Anjali Tate, M.D.,  Gynecology, Obstetrics , San Jose, Silicon Valley, California

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Ready to Start a Family?  Make it a Healthy and Happy Pregnancy

By Anjali Tate, MD
Obstetrics & Gynecology

So you are ready to start a family but where do you start? Pregnancy can seem like a very daunting and scary time for a woman. But with a little preparation and knowledge, it can be a very enjoyable and unique time.

Getting Ready to Have a Baby
A good first step in preparing for pregnancy may be a pre-pregnancy or preconception appointment with your doctor. This time can be used to help educate a woman so that she is ready and healthy for pregnancy. A preconception appointment is used review a woman’s reproductive, medical and surgical history. If a medical condition such as diabetes or hypertension exists, this is the time to identify and treat the condition.

However, there are a few things a woman can do for herself before conception. Before considering a pregnancy, you should begin taking a daily vitamin that contains folic acid. Folic acid has been shown to decrease the risk of having a baby with a neural tube defect, such as spina bifida. The U.S. Public Health Service recommends that a woman start taking 400 micrograms of folic acid daily before conception and in early pregnancy. Many over-the-counter prenatal vitamins that do not require a prescription are readily available and contain the adequate amount of vitamins and minerals.

You should try to reach your ideal body weight before becoming pregnant. This means losing weight if you are overweight to reduce your risk of high blood pressure complications during pregnancy; or gaining weight if you are underweight to reduce the risk of delivering a low birth-weight baby. An exercise routine can be started during the preconception time. In general, you may continue your normal exercise routine throughout pregnancy unless you are instructed by your doctor to decrease or modify your activities.

When planning a pregnancy, it is recommended that you do not have more than two 5-ounce cups of coffee, three 5-ounce cups of tea or two 12-ounce glasses of caffeinated soda a day.

Now is the time to stop smoking and alcohol consumption.

What to do After Conception
When conception occurs you might begin to notice some changes in your body. There are a few common signs of early pregnancy. You may experience all, some or none of these symptoms:

  • A missed period
  • Frequent trips to the bathroom
  • Fatigue
  • Nausea, and
  • Sore breasts 

A home pregnancy test can be used to detect whether you are pregnant or not. By placing a drop of urine on a chemically treated strip, a home pregnancy test detects human chorionic gonadotropin (hCG), a hormone released by the placenta when a woman is pregnant. 

Most women will find out they are pregnant at about two months and begin their prenatal care at that time. At the first prenatal appointment a complete physical may be performed including a review of a woman’s medical history. At this time prenatal lab testing will begin. The initial lab tests consist of the mother’s blood type, blood count, rubella immunity, hepatitis screening, syphilis screening, cystic fibrosis screening (optional) and HIV(optional) testing. Subsequent prenatal appointments are typically scheduled about every four weeks if the pregnancy is uncomplicated, with more frequent appointments toward the end of the pregnancy. The baby’s heartbeat is usually heard for the first time at the three month appointment. 

Many, but not all, conditions that can affect the health of your baby can be detected during pregnancy; often early enough to determine the special care your baby will need both before and after birth.

An ultrasound is generally performed for all pregnant women at about 16-20 weeks gestation. This ultrasound will confirm that the placenta is healthy and attached normally and that your baby is growing normally in the uterus. The baby's anatomy, heartbeat and movement of its body, arms and legs can also be seen on the ultrasound. If you wish to know the gender of your baby, it can usually be determined at 20 weeks. 

A triple marker blood test screen can also be performed at this time. A mother’s blood is used to detect high levels of hCG, alpha-fetoprotein (AFP) and estrogen. Together these tests screen for an increased risk of a baby with Down’s syndrome (trisomy 21), trisomy 18 and a baby with spinal cord defects.

Between 15-20 weeks, women who will be over the age of 35 at the time of delivery or who are at high risk of giving birth to a baby with genetic or chromosomal disorders may chose to have an amniocentesis. An amniocentesis is performed with an ultrasound so that a small sample of amniotic fluid can be removed for genetic analysis. Alternatively, a chorionic villus sampling can be done to detect the same disorders earlier in a pregnancy.

At about 24 week’s gestation, a glucose screen is performed to screen for diabetes which occurs in 3%-12% of pregnant women. You are given syrup at the lab which “loads” you with 50 grams of sugar; your blood is then taken an hour after drinking the syrup. Your glucose level is tested to determine your body’s ability to metabolize the sugar. A blood count is also done at this time to screen for anemia.

Weight Gain During Pregnancy: What’s “Normal?”
Many women will ask how much weight you should gain during pregnancy. A woman of average weight before pregnancy can expect to gain 25 to 35 pounds during pregnancy. Underweight women should gain 30-40 pounds during pregnancy. Overweight women may need to gain only 15-25 pounds during pregnancy. [The following sentence would make a good sidebar] In general, you should gain about 2 to 4 pounds during your first three months of pregnancy and 1 pound a week for the remainder of your pregnancy. 

Where does the weight go? About 6 to 8 pounds goes to the baby with 2 to 3 pounds to the placenta and 2 to 3 pounds to the amniotic fluid. The rest of the weight goes to maternal fat stores for delivery and breastfeeding, and increased maternal blood supply. 

Eating Healthy: Even More Important When You’re Pregnant
Healthy eating in pregnancy is very important for your baby to grow and develop. You should consume 200 to 300 more calories per day than you did before you became pregnant. Avoid all alcohol during pregnancy. Limit caffeine to no more than two 5-ounce cups of coffee, three 5-ounce cups of tea or two 12-ounce glasses of caffeinated soda per day. Saccharin is strongly discouraged during pregnancy because it can cross the placenta and may remain in fetal tissues. The FDA-approved sweeteners include aspartame and acesulfame-K. Limit cholesterol intake to 300 milligrams (mg) or less per day.

Exercise…a Good Idea
If you have never exercised regularly before, you can safely begin an exercise program during pregnancy after consulting with your health care provider, but do not try a new, strenuous activity. Walking is considered safe to initiate when pregnant. Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it. The safest activities are swimming, brisk walking, indoor stationary cycling and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury while providing a benefit to your entire body, and can be continued until birth. [Another good place for a photo: pregnant woman exercising]

Tennis is a generally safe activity, but changes in your balance during pregnancy may affect rapid movements and make you prone to injuring your knees. Other activities such as jogging can be done in moderation. You may want to choose exercises or activities that do not require great balance or coordination, especially later in pregnancy.

Always begin your program with a warm up and keep your peak heart rate below 140 beats per minute. Drink plenty of fluids during your workout. It is important to listen to your body — don’t over exert!

Sex During Pregnancy
Many women will ask about having intercourse during pregnancy. There is no reason to change or limit your sexual activity during pregnancy unless your health care provider advises otherwise. Intercourse or orgasm during pregnancy will not harm your baby. Your baby is well protected in your uterus by the amniotic fluid that surrounds him or her.

One Final Thought
Finally and most importantly, please remember that pregnancy is an exciting and wonderful time in any woman’s life — enjoy this special time in good health. 

For preconception and pregnancy counseling, I invite you to call for an appointment

Dr. Anjali Tate

Updated 10/8/12

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