Staying healthy begins with regular check-ups, with the first prenatal visit usually occurring between eight and 10 weeks. Sometimes women are seen earlier in their pregnancy, especially if they are experiencing symptoms, such as bleeding or cramping. These can suggest an impending miscarriage, but can also occur in a normal pregnancy.
The first visit includes a review of past medical history, a physical exam, blood tests and may include an ultrasound to confirm the due date. Patients return for check-ups at four-week intervals initially, and visits become more frequent as their due date approaches.
Routine screening tests include a full screen for infection, a fetal anatomy ultrasound at 18 to 20 weeks, gestational diabetes screening at 26 weeks and a culture for Group B streptococcus (GBS) at 36 weeks.
GBS are bacteria that approximately 20 percent of women carry, and transmission to the baby can be prevented with antibiotics during labor. There are also options to screen for risks of neural tube defects and genetic abnormalities, such as Down syndrome, which can be discussed during prenatal visits.
Nutrition
Prenatal vitamins with 400 to 800 micrograms of folic acid should be taken daily, starting prior to pregnancy if possible. Folic acid is a B vitamin critical for cell division and has been proven to decrease the incidence of neural tube defects, such as spina bifida and anencephaly. Patients who are at higher risk for neural tube defects have higher requirements.
Fish and Fish Oil Supplements
There is evidence that Omega 3 fatty acids are important for the developing fetal brain. These can be obtained by modifying your diet to include fish twice a week or taking fish oil supplements in the form of Docosahexaenoic Acid (DHA) 200mg daily. Some prenatal vitamins already contain DHA. If you choose to eat fish twice a week, be sure to choose fish that is low in mercury.
Vitamin D
Living in Seattle puts women at a higher risk of vitamin D deficiency because of decreased sun exposure, especially during winter months. Supplements of 1,000-2,000 IU are generally thought to be safe and should be considered in addition to prenatal vitamins.
Calcium/Iron
Calcium is also important in the development of fetal bones, and 1,200 mg a day should be the goal between vitamins and diet. Your physician will screen for anemia (low blood count) during pregnancy and may recommend iron supplements, as well.
Weight Gain
Starting pregnancy at a healthy weight and gaining weight appropriately are important and may reduce the risk of gestational diabetes, large infants (for their gestational age), Cesarean-section delivery and maternal weight retention after delivery.
The average weight gain for a patient with a normal BMI should be 25 to 35 lbs.
On the other hand, being underweight or not gaining enough weight during pregnancy increases the risk of having preterm birth and low-birth-weight babies. The Institute of Medicine has established new guidelines recommending weight gain based on a woman’s body mass index (BMI or kg/m2) at the start of pregnancy.
Smoking
Smoking during pregnancy also increases the risk of preterm labor and having a low birth weight baby, so quitting is strongly recommended.
Nausea
Many women suffer from nausea and vomiting in early pregnancy, and this can make it difficult to get adequate nutrition. If you are struggling with nausea, try small meals throughout the day, take your prenatal vitamin at night with a snack and find fluids that you can tolerate to help you stay hydrated. Fluids that are cold, carbonated and sour, such as lemonade, are sometimes better tolerated.
H1N1
It is important for all pregnant women to get vaccinated with both the seasonal flu vaccine and the H1N1 inactivated vaccine. Pregnant patients who get H1N1 are at high risk for severe flu complications, such as pneumonia, preterm labor and even maternal death. The vaccine can also offer passive protection to your newborn baby. If you have flu-like symptoms, such as fever, cough or sore throat, you should contact your health-care provider immediately.