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Information from Your Family Doctor
Pregnancy: Prenatal Care
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Am Fam Physician. 2003 Sep 15;68(6):1165-1167.
What will happen during prenatal visits?
Your doctor will probably start by asking you about your medical history and how you have been feeling. You will probably be weighed and have your blood pressure taken at every visit during your pregnancy. Your doctor also may listen to the baby's heartbeat at every visit, and may measure how large your abdomen (or stomach area) has grown since your last visit.
On your first visit, you will probably have a pelvic exam to check the size and shape of your uterus (womb) and a Pap smear to check for signs of cancer of the cervix (the opening of the uterus).
Urine and blood tests may be done at the first visit and again later. Urine tests are done to check for bacteria in your urine, high sugar levels (which can be a sign of diabetes), and high protein levels (which can put you at risk for preeclampsia, a type of high blood pressure in pregnancy). Blood tests are done to check for low iron levels (anemia).
Sometimes, an ultrasound exam can help show when your baby is due or check on your baby's growth and position in your uterus. An ultrasound exam uses sound waves to create an image of your baby on a video screen.
Other tests may be needed if you or your baby are at risk for any problems.
How much weight should I gain during pregnancy?
You should gain about 25 to 30 pounds. If you do not weigh enough when you get pregnant, you may need to gain more. If you are very heavy when you get pregnant, you may need to gain only 15 to 18 pounds.
Pregnancy is not the time to try to lose weight. It is best to gain about two to three pounds during the first 12 weeks and about one pound a week after that. Talk to your doctor about how much weight you should gain.
What should I eat?
The food you eat also feeds your baby, so choose healthy foods. You need about 300 extra calories each day. Be sure to include the following in your daily diet:
Three servings of milk or dairy products
Four servings of vegetables
Three servings of fruit
Nine servings of breads, cereals, rice, or pasta
Two to three servings of meat, fish, poultry, dried beans, eggs, or nuts
Six to eight glasses of liquids
Your doctor may suggest that you take vitamins that include iron to help protect you against anemia, calcium to help keep your bones strong, and folic acid, especially early in pregnancy (and even before you get pregnant), to help prevent neural tube defects (serious problems with the baby's brain and spinal cord, often called spina bifida).
Is it okay to take medicine?
Check with your doctor before taking any medicine, including aspirin and cold medicines. Even medicines you buy without a prescription can cause birth defects, especially if they are taken during the first three months of pregnancy.
How long can I keep working?
This depends on several things: if you have any problems with your pregnancy, what kind of work you do, and if you are exposed to anything at work that could harm your baby. For instance, lifting heavy objects or standing for a long time can be hard on a pregnant woman. Radiation, lead, and other heavy metals, such as copper and mercury, could hurt the baby. Working in front of a computer screen is not thought to cause harm to an unborn baby.
What about exercise?
Unless you have problems in your pregnancy, you can probably do whatever exercise you did before you got pregnant. You may feel better if you are active. Some women say exercising during pregnancy makes labor and delivery easier. Walking and swimming are great choices. If you did not exercise before pregnancy, start slowly. It is probably best to avoid doing anything that could cause you to fall, such as water skiing or rock climbing.
Is it okay to have sex?
Yes, unless your doctor thinks you are at risk for problems. Do not be surprised if you are less—or more—interested in sex. As you get larger, you may find you need to try different positions. If you have oral sex, tell your partner not to blow air into your vagina. This could force air inside you, which could cause an air embolism. Air embolisms can cause permanent brain damage and even death to a pregnant woman and her baby.
What can I do to feel better while I'm pregnant?
Here are the most common discomforts of pregnancy and some tips for handling them:
Nausea or vomiting may strike anytime during the day (or night). Try eating frequent, small meals, and avoid greasy foods. Keep crackers by your bed to eat before getting up in the morning.
Talk to your doctor if morning sickness lasts past the first three months of pregnancy or causes you to lose weight.
Sometimes tiredness in pregnancy is caused by anemia, so tell your doctor if you are feeling tired. Get enough rest. Take a daytime nap if possible.
Gently stretch the calf of your leg by curling your toes upward, toward your knee.
Drink plenty of fluids. Eat foods with lots of fiber, such as raisins and bran cereals. Do not take laxatives without talking to your doctor first. Stool softeners may be safer than laxatives.
Do not strain during bowel movements. Try to avoid becoming constipated. Clean yourself well after a bowel movement (wet wipes may be less irritating than toilet paper).
Urinating More Often
You may need to urinate more often as your baby grows, because the baby will put pressure on your bladder. This cannot be helped.
Avoid clothing that fits tightly around your legs or waist. Rest and put your feet up as much as you can. Move around if you must stand for a long time. Ask your doctor about wearing support hose.
Your hormones are on a roller coaster ride during pregnancy. Plus, your life is undergoing a big change. Do not be too hard on yourself. If you feel very sad or think about suicide, talk to your doctor right away.
Eat frequent, small meals. Avoid spicy or greasy foods. Do not lie down right after eating. Ask your doctor about taking antacids.
The amount of discharge from the vagina increases during pregnancy. Yeast infections, which also can cause discharge, are more common during pregnancy. It is a good idea to talk with your doctor about any unusual discharge.
Brush and floss regularly, and see your dentist for cleanings. Do not put off dental visits because you are pregnant, but be sure to tell your dentist that you are pregnant.
This is related to changes in the levels of the female hormone estrogen. You also may have nosebleeds.
Edema, or Retaining Fluid
Rest with your legs up. Lie on your left side while sleeping so blood more easily flows from your legs back to your heart. Do not use diuretics (water pills). If you are thinking about cutting down on salt to reduce swelling, talk with your doctor first. Your body needs enough salt to maintain the balance of fluid, and cutting back on salt may not be the best way to manage your swelling.
Stretch marks appear as red marks on your skin. Stretch marks really cannot be prevented, but they often fade after pregnancy. Lotion can help keep your skin moist and may help reduce the itchiness of dry skin.
Other skin changes may include darkening of the skin on your face and around your nipples, and a dark line below your belly button. Staying out of the sun or using a sunscreen may help lessen these marks. They will probably fade after pregnancy.
Call your doctor if you have:
Blood or fluid coming from your vagina
Sudden or extreme swelling of your face or fingers
Headaches that are severe or will not go away
Nausea and vomiting that will not go away
Dim or blurry vision
Pain or cramps in your lower abdomen
Chills or fever
A change in your baby's movements
Less urine or a burning sensation when you urinate
Any illness or infection
Anything that bothers you
“Do not do this, do not do that.” You have probably heard every old wives' tale. Here are some warnings that are worth paying attention to:
Do not smoke. Smoking raises your risk for miscarriage, premature birth, low birth weight, and many other problems.
Do not use drugs. Cocaine, heroin, and marijuana increase your risk of miscarriage, premature birth, and birth defects. And your baby could be born addicted to the drug you have been taking.
Do not drink alcohol. Drinking alcohol during pregnancy is the major cause of preventable birth defects, including mental slowness.
Do not clean a cat's litter box or eat raw or undercooked red meat. You could get toxoplasmosis, a disease that can cause birth defects in your baby.
Do not sit in a sauna or hot tub. This raises your risk of miscarriage and birth defects.
Do not douche without talking to your doctor about it first. Douching could force air into your vagina, which can cause an air embolism.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 2003 by the American Academy of Family Physicians.
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