Treatment
Now more than ever is the time to follow guidelines for a balanced, nutritious diet. Early in pregnancy, your baby's central nervous system and organs are forming; later in pregnancy, the baby is growing longer and heavier. Your body needs increased nutrients and protein to keep your baby healthy during pregnancy, particularly if you plan to breastfeed after delivery.
As a basic guideline, nutrition experts who specialize in prenatal care recommend you plan your meals and snacks to include foods from the following:
Bread, cereal, rice and pasta, particularly whole-grains
Fruit and vegetables
Low-fat milk, yogurt and cheese
Meat, poultry, fish, dry beans, eggs and nuts
A note about fish. Some fish contains high levels of mercury that can harm your baby's developing nervous system if eaten regularly. However, a recent federally-funded report recently released by the Institute of Medicine (IOM) showed that the heart benefits of seafood outweigh the risks. The report showed that omega-3 fatty acids found in fish promote healthy vision and brain development in infants whose mothers consume seafood while they are pregnant or nursing. These healthy fats also appear to lower the risk of delivering a preterm or low-birth-weight baby.
So does this mean you should eat fish or not? The answer is you should eat fish, but you should make sure it's the right kind. Guidelines issued jointly in 2004 by the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) noted that pregnant women can safely eat up to 12 ounces (about two servings) a week of a variety of cooked fish and shellfish with lower levels of mercury, such as clams, oysters, catfish, crab, haddock and trout. If you choose tuna, stay away from albacore, or white tuna, which contains higher levels of mercury levels than canned tuna. The FDA and EPA also recommend that women of childbearing age, pregnant women and breastfeeding women not eat shark, swordfish, king mackerel or tilefish, which have high levels of mercury. Fats, oils and sweets. Foods in this category lack nutrients and provide mostly calories. They should be consumed in small amounts.
Weight Gain and Pregnancy
There is no magic number for how much weight you should gain during pregnancy. Every woman is different when it comes to height, weight, physical activity and metabolism. A healthy pattern of weight gain is about three and a half pounds during the first three months of pregnancy, and about a pound a week for the remainder of your pregnancy, but your health care professional will tell you the appropriate amount for you.
General guidelines from the Institute of Medicine recommend that women who were underweight before getting pregnant gain 28-40 pounds during pregnancy; normal weight women gain 25-35 pounds; and obese woman gain no more than 15 pounds.
Gaining too much weight during your pregnancy can have long-term consequences, according to a study by researchers at Gundersen Lutheran Medical Center in Wisconsin. They tracked the weight of 500 women from their first prenatal visit to between five and 10 years after delivery. Their findings suggest that if you gain too much weight during pregnancy and have trouble shedding it after delivery means the weight may stay with you for years. They also found that breastfeeding and regular aerobic exercise help reduce excess pregnancy weight.
But avoiding excessive weight gain during pregnancy is easier said than done, as most women know. That's especially true if you suddenly have to reduce your normal physical activity because of your pregnancy. To compensate, limit snack foods high in calories and low in nutritional value, such as cookies, doughnuts, chips, soft drinks and cakes. Choose fresh fruits, vegetables and skim milk instead.
Also, if you're obese during pregnancy you have a greater risk of having a stillborn, premature, or overly large baby, or a baby with neural tube defects. Your baby also has a higher risk of being obese in childhood. Thus, ACOG recommends that obese women planning to conceive get a preconception consultation, weight-loss counseling and continuing nutritional counseling and exercise programs after delivery.
Morning Sickness
If you're concerned you're not gaining enough weight or if your appetite is decreased from morning sickness, discuss your concerns with your health care professional. You may want to see a nutritionist to make sure you get enough calories during the day.
The good news is that in 75 to 80 percent of women who suffer from morning sickness, will no longer have this problem after the third month of pregnancy. Your health care professional can provide information on strategies to decrease nausea and or vomiting and offer medications for your morning sickness, if these strategies don't work. Here are some suggestions to help minimize this problem: - Eat saltine crackers or dry bread just before you go to bed at night and when you first wake up in the morning.
- Eat smaller, more frequent meals so your stomach never gets completely empty.
- Avoid greasy or fatty food.
- Drink fluids between rather than during your meals.
- Get enough rest and take breaks when your energy level is low.
- Don't drink large amounts of coffee and tea.
- Avoid highly seasoned foods, cream, and strongly flavored vegetables such as onions.
- Take 350 mg. of ginger in the form of soft capsules three times a day
- Take a daily multivitamin or prenatal vitamin beginning a few weeks before conception at the time of conception.
- Take 25 mg three times a day of vitamin B6 alone or with the antihistamine doxylamine
If you have severe "morning sickness" that continues all day, every day, or lasts beyond the first three months of pregnancy, discuss it with your health care professional. You could have a condition called hyperemesis gravidarum that affects up to 2 percent of pregnant women, causing extreme nausea and vomiting.
Gastrointestinal problems
Heartburn. You may experience heartburn or indigestion during your pregnancy. These problems typically show up later in the pregnancy and are caused when stomach acid backs up into your esophagus, causing a burning sensation in your throat and chest.
This occurs because during pregnancy hormonal changes slow the process of digestion and relax the muscles that normally keep the stomach acids where they belong. Plus, pressure from the baby tends to push on the stomach, causing acid reflux. Here are a few things you can do to minimize discomfort from these feelings:
- Avoid large meals and eat more frequent, smaller meals
- Avoid large spicy meals and fried or fatty foods
- Avoid exercising or going to bed within two hours after eating
- Ask your health care professional about antacids that might provide relief
- Raise the head of your bed a couple of inches by putting the bed's legs on a couple of bricks.
Constipation. You may also experience some constipation during your pregnancy. This occurs partly because your baby puts pressure on your bowel, and partly because of hormonal changes that slow the passage of food through your digestive system.
To minimize constipation, eat foods that are high in fiber, exercise, and drink lots of non-alcoholic and non-caffeinated fluids.
Hemorrhoids. Sometimes your constipation may be accompanied by hemorrhoids, enlarged veins near your anus. You may get hemorrhoids during pregnancy even if you don't have any problems with constipation. They occur, in large part, because the growing baby puts pressure on these veins, causing them to swell.
Try not to strain during bowel movements, because that could make your hemorrhoids worse, leading to itching, soreness or even bleeding. If you have hemorrhoids, increase your fluid and fiber consumption and check with your health care professional first before taking any medication.
Varicose Veins
Varicose veins are veins in your calves, thighs and vagina that become swollen and painful during pregnancy. They get worse if you have to stand for long periods.
The best remedy is to wear support stockings. Lying on your side or sitting with your legs elevated can also help. If you must stand for long periods of time, move around as much as possible and lift your heels or toes to increase circulation to your legs.
Sleeplessness
In the early months of your pregnancy, you may find you're more tired than normal, taking more naps and sleeping longer. In later months, you may begin to experience some sleep problems, including problems falling and staying asleep as the growing baby makes lying down uncomfortable.
Some of these problems may get worse as you get closer to your delivery time, and you may find you get your sleep in shorter stretches.
To help with pregnancy-related insomnia:
- Take warm baths before bed
- Learn relaxation exercises
- Lie on one side with a pillow between your legs, and/or a body pillow that helps you stay in this position.
Emotions
In addition to the physical changes of pregnancy, you may also feel as if you're on an emotional roller coaster as well. During the first three months of pregnancy, you're still adjusting to the idea of being pregnant and the prospect of becoming a mother (if it's your first time) or adding another child to your family.
The middle part of your pregnancy may be more relaxing and calmer as you ease into the routine of pregnancy and begin bonding with the baby.
During the last phase of your pregnancy, however, you may find yourself feeling more anxious, fearing any complications during labor and delivery. Many women experience nightmares or other disturbing dreams about their pregnancy, labor and birth. Dreams are a way of expressing our anxieties.
Discussing your feelings with your partner and health care professional could help allay some of your anxieties and make you feel more positive about the whole experience.
Sexuality
Don't be surprised to find your feelings about sex with your partner change during pregnancy. Some women report feeling increased sexual desire because of hormonal surges. At other times, you may feel a decreased desire for sex.
Additionally, physical changes may interfere with your desire for sex, including nausea, physical discomfort, fear of harming the baby and feeling less desirable because of your weight gain and change in appearance.
Don't worry about hurting the baby during sex; that won't happen because of the cushion provided by the fluid in the amniotic sac. Try different positions that don't put pressure on your abdomen. And if you're concerned that sexual activity might interfere with or cause a pregnancy complication, discuss the matter with your health care professional.
Your partner also may have a different sexual response to you during pregnancy. Some women report their partner draws closer to them during pregnancy, while others say their partners go through their own psychological changes and withdraw from the relationship. If your relationship becomes too strained, your health care professional can refer you for counseling and or other mental health services.
The following discussion addresses treatment options for more serious medical considerations during pregnancy that haven't already been discussed in the Diagnosis section.
HIV transmission. HIV is the virus that causes AIDS. Twenty percent of babies born to untreated HIV-positive women become infected with the virus. But if infected women take anti-viral drugs during their pregnancy, this number can be reduced to close to zero.
If you're pregnant and don't know if you have HIV, you should get screened. If you are HIV-positive, your health care professional can start you on drug treatment to reduce the risk of transmitting the virus to your baby.
Miscarriage. Also known as a spontaneous abortion, a miscarriage is defined as the loss of your pregnancy before 20 weeks' gestation. It's not as uncommon as you may think, occurring in about 15 percent of all pregnancies.
Miscarriage usually happens in the first trimester, that is, during the first 12 weeks of pregnancy. After four months, it's much less likely to occur. However, the risk of miscarriage increases with age.
If you have a miscarriage, it's important to know that it doesn't necessarily mean you won't be able to carry a baby to full term in the future.
Early warning signs of a miscarriage include:
- Vaginal spotting of blood
- Pain in the lower back
- Cramps in the lower abdomen
- Heavy bleeding with clots
Most women who have bleeding or cramps during early pregnancy are NOT miscarrying, and the pregnancy usually progresses normally.
The loss of your baby through a miscarriage is emotionally traumatic. You should discuss your feelings with your partner and others; your health care professional can recommend a bereavement counselor if you want to consider this option for helping you overcome your grief and loss.
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Create Date: 3/1/02
Date Last Updated: 11/21/06
Review Date: 12/23/05
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