Grow Baby Grow

Week 4

Estimated reading time: 39 min reads

Around the 4th to 5th week, once you have missed your period and have taken an at home pregnancy test, you will see the double lines. Congratulations, you are now officially pregnant! After rapidly dividing, multiplying and moving down your fallopian tube, this tiny cluster of cells (a blastocyst) will snuggle up to a section of your uterine wall lining. Once that happens, implantation has occurred. The exterior cells of this tiny cluster become the baby’s placenta nourishing the baby and connecting you and your baby together until delivery day. The cells remaining within the cluster become the embryo.

As your baby nestles into a new 40-week abode, your progesterone level continues to climb, now towering over your last month’s normal level. The hormonal signal for your period to begin is absent, your uterine lining is not shed and your period is missed. YAY! You are pregnant and now you know there is a little life growing inside of you.

Nutrition

Have you ever sat down and really thought about the role good nutrition plays during pregnancy and while breastfeeding? The growth of your baby in utero will influence the rest of his or her life. The focus on your nutrition is not only vital for your expected baby but will also help provide the extra energy needed for you and baby to make it to delivery day as healthy as possible.

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The good news for you is that a healthy diet will let you feel great decreasing the odds that you’ll experience pregnancy complications such as anemia, gestational diabetes and preeclampsia. Wholesome food selections may also help to lessen the unwanted symptoms of pregnancy such as morning sickness, fatigue and constipation. It can help alleviate mood swings, make you less likely to go into preterm labor and improve your odds of a timely labor and delivery. Your well-nourished postpartum body will have fewer pounds to shed and your recovery will be smoother and shorter thanks to the nutritional choices you indulged in!

By simply indulging in sensible, nutrient-enriched and well-balanced meals, you and your baby will thrive from day one of your pregnancy. Gathering the facts, making key nutritional decisions and understanding some of the basics is empowering. You will also most likely need to increase calories, protein, carbohydrates, iron, calcium, and folic acid. Get ready for your new exciting and healthy eating plan.

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Did you know that you need only an additional 300 calories a day during at least the last six months of your pregnancy to nurture your baby nutritionally? It’s important to keep in mind that not all calories are equal and that your baby needs healthy foods packed with nutrients – not the “empty calories” found in soft drinks, candies, and desserts. You can hit that magic 300 caloric intake marker easily by simply adding just one or two healthy snacks at some point during your day. Paying special attention to the quality of your nutrition will help to ensure a healthy weight gain during your pregnancy!

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So how much weight should you gain? According to the latest information given to pregnant women at the Medical University of South Carolina (MUSC) Health Women’s Services in Charleston, South Carolina, if your weight is in the normal range you will see an increase of roughly 25 pounds. If you are overweight you would like to see a gain of around 15-25 pounds. If you are underweight you will be looking at an increase of about 28-40 pounds. Your weight should increase slowly with the majority of weight gain accruing in the third trimester.

Discussing what is an appropriate weight gain is an excellent topic of conversation to have with your health care team at your first prenatal visit around Week 8! You may want to ask for suggestions on how to incorporate a variety of foods in your diet that will help your baby grow. If you have any specific dietary needs or concerns, make sure to ask for a referral for an OB nutritionist.

Choose Organic Whenever Possible

It’s a well-known fact that pesticides are sprayed on conventional produce and they build up in the body over time. This causes a toxic load for the liver to filter, and what the body does not expel can be warehoused in fat cells. Pesticides are neurotoxins that can kill brain cells. The latest research is now linking high pesticide exposure during pregnancy to higher rates of autism.

The best way to obtain the protein and nutrients you and your baby need is from whole foods. Whole foods have been processed or refined as little as possible and are free from additives or other artificial substances. Vitamins and processed supplements cannot duplicate the way that whole foods work with the body. Why not have fun being creative in meeting and maximizing your new nutritional demands?

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Try indulging in a hearty variety of colorful vegetables and fruits.

Consider a wide-ranging mix of proteins from meat to eggs to lentils. If you like diversity, incorporate assorted nuts and seeds like walnuts, almonds, avocado, pumpkin and chia into your diet.

Although they can be pricey, organic foods are a wonderful proactive pregnancy choice. If you decide to eat organically, be kind to your wallet and start selecting and buying organic produce when it is in season. You might also like to consider planning ahead and building a garden to grow your very own produce before you become pregnant. If you are buying conventional produce, choose fruits and vegetables with a protective peel or coating that isn’t consumed (like bananas). You can also lower your pesticide exposure to some extent by washing your produce in warm water and vinegar.

Vegan Diet

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Doctors don’t usually recommend starting a strict vegan diet when you become pregnant. However, if you already follow a vegan or vegetarian diet, you can continue to do so during your pregnancy by doing it carefully. Be sure your health care team knows about your diet. It’s challenging to meet your new nutritional needs if you are not eating fish and chicken, or milk, cheese, or eggs. Research shows you may need to incorporate extra protein and additional vitamin B12 and D supplements. To ensure that you and your baby receive adequate nutrition, consult a registered dietitian for help with meal planning.

 

Protein and Vegetables

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Protein is the building block of life so your diet should be rich in protein to help your baby develop. When envisioning good nutrition, picture your mealtimes full of delicious vegetable and one form of protein. Vegetables contain countless important vitamins and minerals that aid in your baby’s development and will also help you feel your best. Make sure that at least 1-2 servings of your veggies per day are leafy greens so that your baby gets folate, the nutrient important in preventing birth defects. Richly colored fruits are a fantastic way to incorporate natural sugars into your diet at a time when you are trying to eliminate foods that are high in sugar and refined carbohydrates. Always be sure to wash your fruits and vegetable well.

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One delicious way to boost your intake of protein and carbohydrate rich nutrients – especially in the first trimester when your tummy may be having trouble with solids or fibrous foods – is to blend up a green smoothie. By simply adding water, a handful of greens, a scoop of frozen fruit, a touch of flaxseed and a healthy scoop of plain Greek yogurt, you can be sipping on a creamy enriched drink that is yummy and totally good for you and your baby in a matter of seconds!

Seafood

Let’s be honest, fish is an excellent source of nutrition during pregnancy for both you and your baby. Fish contains high-quality protein, vitamins and minerals, and Omega-3 fatty acids. DHA and EPA are Omega 3 fatty acids that are found not only in fish but also in smaller amounts of some nuts and seeds. This healthy fat is vital to your developing baby’s brain and vision. It has also been shown to decrease pregnancy complications like preeclampsia, and lower the chance of developing postpartum depression.

20150722_195008-1-258x300Recent research highlighting that there was very low fish intake among pregnant women led the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) to revise and update their guidelines from the last decade. They are now encouraging pregnant women, those who might become pregnant, breastfeeding mothers and young children to eat more fish—and to eat a variety of fish lower in mercury. “We’re updating our advice because the latest science strongly indicates that eating 8 to 12 ounces per week of a variety of fish lower in mercury during pregnancy benefits fetal growth and development,” says FDA’s Acting Chief Scientist Stephen Ostroff, M.D. He adds that 8 to 12 ounces is an excellent range to maximize the developmental benefits that fish can provide and that, “The science behind that recommendation was not available when we last issued fish consumption advice in 2004.”

Most fish available in the grocery store is, in fact, lower in mercury. That includes many popular species such as shrimp, pollock, salmon, canned light tuna, tilapia, catfish and cod. The FDA, EPA and ACOG recommend that no more than six ounces of your 8 to 12 ounces weekly fish intake be albacore tuna.

That being said, there are certain fish to avoid, as they do contain high levels of mercury which can cause damage to the developing nervous system of your baby. You will need to AVOID shark, swordfish, king mackerel and tilefish during pregnancy. It is also wise to AVOID raw fish during pregnancy as well.

A 2006 review by Consumer Reports stated that some canned light tuna might contain mercury levels even higher than that of white albacore tuna; the recommendation was that pregnant women eat no canned tuna. However, the FDA stands by its current recommendations, stating that the levels of mercury are safe if tuna consumption is limited. It can be confusing when recommendations from trusted sources differ. But since this analysis indicates that amounts of mercury in tuna may be higher than previously reported, some women may want to eliminate tuna from their diet while pregnant or when trying to become pregnant. That, however, is not what the FDA and EPA recommend.

If you live by the ocean and eat the local catch, be sure to read your own vicinity’s local fish safety information. If you don’t like fish, don’t eat it regularly or do not want to eat it while you are pregnant, taking a fish oil supplement to derive their benefits is something you may wish to consider and speak about with your health care team.

Food and Drinks to Avoid

Food-borne illnesses such as listeriosis and toxoplasmosis, which can be life threatening to your unborn baby and possibly cause birth defects, miscarriage or stillbirth, may be contained in certain foods, outdoors or even in cat litter pans. The foods you should steer clear of include the following:

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  • Soft, unpasteurized cheeses (often advertised as “fresh”) such as feta, goat, Brie, Camembert, and blue cheese.
  • Unpasteurized milk, juices, and apple cider.
  • Raw eggs or foods containing raw eggs, including mousse and tiramisu.
  • Raw or undercooked meats, fish, or shellfish.
  • Processed meats such as hot dogs.
  • Fish that are high in mercury, including shark, swordfish, king mackerel, or tilefish.

Hand washing is vital. Wash your hands before you eat or prepare food. When preparing raw meat, wash any cutting boards, knives and other utensils, and sinks that might have touched raw meat with soap and hot water to avoid cross-contaminating other foods. Wash your hands with soap and water after handing raw meat.

Cook all meat thoroughly to an internal temperature of 160*F, until it is no longer pink in the center or until the juices become colorless. Do not taste meat before it is fully coked.

If you’ve eaten any of the above foods during your pregnancy and within two-months experience flu-like symptoms or you are concerned, please speak with your health care team. Follow the guidelines above for the remainder of your pregnancy and if would like more information on these food-borne illnesses, please visit Week 8 on our website.

Alcohol consumption during pregnancy is not safe, no matter what the amount according to FamilyDoctor.org. The consumption of alcohol can cause issues and health problems for your baby anytime during your pregnancy journey.

coffeecups-1-300x219So what’s the latest pregnancy buzz on Caffeine? Although many doctors feel that one or two 6 to 8 ounce cups per day of coffee, tea, or soda with caffeine won’t harm your baby, it’s probably wise to avoid caffeine altogether. High caffeine consumption has been linked to an increased risk of miscarriage and other problems; so limit your intake or switch to decaffeinated products.

img_1309-300x199During this special time it is important to eat as healthy as possible, include generous amounts of healthy green vegetables and richly colored fruits in your diet. Try to decrease the amount of seafood intake and enjoy just one seafood entrée per week. Cut out deli meats (listeriosis) and foods high in sugar and refined carbohydrates. Remove or limit caffeine. Eliminate smoking, drinking alcohol, and the use of any and all drugs (over the counter or otherwise unless specified by a health care provider).

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Prenatal Vitamins and Supplements

Did it ever cross you mind that maybe you should start taking prenatal vitamins before you even become pregnant? Of course you should always check with your health care team before you begin taking any vitamins or herbal products, as some may be harmful to your developing baby. But have you ever wondered if vitamins and supplements are really a necessary addition to pregnancy? Well the answer to both questions is unequivocally “Yes!”

The easiest and most effective way to start taking care of your baby is before conception. A healthy diet is always the best manner in which to get the vitamins and minerals you need but even if you eat a super healthy diet, the key nutrients you need may be still missing or not nearly enough. Remember that prenatal vitamins are a complement to a healthy diet, not a substitute for good nutrition.

image-7-26-16-at-12-27-pm-300x190Research tells us that your diet may affect your baby’s health even before you become pregnant and that taking a prenatal vitamin may actually help increase fertility, reduce the risk of birth defects, lessen bouts of morning sickness and minimize the risk of delivering a baby who is small for his or her gestational age! So a reassuring strategy is to simply take a prenatal vitamin prior to conception. This little indulgence allows your body to stock up on the most essential baby-making vitamins and be ready to nourish your soon to-be baby without leaving any nutritional gaps!

Once you are pregnant, how do you pick the best prenatal vitamin for your specific needs? If you did not take a prenatal vitamin prior to conception, compared to your normal vitamins, prenatal vitamins tend to contain additional nutrients. You’ll want to select first-class nutrients so reading labels and researching ingredients that provide the healthiest prenatal blueprint for both you and your baby will be well worth your time and energy! The selection is daunting so working directly with your health care team is prudent as they might suggest higher doses of certain nutrients depending on your circumstances. Always remember, do not take a supplement in addition to your prenatal vitamin unless recommended by your doctor.

Folic Acid: 400, 500, or 600 Micrograms (mcg.)

Folic Acid helps prevent neural tube defects, the serious abnormalities of the brain and spinal cord that form in the first month of pregnancy usually before most women know that they are even pregnant. Due to this time frame of fetal development, it’s imperative that you begin consuming plenty of folic acid (aka vitamin B9) before pregnancy and especially in the first 28 days of your gestational journey. Doctors recommend women get 400 mcg of folate prior to conception; if your family history shows a high risk of neural tube defects, guidelines recommend targeting for 10 times that amount (or four mg.) from folic acid supplements. Eating wholesome amounts of folate-rich foods such as legumes, asparagus, beets, sunflower seeds, avocado, spinach, broccoli, oranges and breakfast cereals – as many advertise this enrichment right on front of the box – is key! Throughout your pregnancy a vitamin with at least 600 mcg of folic acid is recommended. You should also continue a folic acid supplementation of 500 mcg while breastfeeding.

Be sure to ask your health care team about taking prenatal vitamins and the correct amount of folic acid for you if you’re thinking about becoming pregnant, you are pregnant or you have a familial history of neural tube defects.

Iron: 27 Milligrams (mg.)

Iron is the mineral that is the building block for your baby’s cells supporting his or her growth and development. It helps prevent you developing anemia, a condition in which your blood has a deficiency of healthy red blood cells. If you become anemic while pregnant, your iron dosage may be increased.

The presence of iron in your prenatal vitamin may cause constipation. Always remember to check with your health care team for their advice and suggestions to avoid this problem. They may suggest that you increase your fluids and dietary fiber to 20-30 grams. Fiber is found in fresh fruits, whole-grain breads, cereals, and muffins. Always remember to drink lots of water when increasing your fiber intake. They may also recommend fiber tablets, fiber drinks or other high-fiber products, which you can purchase at your pharmacy or grocery store. Avoid laxatives unless you are advised to use them, and also castor oil as it may alter your ability to absorb nutrients.

If constipation becomes problematic, your health care team may prescribe a stool softener. Drinking ample amounts of water between meals will help to soften your stools and move food more easily through your digestive system as dehydration may make your constipation worse. Sipping on hot soups, teas, and broth to increase your fluid intake may be beneficial. Snacking on dried fruit is a way to increase the fiber you will need. With your health care team’s permission, exercise is extremely good for you and one of the most beneficial ways you can proactively help to lessen your constipation.

If constipation is not relieved, alternatives such as a supplement with no iron, a separate iron preparation that dissolves in the intestines rather than in the more sensitive stomach, or one that is slow-release may be introduced.

Calcium: 150 mg.

Calcium is another critical nutrient for women. Because your growing baby’s calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. All women between the ages of 19-50 need 1000 mg. per day. Making sure your diet is abundantly supported with milk, yogurt, tofu, leafy-green veggies, cheese, black-eyed peas, calcium-fortified juices and canned sardines or salmon with bones will increase your calcium level. Check your prenatal vitamin label to make sure it includes calcium. If your health care team is concerned you’re not getting enough calcium, you are lactose intolerant or you dislike milk and milk products, it may be recommended that you take an additional calcium supplement.

Iodine: 150 mcg.

Iodine will support your baby’s brain and thyroid development. Research tells us that American women are not receiving adequate amounts of this fundamental mineral. The American Academy of Pediatrics now recommends that pregnant women cook with iodized salt and take a daily supplement of iodine for a total intake of 220 mcg every day. In choosing your prenatal vitamin, if it does not have any or enough iodine, you may be able to take a separate iodine supplement!

Vitamin B6: 1.9 mg.

Vitamin B6 helps to reduce the likelihood of nausea and vomiting early in pregnancy. Prescription morning sickness drugs are a combination of pyridoxine (vitamin B6) and doxylamine (an antihistamine).

Other Nutrients

Vitamin A: Take no more than 10,000 IU.

Ingesting over 10,000 IU of Vitamin A can be toxic! If you decide to incorporate this vitamin into your diet, make sure you choose beta-carotene, the safest source of vitamin A.

Vitamin D: 600 IU.

Vitamin D, in combination with calcium, plays a double role in your pregnancy health. It’s needed to help your baby’s bones develop and also to keeping your bones sturdy. Your health care team may be worried that you are not be getting enough vitamin D as this is a shared concern among women. Your level may be screened at your first prenatal checkup around Week 8 to make sure you are not deficient. If your level is low, an additional supplement of 1,000 to 2,000 IU. may be recommended.

Zinc: 11 mg.

Zinc is a mineral that supports your immune system and healthy cell division.

Copper: 0.9 mg.

This trace element is vital in forming blood cells and also preserving nerve, bone and immune system health.

Vitamin C: 85 mg.

Vitamin C is a water-soluble vitamin (dissolves in water) and antioxidant that your body cannot store. The leftover amounts of Vitamin C will exit your body via the urine which means that you’ll need a new stock each day to make sure your baby’s growth and development thrives. Vitamin C is crucial in absorbing iron and supporting your immune system. It is abundantly found in all fruits and vegetables. Mega amounts of vitamin C are present in cantaloupe, orange and grapefruit juices, kiwi, mango, papaya, pineapple, strawberries, raspberries, blueberries and cranberries and watermelon. Veggies with the richest sources of vitamin C include asparagus, broccoli, brussel sprouts, cauliflower, both green and red peppers, leafy greens such as spinach, cabbage and turnip greens, both sweet and white potatoes, green and red tomatoes and tomato juice, and winter squash.

It’s a given that the best food sources of vitamin C are available to you in uncooked or raw fruits and vegetables. Cooking or storing vitamin C-rich foods for long periods may reduce the vitamin C content, as does exposure to light. One simple choice to keep vitamin C levels high when shopping is to pick up orange juice that is in a carton rather than a clear bottle. In order to reduce your vitamin C cooking losses, decide on microwaving or steaming your foods!

Cereals, foods and beverages may be fortified with vitamin C meaning that a vitamin or mineral has been added to the food. Make sure that you always read the product labels to see how much vitamin C is in the product.

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You must be careful in adding Vitamin C to your nutritional plan, as consuming more than 2,000 mg. can be dangerous for your baby. Don’t forget to discuss with your health care team any additional supplements for their recommendation you may need other than your prenatal vitamin.

Prenatal vitamins also contain two to three times the Dietary Reference Intake (DRI) for vitamin E (12 mg), thiamin (1.2mg), riboflavin (1.2 mg), niacin (14 mg) and vitamin B12 (2.2 mg) — and there are no known harmful effects from these doses. Various preparations also contain magnesium, fluoride, biotin, phosphorus, pantothenic acid, extra B6 and ginger (to help fight queasiness).

Look for an Independent Seal Of Approval

To insure your supplements meet your high standards, many organizations employ rigorous criteria for their dietary and prenatal supplements. So be wise and look for seals from the following organizations on your supplements:

Please remember this approval of standards is voluntary and not required by the manufacturers. Your prenatal supplement may not have one of the above seals. This does not mean it is not of high quality so it is always a good idea to discuss any supplements you decide to consume with your health care team.

Taking, stomaching and digesting supplements

What if your prenatal vitamin is hard on your stomach or difficult to take? One of the most common causes for difficulty in swallowing prenatal vitamins is the coating of your vitamin. Make sure your pill have a slick coating. It might be a good idea to take a vitamin minus the calcium as that adds bulk. If size is the problem, talk with your health care team about how you can add this vital mineral in other ways. Perhaps a tasty liquid or chewable variety may solve this problem!

Many women are nauseous after their morning vitamin. you can try to take your vitamin with food or a snack or maybe right before bedtime. If none of these solutions work, remember that there are lots and lots of vitamins out there, so don’t hesitate to try a different one!

If gas, diarrhea or constipation occurs, it may be a result of the additional iron in your vitamin. By drinking lots of fluids, eating fiber-enriched foods and making sure your don’t forget to exercise every day these difficulties should resolve.

Less may be more

img_8469-219x300You need to remember not to overdo it! More isn’t better when it comes to prenatal vitamins. Unless your health care team suggests and recommends additional supplements, stick with the recommended prenatal dosage of vitamins. The consumption of herbal supplements in any form should be discussed with your health care team before, during and after pregnancy to make sure they are recommended, safe and will not affect your pregnancy in any way.

A prenatal vitamin always complements a healthy well-balanced diet; it does not replace it. That being said, remember that it’s still absolutely important to eat a well-balanced, nutrient-rich diet throughout your pregnancy. Just think of your prenatal vitamin as a backup to your super-healthy eating and not the other way around!

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Exercise

Just about all women can and should be physically active throughout pregnancy. Exercise during pregnancy is safe and often recommended although some modification to your workouts may be needed due to natural anatomic and physiologic changes and your baby’s fetal requirements. The American College of Obstetricians and Gynecologists (ACOG) encourages women with uncomplicated pregnancies to engage in aerobic and strength-conditioning exercises prior to conception and following delivery. In December 2015, ACOG published its newly revised COMMITTEE OPINION, Physical Activity and Exercise during Pregnancy and the Postpartum Period.

It’s important that you consult with your health care team, especially if you have any medical condition such as high blood pressure, diabetes, anemia, bleeding, or any other disorder, or if you are obese or underweight before you begin an exercise regime. You will find there’s so much information for you to absorb about your health and the health of your developing baby that you may feel overwhelmed finding it difficult sorting out what’s true from what’s rumor. Whether or not you were physically active before you became pregnant is important for your team to know so they may advise a safe level of exercise for you. An eventual goal of moderate-intensity exercise lasting from 20 to 30 minutes per day on many, if not every day of the week should be developed and adjusted as needed.

img_3064-1-225x300ACOG acknowledges that there are several different types of safe exercises for you to enjoy during pregnancy, and also those that should be modified or given up during your 40-week gestational journey as they may pose a risk to you and your baby. Safe exercises range from simply walking to swimming to stationary cycling to low-impact aerobics. Yoga or Pilates are acceptable as long as you make sure they are modified, meaning that the positions you use during your session do not decreasing the venous return to your heart causing hypotension.

Running, jogging, racquet sports and strength training are also acceptable to engage in as long as you have participated regularly in these activities prior to your pregnancy. It must be noted that playing racquet sports involves rapid movements and quick changes of your balance. So because these two factors pose an increased risk in falling, it is advised they are avoided as much as possible during pregnancy.

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ACOG also recommends avoiding contact sports such as ice hockey, boxing, soccer and basketball. Activities with a high risk of falling such as downhill snow skiing, water skiing; surfing, off-road cycling, gymnastics and horseback riding should also be waived during pregnancy. Scuba diving, sky diving and Hot yoga or hot Pilates should also be put on the list of activities to forgo.

One of the most important things to understand is how your body changes during pregnancy and the impact that those changes will have on your ability to stay fit through exercise. The National Institute of Health (NIH) shares the seven benefits of regular, moderate physical activity during pregnancy, the five steps for safe exercise during pregnancy and what you shouldn’t do during pregnancy on their website. Kicking off your new pregnancy exercise routine is fun! Below are the NIH’s Five Tips for Getting Going!

  • Go for a walk around the block or through a shopping mall with your spouse or a friend.
  • Join a prenatal yoga, water aerobics, or fitness class, letting the instructor know you are pregnant before beginning.
  • Follow an exercise video for pregnant women.
  • At your gym, community center, YMCA or YWCA, sign up for a fitness session for the pregnant.
  • Stand up, stretch, and move at least once an hour if you sit most of the day, as well as during commercials when watching TV.

img_1866Tara Sabo is a certified personal trainer, fitness instructor, and half marathon runner who lives, works, and breathes fitness. She believes fitness can and should always be fun. Sabo’s blog Working Out for Two: How to Exercise Safely During Pregnancy lets you picture through the use of detailed infographics the changes that are taking place in your body during pregnancy and exercise. Although working out for two can be beneficial and empowering, there are still certain safety factors for you to consider. Learning helpful, simple ideas on exercise restrictions and guidelines, the importance of monitoring while exercising, and the signs to let you know that you or your baby may not be responding well to exertion is vital for every expecting mom to know.

Using ACOG’s guidelines, Sabo suggests aiming for a minimum of 30 minutes of moderate-intensity physical activity (one in which you breathe harder but do not overwork or overheat) on most, if not every day of the week. Your pregnancy journey will be all the more amazing for both you and your baby when it’s boosted by the energy of exercise!

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Tocophobia

img_1671-300x292Some form of anxiety is normal for pregnancy, a time of high emotions, excitement, as well as nervousness. But did you know some women are absolutely terrified of pregnancy and anything related to it? Tocophobia, from the Greek tokos, meaning childbirth and phobos, meaning fear, is a pathological dread of pregnancy. Primary tocophobia affects roughly 13 percent of women who have never been pregnant. Though these women are desperate to have a baby, many will postpone or totally avoid pregnancy due to this pathological and irrational fear. Some will even terminate a pregnancy. Secondary tocophobia may be seen in women who have experienced a traumatic obstetric event, a termination of pregnancy, miscarriage, stillbirth, a normal healthy delivery (and for some very distressing reason, she will not consider having another baby) or a depressive illness in pregnancy.

If you believe your fears of pregnancy are irrational, speak openly with your family doctor or health care team. Management of this condition is available through appropriate childbirth education, psychological counseling and support. As with any phobia, it can be treated. Please visit tocophobia for more information.

Miscarriage

Pregnancy is such an exciting time in your life. However, we have come to realize that it is beneficial for you to be aware of miscarriage in the event that you or someone you knows faces one. Learning about early fetal development in your first trimester enables you to have a better understanding of what is happening inside of your body as your pregnancy progresses, and what your health care team may be looking for in the case of a possible miscarriage.

miscarriage1-188x300Miscarriage is the spontaneous loss of a pregnancy from natural causes within the first 20 weeks of gestation. Women usually miscarry before Week 14. Anyone can have a miscarriage. Approximately ten to twenty-five percent of known pregnancies will end in miscarriage. In fact this number is most likely much greater as miscarriages occurring very early in the first trimester are perhaps not yet even detected as a pregnancy. These are called Chemical Pregnancies and occur shortly after implantation. At this point, you may not have realized that you have conceived. Chemical pregnancies are responsible for 50-75 percent of all miscarriages. The bleeding that occurs with a chemical pregnancy is around the time of the bleeding of your normal menstrual cycle.

Sadly, miscarriage is a relatively common experience and yet its frequency does not make it any easier to undergo or accept. The emotional turmoil inflicted on you and your family can be heartbreaking. Understanding the possible symptoms, types, causes, and risks involved in a miscarriage, and the medical care needed when confronting it may allow your emotional healing to begin sooner.

Symptoms

Miscarriage is often a process and not a single event. It may be hallmarked by an abrupt decrease in the signs of pregnancy such as breast sensitivity or morning sickness. You may also experience lightheadedness, dizziness or feeling faint and weight loss. Vaginal spotting with white-pink mucous, or brown or bright red bleeding may be noticed. A gush of clear or pink fluid or tissue may also be passed vaginally. Cramping, often more intense than normal menstrual cramps, may or may not be present. True contractions that might be extremely painful occurring every 5-20 minutes may be experienced, and mild to acute pain in the lower abdomen or back may be observed. If fetal tissue passes from your vagina, it should be placed in a clean container and taken to your health care team’s office or to the hospital for analysis.

If you experience any or all of the above symptoms, it is important that your health care team be notified immediately, or that you visit the nearest Emergency Room (ER) for an evaluation. Please remember that some bleeding may be experienced in 20 to 30 percent of all pregnancies, and approximately 50 percent of the women who experience vaginal spotting or bleeding in the first trimester do go on to have successful pregnancies.

Types

Although there are several types of miscarriages, usually it is simply referred to as miscarriage without specifying the kind. However, your health care team may also use the following terminology to define miscarriage as provided by American Pregnancy Association:

  • Threatened Miscarriage:
    Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
  • Ectopic Pregnancy:
    A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
  • Inevitable or Incomplete Miscarriage:
    Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
  • Complete Miscarriage:
    A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.
  • Missed Miscarriage:
    Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
  • Recurrent Miscarriage (RM):
    Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.

Causes

There are many different causes for a miscarriage, however, the major cause of miscarriage during the first trimester is genetic or chromosomal, meaning the fetus isn’t developing normally. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell, or are due to a problem at the time that the zygote goes through the division process. Typically in this situation, the embryo divides and grows abnormally for an unknown reason, and not a problem inherited from the mother and father. According to the Mayo Clinic, examples of this particular abnormality are:

  • Blighted ovum.
    Blighted ovum occurs when no embryo forms.
  • Intrauterine fetal demise.
    In this situation the embryo is present but has stopped developing and died before any symptoms of pregnancy loss have occurred.
  • Molar pregnancy.
    A molar pregnancy is a noncancerous (benign) tumor that develops in the uterus. A molar pregnancy occurs when there is an extra set of paternal chromosomes in a fertilized egg. This error at the time of conception transforms what would normally become the placenta into a growing mass of cysts. This is a rare cause of pregnancy loss.

There are also various maternal health conditions that may lead to miscarriage such as uncontrolled diabetes, infections including bacterial, viral, parasitic and fungal or sexually transmitted diseases (STD’s), hormonal problems for instance Polycystic Ovary Syndrome, cervical or uterine disorders, thyroid disease or maternal trauma. Environmental toxins such as excessive exposure to lead, mercury or organic solvents, low levels of folic acid and taking certain antibiotics such as clarithromycin are linked to the possibility of causing a miscarriage. Never take any herb, supplement or medication during pregnancy without the consent of a medical professional.

Your routine day-to-day activities such as moderate exercise, sexual intercourse or work (as long as you are not subjected to unsafe chemicals or radiation) will NOT cause a miscarriage! Equally, neither nausea nor vomiting, not even morning sickness, will cause a miscarriage.

The Mayo Clinic states that there are several maternal factors that may increase the risk of miscarriage:

  • Age.
    Women older than age 35 have a higher risk of miscarriage than do younger women. At age 35, you have about a 20 percent risk. At age 40, the risk is about 40 percent. And at age 45, it’s about 80 percent. Paternal age also might play a role. Some research also suggests that women who become pregnant by older men are at a slightly higher risk of miscarriage.
  • Previous miscarriages.
    Women who have had two or more consecutive miscarriages are at higher risk of miscarriage.
  • Chronic conditions.
    Women who have a chronic condition, such as uncontrolled diabetes, have a higher risk of miscarriage.
  • Uterine or cervical problems.
    Certain uterine abnormalities or weak cervical tissues (incompetent cervix) might increase the risk of miscarriage.
  • Smoking, alcohol and illicit drugs.
    Women who smoke during pregnancy have a greater risk of miscarriage than do nonsmokers. Heavy alcohol use and illicit drug use also increase the risk of miscarriage.
  • Weight.
    Being underweight or being overweight has been linked with an increased risk of miscarriage.

Prenatal genetic tests such as Chorionic Villus Sampling (CVS) and Amniocentesis that are described in Week 12 are invasive procedures and do carry a slight risk of miscarriage.

Medical Intervention

The diagnosis of miscarriage is a sensitive one. If bleeding or pain is noticed, you must contact your health care team immediately as you may be experiencing a Threatened Miscarriage. Rest will most likely be advised until your symptoms subside; exercise and sexual activity will probably need to be avoided. Although these suggestions have not been proven to reduce the risk of miscarriage, they might improve your comfort and overall wellbeing during this time. Avoid travel right after your diagnosis as prompt medical attention may be necessary.

If your symptoms do not subside, an examination will follow. Your health care provider will perform a pelvic exam to determine if there are any problems with your uterus and if dilatation has begun. An ultrasound will allow your baby’s development and heartbeat to be assessed and visualized. If it is determined that the embryo has died or was never formed, a miscarriage will occur.

Your health care team will follow a specific protocol for the treatment of miscarriage. Their primary goal is to prevent hemorrhaging or infection at this time.

The Mayo Clinic explains three possible protocols:

  • Expectant management.
    If you have no signs of infection, you might choose to let the miscarriage progress naturally. Usually this happens within a couple of weeks of determining that the embryo has died. Unfortunately it might take up to three or four weeks. This can be an emotionally difficult time. If expulsion doesn’t happen on its own, medical or surgical treatment will be.
  • Medical treatment.
    If, after a diagnosis of certain pregnancy loss, you’d prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. Although you can take the medication by mouth, your health care provider might recommend inserting the medication vaginally to increase its effectiveness and minimize side effects such as nausea and diarrhea. For about 70 to 90 percent of women, this treatment works within 24 hours.
  • Surgical treatment.
    Another option is a minor surgical procedure called suction dilation and curettage (D&C). During this procedure, your health care provider dilates your cervix and removes tissue from the inside of your uterus. Complications are rare, but they might include damage to the connective tissue of your cervix or the uterine wall. Surgical treatment is needed if you have a miscarriage accompanied by heavy bleeding or signs of an infection.

Once your health care team has implemented the appropriate protocol and care for your miscarriage, you will need to pay close attention to the possibility of bleeding over the next few days. In the event of increased bleeding or the start of chills or fever, your health care team must be called immediately.

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Moving Forward

Following a miscarriage, you will often have many questions about your physical and emotional recover, and when you can begin to try and conceive again.

Physically, your journey back to day-to-day life after a miscarriage is a relatively speedy one. It may take a mere few hours to a couple of days depending on your baby’s gestational age and the protocol chosen, and may take longer if anything unusual is experienced such as excessive bleeding, a fever or abdominal pain that would cause your health care team to be notified. It will take about 4-6 weeks for your period to return to normal. Any type of contraception should be started immediately after a miscarriage. However, it is important that two weeks following your miscarriage sexual activity should be avoided in addition to inserting anything into the vagina, such as a tampon.

Your emotional healing after a miscarriage may be a slow process and may take much longer than your physical healing. Miscarriage can be an immense loss that your colleagues, friends and family might not fully understand. Your emotions might run the gamut from rage and blame to utter hopelessness. Time is needed to grieve the loss of your pregnancy, together with the hopes and dreams that come with your pregnancy. Seeking help from loved ones is vital as well as from professionals, especially if you are experiencing profound sadness or hopelessness.

Miscarriage is usually a one-time occurrence and will follow with a healthy pregnancy. Statistics tell us that less than five percent of women have two consecutive miscarriages, and only one percent have three or more consecutive miscarriages.

If you experience multiple miscarriages, typically greater than three in a row, you should consider scheduling an in-depth consultation and an intense prenatal workup with your health care team. This includes being tested to identify a possible underlying cause such as uterine abnormalities, coagulation problems or chromosomal abnormalities. Your health care team may encourage this testing after two losses. Following testing, if the reason for your miscarriage cannot be discovered, please don’t despair as approximately 60 to 70 percent of women with unexplained repeated miscarriages do go on to have healthy pregnancies. You may want to consider in vitro fertilization, embryo transfer, or artificial insemination to achieve a successful pregnancy if you have a history of unexplained miscarriages.

Following a miscarriage, you should discuss getting pregnant again with your health care team, and seek guidance about the right time to conceive. Being physically and emotionally prepared is vital while waiting for conception to occur and that includes maintaining a healthy diet. Saying no to caffeine, alcohol and tobacco, which are known to raise the risk of miscarriage, is paramount. Indulge in calcium-rich foods, low-fat dairy products, almonds, beans, and nutritious green vegetable such as kale and spinach. Organic free-range protein sources are essential such as eggs and poultry. Olive oil is also a wonderful healthy option. Together diet and exercise will benefit you in maintaining a normal weight.

A daily dose of folic acid is recommended and can be found in a prenatal supplement. Low levels of folic acid have been associated with miscarriage. If you have been diagnosed as a high-risk pregnancy, bed rest may be advised. A low-stress lifestyle is always beneficial.

Although there have been no studies showing that homeopathy prevents miscarriage, the literature on homeopathy does report women who have had successful pregnancies after miscarriage when being treated with this type of alternative medicine.

img_3907-300x200Did you know that after a miscarriage it is possible to become pregnant during the first menstrual cycle? If a pregnancy occurs immediately following your miscarriage, your health care team should be notified. They may also advise bed rest and progesterone if there is a history of previous miscarriages, along with the close monitoring of any chronic medical condition in safeguarding your pregnancy.

For the most part, there is nothing you can do to prevent a miscarriage. What you can do is work closely with your health care team and be extremely prudent and watchful for known pregnancy risks. With regular prenatal care, good-quality sleep, abstinence from contact sports, and implementing the pregnancy strategies mentioned above, you can reassure yourself that you are taking the best care of both yourself and your developing baby.

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