1st Trimester of Pregnancy | Doctor Ryan - Family Medicine

1st Trimester of Pregnancy

INTRODUCTION

Congratulations on your first trimester of pregnancy.  For those who don’t know, the 1st third of your pregnancy is week 1 through week 13 (months 0 through 3).  There is usually a lot of excitement around the initial knowledge of that positive pregnancy test and then a little bit of waiting that comes until the pregnancy “feels like it’s real”.  There’s no baby bump yet and no regular way to find a fetal heartbeat until you get closer to 12 weeks along.  Yet, you are a parent now for your unborn child.  Many of the choices that you now make, you are making as a parent.  While you may not LOOK any different, you might FEEL different.  This is the wonderful beginning of caring for someone much, much smaller than yourself. 

CLINIC VISIT INFORMATION

Initial confirmation of pregnancy visit; often times I will have my pregnancy patients complete a few forms that give me more information on your general health.  Please bring these in to your next visit!

Pregnancy physical exam and labwork; usually this is about 4 weeks after your 1st visit. 
Typical labwork usually includes: blood type, hemogram, and checking for any illnesses (such as HIV) that might affect the pregnancy.  Fortunately, it is very rare when I have to discuss any abnormal lab results with my patients.

Routine pregnancy visits every 4 weeks

COMMON QUESTIONS

1) What can I do right now to give myself the best chance of a healtheast pregnancy?

We might as well start off with a loaded question!  There are several things that you can do right off the bat to improve your chances of a normal pregnancy and normal labor.  This includes:

Updating yourself with any important vaccines, such as your flu shot! 
-Please give an accurate personal history of medical problems, medications, surgeries, previous pregnancies and any medical issues that run in the family
-No drinking alcohol or using drugs.
-NO SMOKING!
Every time that you smoke a cigarette, the baby stops practicing it’s breathing movements (we see this on ultrasound). If you continue to smoke, the pregnancy is at risk for several other complications. If you need help quitting, please ask!
Eating healthy. While this is not the time to “diet”, this is the time to eat healthy foods when you are hungry. See the question below for more info.
Exercise regularly. See below.
Take your prenatal vitamin with 400 micrograms (mcg) or 0.4 milligrams (mg) of folic acid. There is still a little debate on whether DHA is also helpful for the baby’s brain development. I haven’ seen enough good evidence on this topic to make this a regular recommendation to my patients. I don’t think that this would do any harm
Wear your seatbelt!
Avoid unnecessary medication and herbal supplements. Please ask if you have any questions about your current medications.

2) Can I exercise?
-I typically will recommend some form of exercise 3 to 5 days each week, about 30 to 45 minutes each time. This is not the time to train for a marathon, but it is a good time to re-evaluate whether you are getting yourself enough activity each week. At the beginning, take it slow and gradually increase your exercise over time.  Make sure that you are staying well hydrated!

3) What should I eat? 
As a general rule, you can eat almost anything within reason.  When you are hungry, you should eat HEALTHY snacks.  You could easily find yourself eating 6 or 7 times out of the day during your pregnancy (3 meals with multiple healthy snacks).  Ultimately the baby needs the extra calories that you would find in a cup of milk which isn’t all that much. 

What should I not eat?
-This is not the time to obey every craving that your baby commands. 🙂
-Large quantities of fish are typically to be avoided, especially albacore tuna due to the mercury content. Uncooked fish (sushi), raw oysters, uncooked shellfish are typically off limits as well. 
-Deli meat is also a no-no as it can rarely contain a bacteria call listeria. 
Unpasterized (soft) cheeses.
Uncooked or undercooked eggs and meat

How much should I eat for the baby? 
Your baby needs about 300 CALORIES each day (which isn’t alot).
This about the equivalent of a yogurt cup and a cup of your favorite cereal OR a english muffin with an egg and slice of cheese.  So when your mother is telling you to keep eating, you can tell her that I said that you’re supposed to eat when you’re hungry. Just listen to your body!

How much weight should I gain?
For those who start off at a healthy weight, I usually like to see my patients gain about 25 to 35 pounds. Below is a general idea of what we see. If you have any questions or concerns about your weight, please ask me.
1st Trimester: 5 pounds
2nd Trimester: 10 pounds:
3rd Trimester: 15 to 20 pounds

4) Do I need to do an early ultrasound?
While an ultrasound can be exciting, they usually are not necessary at the beginning of your pregnancy. For those moms who are unsure of their last menstrual (your period) date, I usually will ask you to get an ultrasound so that we can verify your due date. In most situations where you already know the 1st day of your last menstrual period, it is quite easy to give you an accurate due date. Don’t worry though, you will have an opportunity to see the baby around the 20th week of your pregnancy- that’s the best time to figure out the sex anyway (if you want to know…)

5) What medications can I take for common symptoms, such as for constipation or a cold?-It is important that you always review any current prescription and regular over-the-counter medications you are taking with your doctor at the beginning of your pregnancy
-Unfortunately, it is sometimes difficult to keep track of what medications are safe during prengnancy, especially when pretty much every box says “IF PREGNANT, PLEASE TALK TO YOUR DOCTOR”. For most aches and pains, TYLENOL (ACETAMINOPHEN) is safe.
-For the rest of the medications, I’m going to cheat. See below an excellent link provided by www.babycenter.com, webmd.com, on what over-the counter-medications you can take without concern. Whenever receiving a prescription, always remind the doctor that you are pregnant. And when in doubt (for herbal remedies, over-the-counter, or prescription medication) always check with your doctor.
http://www.babycenter.com/0_chart-over-the-counter-medications-during-pregnancy_1486462.bc
http://www.webmd.com/baby/taking-medicine-during-pregnancy

6) What medications should I avoid?
-Ibuprofen and aspirin should be avoided; I list these first since they are commonly taken for all sorts of common aches and pains outside of pregnancy.
-Any medication with alcohol in it (which can include some cold medications).
-When the box says, “Check with your doctor” please go ahead and do so.  I will always take the time to answer any medication questions you might have.

7) Common symptoms during the 1st trimester

Nausea and vomiting.  Usually these symptoms are strongest around 9 weeks and can be treated in a variety of ways.  Easy things to try include eating small amounts of non-spicy foods, changing the time of when you take your prenatal vitamin, or try over the counter medication. Call your doctor if:
• Weight loss of 5 to 10 pounds or more during the first trimester
• You lose weight rapidly, more than a pound a week for several weeks
• You cannot keep any food or fluids down for over 24 hours
• Your urine becomes very dark yellow, or you do not urinate for 8+ hours
• You have abdominal pain, fever, severe weakness, or feel faint
• You vomit once an hour or more, and after every meal/snack
• Your nausea is so severe, you cannot eat without vomiting or retching

Over the counter medication for nausea includes:
pyridoxine (vitamin B6) taken 25mg every 8 hours
Unisom one tablet an hour before bedtime. This medication usually makes you drowsy.

Emotional symptoms. You might feel moody, forgetful or unable to concentrate. All of these symptoms can be quite normal. However if you feel like your moodiness is getting in the way of you enjoying your normal daily activities, your relationships, or your performance at work, then it’s time to mention this to your doctor.

Constipation. Pregnancy hormones typically slow down your digestive tract which can help you absorb nutrition, but also back you up. The extra iron in your prenatal vitamin doesn’t help either. Certain types of stool softeners can be helpful, but talk this over with your doctor first.

Acid reflux. Your digestive tract is relaxed and food stays in your stomach longer, which may cause heartburn.

Visible veins. The blue veins in your belly, breasts and legs may become more noticeable as your body makes extra blood and your heart pumps faster to meet the needs of pregnancy. This is quite normal and most of the time goes away after the pregnancy.

Breast changes. Many women notice changes in their breasts early in pregnancy. The hormones in your body are changing to help prepare you for breastfeeding. As these changes occur, your breasts may feel tender and swollen.

Vaginal changes. Often times, women notice thin, whitish discharge, which is normal during pregnancy. If you have significant vaginal itching/pain or any other rash in that general area, its a good thing to call your doctor about.

8) Can I have sex?

Yup.  Most pregnant women can have intercourse without concern.  It is one of the pieces of maintaining a normal healthy relationship.  I do tell couples that sometimes their sex life can change with pregnancy.  A woman’s attitude toward sex can be affected by how her body changes and how her hormones change during the pregnancy. On a very rare occasion, if a woman has symptoms of labor that is too early (pre-term labor), we discuss holding off on intercourse for a while. 

9) Can I travel in the first trimester?

99% of the time the answer is yes.  I always appreciate it when my patients let me know that they’re going on a big trip (cross country or international).  It gives me an opportunity to review how the pregnancy is going and review your activity plans.  Fortunately, it is very rare that I need to place any restrictions on vacation plans. 

It’s important to stop the car every couple hours to get the blood in your legs moving.  This rule also applies to airplane flights. 

10) WHEN TO CALL YOUR DOCTOR
There really isn’t a bad time to call me when you have a medical concern. On occasion I will have a patient who states how worried they have been about a medical issue, but felt bad calling about it. If you are worried about something, then it is worth calling about. Below are some general guidelines, but I encourage you to call if you feel like there is something else that is not right.

1) Significant abdominal cramping, similar to that of your menstrual period or worse
2) Vaginal bleeding.
3) Fever of 100.4 or higher.  Often times can be caused by a viral illness, but it’s worthy reviewing your symptoms. 
4) Nausea and vomiting that is constant and keeping you from drinking fluids regularly.
5) Daily mood changes (sometimes in the form of depression or anxiety) that prevent you from getting work done, allowing you to enjoy your normal daily activities, or interfering in your relationships.