The Definitive Pregnancy Guide

Pregnancy at 4 months

At Desert Perinatal Associates we specialize in high-risk pregnancies, so we are always being asked for advice on managing a pregnancy.  The do’s, the don’ts, what’s safe, what’s not safe.  To ease your mind we put together this pregnancy guide that can help to answer some of the most common pregnancy questions.

It’s normal to have questions and we are here to help.  If we missed something, or if you still have concerns please be sure to talk with your physician the next time you visit Desert Perinatal Associates.

Acne:   

Many women will experience acne for the first time when they are pregnant and unfortunately, women who already have acne will often notice a worsening of their acne symptoms.  Placental hormones increase the oil production in your skin, thus increasing the amount of acne.  There are some products that can help, but you should avoid skin cleansers or creams with high levels of Salicylic acid and all Retin-A products.   However, it is okay to use over-the-counter Benzoyl Peroxide cream as well as creams containing Clindamycin and Erythromycin.

Alcohol:

Alcohol is a toxin and travels easily through the placenta to your baby.  Large frequent amounts of alcohol can cause fetal alcohol syndrome, which can result in physical facial abnormalities as well as severe neurological and developmental problems.  The greatest risk factor for fetal alcohol syndrome is binge drinking or drinking seven or more alcoholic drinks per week.  However, it is recommended that pregnant patients stay away from all alcohol during all stages of pregnancy.

Anti-Depressants:

About one quarter of our patients are on an anti-depressant/anti-anxiety medication such as Prozac, Zoloft, Lexapro and Celexa.  Unfortunately, many doctors tell their patients to go off their anti-depressants as soon as they become pregnant.  We recommend NOT doing that.  The only anti-depressant we would recommend discontinuing is Paxil.   The common Serotonin Reuptake Inhibitor (SSRI) antidepressants such as Prozac and Zoloft are possibly associated with high blood pressure in the newborn baby’s lungs, known as pulmonary hypertension.  THIS IS LESS THAN 1% of babies.  Also, you may hear that the above medications may result in fetal withdrawal when your baby is born.  Again, for the most part this is theoretical and, if it occurs, it is extremely rare.  We feel that depression and/or anxiety are real diseases, and, therefore, medication is a necessity and we recommend NOT discontinuing it unless your OB/GYN or maternal-fetal medicine (MFM) recommends it.  It can be dangerous just to stop these medications abruptly.  Untreated depression and/or anxiety are risk factors for preterm labor, and most MFM specialists feel comfortable with their patients staying on these medications.  Always consult with your doctor before starting or stopping any medications for depression.

Artificial Sweeteners:

Sucralose (Splenda®), Aspartame (Nutrasweet®), and Stevia® are popular sugar substitutes found in many products.  Only Aspartame and Splenda have been cleared by the FDA to be used in moderation during pregnancy.  Stevia comes from a South American shrub. Although it is more “natural”, it is not officially “cleared” by the FDA.  However, it would be very unusual for it to cause any problems to an unborn baby.

Caffeine:

Caffeine is found in coffee, tea, and chocolate.  The studies that have looked at the risk of caffeine intake in pregnancy show conflicting results.  There is a great deal of conflict concerning the amount of caffeine that it takes to increase the risk of first trimester miscarriage.  If there is a risk, it most likely is increased with someone drinking more than 4 cups of coffee a day.  There has never been a study that shows that there is an increased risk of someone having only one cup of coffee a day (<100 mg/day).

Approximate caffeine content in common drinks (mg):

  • Can of Coke or Pepsi                                      35-39mg
  • Cup of brewed coffee                                   95-200mg
  • 16 oz Latte or Cappuccino                             126-350mg
  • Cup of Espresso                                               47-100mg
  • 8 oz of black tea                                                14-70mg
  • 8 oz of green tea                                              24-45mg
  • 8 oz hot cocoa                                                   14-18mg

Calories:

Eating right during your pregnancy is one of the best things you can do for your baby.  You don’t need to increase your calories during the first 3 months of your pregnancy.  During your second trimester, you should increase your caloric intake by about 340 calories per day and in your third trimester by about 450 calories per day.  Your basic calorie need will depend upon your age, height, weight, and activity level.   You should talk with your doctor about the suggested weight gain that is right for you.  Typically, if you are overweight, you do not need to gain more than 15 lbs during a pregnancy.

Exercise:

Exercising in pregnancy is usually safe and recommended.  Any low impact exercise such as walking, swimming, bicycling, and using an elliptical machine are excellent forms of exercise during pregnancy.  If you are able to talk normally and don’t feel faint during the exercise, then your exercise level is probably safe for the baby. Recent studies suggest that there is decrease blood flow to the fetus if your heart rate is >140 beats/minute.  So, if there is some doubt, you can check your heart rate while you work out.  If there is a question, discuss your exercise wishes in pregnancy with your doctor.   Be aware that your balance may be a little off due to pregnancy weight increases and hormonally induced joint softening, so be careful.  Downhill skiing, contact sports, water skiing, aggressive horseback riding, and scuba diving should all be avoided during pregnancy. Prenatal Yoga is an excellent way to stay in shape during pregnancy.  Our spa, Belly Bliss, offers prenatal yoga classes 4 times a week.

Eating Fish:

Fish often contain mercury that can affect part of the fetal development. The larger the fish and the higher up the food chain, the more mercury it may contain. Certain fish should be eaten in limited quantities or avoided altogether.  Avoid altogether the following: shark, swordfish, tilefish, and king mackerel.  Eat no more than 1 meal (6 oz or 140g) per week of the following: tuna steak and albacore (white tuna).  Eat no more than 2 meals (12 oz or 280g) per week of the following: shrimp, salmon, catfish, fish sticks, oysters, pollock, and canned light tuna. (Note: for tuna eaters this is equivalent to 6 tuna sandwiches or 3 tuna salad servings per week.)  Of note, “farm raised” fish tends to have very little mercury so you may have more servings of these fish.

SUSHI is no more dangerous in pregnancy (as long as you go to a place that is clean and prepares it correctly).  You cannot cook out mercury so you need to use the same rules concerning fish whether it is cooked or not.

Getting the Flu Shot:

Suffering from the flu while pregnant often lasts twice as long as usual and can be twice as severe.  Getting the flu while pregnant can cause a miscarriage and preterm labor.  Moreover, if you catch the flu while you are pregnant, it significantly increases the risk for harm to you during the pregnancy.  Specifically, it increases the risk of bacterial pneumonia and maternal death.  Almost every MFM doctor has taken care of a patient that elected to NOT have the flu vaccine and ended up losing her life when she contracted the flu.  Also, there is no evidence that the flu shot increases the risk of autism to your unborn baby.  The flu shot is recommended in pregnancy during all trimesters.  It neither gives you the flu nor harms your baby.

Hot Bath or Hot Tubs:

Hot temperatures can affect the cells of the developing fetus during the first trimester.   However, it takes a great deal of effort to get your body temperature so high (104 F) that it increases the risk of harm to your unborn fetus so, you typically do not have to worry about hot showers/baths.  If you are concerned, then you can wait until the second trimester.  We worry much more about patients that get high fevers in pregnancy.

Lunch meat / Hot Dogs:

It is amazing how many people have heard that deli meats, hot dogs, soft cheeses, etc. have to be avoided in pregnancy.  The truth is that the bacteria that we are concerned about, listeria, is a very rare cause of infection in pregnancy.  Every now and then, you will hear about a listeria contamination of some foods.  Many times, it can be in foods that have nothing to do with deli meats and cheeses.  So, feel free to eat lunch meats, hot dogs and cheeses.  However, you should avoid unpasteurized milk/cheese in pregnancy due to the risk of it contracting listeria.  Listeria is a bacteria found in contaminated foods that can spread to the placenta.   It can cause miscarriages and stillbirths.  Infection is VERY rare – occurs in only 1 out of 10,000 pregnancies.
A blood test can often determine if you have been exposed.  Early antibiotic treatment can often cure you and your baby.

Massage:

Studies indicate that massage therapy performed during pregnancy can reduce anxiety, decrease symptoms of depression, relieve muscle aches and joint pains, and improve labor outcomes and newborn health.  Studies done in the past 10 years have shown that hormone levels associated with relaxation and stress are significantly altered, leading to mood regulation and improved cardiovascular health, when massage therapy was introduced to women’s prenatal care. In women who received bi-weekly massages for only five weeks, hormones such as norepinephrine and cortisol (“stress hormones”) were reduced and dopamine and serotonin levels were increased (low levels of these hormones are associated with depression).  Prenatal massage is the specialty for the massage therapists at our spa, Belly Bliss.

Pain:

Our most common phone call, outside of your appointment, is due to pain.  Pain in your abdomen, back and pelvis/crotch are extremely common in pregnancy and pretty much affects all pregnant women to some degree.  Although not a guarantee, typically pain is NORMAL as long as you have no other symptoms.  In other words, if you have no fever, no vaginal bleeding, and no leaking of amniotic fluid, then your pain is most likely normal.  Obviously, there can be some exceptions to this rule, so call your doctor if your pain is severe and unrelenting.

Sex:

Intercourse and having an orgasm is usually safe in pregnancy.  You will often have uterine contractions if you have an orgasm, but it rarely will put you into labor.  It is best to avoid the traditional “missionary position” (man on top) past 30 weeks due to pressure on the major blood vessels.   Of course, avoid any position that causes discomfort.  There are some conditions that your doctor will tell you to avoid sexual intercourse.  Typically, these are incompetent cervix, preterm labor and what is known as a placenta previa.

Sleeping on your Back:

The reason you are told to not sleep on your back is that it may partially hinder the blood flow to your baby due to the weight of the pregnant uterus compressing your major blood vessels.  Sleeping on your back is usually safe until you are towards the end of your pregnancy.  We tell our patients that you can lie on your back as long as you are not feeling faint or having problems breathing; this may be a sign that the blood flow is being compromised.  Move from your back to your side at that point.  Many women will often turn onto their back while sleeping.  This is absolutely fine and nothing to worry about.  We did survive as a species and you will not kill your baby just because you woke up and you were on your back.

Smoking:

Smoking, as well as second-hand smoke is very harmful to the developing baby.  Nicotine and carbon monoxide are the most harmful components.  They both result in decreased oxygen to the baby.  The risk of fetal death and preterm delivery is doubled in mothers who smoke.  Smoking (and second-hand smoke) also increase the risk of Sudden Infant Death Syndrome (SIDS) and learning disorders.  If you are a smoker, or if you live with a smoker, this is a very good time for you or your partner to stop.  Of note, and you can talk to your doctor about this, but, it would be better for you to take the nicotine patch rather than smoke.  The nicotine patch has nicotine, but, smoking has nicotine with lots of poisons and carbon monoxide.  You can talk to your doctor about this, but, we would recommend that you try and quit smoking and to use the patches if it can lead to a better chance of success.

Stretch Marks:

Stretch marks, also known as striae, are due to the stretching of the skin and hormonal changes of pregnancy. The collagen deep in your skin actually tears and scars as it heals. Stretch marks are thin marks, usually no more than a few inches in length, that are often dark red or brown, depending on your skin color. Many women already have some around their thighs from growing during puberty.  More than half of women get stretch marks during pregnancy. They start usually during the second half of the pregnancy. Some often appear on your breasts while nursing.  Pregnancy stretch marks usually appear on the abdomen, but they can also appear on the buttocks, thighs, upper arms, and breasts.   If your mother had them, there is a higher chance that you will get them as well. Gaining a lot of weight will also lead to stretch marks.  Trying to gain less weight is probably the best thing you can do to minimize stretch marks.  Older pregnant women often get less of them. Unfortunately, most creams that are meant to prevent them are not very effective.  Luckily, the stretch marks often fade after the baby is born and tend to become a little lighter than the rest of the body.   Tretinoin (Retin-A®) taken after you’ve stopped nursing might minimize the appearance of stretch marks.

Travel:

We recommend NOT traveling in the 3rd trimester.  Not because it is especially dangerous, but, because you are far away from a hospital for help (if you are in the air).  Also, if you travel in the 3rd trimester and you have to go to the hospital for problems such as bleeding and contractions, the hospital and doctors know nothing about you and your care may suffer.  Also, if you are away and start bleeding or contracting, it may be hard to come back and you could be stuck at your travel destination until your delivery.  Also, your insurance may have a problem with you delivering out of town and may not pay for it.

Water Intake:

It is important to increase your hydration during pregnancy.   You need more water than usual due to increased perspiration and the need to cleanse out pregnancy-related metabolites from your body.  Extra hydration will also help you avoid constipation and help to prevent preterm labor and bladder infections.  Mixing your water with lemon and orange wedges can help with taste in the case you are not a “water drinker.”  The best thing to do is have a bottle of liquid with you at all times.  A general rule is that if your urine looks a very dark and concentrated yellow, you are not drinking enough.

Weight Gain:

The amount of weight you should gain will depend upon your pre-pregnancy weight and height.  Note that your weight gain will often be irregular from week to week.   We follow your weight gain from the beginning of pregnancy rather than visit to visit.

If you are of normal BMI at the start of pregnancy, you should gain between 25 and 35 lbs (11-16 kg), gaining 1 to 5 lbs (0.5-2.2 kg) in the first trimester and about 1 lb (0.5 kg) per week for the rest of your pregnancy.

If you are underweight (low BMI) at conception, you should gain 28 to 40 lbs during pregnancy.

If you are overweight (BMI:  25-30) at conception, you should gain 15 to 25 lbs during pregnancy.

If you are very overweight (BMI >30) at conception, you should gain 10-15 lbs during pregnancy.

If you are pregnant with twins, and you are of normal weight, you should gain 37 to 54.  This, also, may vary depending on your pre-pregnancy weight.  Don’t forget that there is lots of water weight with twins, so don’t get too upset if you find yourself gaining lots of weight towards the end of your pregnancy.