The first trimester is loosely defined as from conception up until about 13 weeks. The assumption is that conception occurred two weeks after your last period began. During the first trimester you will typically be seen every four weeks unless your personal history requires that you be seen more often. Your doctor will let you know during your initial obstetrical visit.
What can I expect at my initial obstetrical visit?
At this first visit you can expect to have an ultrasound in order to ensure that the dating of your pregnancy is what we expect from your period. For those patients who are not certain of their last period date the dating will be established from the initial ultrasound. The optimal dating ultrasound is obtained during the 7th week up to the 12th week of pregnancy. We typically would like you to schedule your initial visit during your 8th to 10th week. If you previously had a miscarriage or an ectopic pregnancy we would like to see you during your 6th to 8th week of pregnancy. By your 11th to 12th week we are typically able to obtain the fetal heart rate by doppler. An ultrasound will be done at each visit until that point.
Your doctor will go over in detail your medical, surgical, social and family history. We will ask detailed questions about any chronic medical problems such as diabetes, hypertension, and thyroid disorders. We will also need to know specific information about your menstrual period and prior pregnancies. Your social history such as whether you smoke or drink alcohol will also be assessed. We will go over your nutritional goals. A medical assessment will be done and blood work as well as cultures will be done at the first visit.
First trimester screening
First trimester screening is typically done during the 11th up to the 14th week of pregnancy. It involves going to the Saint Agnes Women's Health Center and having a consultation with a Maternal Fetal Medicine doctor. During this evaluation you will have an ultrasound and blood work done. If you opt for first trimester screening the test can detect up to 85% of fetuses with Down Syndrome. This test does not screen for neural tube defects and an additional blood test will be performed during the second trimester to determine this risk. If you are interested in first trimester screening we will discuss this in much further detail during your visits.
What are some common first trimester concerns?
It is not uncommon to feel fatigued during the first trimester. You will be asked to take a prenatal vitamin supplement daily. Currently we recommend that you take prenatal vitamin with DHA. This supplement should ideally be started prior to conception at least two months prior to becoming pregnant. Our recommendation is to try to stay as active as you were before becoming pregnant. Make sure that you are enjoying at least six to eight hours of rest nightly. This will help you with your energy.
Nausea and vomiting
It is also common to have "morning sickness." Many people, however, do not have these feelings only in the morning. Most women who have problems with nausea and vomiting will start to notice symptoms prior to 9 weeks. Therefore, you may experience this prior to your first appointment. It is important to quantify how many episodes you are having. In severe cases a diagnosis of hyperemesis gravidarum may be made.
Ideally you would have been taking a multivitamin prior to conception as women who have been taking multivitamin tend to have less symptoms. We recommend modifying your diet by eating small but frequent meals. Your goal should be to eat 5-6 times a day with 300-400 calorie meals. Avoid spicy meals and fried foods. Bland high protein snacks may also help. If you are currently taking a prenatal vitamin with iron you may want to stop taking this vitamin and substitute it for a prenatal vitamin that does not contain iron. A prenatal gummy vitamin may be the right choice for you. If you are still finding that you need additional help with your symptoms you may want to try ginger capsules. Ginger capsules (250 mg) can be used up to four times daily. Another supplement that has been found to be helpful in treating nausea in pregnancy is vitamin B6. This vitamin at 25 mg can be taken every six hours and the maximum daily dose should not exceed 200 mg per day. Your prenatal vitamin will likely also have vitamin B6 so just make sure that you are not exceeding the recommended daily dose. If you are not able to control your symptoms and are not able to tolerate eating you will need to come in to be evaluated. We may need to prescribe additional anti-nausea therapy to help you with your symptoms.
Abdominal cramping/ Bleeding
You may experience some uterine cramping or menstrual like cramps during the first trimester. These are typically secondary to uterine growth and the uterus stretching. Most of the time this is a normal process however if you are having severe pain or the pain is one sided we would ask that you contact us at the office for an evaluation.
Bleeding during the first trimester can be very distressing. Miscarriage most often occurs during the first 13 weeks of pregnancy and occurs in up to 15-20% of pregnancies. If you are having abdominal cramping and bleeding and passing tissue a miscarriage is likely and you need to call the office for evaluation.
Bleeding without cramping can be due to a vaginal infection, cervical irritation, intercourse. If you are having some light spotting and no cramping or pain your pregnancy it is possible that your pregnancy may proceed normally.
If you are concerned that you may be having a miscarriage please call the office immediately.
You may find an increase in frequency almost immediately. If you are also having symptoms of burning or pain this may indicate an infection. You will need to come in to be evaluated. A urine sample is obtained at each obstetrical visit. Be prepared to leave a urine sample at each visit.
A very common cause of headaches in pregnancy is dehydration. Please ensure that you are drinking at least 80 ounces of water daily. Some patients have a history of headaches. If you suffer from migraine headaches or tension headaches try to avoid your established triggers. If this headache is sever and different from your prior headaches let us know right away. Prior to continuing any medication for migraines or tension headaches you may have previously been prescribed please contact us to ensure that this medication is safe to continue taking. If you feel that you need to take something for your headache Tylenol is considered to be safe in pregnancy. Avoid aspirin containing products as well as ibuprofen. If your headaches persist even after Tylenol you will need to be evaluated.
Vitamins and supplements
A prenatal vitamin should be taken daily. We recommend a prenatal vitamin with DHA. You may take an over the counter formulation. Most prenatal gummies do not contain iron. We recommend 30 mg of elemental iron daily this is typically found in a prenatal vitamin. Iron rich foods are an essential component to your diet. Calcium is also important for skeletal development. You should ensure that your diet is rich in both.
Vegetarian and Vegan Diets
You may need to consult a nutritionist given that it is very difficult to meet the minimum daily requirements with a strict vegetarian diet and even more difficult with a vegan diet. Plant based foods may not have complete complement of essential amino acids and as such you may want to incorporate fortified soy products in moderation.
In general Shark, Swordfish, Tile Fish, King Mackerel should all be avoided during pregnancy given their high mercury levels. You should limit your weekly intake of fish to around 2 servings a week or 12 ounces of fish per week. Tuna can still be consumed but we recommend canned light tuna rather than albacore white tuna given that albacore tuna has a higher mercury content. Common fish and shell fish that are consumed include: shrimp, catfish, pollock and salmon. These have a lower mercury content. Methylmercury can cause severe neurologic damage as well as milder intellectual and psychosocial deficits.
You should also limit the total caffeine intake. We recommend limiting your daily intake of caffeine from coffee, tea or chocolate to 200 mg daily. An eight ounce cup of coffee is around 140 mg. An eight ounce cup of tea is around 50 mg. A serving of chocolate can be anywhere from 15-30 mg.
Nutrasweet, Saccharin, and Stevia are all considered safe in moderation.
Deli Meat/ Unpasteurized Dairy
Make sure that you avoid unpasteurized dairy especially soft cheeses. If you choose to eat deli meat ensure that you have recooked this meat until it is steaming to minimize your exposure to Listeria. Listeria can lead to serious complications in pregnancy. If you believe you have been exposed please call the office.
Exercise and weight gain
Exercise is an important part of your personal care and you should continue your prior exercise regimen as long as you were engaging in moderate physical activity and you do not have an obstetrical or medical condition that limits your ability to perform physical activity. Please let your provider know at your initial visit what your current exercise regimen entails so that specific recommendations can be made. If you do not currently exercise we recommend starting with activities such as walking 30 minutes at least three time a week and gradually increasing your activity.
At your initial visit your weight and height will be assessed. Your BMI is calculated based on both of these factors. If you would like to calculate your BMI you may find a BMI calculator online to help you calculate your BMI. The Institute of Medicine has published weight gain recommendations for pregnancy and they are as follows:
BMI based weight gain recommendations
If you are considered underweight or with a BMI <18.5 your recommended weight gain in pregnancy is 28-40 pounds
If your BMI is in the normal range 18.5-24.9 your recommended weight gain in pregnancy is 25-35 pounds
If your BMI is in the overweight range 25-29.9 your recommended weight gain is 15-25 pounds
If you are obese with a BMI >30 than your recommended weight gain is 11-20 pounds
First Trimester Exposures
Alcohol consumption is not recommended during pregnancy. It is quite possible that you may have had alcohol prior to finding out that you were pregnant. Alcohol does cross the placenta and we recommend that you do not continue to consume alcohol.
If you are currently a smoker we will work with you to create a quit date if you have not already considered smoking cessation. Nicotine exposure has well documented effects on the fetus that we would like to avoid.
Smoking increases the risks of abortion by up to 1.8 times. Complications of pregnancy such as abruption, placenta previa, and premature rupture of fetal membranes are all seen more frequently in smokers. A low birth weight and sudden infant death syndrome are also seen more frequently.
If conservative measures to help with smoking cessation are not successful we may recommend medical therapy. Please inform us if you are struggling with quitting.
Hair Dyes and Perms
No studies have shown any problems with hair dye or perms. Nevertheless, we do not recommend dyes or perms until after the first trimester.
Viruses and Parasites
You may be exposed to different viruses or parasites during pregnancy.
If you own a cat you should know that a small portion of cats carry a parasite that can cause toxoplasmosis. If you are pregnant and exposed to cat feces or urine which can occur while changing cat litter or gardening you may place your pregnancy at risk of developing birth defects in the fetus. Therefore we recommend that someone else in the home care for the cat litter and that you wear gloves during gardening. Also care should be taken when handling raw meats. Make sure that you thoroughly clean your cutting board and that raw vegetables are not exposed to the cutting board you use for meats. You should also make sure that you are washing your hands thoroughly after either one of these activities. The cat cannot transmit the disease by merely living in the same household.
Hand Foot and Mouth Disease
If you work with small children or have small children of your own you may be exposed to hand foot and mouth disease. This is a self-limiting. If you have not previously been exposed you may have a mild symptoms or no symptoms at all. There is no treatment and this virus does not cross the placenta or pose a threat to the fetus in most cases. Strict hand washing practices will help to avoid the spread of this infection. If you believe you may have been exposed contact our office with any additional questions.
Slapped Cheek Disease
B19 or Parvovirus infection during pregnancy can lead to complications in pregnancy if you have not previously been exposed. If you have had significant exposure to this virus or are having symptoms please contact our office immediately as we will want to evaluate you. Ways to avoid exposure good hand washing practices and avoidance of exposure to those who you believe may be infected. If you have any additional questions please call the office.
Ideally if you were not exposed to chickenpox or varicella prior to pregnancy then you have received varicella vaccine. If you have not had either than you will need to be very careful with your exposure to chickenpox throughout your pregnancy. You will need to let us know as soon as you believe you may have had an exposure.
The Common Cold
Most colds are self-limiting. Increased rest, increased fluids and time will likely be enough for most patients with the common cold. If you find that you need to take a medication to help with certain symptoms please see our list of preferred medications to use during pregnancy.
Use humidified air to help alleviate your nasal congestion. Oral decongestants should be avoided during the first trimester.
Acetaminophen (Tylenol) for sore throat, fevers, and headache is acceptable.
Loratidine (Claritin) and Cetirizine (Zyrtec) are considered the preferred agents to treat allergy symptoms. You can take 10 mg once daily.
First, conservative measures like modifying your diet is usually the most effective treatment for heartburn symptoms. We recommend you eat small, frequent meals (4-6 meals per day). Avoid caffeine, chocolate, spicy foods, fatty foods, citrus foods and allow ample time between eating and lying down.
If dietary modifications do not help alleviate your heartburn, antacids may be taken. Ranitidine (Zantac - Category B) would be the preferred agent, however we recommend you discuss this at your prenatal visit in order to ensure that this is the right option for you.
During the flu season we recommend that you obtain the flu vaccine. This vaccine is considered safe in any trimester. The nasal spray which is the live attenuated version of the flu is not recommended in pregnancy.