My First Trimester

Eighty-five per cent of the population is Rh-positive; fifteen per cent is Rh-negative. The challenge arises when an Rh-negative mom is carrying an Rh-positive baby. The placenta keeps the mother’s and baby’s blood separate. If this natural barrier is broken such as during a miscarriage, trauma or delivery, the mother’s Rh-negative blood may be exposed to her baby’s Rh-positive blood. This results in antibodies being made in the mother’s blood which will destroy the baby’s red blood cells. Immunoglobulin (Rhlg) such as RhoGAM^® Brand prevents this from happening.

You will be given an injection of Rh immunoglobulin (Rhlg) around 28 weeks if you are Rh-negative. Once your baby has been delivered, and if the baby has Rh-positive blood, another dose of Rhlg should be given. This will prevent mom from making antibodies in response to her baby’s Rh-positive blood cells that may have crossed into her blood stream.

The therapy of Rhlg will need to be repeated for every future pregnancy delivering an Rh-positive baby. For more information on the Rh Factor, Rhlg dosing and how this may impact your pregnancy, consult with your health care team or visit ACOG and RhoGAM.com.

There are several medical conditions which may affect your pregnancy such as diabetes, Inflammatory Bowel Disease (IBD) and celiac disease. Your weight is important. If you have a high body mass index (BMI > 30) before or during pregnancy, you and your baby will be at greater risk for complications.

Thyroid conditions will need to be monitored during pregnancy. Your health care team will test your thyroid hormone levels if your medical history includes any thyroid conditions and medication for thyroid function. Depending on the results, adjustments to medication may need to be made. A diagnosis of a thyroid condition during pregnancy is based on a careful history, physical exam and laboratory testing. For more information on thyroid function during pregnancy and how it impacts both you and your baby, visit the American Thyroid Association.

Hypertension or high blood pressure will need to be monitored. You may be considered hypertensive if your blood pressure is higher than 130/85. If you are hypertensive, your health care team will follow this level closely throughout your pregnancy.

Everyone is aware of the significance of high blood pressure during pregnancy and the need for close surveillance by your health care team. But did you know the risks of low blood pressure can be just as significant? According to Midwife, Lecturer, and Active Researcher Dr. Jane Warland, the University of South Australia, hypotension during pregnancy is responsible for possible poor placental perfusion which increases the risk for preterm birth, low birth weight, Intrauterine Growth Restriction (IUGR), fetal distress during labor, fetal death prior to or during labor and post partum hemorrhage. If your blood pressure is below 90/60, discuss how this condition will be managed with your health care team.

If you have answered “Yes” to any of the above medical conditions, discuss at length with your health care team how your condition(s) could possibly affect your pregnancy and birth plan. Please do not be afraid if you are considered high risk. High risk does not and should not be frightening or worrisome. It simply means you will have additional testing and increased monitoring of you, your expected baby and the placenta and umbilical cord throughout your pregnancy.

Be very open with your health care team about any concerns and anxieties you may be having. This heartfelt communication will help lead to the proactive care you need for a wonderful pregnancy and pregnancy outcome.

If you are determined to be high risk, your health care team may suggest you consult with a Maternal Fetal Medicine (MFM) Specialist or Perinatologist. These specialists are knowledgeable and trained to give the appropriate medical care for a high risk pregnancy. The Society for Maternal Fetal Medicine states that these specialists have expertise in:

•    “The diagnosis and treatment of women with complications of pregnancy.”
•    “Pre-existing medical conditions which may be impacted by pregnancy.”
•    “Medical conditions which impact the pregnancy itself.”

For further information and to find a MFM Specialist in your area, please visit MFM Specialists.

As your tummy and uterus enlarge and stretch during pregnancy, the placenta will also stretch with them. Although the placenta doesn’t actually move, in most cases it stretches away from the cervix by the third trimester. The placenta should be near this optimal position by the third trimester for delivery, not blocking the cervix. This condition can be diagnosed with an ultrasound. If you are diagnosed with placenta previa, your medical team will watch this condition carefully. Make sure to follow all of their directions. They may decide the need for limited activities, pelvic rest, bed rest, or hospitalization to closely monitor both you and your baby depending on the gestation of your pregnancy and any other health concerns. Your health care team may also opt for a C-Section delivery if placenta previa is still an issue as you get closer to delivery day.

Any vaginal bleeding during pregnancy should be reported to your health care team immediately, as placenta previa has the potential to cause complications and can be dangerous for both you and your baby. For more information on the symptoms of and treatments for placenta previa, please visit Medline Plus at the National Institute of Health.

The American College of Obstetricians and Gynecologists (ACOG) and the CDC recommend that OB/GYNs counsel women on basic prevention measures to guard against CMV.

CMV is very prevalent among healthy children 1 to 3 years of age as they are at high risk for contracting CMV. Since CMV can be transmitted to an unborn child from a pregnant mother experiencing a primary or recurrent CMV infection, how can you minimize your risk? Here are a few simple preventative steps you can proactively incorporate into your daily routine from Stop CMV – The CMV Action Network:

• Wash your hands often with soap and water for 15-20 seconds, especially after changing diapers, feeding a young child, wiping a young child’s nose or drool, and handling children’s toys.
• Do not share food, drinks, or eating utensils used by young children.
• Do not put a child’s pacifier in your mouth.
• Do not share a toothbrush with a young child. 
• Avoid contact with saliva when kissing a child.
• Clean toys, countertops, and other surfaces that come into contact with children’s urine or saliva.  

Some babies born with congenital CMV are symptomatic at birth, others are asymptomatic. Children born with congenital CMV may develop permanent medical conditions and disabilities, such as deafness, blindness, cerebral palsy, mental and physical disabilities, seizures, and death.

Become your expected baby’s guardian today by taking an active role in your personal hygiene and healthcare decisions and prevent CMV. Consult your health care team if you are concerned about the CMV infection during pregnancy, you develop a mononucleosis or flu-like illness during pregnancy, or you feel you may be a candidate for CMV screening or treatment.

If you would like further information on CMV and how it may affect your pregnancy and your baby’s future, please visit Stop CMV.

Women with recurrent genital herpes have antibodies which protect the baby from neonatal herpes infections. However, if a mother acquires genital herpes during the last trimester of her pregnancy there is a 30–50 per cent chance of transmitting this infection to her baby. Acyclovir, an anti-viral medication used to treat genital herpes, if taken during the last trimester, may help prevent a neonatal infection.

It is recommended that any woman with an outbreak of genital herpes at the time of delivery should have a Caesarean section. For more information on genital herpes and how it may impact your pregnancy, please visit the CDC and the March of Dimes.

In preventing infections which may prove harmful to you and your baby, Dr. McGregor advises you to see your health care team for any symptoms of a bladder (urinary tract) infection, vaginitis symptoms and an unexplained fever. He also advocates good dental hygiene and care, reporting any vaginal bleeding, discharge or fluid leakage to your health care team, and avoiding membrane stripping to induce labor. Dr. McGregor also encourages moms to be vaccinated for Influenza (Inactivated) and Tdap (Tetanus, Diphtheria and Pertussis) at 28 Weeks if their adult vaccinations are not up to date.

If your urine is negative for GBS, you will have a rectovaginal swab taken at 36 0/7 – 37 6/7 Weeks gestation and cultured to ensure that you are still GBS negative. If you are positive for GBS at this initial visit or at a later date, discuss with your health care team how GBS will impact your birth plan and the intravenous antibiotics that will be required during labor and delivery.

According to Researcher, James A. McGregor, MDCM, Retired Professor of OB-GYN, Division of Perinatology, University of Southern California, Keck School of Medicine, any infection can be potentially life threatening to your baby. Approximately 1 in 4 pregnant women carry GBS, the most common cause of life-threatening infections in newborns according to the CDC. GBS can not only infect babies during pregnancy, but also during the first few days and weeks of life.

“Women should have accurate information to know how to best protect their babies”, states Group B Strep International’s co-founder, Marti Perhach. For awareness materials and further information, please visit GBS today. If you would like to proactively pass vital GBS information to other pregnant moms, please visit ACOG.

The chance of contracting listeria is ten times higher for pregnant women than that of the overall population, and twenty-four times higher for Hispanic women. Symptoms can be as mild as fever, chill, muscle aches, diarrhea and upset stomach, and can take a few days or possibly weeks to emerge. A pregnant mom may not even be aware that she has it. The more serious symptoms of a listeria infection for the pregnant mom may range from headache, stiff neck and confusion to a loss of balance and even convulsions. This is why prevention is vital and that you take appropriate food safety precautions during pregnancy.

The USDA’s Food Safety and Inspection Service (FSIS) and the U.S. Food and Drug Administration (FDA) provide the following guidelines for pregnant women:

• Do not eat hot dogs, luncheon meats, or deli meats unless they are reheated until steaming hot.
• Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
• Do not eat soft cheeses such as feta, Brie, Camembert, blue- veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pasteurized milk. It is safe to eat hard cheeses, semi-soft cheeses such as mozzarella, pasteurized processed cheese slices and spreads, cream cheese and cottage cheese.
• Do not eat refrigerated pate and meat spreads. It is safe to eat canned or shelf-stable pate and meat spreads.
• Do not eat refrigerated smoked seafood unless it is an ingredient in a cooked dish such as a casserole. Examples of refrigerated smoked seafood include salmon, trout, whitefish, cod, tuna, and mackerel which are most often labeled as “nova-style,” “lox,” “kippered,” “smoked,” or “jerky.” This fish is found in the refrigerated section or sold at the deli counters of grocery stores and delicatessens. It is safe to eat canned fish such as salmon and tuna or shelf-stable smoked seafood.
• Do not drink raw (unpasteurized) milk or eat foods that contain unpasteurized milk.
• Use all refrigerated perishable items that are precooked or ready-to-eat as soon as possible.
• Clean your refrigerator regularly to avoid cross-contamination.
• Use a refrigerator thermometer to make sure that the refrigerator always stays at 40 °F or below.

It’s important to note that if you have eaten food contaminated with listeria and are asymptomatic, most professionals believe you don’t need any tests or treatment, even if you are pregnant. Although you should inform your health care team if you are pregnant and have eaten the contaminated food, and within 2 months experience flu-like symptoms.

If a pregnant mom does contract listeria, antibiotics are given to treat it. In most cases, the antibiotics also prevent infection of the fetus or newborn. Antibiotics are also given to babies who are born with listeria.

If you experience any symptoms of listeria, consult your health care team immediately. A blood test can be performed to find out if listeria is the cause of your symptoms.

For more information on listeria prevention and how listeria infection can impact both you and your baby during and after pregnancy, please visit the CDC and the NIH.

If you have been recently infected, it is advised you wait six months before becoming pregnant. Usually, if you have been infected with toxoplasma before you became pregnant, your unborn child is protected by your immunity. Your health care team may advise a blood test be drawn to check for antibodies to toxoplasma if you are pregnant. If you become infected during pregnancy, medication is available. You and your baby should be closely monitored during your pregnancy and after your baby is born.

Unfortunately, this infection may possibly result in miscarriage prior to 20 weeks or a stillbirth after 20 weeks. Although on occasion infected newborns may exhibit serious eye or brain damage at birth, the majorities of infected infants do not have symptoms present at birth but may develop serious signs later in life, such as blindness or mental disability.

The March of Dimes suggests the following simple steps in avoiding contamination:

• 

  Don’t eat raw or undercooked meat, especially lamb or pork. Cooked meat  should not look pink, and the juices should be clear.

• Wash your hands with soap and water after handling fruits, vegetables or raw meat.
• Don’t touch your eyes, nose or mouth when handling raw meat.
• Clean cutting boards, work surfaces and utensils with hot, soapy water after using them with fruits, vegetables or raw meat.
• Peel or thoroughly wash all raw fruits and vegetables before eating.
• Use work gloves when you’re gardening. Wash your hands afterwards.
• Don’t let your cat go outside your home where it may come in contact with the parasite.
• Ask someone else to clean your cat’s litter box. If you have to do it yourself, wear gloves. Wash your hands thoroughly when you’re done emptying the litter.
• Stay away from children’s sandboxes. Cats like to use them as litter boxes.

For further information on toxoplasmosis and how it can impact you and your baby during pregnancy and after birth, please visit the CDC and the March of Dimes.

However, just in case you find yourself wanting these additional ultrasounds or another that is not covered by your insurance carrier, just put $10 a week aside to help cover this cost.