depending on how far along you are in your pregnancy.

Schedule your first prenatal visit as soon as you think you are pregnant, even if you have confirmed your pregnancy with a home pregnancy test. Early and regular prenatal visits help your health care provider monitor your health and the growth of the fetus.

The First Visit

Your first prenatal visit will probably be scheduled sometime after your eighth week of pregnancy. Most health care providers won’t schedule a visit any earlier unless you have a medical condition, have had problems with a pregnancy in the past, or have symptoms such as spotting or bleeding, stomach pain, or severe nausea and vomiting.

Because your first visit will be one of your longest, allow plenty of time.

During the visit, you can expect your health care provider to do the following:

  • Answer your questions. This is a great time to ask questions and share any concerns you may have. Keep a running list for your visit.
  • Check your urine sample for infection and to confirm your pregnancy.
  • Check your blood pressure, weight, and height.
  • Calculate your due date based on your last menstrual cycle and ultrasound exam.
  • Ask about your health, including previous conditions, surgeries, or pregnancies.
  • Ask about your family health and genetic history.
  • Ask about your lifestyle, including whether you smoke, drink, or take drugs, and whether you exercise regularly.
  • Ask about your stress level.
  • Perform prenatal blood tests:

(1) to determine your blood type and Rh (Rhesus) factor. Rh factor refers to a protein found on red blood cells. If the mother is Rh negative (lacks the protein) and the father is Rh positive (has the protein), the pregnancy requires a special level of care.

(2) to do a blood count—hemoglobin, hematocrit

(3) to test for hepatitis B, HIV, rubella, and syphilis.

  • Do a complete physical exam, including a pelvic exam, gonorrhea and chlamydia cultures, and Pap test to screen for cervical cancer.
  • Do an ultrasound test, depending on the week of pregnancy.
  • Offer genetic testing: screening for Down syndrome and other chromosomal problems, cystic fibrosis, other specialized testing depending on history.

Prenatal Visit Schedule

If your pregnancy is healthy, your health care provider will set up a regular schedule for visits that will probably look about like this:

  • Before 28 weeks: Monthly
  • Weeks 28 to 36: Every 2 weeks
  • Week 36 to Birth: Weekly

Later Prenatal Visits

As your pregnancy progresses, your prenatal visits will vary greatly. During most visits, you can expect your health care provider to do the following:

  • Check your blood pressure.
  • Measure your weight gain.
  • Measure your abdomen to check your developing infant’s growth—"fundal height" (once you begin to "show").
  • Check the fetal heart rate.
  • Check your hands and feet for swelling.
  • Feel your abdomen to find the fetus’s position (later in pregnancy).
  • Do tests, such as blood tests or an ultrasound exam.
  • Talk to you about your questions or concerns. It’s a good idea to write down your questions and bring them with you.

Several of these visits will include special tests to check for gestational diabetes (between 24 and 28 weeks) and other conditions, depending on your age and family history.

Stress and Pregnancy

It is normal to feel some stress during pregnancy. Your body is going through many changes, and as your hormones change, so do your moods. Too much stress can cause you to have trouble sleeping, headaches, loss of appetite, or a tendency to overeat—all of which can be harmful to you and your developing baby.

High levels of stress can also cause high blood pressure, which increases your chance of having preterm labor or a low-birth-weight infant.

You should talk about stress with your health care provider and loved ones. If you are feeling stress because of uncertainty or fear about becoming a mother, experiencing work-related stress, or worrying about miscarriage, talk to your health care provider during your prenatal visits.

Posttraumatic Stress Disorder (PTSD) and Pregnancy

PTSD is a more serious type of stress that can negatively affect your baby. PTSD occurs when you have problems after seeing or going through a painful event, such as rape, abuse, a natural disaster, or the death of a loved one. You may experience:

  • Anxiety
  • Flashbacks and upsetting memories
  • Nightmares
  • Strong physical reactions to situations, people, or things that remind you of the event
  • Avoidance of places, activities, and people you once enjoyed
  • Feeling more aware of things
  • Guilt

PTSD occurs in as many as 8% of women during pregnancy, increasing their infant’s risk of preterm birth or low birth weight. PTSD also increases the risk for behaviors such as smoking and drinking, which contribute to other problems.

Reducing stress is important for preventing problems during your pregnancy and for reducing your risk for health problems that may affect your developing child. Identify the source of your stress and take steps to remove it or lessen it. Make sure you get enough exercise (under a doctor’s supervision), eat healthy foods, and get lots of sleep.

If you think you may be depressed, talk to your health care provider. Getting treatment and counseling can help.


Reference: National Institutes of Child Health and Human Development