November 23, 2014

Alyssa Stitt, MD
Family Medicine, Primary Care
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One of the best gifts expectant parents can give their baby is the gift of a healthy pregnancy. Expectant mothers who regularly receive prenatal care have healthier babies and are less likely to experience serious pregnancy-related complications. Early, regular prenatal care is the single most important thing an expectant mother can do to deliver a baby with a clean bill of health.

Prenatal Care Begins Before Conception
Ideally, prenatal care should begin before pregnancy with a check-up by a health care provider. This includes a routine exam and testing to ensure the mother-to-be is in good health. And, it is important to establish healthy lifestyle habits including smoking and drinking cessation before conception.

 – Get Fit. Being physically fit without being fanatical improves fertility and the chances of conceiving. Starting with a good weight baseline helps keep a woman on the right track to delivering a baby with a healthy birth weight.

 – Take Vitamins. It’s especially important for women who are planning to become pregnant to take a multi-vitamin with folic acid and iron because neural tube defects (like spina bifida) can happen in the first 28 days of pregnancy, often before a woman even knows she’s pregnant. Doctors recommend taking 1 mg of folic acid every day throughout pregnancy. Additionally, the iron in the prenatal vitamins will help boost mom’s iron supply making it more readily available for her growing baby.

Taking Care of Mom and Baby After Conception
Mothers-to-be need to make additional healthy choices and smart decisions after conception to help prepare for a safe pregnancy and the arrival of a healthy baby. Following are some basic guidelines recommended by the American Academy of Family Physicians (AAFP).

 – Exercise. Exercise may help ease discomfort during pregnancy, make labor and delivery easier and reduce the risk of pregnancy-related complications including preeclampsia and gestational diabetes. Try to get at least 30 minutes of exercise each day. Walking and swimming are great choices. It’s best to avoid contact sports or anything that could cause a fall.

 – Eat a healthy diet.One of the most important things a woman can do for herself and her child is to eat a healthy, balanced diet from the five food groups. But, during pregnancy the foods mom doesn’t eat can be just as important as the ones she does. There are some foods to avoid when eating for two.

  • Fish: There is a lot of buzz about fish and mercury. Fish is actually a great source of protein, iron and valuable omega 3 fatty acids. It is safe to consume fish by following these simple guidelines. Eat no more than two or three servings of fish totaling 12 ounces or less per week including canned fish. The best options are salmon, shrimp, canned tuna and catfish. Avoid the fish with highest risk of mercury content, including shark, swordfish, tilefish and King Mackerel. Ask your doctor for the Minnesota Fish Guide for safety in pregnancy for local regulations.
  • Dairy: Eat four or more servings of dairy foods each day which provides enough calcium for Mom and baby but avoid soft cheeses such as Brie, feta, Camembert and blue cheese as these carry increased risk for listeria. It is safest to consume dairy products that are pasteurized.
  • Coffee: Limit coffee and other drinks containing caffeine to one serving each day.
  • Artificial Sweeteners: There is insufficient information regarding the safety of artificial sweeteners such as aspartame during pregnancy, the best bet is moderation. Limit usage to one or two servings a day or less, and avoid them when appropriate alternatives exist.

Make realistic weight gain expectations during pregnancy. Although it varies from woman to woman, most women gain about 25 to 35 pounds. Women who begin pregnancy underweight may need to gain more and women who are overweight, may need to gain a bit less.

Identifying Concerns in Pregnancy:
Thanks to advancements in research and technology, it is now possible to identify more problems and risks earlier in pregnancy than ever before. The following are optional, but available tests that may be offered or recommended by a physician during pregnancy:

 – First Trimester Screening: In the last 5-10 years, newer guidelines have been established for first trimester screening between 11-13 weeks which combines lab testing and an ultrasound to helps identify the risk of chromosomal abnormalities in the trisomy family including Down syndrome. This may be especially important for women over 35 who carry an increased risk for these findings.

 – Progesterone Treatments: In the last 5-10 years, more emphasis has been placed on prevention of preterm labor. Weekly progesterone injections or daily progesterone vaginal suppositories beginning between 16 and 20 weeks for women who have a history of preterm labor and delivery have been shown to reduce the risk.

 – Group B Strep Screening: Studies show that the vast majority of babies who get sick in the first days of life are from a preventable infection by the bacteria Group B streptococcus which can commonly be found in many women’s urine, vaginal secretions or stool. It is now routine for all pregnant women to be screened for Group B strep at 36 weeks and, if test positive, be treated with antibiotics during labor.

 – Chorionic Villus Sampling or Amniocentesis: These tests check for certain birth defects between 12 and 18 weeks of pregnancy including Down syndrome. Testing of this fashion can be pursued if mom had abnormal results of a routine prenatal screening test, if she is 35 years or older, or if there are specific genetic disorders in the family such as Tay-Sachs disease, Cystic Fibrosis or Down syndrome for which screening is desired. They are done at a tertiary care center and carry with them a small risk of miscarriage. Women wishing to pursue this kind of testing will first meet with a genetic counselor to review in detail the risks, benefits and alternatives.

 – CF Carrier Screen: This blood test screens whether or not a person carries the abnormal gene that causes cystic fibrosis, an inherited disease that affects breathing.

 – Maternal Quad ScreeningThis screening is recommended for any expectant mothers to determine if their baby is at an increased risk for serious birth defects including neural tube defects like spina bifida and chromosomal abnormalities like Down syndrome. It is an optional test available between 16-18 weeks.

 – Ultrasound: An expectant mother typically gets at least one ultrasound in pregnancy. A first trimester ultrasound may be done to confirm the due date and identify a multiple pregnancy. A routine 18-20 ultrasound is typically done to check the baby’s age and size, and look at the growing internal organs to identify serious birth defects, although there is no guarantee that more subtle findings may be missed. A woman may also have an ultrasound later in pregnancy to diagnose any complications like growth restriction, low or high fluid accumulation, breech position, fetal distress or other more infrequent complications.