CME | Expecting the unexpected: The pregnancy side effects nobody warned you about

Lauren Brown-Berchtold: Hello and welcome to CME on the Go. The podcast crafted specifically for family physicians and by family physicians. Whether you're seeking clinical insights, professional development, or just a sense of comradery, you'll find it all here. Plus, you can earn CME credit with every listen. So grab a delicious coffee, hit play, and let's embark on this journey together.

I am Dr. Lauren Brown Birch Told, and I'm the program director for VCME Family Medicine Residency in Modesto, California.

Tamaan Osbourne-Roberts: Hi, I'm Teman Osborne Roberts for a federally qualified health center, family medicine, obesity medicine, and lifestyle medicine physician from Denver, Colorado. I'm also an occasional policy expert and an occasional standup comedian and an avowed tea drinker.

So take that Lauren, with your coffee.

Jason Marker: I'm Dr. Jason Marker. I'm one of the associate directors of the Family Medicine Residency Program at Memorial Hospital in South Bend, Indiana. I'm kind of a lightweight. I prefer a nice steamed melt. Thank you.

Lauren Brown-Berchtold: Now that we know all of our preferences moving forward, I am coming with a case for you guys today.

Right. And it doesn't have labs or imaging results. You know, rarely do we have such things, but I'm coming in with a lady in her early thirties who's saying, Hey, I am going to Iceland for a trip with my family, and oh my gosh, I. I'm pregnant and I don't have time to establish for pregnancy right now, but what am I supposed to do on this huge family vacation?

Do I get to drive around? Can I go into those really cool hot springs that a volcano was trying to destroy? Can I eat fish? What about hot dogs? Do I need to take aspirin on the plane? What if I get caught and die? Do I have compression hose that I have to carry? Do I have a drink? Can I drink coffee? What about tea?

Can I go on adventure sports? And you have this barrage of like 18 questions that you get to answer. What are your guys' thoughts? What comes up for you?

Tamaan Osbourne-Roberts: I think that my thoughts can be best summarized as moments like this, that I lock myself in the office and dive into up to date and other point of care resources, desperately trying to find the answer to things that may have a, an evidence based somewhere, but not right in front of me. And I will say, having been to Iceland. Every single one of those questions would definitely come up.

Lauren Brown-Berchtold: So real, right?

Tamaan Osbourne-Roberts: Really real.

Jason Marker: I've never been to Iceland, but these questions still come up. They come up for a lot of my patients who I've been doing pregnancy care for through the years. And I guess I usually start by saying like, what? What do you think the answers are? What have you already read? Where have you read it?

Have you talked to other family members who've been pregnant recently? Or only family members who were pregnant a long time ago. Like, these are all really important free questions for me before I start revealing the answers that I think might be right from experience and study and the learning that I've done over time.

So I think getting on the right footing with the patient, understand where they're coming from. Are these just questions they were told to be worried about or are they actually worried about them? What have they already read? Is that. A good starting place for me. I

Lauren Brown-Berchtold: thought you were gonna say, what do you think the answers are to the patient?

Because you're like, I don't know, so hopefully you do.

Jason Marker: No, I, I don't use the answers. I talk like a lot of women and couples really through these questions. Sometimes it's actually not even the patient that's most worried about it. There's a, a significant other out there who says like, she wants charcuterie all the time.

And I don't, I'm, I've read, I can't give her charcuterie what is going on here.

Lauren Brown-Berchtold: We're a parent.

Jason Marker: Yeah, this is, this is part of part of our conversation with pregnant patients all the time. I think.

Lauren Brown-Berchtold: Yeah, totally, totally. I, I, I like both of your responses 'cause they are both very honest and across the spectrum of responses.

And a as I like to do this, this patient is me. I love bringing myself into, into these cases because I can be really honest and say like. The frenetic energy that I was bringing in as an example, is how I felt. I felt so concerned. The difference is I didn't ask anyone. I just decided to be crazy with myself as I was really stressed about these, these questions.

And what's interesting about that is I did an OB fellowship, right? And so then in my first pregnancy, I was that stressed about all these specific questions. Imagine someone who has no experience with with healthcare and with. The provision of healthcare and they're dealing with this life changing diagnosis of you are going to have a child.

The anxiety is very real, and I think that I didn't necessarily understand that in a visceral way until I experienced it myself. So what we'd like to do today with this episode is do. A deep dive into one particular topic and then high level overview of various centric components of pregnancy, questions and issues that are gonna come up with family doctors probably every day.

And there isn't a great like one evidence-based review of the literature that's going to give you just one answer with a quick two minute search. Does that sound like a plan? I

Jason Marker: love it.

Tamaan Osbourne-Roberts: I love it. Let's do it. I am with you. I am with you. So that being the case, let's just start off at high level, but also high frequency.

Let's talk about nausea and vomiting. Oh, yeah, yeah. No worries. And yeah. Yeah. This is something that we've all seen with our patients because per the, the, the study, 70% of pregnancies. Have this as a side effect. I'll admit. I feel like that number might be low based on the patients as well as the people in my life that I, I have been around who've been pregnant.

There's been a lot of study put into this, obviously because it's very common, it's extremely bothersome and concerning for, for many pregnant women, and we have really finally come to a point where we can actually. Nail down the cause. This was a, a mystery for a very, very long time, including, you know, during my training, but there were a lot of theories about it.

But there was an article in Nature in 2024 that linked early pregnancy nausea and vomiting to a specific hormone called GDF 15 that comes out of the fetal placental unit.

Lauren Brown-Berchtold: And so who knows what that even means or, or what the implications are. But I think the exciting part is that now we can try to find better tools to, to combat that GDF 15 thing that is causing so much misery.

And as the one person on this call who has actually experienced pregnancy personally in my body. I'll just say, this is no joke. It is really shocking how many parking lots I vomited in on my daily commute to and from work during my first trimester.

Jason Marker: Also, I think it's interesting how the fundamentals of managing these symptoms are, are really just that they're really pretty fundamental.

I, I wanna start by talking about food choices just a little bit here. One of the solutions to some of this nausea and vomiting is just to try to fool the stomach into thinking that there's nothing there. Frequent small meals. Not getting too full, not getting too hungry. Avoiding fad and spice and prioritizing protein and bland foods, kind of along the lines of the BRAT guidelines that we all find useful for maybe kids that are vomiting, remembering things like ginger, which can be a really helpful supplement for folks, whether that's in the form of tea lollipops or lozenges.

Oftentimes, I'll talk to women about just. Needing to be snackers, like they're gonna snack their way through the first trimester. And obviously not every woman is gonna find the same food. It helps to settle her stomach as the next woman does. And so there's a little bit of trial and error here.

Frequently. We talk about. Carbohydrates as being a thing that's easy on the stomach, just a little bit of a cracker to nibble on through the course of the day. Again, never overextending the stomach, never letting it feel too hungry, trying to get to that 12, 13, 14 week window. And this finally abates a bit on its own.

Tamaan Osbourne-Roberts: Yeah, no, that's, that's a, a series of really, really great things. You know, ginger in particular, I've seen work incredibly well. For my patients and for other people in, in my life. And it's, it's out there. There are all sorts of ginger, everything that you can find all over the place. There's a few other non-pharmacologic options that might be effective.

Some people yes, some people, no, it's gonna vary a lot. They can certainly consider C bands, which are those acupressure bands, uh, that put pressure at the wrist that are sold primarily for motion sickness or c sickness. They, they can also work here. Nasal menthol inhalers do work for some people similar to acupressure, acupuncture.

Can work for some folks. Aroma therapies since C, for a lot of people, this really is a trigger, primarily is via smell. Hypnosis has some limited evidence as well, and there're it's really reported to be helpful for some people. It's very important to note that vitamin B six and Doxylamine, which are. The components of the collegiates are actually the first line therapies for nausea and vomiting in pregnancy.

Lauren Brown-Berchtold: Yeah. And even though our episode is trying to focus on non-pharmacologic things, vitamin B six and Dala Lamine are sold over the counter at. Every pharmacy and, and corner store. And so I work with the patient population who cannot get DICLEGIS paid for to save our lives. And so I, I sort of think about these things as supplements to the rest of these lifestyle modifications, non-pharmacologic things that that can be used.

I'll be honest, I've tried all these things and more, some worked, sometimes, some didn't. Most of the time I, I experienced the, the weirdness of eating two oranges and a stack of uncooked pepperoni every night for dinner for two months. 'cause I was just looking for something that made me feel better. And that happened to be what it was for a while, and I would've done anything to feel better.

And so, man, I I, I have such. Empathy for my patients who come in with just misery and, and don't really see a reason to gate keep any of the options that we've talked about thus far and, and probably more from a pharmacologic perspective, the differentiation in hyperemesis gravidarum versus the normal nausea and vomiting of pregnancy that is so common is hyperemesis Derm specifically is.

About 2% of the pregnancies that are experiencing nausea, vomiting in pregnancy and it's differential is that it is severe. This is not, I'm vomiting a couple times a day. This is, I cannot function, I can't go to work, I cannot eat, I cannot sleep, I cannot get up to do anything. Commonly are going to see patients who have observable weight loss, and so in your EMR you will be noticing that there is.

Commonly you'll talk about a 5% weight loss of your total weight, and you might see electrolyte changes. Like this is a really serious issue. And so it's funny for me to think about my experience with nausea and vomiting, and it's really important for us to not be lackadaisical and sort of sit back on like, yes, it's miserable and you'll get through it.

Because there are a significant number of people who are going to end up needing potentially hospitalization because they're unable to give themselves enough nutrients, let alone their baby. And so it's something we gotta keep on the top of our minds.

Jason Marker: Alright, gang, as much fun as it would be to talk about nausea and vomiting.

For the rest of this episode, we're not going to, I'd like to transition us from this larger topic to more of a rapid fire review of a lot of common issues in pregnancy. So, Mann, why don't you start us off, take us away with some hot takes. On nutrition in pregnancy.

Tamaan Osbourne-Roberts: Oh, geez. Okay. We're not talking about anything controversial whatsoever.

No. We've just, we have just discussed that food choice during pregnancy is a really important thing. To a lot of patients. Patients who are pregnant really sometimes can eat some things, not others. I, I have to admit, two months of raw pepperoni might be the first time I've heard that one, but yeah, that does come up.

But that actually leads us very, very well. Into concerns around what sorts of food can cause Listeriosis. Now, I think we've all been trained at some point to say there are really foods that pregnant women shouldn't eat because of the higher risk of Listeriosis. And just to back up a little bit, there is an increased risk of Listeriosis during pregnancy, approximately one in six Listeriosis cases.

That happen are two pregnant people. This is a real thing. There's probably, for the general population, about a 10 times increased risk of Listeriosis during pregnancy as opposed to during non-pregnant states. And it's, it's a real thing to think about. Now the question then becomes, what can people eat or not?

Because I know we've all walked into a room with an individual patient or in the cases I mostly have had into a room full of people during a centering pregnancy that sort of a group meeting and have run into that discussion. We say, well, don't eat this, and there's this collective guest from everybody available on this day.

That's the only thing I can keep down and, and you run into that. So let's talk a little bit about the specifics. One of the things to remember about. The Listeriosis is that it's an active bacterial infection. It doesn't occur from a toxin or so, a product that listeria monocytogenes creates. It's an active infection with the bacteria itself.

So if you kill the bacteria, the food will be safe and you won't have an issue, even if it is fed it in it before. So the primary thing people need to think about. Is foods that are properly pasteurized, properly canned, or properly heated to typical food. Safe cooking temperatures are all going to be okay.

So for instance, something that is recommended not to eat are lunch or delic meats, typically, because those are prepared, they're then stored cold. There's an opportunity for listeria to grow, which wouldn't affect people with a normal immune system, but an altered immune system such you see in pregnancy can be an issue However.

If you take a hot dog and you cook it through till the center gets to, I believe it's 145 degrees, which is considered food safe with pork and beef, you should kill everything in there. Now, if somebody doesn't love hot dogs, it's the only thing that they can eat is it's easier and safer for them to avoid that short.

But if they're like, I just gotta have one, and they're afraid of ending up like. Spelling, I think it was on, be called out on the cover of, of some magazine for having eaten a hot dog or in pregnancy. The reality is if you cook this at home and you're cooking it to an appropriate temple, there's, it's, it's going to be rendered sick.

But whether or not to take that risk, oh, I suppose that's an individual thing. The same applies to smoked seafoods, a typical novalock, the app, don't want to eat that. However, cooked, smoked seafood that has been heated through an appropriate temperature in a castle or something else like that would be all right.

One thing to stay away from in general, however, is soft cheeses. Certainly any cheese made from a pasteurized milk, which folks will still encounter out there in the wild. And definitely any cheeses that are soft cheeses and fresh cheeses and, and things like that, it's just easier to to, to be a little safe in regards to that.

So another thing that actually comes up for a lot of pregnant women is, can I eat sushi during pregnancy or ceviche or poke, or another type of raw fish preparation? I'm sorry to say that the evidence is still being collected and ongoing. There is kind of the evidence of the Commons, which is there are whole cultural groups of hundreds of millions of people that probably eve rockish during pregnancy, and they would say, we do it all the time.

It's fine. The concern, again, is bacterial contamination in that sort of a moment, and it's very, very hard, especially when eating these things away from the home. To guarantee that there won't be cross-contamination. So the general recommendation is that cooked sushi can potentially be okay, but you would need to ensure it's not being cross-contaminated with the same cutting surfaces and knives that are being used for raw sushi, which is going to be a reality probably in any restaurant out there.

You know, that's going to be one set of equipment which makes sushi a little harder to, okay. The other thing I should mention is even amongst sushi, it's important to stay away. From high Mercury fish, which are some of the more popular ones, like the various tunas and tile fish. And we don't see shark that much in sushi bars, but you know, memorizing all of the different fish and all of the mercury content is possible, but also little difficult.

So this is one which is probably just a little safer to say it's a celebratory meal postpartum.

Lauren Brown-Berchtold: A celebratory meal. Postpartum.

Jason Marker: Yeah. Nice. Something to look forward to.

Lauren Brown-Berchtold: Probably right along with the glass of wine. Right? Like that's gonna be a postpartum time.

Tamaan Osbourne-Roberts: Exactly. Exactly.

Lauren Brown-Berchtold: I, I have to say the reference to the hot dog on a magazine, incredible.

And two man, I love my audacity in giving a rapid fire, hot take nutrition topic to you of all people to man, because I should have known that there was gonna be too much goodness. And I think that this is such a common. Conversation and question that I really appreciate the specificity that you walked us through there.

To summarize, there's a lot of hype. Use some common sense drink water. That's what I'm gonna go with. Jason, what advice do you give to pregnant patients with regards to exercise and does that change and how does it change depending on their trimester?

Jason Marker: For women who have been exercising regularly and find themselves to be pregnant, my general advice is you should continue to do that.

You need to be thoughtful about keeping your abdomen safe. So it might depend a little bit on what kind of exercise they've been doing. A lot of really heavy weightlifting could become a problem to the maturing placenta and the exchange of blood and nutrients with the baby at some point along the way.

But a lot of women who do that as more than just a hobby, you're really trained to do that well. Can't continue to do that for quite a while into their pregnancy. I think for women who have not been exercising and suddenly are pregnant and feel like maybe they want to start exercising, it's a little bit different conversation.

They need to start low and go slow. So there's good advice about what do they wanna do. Realizing, of course, for all of these folks there. Center of gravity is gonna slowly begin to shift forward. So they really need to think about the safety with doing things like bicycle riding or cross country other things where the balance is gonna be a really important part of that as well.

But generally, exercise is good and really wouldn't need to be a heavily restricted, really well into close, close to the end of pregnancy for most women. Hydration becomes a factor. I think a lot of pregnant women kind of live on the edge of some dehydration anyway, and adding in additional exercise to the mix is gonna land you with some brax and hicks contractions, probably it's closer you get to your due date.

So to be especially careful with hydration, abdominal safety and just being smart about the intensity of your exercise is gonna be the real thing to consider support of the abdomen, especially in athletic activities that. Create a lot of bouncing and jarring of the abdomen is something to think about too.

And there are a lot of abdominal supports out there that are marketed specifically to pregnant persons to help support their abdomen so they can continue to do some of those activities along the way. Athletic activities that. Unweight the body. So I'm thinking about swimming in particular, can be really therapeutic and useful for women as they are throughout their pregnancy, and can do that with a lot of vigor and stay hydrated and be able to not have some of that bouncing around with their apnea.

I guess those are probably my highlights when it comes to exercise.

Tamaan Osbourne-Roberts: Okay, so what you're saying, Jason, is that here in Colorado all of my downhill skiers? That's fine.

Jason Marker: That's probably, if they're not fine, that is not fine. However, I, I have taken care of some skiers who transition over to cross country skiing, and as long as they stay hydrated, which is something's hard to do, you don't think about that in the winter so much as you do in the summer.

Like there's a lot of analogous activities to sports that they may have been doing that would be a little bit more dangerous. The analogous export, they, they can probably still really enjoy and get into anything that requires, that has like high speed impact potential, whether it's, you know, tennis, pickleball, things like that are, are potentially problematic.

You just have to protect that abdomen and realize there's a human being going in there that you need to be thoughtful about.

Tamaan Osbourne-Roberts: Okay, well make sure to pass that along to my skydiver and scuba divers. Lauren, I know you are dying to give us a hot take about hot springs and hot tubs.

Lauren Brown-Berchtold: Oh, man. Like I said, this was a real question I had, and here's what I learned on a deep, dark dive down a PubMed rabbit hole.

The anecdotal concern that everyone sort of talks about, about hot tubs and and hot baths comes down to this. Significant and sustained core body temperature elevations of, of several degrees, right, are going to potentially cause some issues with neural tube defects and or miscarriages. And so that is a real thing.

Now, usually the neural tube is closed by around eight weeks. And so in the late first trimester, how real is that concern? It's really uncertain. How can we study this? Right? But in general, that concern becomes exponentially less as we get to the late first trimester. The second component though, is that you are unlikely to have that significant and sustained core temperature, elevation from transient exposure, submersion.

And so you know, if you have like a water heater at your house that is set to any standard safety measure, you're probably not going to be able to get yourself hot enough to have concerns about the neural tube. If you are going to a hot tub though, you really should be like, Ooh, my core body just. Popped in and now I'm gonna pop back out and maybe put my feet in the tub.

The other part of this is actually maternal fevers, right? If you have an uncontrolled maternal fever and your core body temperature is, is sustained in that elevation, that can also lead to some of these issues. And so it is a risk, but it is probably overblown from a perspective of the entire population of pregnant women in the first trimester and could be managed pretty easily.

Jason Marker: You know, the other part of that that I think about is all those warnings at every hot tub I've ever been at before, partly has to do with OD dilation, transient hypotension, risk of syncope and falls. Here you have a person whose center of gravity is suddenly. Further out in front of them than they are used to who has a transient drop in their blood pressure on a wet tile surface.

Like I think there's issues related to that traumatic concern to the pregnancy that I think are also worth talking to those pregnant patients about.

Lauren Brown-Berchtold: Totally.

Jason Marker: Alright, next up to man round ligament pain. Go.

Tamaan Osbourne-Roberts: Don't miss things.

What things do I now miss? Oh crap. Rev Fire. Rev Fire. That was really good. What else could it possibly be? No, it really that, that's about it. Uh, what it comes down to is round ligament pain. Incredibly common, incredibly bothersome for a lot of women, but it can look a lot like some things that potentially have warning signs, like such as an ectopic pregnancy, you know, rupture, things like that.

So it's very important when a pregnant patient comes in. Lower abdominal pain to evaluate it properly. Determine if they have any bleeding, if they do obvious that leave that requires appropriate, you know, follow up and evaluation. Does the pain seem to be of a type or severity that makes your gut go, eh, you know, well chase that and follow that.

Is it in very large proportion of cases, round ligament pain? Yes, it is. But ensure there are no red flags warning signs in that you're not missing something that could be potentially dangerous.

Lauren Brown-Berchtold: Yeah, this is gonna go away once those ligaments give up. Trying to keep the uterus in the pelvis and just accept that as a done deal and, and stretching and belly support might help.

Tamaan Osbourne-Roberts: Alright, Lauren right back at you varicose veins.

Lauren Brown-Berchtold: Appreciate that. When I think about varicose veins, I don't have too many red flag symptoms that I'm going to be thinking about. These are generally going to be pretty self-evident and whenever I hear about a pregnant patient with like calf or lower leg pain, I need to make sure that, that, that I'm not dealing with A DVT.

What are your thoughts, Jason?

Jason Marker: This is so common and a lot of these conversations in my patients have started with a person saying to me something like, let me tell you about my mother's legs. I don't want my legs to look like that someday. And we have to talk about compression hose. And even if it's a hundred degree summer day, like you gotta wear those things all the time.

If you wanna hope to. Not end up with some pretty substantial chronic and longstanding changes. Not just cosmetic things too, but the achiness that comes along with that. And sometimes the swelling, chronic venous stasis, like this can be a setup for a lot of things down the road that a lot of pregnant patients just are hoping to not have to have, and yet sometimes they're going to need to along the way just because that's the way their anatomy was from the beginning.

So, compression, stockings, elevation as often, and. Often, as long as they can. These are some ways to get around this, but it's a really stubborn problem because that superhighway of blood back up from lower extremity hits a big roadblock in the uterus on its way back up to the central super,

Lauren Brown-Berchtold: super highway of blood hitting the road.

Jason Marker: It's just gonna. It's just gonna back up all that pressure. You're gonna start blowing those little check valves in the veins of your legs and you're gonna be stuck with it. So it's a really trying problem, but a recommendation for compression hose early and often, and elevation and, well, good hydration is about the best thing we got from that, I think.

Tamaan Osbourne-Roberts: I have to say that's the first time I've heard the human circulatory system compared to the DC Beltway, but Okay.

Jason Marker: Okay. Good. Good.

Lauren Brown-Berchtold: Last hot take that we would be remiss if we didn't discuss is sleep issues and disturbances in pregnancy.

Tamaan Osbourne-Roberts: Yeah, this is a huge problem for a lot of different patients, as you can imagine.

Not simply overall changing shape of body and balance, but changes to the connective tissue system throughout the entire body. You know, cause all, all sorts of difficulties and aches and pains here well as the changes to urination that happens secondary to a growing uterus. Progressively compressed bladder.

A few easy things that you can do here. One is a body pillow. They make many, many different sorts of pregnancy specific and non pregnancy specific body pillows. I can get one with an anime character, if that's your thing. Making sure to avoid evening fluid intake that can, it can be helpful for avoiding nocturia, which is certainly an issue.

I do have to say that there is actually one serious risk to using a body pillow, and that's not to the pregnant person, but to their partner who may never. Get them back. My wife continues to sleep with a body pillow. My son just turned 17 and since that time it has not been something that I had been able to convince her to give up even in favor of myself.

So partners out there, just understand this could, could, could be a problem for you.

Lauren Brown-Berchtold: It sounds like you need a body pillow too, to man.

Tamaan Osbourne-Roberts: I, I, maybe I need therapy. I, I.

Lauren Brown-Berchtold: I thought this was overblown, and you don't necessarily have to go buy a body pillow. You can just get a bunch of pillows. The point is ergonomic alignment of that spine while you're sleeping on your side and, and not getting all twisted outta shape over the course of the hours that you're sleeping. The other thing that you are going to be dealing with when you're taking care of patients in the first trimester is potentially incredibly significant fatigue that feels.

Borderline life changing, right? That you are going to have patients who are convinced something is truly wrong, and it's not that something's wrong, it's that there is a, a little, a little life of a parasite that is sa sapping that energy right on out of them. And luckily, in the vast majority of cases, that's going to resolve hopefully by the end of the first trimester.

Lauren Brown-Berchtold: This was fun. This was fun guys. This was a good review of these. Okay, my friends, on that note, this was really fun. This was a, this was a good like quick review of these topics. As I think about our listeners, like doctors and patients, all of us have questions and it can be really hard to know where exactly to send patients for data, where we can send ourselves for some of this data that feels a little bit more esoteric.

And so this episode I think should be a good reminder for us. And patients to not necessarily believe everything you hear. It's also an opportunity for me to plug one of my favorite apps that I have absolutely no financial stake in, and it's completely free, which is the What To Expect app. When I am in the first visit with my patients for their establishing pregnancy, I have them pull out their smartphone and download that app at that first visit.

It's a book that was around decades ago and it gives you fun, size comparisons of your baby to fruit and vegetables along the way and, and can have some of that anticipatory guidance to really help your patients feel supported when they might be waiting to see you for for several weeks.

Jason Marker: Yeah, that app, and there's others out there that are really great for patients to get even just daily notifications about reminders about their pregnancy, what's happening inside their body.

A lot of the things we talked about today can just be sent as a notification regularly at just the right time in pregnancy to be meaningful for folks who are interested in maybe a paper solution and not an app. I'm gonna plug Emily O's book Expecting Better. It was a real game changer for me, and actually a patient gave it to me.

I read it and thought, this is amazing. And Laster is an economist who. Was pregnant for the first time and was just not getting good advice from people, and she decided to do a bunch of research about what it really says about some of these things that are, are common concerns and questions in pregnancy.

I even wrote a little book report about it and gave it to each of my new pregnant patients at their OB intake visit. Really a high quality document if you're looking for some truth telling and mis buffing in some of these areas.

Tamaan Osbourne-Roberts: And I'm gonna put it actually in a plug for a book for the family.

Sometimes pregnancy can be a bit confusing for younger people who already happen to be in a family. And I'm going to put a plug in for a book. It's not The Stork by Robbie Harris and Michael Berley provides a great explanation as to where babies come from, what happens during the pregnancy in a remarkably age appropriate, but very direct and very honest way.

Lauren Brown-Berchtold: I'm gonna say that that round robin of resources feels like a gratitude for today. That we have all of these great places for us to go. Yeah. And reference for both ourselves and our, and our patients. And so with that to our listeners, thank you all for joining us for another episode. We appreciate you joining us on this journey to elevate family medicine.

To continue this journey. Stay tuned for new content brought to you twice a month with CME on the go. Visit the show notes for instructions on how to claim CME credit and find additional resources for today's episode. Until next time, serve from your values. Pursue your vision. And man, if you see a pregnant lady out there, like just send some good vibes to them through the ether.

See you next time at CME on the go, a production of Inside Family Medicine.