Medical Care During Pregnancy

Why Is Prenatal Care Important?

Prenatal care is health care that a woman gets while pregnant. Going early and regularly for prenatal care can help moms-to-be — and their babies — stay healthy. Regular care lets doctors find and deal with any problems as soon as possible.

It's important to start prenatal care as early as possible — ideally, before a woman even becomes pregnant.

How Can I Find Prenatal Care?

Pregnant women usually are cared for by:

• obstetricians: doctors who specialize in pregnancy and childbirth
• obstetricians/gynecologists (OB/GYNs): doctors who specialize in pregnancy and childbirth, as well as women's health care
• family practitioners: doctors who provide a range of services for patients of all ages (sometimes, this includes obstetrical care) instead of specializing in one area
• certified nurse-midwife: an advanced practice nurse specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for pregnancies without problems

Any of these care providers is a good choice if you're healthy and there's no reason to expect problems with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case a C-section has to be done.

Your health care provider may refer you to a doctor with expertise in high-risk pregnancies if you:

• have a chronic condition like diabetes or heart problems
• have an increased risk of preterm labor
• are older than 35
• are pregnant with more than one fetus
• have another complicating factor that might put you in a high-risk category

Even if your pregnancy isn't high-risk, this may still be a good time to make a change in health care providers if you're not comfortable with your current doctor.

Routine Visits and Testing

You should call to schedule your first checkup during the first 6 to 8 weeks of your pregnancy, or when your period is 2 to 4 weeks late. Many health care providers will not schedule the first visit before 8 weeks, unless there is a problem.

If you're healthy and have no complicating risk factors, you can expect to see your health care provider:

• every 4 weeks until the 28th week of pregnancy
• then, every 2 weeks until 36 weeks
• then, once a week until delivery

At each checkup, your weight and blood pressure are usually recorded. The size and shape of your uterus may also be measured, starting at the 22nd week, to see whether the fetus is growing and developing normally.

During one or more of your visits, you'll provide a small urine (pee) sample to be tested for sugar (glucose) and protein.

Glucose screening usually takes place at 12 weeks for women who are at higher risk for gestational diabetes. That includes women who:

• previously had a baby that weighed more than 9 pounds (4.1 kilograms)
• have a family history of diabetes
• are obese

All other pregnant women are tested for diabetes at 24 to 28 weeks. They'll drink a sugary liquid and have blood drawn after an hour for a blood glucose test. If the blood sugar level is high, more testing can confirm whether it's gestational diabetes.

Prenatal Tests

Many parents-to-be choose to have prenatal tests. These can help health care providers find things like a birth defect or a chromosomal problem in the fetus. Prenatal tests are done in the first, second, and third trimesters.

Some prenatal tests are screening tests that can only reveal the possibility of a problem. Other prenatal tests are diagnostic tests that can accurately find whether a fetus has a specific problem. A screening test sometimes is followed by a diagnostic test. These can include blood tests, amniocentesis, CVS, and ultrasound exams.

Common Pregnancy Concerns

Some women worry about medical conditions they already have, such as diabetes, and how they could affect a pregnancy. It's important to talk with your doctor, who may recommend a change in medicines or treatments that could ease your concerns.

Other conditions that can come with pregnancy include:

• gestational diabetes: Some pregnant women develop this condition, usually after the first trimester. The placenta provides the fetus with nutrients and oxygen, and also makes hormones that change the way insulin works. Insulin helps the body store the sugar in food, which is later converted to energy. In gestational diabetes, a problem with insulin leads to a high blood sugar level.
• preeclampsia (also called toxemia of pregnancy): This condition can happen after the sixth month, causing high blood pressure, edema (fluid buildup in body tissues that causes swelling of the hands, feet, or face), and protein in the urine.
• Rh-negative mother/Rh-positive fetus (also called Rh incompatibility): Most people have Rh factor in their red blood cells (they're Rh positive). Those who don't are Rh negative. A simple blood test can determine your Rh factor. If your baby is Rh positive and you're Rh negative, problems can happen when the baby's blood cells enter your bloodstream. Your body may react by making antibodies that can pass into the fetus' bloodstream and destroy red blood cells.

These conditions are serious but manageable. So it's important to learn about them and discuss them with your health care provider.

Diet and Weight Gain

Many pregnant women wonder about weight gain. Generally, women of normal weight should gain about 25–35 pounds during pregnancy. For women who start their pregnancy overweight, total weight gain should be closer to 15–25 pounds. Those who are underweight should gain 28–40 pounds.

Controlling weight gain is harder later in a pregnancy, so try to avoid gaining a lot of weight during the first few months. However, not gaining enough weight can cause problems too, such as poor fetal growth and premature labor.

Pregnancy is not a good time to start a diet, but it is a great time to enjoy healthier foods. Doctors recommend that women add about 300 calories to their daily intake to help nourish the developing baby. Protein should supply most of these calories, but your diet also should include plenty of fresh fruits, grains, and vegetables.

Your health care provider may prescribe a prenatal vitamin to make sure you get enough iron, calcium, and folic acid. It's also a good time to get regular, low-impact exercise.

What Else Should I Know?

For your baby's sake and yours, it's important to take especially good care of yourself during your pregnancy. Follow these basics:

• Don't smoke, drink alcohol, or take drugs.
• Get enough rest.
• Eat a healthy diet.

OTC Medicines

Over-the-counter medicines are generally considered off-limits because of their potential effects on the fetus. Most doctors recommend not taking any OTC medicines if possible, but might offer a list of those they think are safe. Be sure to discuss any questions about medicines (including natural remedies, supplements, and vitamins) with your doctor.

Food Safety

When you're pregnant, it's also important to avoid foodborne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage. Foods to steer clear of include:

• soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
• unpasteurized milk, juices, and apple cider
• raw eggs or foods containing raw eggs, including mousse and tiramisu
• raw or undercooked meats, fish, or shellfish
• processed meats such as hot dogs and deli meats (these should be well cooked)

Also avoid eating shark, swordfish, king mackerel, marlin, orange roughy, tuna steak (bigeye or ahi),and tilefish. Fish and shellfish can be an extremely healthy part of your pregnancy diet because they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat. But these types of fish may contain high levels of mercury, which can damage the developing brain of a fetus.

Vaccines

Your doctor may recommend a couple of vaccines during pregnancy. The flu shot can curb flu-related problems for expectant moms, who are at higher risk of problems from the illness. The flu shot is recommended by the Centers for Disease Control and Prevention (CDC) during any stage of pregnancy. Pregnant women should only get the shot, and not the nasal spray (or mist) form.

The Tdap vaccine (against tetanus, diphtheria, and pertussis) is now recommended for all pregnant women in the second half of each pregnancy, regardless of whether they've gotten it before or when it was last given. This is because there's been a rise in pertussis (whooping cough) infections, which can be fatal in newborns who have not yet had their routine vaccinations.

Physical Changes of Pregnancy

Pregnancy can cause a number of uncomfortable (but not necessarily serious) changes, including:

• nausea and vomiting, especially early in the pregnancy
• leg swelling
• varicose veins in the legs and the area around the vaginal opening
• heartburn and constipation
• backache
• tiredness
• sleep loss

If you have any of these changes, you're not alone! Talk to your doctor about ways to ease your discomfort.

Talking to Your Health Care Provider

When your body is going through physical changes that may be completely new to you, it isn't always easy to talk to your health care provider. Maybe you're wondering whether you can have sex or what to do about hemorrhoids or constipation, or maybe you're feeling feeling worried about the delivery.

You might feel embarrassed to ask these or other questions, but it's important to do so — and remember, your health care provider has heard them all before. Keep a running list of questions, and take it with you to each visit.

Also, call your doctor right away if you have:

• heavy bleeding
• a sudden loss of fluid
• a noticeable absence of movement by the baby
• more than three contractions in an hour