Thursday, October 29, 2020

Common Pregnancy Questions, Answered!


First Trimester

When should I tell friends and family that I am pregnant?

There is no one right answer to this question. In asking this question, often people want to know when their chances of losing a pregnancy, or miscarriage, are low. Since 15% to 20% of all pregnancies end in miscarriage, many people prefer to share news of their pregnancy only once the risk of loss is minimal.

While there is never a point in pregnancy at which it is impossible to lose a baby, the risk of miscarriage is only about 1% in healthy women once ultrasound or other devices recognize a heartbeat. Many people choose to tell others of their pregnancy once they have either seen or heard the heartbeat. Others prefer to wait until the results of any genetic test such as amniocentesis or screening tests (first trimester free fetal DNA or nuchal translucency measurement with blood markers or second trimester quad screen) have returned. Still others wait until there are visible signs of the pregnancy.

What can I do about morning sickness?

Nausea and vomiting in early pregnancy, often known as morning sickness, occurs in as many as 70% of all pregnancies. For some mothers, morning sickness is only an inconvenience, whereas for others it can be crippling. If you are troubled by nausea and vomiting in pregnancy, a good place to start in managing the symptoms is to identify triggers. Foods, smells, and sensations of heat and cold can often start episodes of nausea and vomiting. It may also be useful to identify particular times of day or locations where nausea and vomiting is most troublesome and time important activities and meals around them.

When troubled by morning sickness, some women find that eating bland foods such as dry crackers offers them relief. Others report that ginger tea can be soothing. Supplementation with additional vitamin B6, or Pyridoxine, has been shown in several studies to be helpful in relieving moderate or severe nausea. Vitamin B is available in many drug and health food stores. Vitamin B can be taken at 25 to 50 milligrams two or three times a day. For those women who continue to be troubled with symptoms, doctors or midwives may be able to prescribe medication.

If you are troubled by morning sickness, it is important to recognize that nausea and vomiting is, in general, not dangerous. In fact, some evidence suggests that pregnancies complicated by nausea and vomiting may end in healthier outcomes than pregnancies in which morning sickness was not experienced. Only in rare cases is hospitalization of the mother needed. And even rarer still, are those situations in which severe nausea and vomiting, or hyperemesis, compromises a mother’s or a pregnancy’s long-term health. Nonetheless, the symptoms can make the first weeks of pregnancy miserable. Fortunately, with or without treatment, most women note marked improvement by 12 to 16 weeks of pregnancy.

I had some bleeding early in my pregnancy. Is this normal?

Bleeding early in pregnancy is not normal but it is common. Twenty percent to 25% of pregnancies are complicated by early bleeding. In general, the cause of such bleeding remains a mystery. In approximately one-quarter of cases with early bleeding, particularly those in which bleeding is heavier, pregnancy may end in miscarriage. Another quarter of those with early bleeding will have further complications during their pregnancy, either continued bleeding or early contractions (preterm labor) or early rupture of the membranes (breaking the bag of water before their due date). In approximately half of all pregnancies with early bleeding, however, the bleeding slowly disappears and the pregnancy continues without further complication.

Because bleeding can also be a sign of a pregnancy in the fallopian tube, or ectopic pregnancy, women with bleeding should contact their health care provider. The health care provider will often arrange blood tests or ultrasound to evaluate a pregnancy’s continued health and location. Notifying your physician or midwife is especially important if you have pain in association with your bleeding.

No particular treatment is necessary when bleeding is noted early in pregnancy. Bedrest, hormone treatments, nor other medicines improve the health of a pregnancy in which bleeding is noted. If your blood type is negative (e.g., A negative), your health care provider may wish to treat you with an injection of RhoGAM to prevent problems in future pregnancies.

When will I have an ultrasound? And is it necessary to have one?

Ultrasounds are obtained during pregnancy for two reasons. The first is to help diagnose the cause of a particular symptom or physical finding, and the second is to screen for problems or conditions that might be present but have not caused symptoms. Ultrasounds obtained for the first reason are done when the problem arises; for example, at the time of pain or bleeding or if your health care provider thinks that the size of your uterus is smaller than expected for the age of the pregnancy.

While ultrasounds obtained to evaluate ongoing problems seem to be of clear benefit, the advantage of screening ultrasounds is widely debated. Because ultrasound may detect some but not all birth defects, the benefit of the procedure early in pregnancy is not always clear. Despite this debate, many patients and health care practitioners decide to obtain an ultrasound at 16 to 20 weeks of pregnancy, when the pregnancy is large enough to be seen in some detail but still young enough that if severe defects are found, termination of the pregnancy could be considered. Recently, it has become common to have blood tests alone or in combination with a special ultrasound called a nuchal translucency screening during the first trimester to screen for birth defects.

Should I have a blood test for Down syndrome?

The decision to pursue genetic testing is a personal one. If a severe birth defect or syndrome were detected, would you consider pregnancy termination (abortion)? Would you just want to know so you could prepare yourself and others before the birth? Medical management of a continuing pregnancy will probably not change based on the results of the test.

While these decisions are difficult, it is perhaps best to consider the issue before proceeding with testing. Getting information simply for the sake of having information is not always best.

Most newborns have 46 chromosomes, which are large collections of genes and DNA. Twenty-three of the baby’s chromosomes come from the mother and 23 come from the father. Rarely a pregnancy receives too many or too few chromosomes. The most common chromosomal abnormality resulting in a live birth is Down syndrome, which is the result of having an extra chromosome (47 chromosomes in total). The risk of having Down syndrome rises with advancing maternal age and leads some older women to choose amniocentesis or chorionic villus sampling (CVS) early in pregnancy. Amniocentesis uses a needle to remove some fluid from around the baby. CVS uses a needle to remove a small sample of the developing placenta. Material from the fluid or placenta can be examined and the chromosomes counted.

There is a small risk of miscarriage with amniocentesis and CVS. And the majority of Down syndrome babies are born to younger women (even though the risk is lower in younger women, younger women have more babies than older women). So, there has been lots of interest in developing tests that don’t require such an invasive procedure. Several noninvasive screening tests have been developed, each of which measures the levels of different substances in the maternal blood. For example blood tests and a special ultrasound called a nuchal translucency screening during the first trimester can help a couple evaluate their risk of having a baby with Down syndrome. A newer screening test looks for small amounts of fetal DNA in a mother’s circulation.

Women at increased risk on screening then have the option of choosing amniocentesis or CVS. It is important to remember that a screening test with a positive result does not mean that there is a problem with the pregnancy. A positive result indicates that the risk of complication like Down syndrome is higher (not high) and that the couple needs to consider if further testing is appropriate. Similarly, a test that is negative doesn’t mean that there is absolutely no problem. It just means that the chances of a problem are less likely.

Second Trimester

Can I exercise?

Yes. In uncomplicated pregnancies, there is no evidence to suggest that exercise has any negative effect on either a mother’s or a baby’s health. In fact, some studies suggest that exercise during pregnancy improves outcomes. In planning exercise during pregnancy, it may be best to follow these guidelines:

  • Drink plenty of water or sports drinks.
  • Don’t exercise to exhaustion. If you feel dizzy or lightheaded, slow the pace of your exercise or stop for a while until you feel better.
  • Use exercise in pregnancy to maintain fitness, not to push to the next level of training.
  • Recognize that your energy and stamina will decrease as pregnancy advances so you will probably find that you aren’t able to exercise as hard or as long as before becoming pregnant.

Most aerobic exercises are appropriate to continue in pregnancy. Walking, running and swimming may all be continued in pregnancy. Only a few forms of exercise should be avoided during pregnancy. Because your center of gravity and sense of balance shift with advancing pregnancy, activities requiring fine balance (inline skating, bicycling) are probably best avoided, particularly late in pregnancy. Activities in which there is a risk of falling or hitting your abdomen are also best avoided. Such activities may include water skiing, contact sports and snow skiing (even if you are an expert skier, others around you may have less control). Finally, practitioners often recommend that pregnant women avoid exercises that require them to lie flat on their back for periods longer than 5 to 10 minutes, although there is little evidence to suggest that such positioning is really harmful. Stretching or other similar exercises such as yoga are fine during pregnancy if you keep the above cautions in mind.

Third Trimester

When should I stop working?

The decision to stop working is a careful balance of how a mother is feeling, the reward and satisfaction she receives from her job, and the nature of her job. In uncomplicated pregnancies, continuing to work up until the time of labor has not been associated with important complications. Occasionally, problems such as preterm labor or elevated blood pressure arise during pregnancy that lead providers to recommend that women stop working. Because one’s maternity leave is often limited, many women without such problems prefer to preserve their leave for when the baby has been born and, therefore, work until time of delivery. Remember, babies may be born as late as one to two weeks after their expected due date. If you stop working one or two weeks before, you may spend as long as a month at home waiting for the newest arrival.

Concerns about specific symptoms or jobs are probably best discussed with your health care provider.

When will the baby come?

Although you have been given a due date by your health care provider, it is best to remember that this is just an estimate. While large populations of women on average deliver on their due date, individuals in that population may deliver several weeks before or after that target. You may note signs, such as increasing contractions, loss of the mucous plug, a small amount of vaginal bleeding (a bloody show), that indicate that you are more likely to deliver sooner rather than later. Similarly, your health care provider may examine your cervix, find that it is dilated, and tell you that this increases your chances of delivery in the next several days. It is important to remember, however, that none of these signs are absolute. Women may have contractions and be dilated as much as 3 or 4 centimeters for several weeks. Similarly, someone with a cervix that is not dilated and has had no discomfort or contractions may suddenly rupture her membranes and go into labor as her due date approaches.

Many providers today prefer not to let women go more than one or two weeks past their due date. Women who go more than two weeks past their due date are at increased risk of complications with their pregnancy. Accordingly, as your due date passes, your health care provider may wish to obtain testing (fetal heart rate monitoring and/or ultrasound) to help confirm the pregnancy’s continued health and may discuss using medicines or other things to start (induce) labor. The decision to proceed with induction will be made together with your health care provider as you consider your health, the pregnancy’s health, and your expectations and wishes regarding labor and delivery.

How long is my maternity leave?

Maternity leaves vary somewhat with individual pregnancies and complications of pregnancy and labor and delivery. In the United States, usual disability coverage (paid leave) is six weeks for a vaginal delivery and eight weeks for a cesarean delivery. (In other countries, two or more months of leave are common.) Some women will be ready and eager to return to work sooner than these periods, and others will require further leave. The details of your maternity leave are probably best discussed with your human resources manager and your health care provider. It is important to remember that the decision to extend maternity leave often requires a medical reason.

Because the newborn period can be both a challenging and a special time, many women prefer to take longer maternity leaves. The Family and Medical Leave Act provides for up to 12 weeks of unpaid maternity leave. In general, this means that your job will be held for you should you choose to return inside of that 12-week period. The Family and Medical Leave Act does not mandate that your employer pay you during this time. Some women have accumulated vacation leave that they can use during this period, however. Again, individual details are probably best considered with your human resources manager.

Medically trained in the UK. Writes on the subjects of injuries, healthcare and medicine. Contact me

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