P R E N A T A L  H E A L T H

PRENATAL HEALTH

Following is information regarding prenatal health, generally organized by trimester. I offer this set of considerations and information as anticipatory guidance directed towards issues that often come up during pregancy. These sections cover a broad array of subjects related to prenatal health. If you have additional questions or concerns about these topics or anything that is not covered in the following sections, please bring them up during our next visit or, if the question is pressing, email it .


FIRST TRIMESTER

To eat or not to eat….ah the dilemma

Now that you are pregnant, there are so many concerns you have. Don’t worry, nine months is a long enough time to get it all straightened out. The question “what to eat, if indeed I ever get my appetite back?” probably sums up one of the highlight challenges of the first trimester.

Bottom line is: trying to get perfect nutrition is an impossible feat and clearly not the highest priority of the first twelve weeks. If it were, I’m sure that we would all be ravenously hungry (especially for dark green leafy vegetables and salmon) instead of being dominated by a vast array of aversions including those of an olfactory nature (fumes). 

Of course good nutrition is very important, so when you can eat, better to consume nutritious calories if at all possible. That being said, I have also recognized over the course of many years of watching pregnant women, that most of us could eat very little the first trimester, have trouble keeping our vitamins down, and do not feel inclined to engage in our regular exercise routines. Even though this is the reality that every woman faces first trimester, we still seem to be upset that we can’t eat and think that somehow, we must be doing something wrong (guilt…..the plight of motherhood, why not get started now).

What does seem to be suggested by the physiology of pregnancy, however, is that it is wise not to ingest toxins while the baby’s organs are forming. The bionic nose is part of this protective mechanism. It’s fun to let go and trust it, instead of becoming bogged down with a lot of rules of conduct.  So just to add a note of hope to the dismal way we often feel re: our appetite the first trimester . . . it usually doesn’t last past 12 weeks (there are exceptions as in everything). You don’t have to wait to give birth before enjoying food once more.

SOME SUGGESTIONS TO MAKE YOUR FIRST TRIMESTER MORE COMFORTABLE

- Take chewable vitamins (2 Flintstones for example), in order to ensure your folic acid requirement.

- Don’t force yourself to exercise, thinking that you will never get your energy back, so you’d better overcompensate now. You will!!

- Keep fresh air moving.

- Carry around an individually packaged mint tea bag. Have it ready to sniff, in case you feel nauseous.

- Ginger, as a tincture under the tongue or chewing ginger candies can help with abating queasiness. Keep in mind that when we say help, we don’t mean make disappear (don’t get mad).

- The nguyens acupuncture point is certainly easy enough to access and is one of the few techniques that was actually studied and proven useful in terms of diminishing nausea during the first trimester.  It is located about 3 fingerbreadths back from the bend of the wrist, between the two stringy ligaments on the forearm (thumb side).

- We’ll get to suggestions for healthy eating later, when you can eat. No need to worry about weight gain either, as it is possible to lose weight or gain as little as 2 lbs in the first 12 weeks (first trimester).


ANTEPARTUM TESTING

A few guidelines to keep in mind when facing the battery of possible tests you will consider doing during your pregnancy. Just because a test exists doesn’t mean that you need to do it. Most of us think that we should test for everything we can and it will give us the certainty we crave of the baby’s well being. We are therefore grateful that such testing exists. We should be, as long as we don’t ignore the obvious caveat that we will have to deal with the results.

Usually the most damaging aspect of agreeing to many antepartum tests is that we are unaware as to what information the test will really give us. We tend to be a bit blinded by our desire to know everything, hence the reverence of the technology that can deliver this certainty

Most antepartum testing comes in two varieties: screening or diagnostic. Practitioners inherently understand how the certainty of the information differs between these two varieties. Let me explain:

Let’s take the Ultrascreen or Nuchal Translucency test. This test is a brilliant screening test. Its selling point is that it can predict within about 96 percent accuracy whether or not your baby has down’s syndrome, very early in the pregnancy (11-13wks). You are also able to do this without introducing the risk of amniocentesis (no needle goes into the uterus, therefore no risk of miscarriage). I agree that the test is brilliant, but would just like to recount some of my patients’ experiences with this test to illustrate the kind of information that screening tests can give.

I had one mom who was 41, not expecting to be pregnant for the fourth time. Because of her increased chances of adding the potential challenge of a down’s baby (at her age about one in 40) to her already full family of three boys, she decided to do the Nuchal Translucency or ultrascreen, after informed consent from me. What this particular screening test does is just to add yet another variable (early ultrasound) to the probabilities and statistics equation used to calculate her risk.
The former test plugged the levels of four unique substances in the mom’s blood (amongst them AFP and free estriol) into an equation along with her age (41). The results were presented in the following format: Her risk of a down’s baby before testing was 1:40 (based exclusively on the age-related risk). Her results after screening were 1:41, basically the same as her age-related risk. (Ideally speaking the results after screening would read 1: over 271).

Clearly this particular result fell into the category of needing to continue on to the diagnostic test, which is the one that gives you a definitive answer instead of an estimated probability of the risk. Lo and behold though, the reason she had chosen to do the Nuchal was because she absolutely did not want to do the amnio (diagnostic test) with the inherent (although very small 1:200-500) miscarriage risk. Her perinatologist assured her that he could look again at the 20-week anatomy scan for soft signs of down’s. However, she had to continue the remainder of her pregnancy, having seen the results of the screening test point to a one in 40 chance of her having a down’s baby (which was where she started in the first place looking just at her age-related risk) and the authority that this testing carried. The fact that the perinatologist did not see any of these signs at the 20 wk anatomy scan was extremely reassuring to her now befuddled, angst-ridden self.

Fortunately she had the experience of having given birth to 3 healthy boys previously, and somehow that carried her through to the birth of her perfectly normal fourth boy.

This is a true story.

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I must tell one more story to illustrate another scenario that could really take the wind out of one’s sails if it happened to you. Another true story. I consulted with a mom, who I eventually helped through the pregnancy and birth of her third healthy baby. When I met her at the consult we shared teary moments about how she had found positive for a baby with a neural tube defect (probably spina bifida, a very rare abnormality of the formation of the spinal column) and had terminated her former pregnancy. Although she still grieved the child, the piece that was the most disturbing was that she (along with her very supportive husband) had had to make the decision to terminate the life of this child and felt terribly responsible for this. That is only natural, but the thought that haunted her was what if the sonogram, or amnio, was wrong? It is a harrowing experience to live with this sense of responsibility. I’m not suggesting by this story that we eradicate the option to test, but just that we go into it with full realization of the position the results of these tests may place us in. If after this being said, you decide to test, then I feel that the results will serve you very well. Deep breath (me too)!!

> SECOND TRIMESTER