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Prenatal FAQ

Carefully researched answers to questions about prenatal care for expecting moms. The information on this page is meant for educational purposes only and does not substitute for actual medical treatment. If you are experiencing pain or symptoms, please speak to your doctor or call our office to schedule an appointment.

Should I get the COVID vaccine if I'm pregnant? Which trimester should I wait to get it?

Yes, all pregnant patients should get the COVID vaccine. There is strong evidence from tens of thousands of individuals over the past few months regarding the safety of the COVID-19 vaccine. We know that pregnant women who get COVID-19 are at an increased risk of having a severe disease which can result in needing ICU care and or ventilator support, and death. Currently, more than 95% of those who are hospitalized or dying from COVID-19 are unvaccinated. Getting the vaccine protects yourself, your baby, and your family. It is best to get it as soon as possible, irrespective of the trimester.

American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) both recommend that all pregnant women get the COVID-19 vaccine.

I am in my late 30s/early 40s. Does this change anything in terms of my current or future pregnancy?

Choosing to start a family later in life is becoming more and more common. There are certain risks, both to the fetus and mother, that increase with maternal age. Metabolic changes often associated with aging, such as high blood pressure and heart issues, can worsen during pregnancy. Your obstetrician may recommend more frequent obstetric visits to closely monitor your blood pressure and ensure you and your baby's safety. A serious condition called preeclampsia can result due to maternal hypertension (high blood pressure) and increased protein in the urine. Depending on various factors, you may need to be delivered.

The genetic health of a woman’s oocytes, or eggs, decreases as she ages. Chromosomal disorders such as Down syndrome are more common in babies born to women over the age of 35. Aging can affect a woman’s chances of conceiving a baby due to a decreased number of healthy eggs. Due to this, some women opt for genetic testing and IVF to overcome fertility complications associated with increasing age. Many women are successful in conceiving a child through an exploration of options despite these challenges.

A pre-pregnancy health care visit will allow you and your obstetrician to visualize a holistic picture of your health so she can develop a personalized plan for your pregnancy. An obstetric practice offers prenatal screening, diagnostic genetic testing, and fertility evaluation, which can be helpful tools in developing your pregnancy plan.

What steps should I take if I am considering getting pregnant?

Preparing for pregnancy (especially your first) can be a confusing and overwhelming task. An obstetrician will counsel you each step of the way and provide you with the information to best prepare your body and lifestyle for pregnancy and childbirth. She will discuss important aspects of your health history such as your reproductive health, vaccinations, and necessary medical supplements.

Before you become pregnant, your obstetrician may recommend additional steps such as stopping smoking, limiting alcohol intake, and limiting caffeine to less than two cups of coffee per day. Preventative measures such as including a daily prenatal vitamin in your regimen containing at least 400 micrograms of folic acid can protect your baby from certain developmental defects. You can take a daily prenatal vitamin in the preconception stage, even if you are not pregnant yet. Your ob may also recommend that you introduce or maintain a healthy diet, exercise routinely, and engage in stress-reducing activities.

How common is infertility?

The CDC defines infertility as the inability to conceive after having unprotected sex for a year if you are under 35 years old, and 6 months if you are 35 or older. Infertility affects about 6% of married women between the ages of 15 and 44. Approximately 12% of women between the ages of 15 and 44 have difficulty getting pregnant or carrying a baby through the end of pregnancy. Men can also contribute to infertility which is why a full fertility evaluation for a couple includes testing for both partners. If you and your partner are having trouble getting pregnant, Your obstetrician will provide a fertility evaluation and testing to assist you in discovering your potential options for becoming pregnant. In some cases, she may refer you to a specialist to best assist you. A number of options now exist for women and men to assist in conception such as IVF, sperm donation, egg donation, surrogacy, and intrauterine insemination (IUI). Speak to your obstetrician to learn more about what options may work for you.

Should I get the flu shot while I'm pregnant or trying to get pregnant?

Yes. The American College of Obstetrics and Gynecology (ACOG) recommends the influenza (flu) vaccine as essential to prenatal and post-pregnancy care. Specifically, the CDC's immunization advisory board and ACOG recommend that women who are or may become pregnant between the months of October and May (flu season) receive an inactivated form of the vaccine. Vaccination against influenza should occur annually.

Current scientific literature supports the safety of the flu vaccine for pregnant women. In fact, the benefits have been shown to far outweigh any potential risks. Because women are in a state of immunosuppression during pregnancy, they (and their babies) are at a higher risk for certain infectious diseases as well as serious complications from the flu. Because of this, it's important that women who are currently pregnant or who are attempting pregnancy receive the flu vaccine. Furthermore, current studies have not observed an increased risk of first-trimester pregnancy loss nor negative developmental effects as a result of receiving the flu vaccine.

How safe is getting regular ultrasounds during my pregnancy?

Ultrasounds are performed to help visualize your baby inside the uterus. These scans are necessary to check the regular development of your baby, to ensure the fetus is meeting proper milestones, and to rule out any congenital anomalies. Current research does not indicate that ultrasound waves are harmful to your developing pregnancy, and they can actually improve perinatal outcomes in higher-risk pregnancies by allowing early interventions.

I am having terrible morning sickness. What are my natural and medical options for treating it?

Morning sickness is an extremely common complication of pregnancy. Despite its name, morning sickness can occur anytime during the day. Up to 90% of women experience either nausea, vomiting, or both at some point during their pregnancy. These symptoms are typically at their most severe during your first trimester (up until 12 weeks), so you can expect your nausea and/or vomiting to lessen considerably after that point.

The most severe form, known as hyperemesis gravidarum, occurs in about 0.3-3% of pregnancies. Hyperemesis gravidarum requires close monitoring by an obstetrician and in some cases, may require hospitalization. You should discuss your symptoms as well as their frequency and severity with your obstetrician to determine if intervention is needed.

There are several natural methods of improving pregnancy-associated nausea. You can try eating six, small meals throughout the day to ensure your stomach is not empty for prolonged periods. You can also try following the BRATT diet, which is composed of low-fat foods that are easier to digest. These foods include bananas, rice, applesauce, toast, and tea.

If your symptoms do not improve after trying these natural methods, talk to your obstetrician to see if medication options are right for you. There are several safe over-the-counter treatments she may recommend, such as Vitamin B6 tablets and Unisom (a sleeping aid). Lastly, if all other options are exhausted, your obstetrician may prescribe you a medication called Diclegis® or Bonjesta®.

Are there any vitamins or supplements I should be taking during my pregnancy?

A prenatal vitamin has a variety of vitamins and minerals that support a healthy pregnancy both for the fetus and the mother. Folate, or folic acid, is a particularly important B vitamin for preventing neural tube defects and other associated pregnancy complications. The current recommended supplemental dose of folate is 400 micrograms/day, though you can take up to 1000mcg (1mg) per day.

Normal prenatal vitamins do not contain excessive amounts of vitamin A, but this micronutrient should be avoided in excess as it may lead to the development of birth defects in the first 60 days following conception. Dr. Butt may make additional adjustments depending on your dietary lifestyle choices, such as vegetarianism, veganism, and others, in order to ensure your adequate intake of nutrients and micronutrients. There are a variety of brands to choose from for your prenatal vitamin. Speak with your obstetrician for brand recommendations that contain the comprehensive vitamins and minerals needed for pregnancy.

I forgot to take my prenatal vitamin yesterday. Will my baby be affected?

If you forgot to take your prenatal vitamin or folic acid, don’t worry. This happens sometimes! Missing a day here or there will not negatively impact the health of your pregnancy. The best thing to do is get back on schedule with when you normally take your supplements. If you find yourself forgetting regularly, try setting a recurring alarm on your phone, or placing your vitamins in a place where you’ll see them each day (such as next to your toothbrush or on your nightstand).

What is gestational diabetes and what does it mean for my pregnancy?

As pregnancy progresses, the placenta begins producing hormones that cause an overall rise in blood sugar. Sometimes, the body is unable to compensate for this rise in blood sugar and the cells become less responsive to insulin,(the hormone that allows sugar into our cells) which is known as "insulin resistance". In 6% of pregnant women, this may result in a condition called gestational diabetes, or diabetes as a result of metabolic changes that occur during pregnancy. Certain factors such as being overweight, a family history of diabetes, and abnormal weight gain during pregnancy can put you at risk for developing gestational diabetes. A diagnosis of gestational diabetes is associated with increased fetal birth weight, preeclampsia, and a predisposition to developing type 2 diabetes in the future.

Your obstetrician will monitor you throughout your pregnancy for signs of insulin resistance. Oftentimes, gestational diabetes can be controlled with diet and exercise to maintain appropriate blood sugar levels. She may also prescribe certain medications in addition to these lifestyle changes as she deems necessary.

I am worried about preeclampsia. What is it, and can I get a test for it?

Preeclampsia is a potential pregnancy complication characterized by maternal hypertension (high blood pressure) and high protein levels. It is believed to be caused by malformation or malfunction of the small blood vessels that supply the placenta. Unfortunately, research has not pinpointed an exact reason why this occurs. It may be as a result of several combined factors such as immune system issues, genetic components, or physical blood vessel damage.

If this condition is not monitored properly, it can result in maternal organ damage as well as possible harm to the baby. Unfortunately, the condition cannot be fully treated, only managed, as preeclampsia only resolves once the baby is born. Most (about 90%) of cases occur after week 34 of pregnancy. In these cases, both maternal and newborn outcomes are very good.

Preeclampsia screening should be done preliminarily by your obstetrician at each of your appointments. Regular blood pressure measurements and assessment of your urine sample at the time of your visit can help your obstetrician determine your risk of developing preeclampsia. Should your doctor determine your risk to be high, she will discuss proper care of the condition throughout the remainder of your pregnancy.

Should my diet change while I am pregnant or trying to conceive? What foods should I avoid eating while pregnant?

Good nutrition is essential for an overall healthy lifestyle, but is extra important in the prenatal period due to the increased demands pregnancy places on your body. The common phrase "eating for two" can be slightly misleading. Pregnant women should be consuming around 300 calories per day in addition to their normal dietary needs. These guidelines may be modified based on the individual needs of the mother and her starting weight. Some examples of 300 calories snacks include a yogurt cup and ½ piece of fruit or a ¼ cup of almonds with an apple and a small serving of chocolate. You should monitor your calorie intake according to the pregnancy plan laid out by your obstetrician in order to promote the healthy weight gain needed to support both you and your baby.

Immune changes that occur during pregnancy can put you and your baby at risk for bacteria present in certain food items. Listeria and salmonella are bacteria that can cause foodborne illnesses that may become harmful to the baby, even without noticeable symptoms in the mother. CDC guidelines recommend avoiding these common foods:

  1. Raw seafood

  2. Uncooked smoked seafood

  3. Any unpasteurized juice or dairy products

  4. Raw sprouts

  5. Undercooked eggs

  6. Lunch or deli meat (not reheated to 165)

A more comprehensive list of foods to avoid can be found here:

Non-nutritive sweeteners (NNS) such as Splenda®, Sweet'N Low®, and Stevia® have become an increasingly popular alternative to cane sugar. In clinical trials with non-pregnant individuals, NNS were shown to alter the gut microbiome, metabolic regulation of fat and sugar storage, kidney function, and appetite. While no studies have been conducted on the effect of NNS on pregnant individuals, studies performed on animal models showed an association with altered sweet taste preference as well as metabolic dysregulations. Some natural forms of sweetener include products such as honey or agave, which has a low glycemic index (i.e., does not cause high spikes in blood sugar).

How much should I exercise while pregnant?

Regular exercise is an integral part of a balanced lifestyle and it has been shown to improve metabolic and physiological function as well as regulate stress levels. The CDC guidelines recommend that in order to achieve the benefits associated with exercise, adults complete 30 minutes of moderate physical activity 5 times per week.

During pregnancy, women benefit from regular exercise in a similar manner. While there are certain circumstances where a woman's mobility is limited during pregnancy, a sedentary lifestyle has been found to contribute to the development of hypertension, gestational diabetes, preeclampsia,  and increased maternal and fetal BMI. As your pregnancy progresses, Your obstetrician may recommend specific exercise modifications to protect both you and your baby. She can make exercise recommendations as well for those who do not have a regular exercise routine.

How much weight should I gain during pregnancy?

Appropriate weight gain throughout your pregnancy allows your body and the baby to have access to the necessary nutrients and energy to achieve developmental milestones. According to the CDC, appropriate weight gain is associated with proper development of the fetus that leads to improved breastfeeding, healthy birth weight, and proper immune function. Your obstetrician will address your individualized needs to determine a goal weight range while considering a multitude of factors. She will take into account considerations such as starting BMI (calculated by weight in kg/meters squared), single vs. multiple gestations, and nutrition and exercise habits. The CDC's general recommendation for weight gain is based on starting maternal BMI, however, you should defer to your obstetrician's personalized recommendations for your goal weight during pregnancy.

CDC's recommendations:

Is bleeding normal during pregnancy?

Bleeding during pregnancy is in fact very common and not necessarily a cause for concern. There are many causes of vaginal bleeding, both serious and benign (harmless). According to the American College of Obstetricians and Gynecologists, bleeding occurs in between  15-25% of early pregnancies and can be caused by normal implantation of the egg onto the wall of the uterus, sexual intercourse, or even a pelvic exam. In later pregnancy, bleeding may be due to more concerning causes (typically involving the placenta). It is important that you communicate with your obstetrician if you do experience bleeding to rule out any possibility of a more serious cause.

How can the Rh factor affect my pregnancy?

Rh is a protein found on the red blood cells of individuals that are Rh-positive, while individuals that are Rh-negative lack this protein. Rh is an inherited protein similar to the blood type we inherit from our biological parents. It is estimated that 85% of people in the United States are Rh-positive and the remaining 15% of the population are Rh negative.  Problems may arise during pregnancy if the mother is Rh-negative and the fetus inherits the gene for Rh protein, meaning they are Rh-positive. This is known as Rh incompatibility and can be associated with health concerns for the fetus.

In cases of Rh incompatibility, the mixing of maternal and fetal blood can lead to the formation of antibodies from the mother's immune system against the Rh protein in the baby's blood. This immune response can damage the red blood cells in the baby which are vital for bringing oxygen to their tissues and organs. Your obstetrician will take preventative measures against Rh incompatibility by testing your blood for the Rh protein and evaluating the potential for your baby to be Rh-positive. These results will help Your obstetrician to determine whether a shot containing Rh immunoglobulin (RhoGAM®) is necessary to prevent your body from forming anti-Rh antibodies.

Is there anything I can do to improve my sleep during pregnancy?

A good night’s sleep is an important component of an overall healthy lifestyle just like diet and exercise. Sometimes, a poor night's sleep can feel like it affects your whole day. When poor sleep becomes a chronic problem, especially during pregnancy, it is important to take active steps in improving your sleep habits. Studies have shown that sleep quality in pregnant women (typically the worst in the third trimester) was improved significantly by moderate physical activity, particularly in the first and third trimester. Additional lifestyle changes such as reducing blue light exposure in the evening can have beneficial effects on your circadian rhythm. Multiple studies indicate that even as little as two hours of blue light exposure in the evening can suppress melatonin levels necessary for sleep. There are apps available to reduce blue light emitted from your computer and phone screens, which may be beneficial in improving your natural sleep cycle. If these measures are not working well for you, talk with your obstetrician about further steps you can take to improve your restfulness.

Prenatal FAQ: FAQ

References List

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