Sunday, July 25, 2021

The Start of Your Pregnancy Journey

This is an INFORMATION page, verified by physician

The Positive Test

Welcome to the start to your pregnancy journey! This is an exciting season in life. In preparation for your baby, now is the time to review your diet, lifestyle, vitamin supplements and medication. If you’ve followed the advice in the BEGINNINGS section of this website you will already be well prepared. But we know that some pregnancies are happy accidents so now is the time for a quick re-cap.

Folic Acid

You should be taking folic acid. This can help prevent birth defects such as spina bifida where the baby’s spine and brain doesn’t form as normal. The normal dose for folic acid is 400 micrograms. This is in all routine pre-pregnancy supplements. Haven’t been taking these vitamins? Please go to your local pharmacy and start taking folic acid as soon as you’ve had a positive pregnancy test. Some women need to take an increased dose of folic acid 5mg daily but your GP will already have discussed this if it applies to you.

Vitamin D

Surprisingly, for a population living on a sunny Caribbean island, Vitamin D deficiency is relatively common. This is due to use of high factor sunscreen and working indoors. It is recommended that all pregnant women take a Vitamin D supplement throughout pregnancy. Rather than having a vitamin D blood test, the best advice is to choose a pregnancy vitamin supplement which contains both folic acid and vitamin D.

Caffeine

It is recommended that women restrict their caffeine consumption in pregnancy. High caffeine intake is possibly linked to growth restriction in the late stages of pregnancy. Reduce your caffeine intake so that you are having no more than 200mg of caffeine per day. This is the equivalent of 1 to 2 cups of coffee per day. Remember teas, colas and other beverages may contain caffeine too.

Current advice about alcohol is that pregnant women should have no more than one or two alcoholic drinks per week. But it is better if you can give up alcohol altogether as there really is no safe level of alcohol in pregnancy.

Dietary Advice

You should be eating a varied diet. Base your meals on starchy food such as wholegrain bread or pasta, potatoes or brown rice and a good intake of fibre rich foods. You should aim for 5 portions of vegetables or fruits a day and avoid foods and drinks high in sugar or fat. See advice on weight management in pregnancy for more detailed information.

Now, more than ever before we are looking at our diets and considering what we put in our bodies. The modern world recognises personal choice to follow a vegetarian or vegan diet or to remove allergens from our diet which make us feel unwell such as wheat or gluten.

Following a vegetarian or vegan diet means that you need to consider how to ensure that you are getting the full range of vitamins and nutrients. It is important to ensure that you are following good nutritional advice. If necessary, supplement your diet with vitamins and micronutrients to ensure that your body is ready for pregnancy.

Pregnancy places demands on the mother’s body. The baby can only get nutrients across the placenta from the Mother to be. It is therefore important to make sure that your diet is balanced and contains enough protein, energy, vitamins and micronutrients to support the baby’s development.

Vegetarian/Vegan/Pescatarian Dietary Advice

You can continue to follow a vegetarian, vegan or pescatarian diet. But you do need to be careful that you provide your developing baby with all that it needs. Pregnancy needs an increase in protein intake of about 20-25%. You can do this by increasing intake for example by 1.5 cups of lentils or 2.5 cups of soymilk per day. Vitamin B12 is found in animal products so it is very important to make sure that you have B12 supplements to meet your baby’s need. It is very difficult to get iron from plant sources so again supplements may be necessary.

The recommended intake during pregnancy for a woman following a vegan diet are:

  • 1-2 servings of dark greens
  • 4-5 servings of other vegetables and fruit (preferably more veg than fruit)
  • 3-4 servings of beans and soy products
  • 6+ servings of wholegrain products
  • 1-2 servings of nuts, seeds or wheatgerm

If you are vegetarian/pescetarian rather than vegan you may get some of your protein from eggs, dairy and fish and seafood. If this is the case, adjust the advice above according to your protein intake.

Keen to continue your dietary preferences during pregnancy? Discuss this with your obstetrician or GP. Consider seeking specialist advice from a dietician. That way you can be sure that you are doing the best for both you and your baby.

Exercise

It is recommended that most adults should do moderate exercise for 20-30 minutes 2 to 3 times a week. This might include brisk walking, jogging, cycling or swimming. You may be used to doing exercise class such as Pilates, yoga or a work out class. But check whether it is safe to continue in pregnancy.

It is fine to continue exercising regularly. But it is best to avoid high impact exercise in pregnancy. Your ligaments soften due to the pregnancy hormones so it is easier to put joints and muscles under strain. If you have access to a personal trainer they can help you to devise an exercise regimen which will be safe in pregnancy. Or you could switch to programmes designed for pregnancy such as antenatal yoga and swimming.

When is the baby due?

Make a note of your last period and ideally, the last few periods. Your obstetrician will find this information helpful in dating your pregnancy. They will want to offer you an early pregnancy scan but the pregnancy sac can’t reliably be seen before 5 weeks. The tiny baby (fetal pole) can be seen from 5 weeks + 2 days, and a fetal heart from 5 weeks + 6 days so it’s important not to have a scan too early. An inconclusive scan done too early just raises your anxiety.

If you are uncertain about the date of your last period your GP can arrange a blood test to measure the pregnancy hormone called βHCG. This can give an estimate of how far long the pregnancy might be. This might also be helpful if you have irregular period or have recently used hormonal contraception including the morning-after pill.

The First Twelve Weeks

Medications

This crucial stage of pregnancy is the time when all the baby’s organs are forming. This is why it’s vital to be taking your folic acid and vitamin D. It’s also an important time to review any medication that you are taking. Whether prescribed by your doctor or over the counter from the pharmacy.

Don’t stop any prescribed medication without discussing this with the prescribing doctor. There is very reassuring information on the BUMPS website (www.medicinesinpregnancy.org).

Often the first 12 weeks are a time of feeling tired and fatigued. Remember that your body is having to work very hard at nurturing the pregnancy. So don’t feel guilty about listening to your body and resting when you need.

Morning Sickness

Nausea and even vomiting is also common at this stage of pregnancy. It can occur at any time of day, not just the morning.

It helps to eat little and often, especially try to have a biscuit or dry toast even before you get up in the morning. Natural remedies such as ginger and acupressure (travel sickness) wrist bands can help. In severe cases your obstetrician can prescribe some medication to help. It is essential to seek urgent help if you are struggling to keep fluids down. You can quickly become dehydrated and may need intravenous fluids.

Booking Appointment

Between 8 and 13 weeks you will have the Booking Appointment to plan your care in pregnancy, birth and beyond. Your obstetrician will take a detailed history. This will include your medical history, any previous pregnancies and the family history for you and your partner.

Blood Tests

There are some vital blood tests that you need at this stage. These include screening for anaemia, your blood group and antibodies, screening for blood infections such as hepatitis B, HIV and syphilis. You will be offered screening for conditions such as sickle cell disease and thalassaemia. These are known as haemoglobinopathies. These conditions usually cause no or very mild symptoms in carriers. But if a child inherits the abnormal haemoglobin gene from both parents, they can suffer from very serious blood disorders. If you are a carrier of a haemoglobinopathy, your partner will also be offered a blood test. You will be offered a scan which will confirm the estimated date of delivery and will start to look at the baby’s anatomy.

Other Tests

There are some extra tests which can detect the risk of problems in the baby at this early stage. The 12 week scan will look at the development of the baby’s skull and spine. This is looking for conditions linked to spina bifida. There is a hormone blood test which can also show if the risk of spina bifida is increased but it is very unusual for this not be picked up on the scan.

Older women have an increased risk of having a baby with three copies of a chromosome. Such as in conditions like Down syndrome (three copies of chromosome 21 as shown below).

Standard human karyotype

There are now tests which can detect an increased risk of the baby having a chromosomal or heart problem. This is a detailed scan looking at the thickness of the skin on the baby’s neck – the nuchal translucency test. This is not included in a routine 12-week scan. Discuss this with your obstetrician if you might want this test. There is also a blood test – the Panorama test – which can pick up the baby’s DNA in the mother’s blood and can detect whether a baby has an extra copy of chromosome 21 (Down syndrome), 18 (Edward syndrome) or 13 (Patau syndrome). These are not routine tests and may not be covered by your insurance.

Pregnancy Loss

Sadly, not all pregnancies go on to develop normally. Approximately 1 in 6 pregnancies end in an early miscarriage. 1 in 100 pregnancies do not develop inside the womb, known as an ectopic pregnancy. For more information on pregnancy loss please see the section in the Beginnings.

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about the author

Dr Lisa Joels

MB ChB, MD, FRCOG, FHEA

OBSTETRICIAN & GYNAECOLOGIST

Dr Joels has 34 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20). These are both University teaching hospitals, each having more than 4,000 deliveries a year and providing tertiary obstetric and neonatal services as well as gynaecological services to their local population.



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