Your First Trimester

Recommendations and information provided by Fairfax OB-GYN Associates

 

Prenatal Vitamins

Highlights:

  • Folic acid intake has been shown to reduce birth defects, including spina bifida and cleft lip
  • Vitamin B6 can reduce nausea of pregnancy
  • Vitamin D supplementation may reduce the risk of pre-eclampsia, a serious pregnancy complication
  • Iron is needed for a healthy increase in blood volume to carry oxygen to your baby
  • Omega 3 fatty acids and DHA help support normal brain and nerve development

And these are just some of the benefits!

Prenatal vitamins are available over-the-counter or by prescription. (Some drug companies offer discounts on their prescription vitamins, if that is a concern, just ask us!)

Omega 3 fatty acids and DHA are available in some prenatal vitamins and in both fish oil and plant-based supplements.

Prenatal Gummi Vitamins do not contain iron, so we recommend a more complete supplement by 20 weeks.

For those who want to see the U.S. Recommended Dietary Allowances for vitamins and minerals during pregnancy, check out the pregnancy part of these tables: USA RDA's

 

 

Managing Nausea and Vomiting in Pregnancy

The American College of Nurse-Midwives offers great, detailed tips for managing symptoms: Managing Nausea

If no relief, we encourage you to take Vitamin B6 (50 to 100 mg by mouth daily) for the nausea and consider adding the antihistamine doxylamine (Unisom or generic brand Equate), sold as a sleep aid (25 mg pill at bedtime).

If symptoms are severe or persistent, please talk to us about prescription options.

 

 

Food Safety for Moms-To-Be

Some foods should be avoided by pregnant women because they can cause illness.

Examples are unpasteurized soft cheeses, raw fish or eggs, and fish high in mercury.

This link to the FDA has helpful details. Be sure to scroll all the way down the page to look for foods that may be part of your diet.

FDA Foodborne Illness

 

 

Common Discomforts

 

 

Over-the-Counter Medications

Safe medications to take during pregnancy (you may take them without calling us first):

  • For aches and pains: Tylenol (no more than 4000 mgs in 24 hours)
    • Please talk with us if you need to take Tylenol for more than 5 days.
  • For allergies (seasonal): Zyrtec or Claritin
  • For constipation: Fibercon or Metamucil, Colace, Milk of Magnesia
  • For cough: Lozenges, plain Mucinex or Robitussin, each without Dm (Dextromethorphan)
  • For diarrhea: Kaopectate, Imodium
  • For fever: Tylenol (no more than 4000 mgs in 24 hours)
    • Please talk with us if you need to take Tylenol for more than 5 days.
  • For heartburn: Tums, Rolaids, Maalox, Mylanta, Zantac, Pepcid
  • For hemmorhoids: Tucks pads, Preparation H, Anusol
  • For insomnia: Benadryl, Unisom
  • For nasal congestion: Saline drops, Afrin or Sudafed (if blood pressure is normal), short term use only
  • For nausea/vomiting: Vitamin B6, Unisom (Doxylamine)
  • For runny or stuffy nose: Chlor-Trimeton, Benadryl
  • For sore throat: Lozenges such as Halls, Vicks, or Chloroseptic

Medications to avoid during pregnancy (avoid these over-the-counter medications):

  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve)
  • Pepto-Bismol
  • Alka-Seltzer
  • DextroMethorphan

 

 

Zika Virus Precautions

Infection with zika virus (from mosquito bites or sex with someone who has been infected) has been linked to birth defects, especially microcephaly, where the fetal brain does not grow properly. Severe physical and mental impairment of the baby is possible. Please tell us if you or the baby’s father have travelled to an area that is high risk for Zika within 6 months of becoming pregnant or during pregnancy. Partners should use condoms for 6 months after possible exposure to Zika virus.

For full details, go to: CDC on Zika

If you may have been exposed to Zika virus, talk to your doctor or midwife about testing. If you need specific testing that is only available through a local office of the Virginia Health Department, we will make the arrangements before we send you. Here are location details.

For Prince William County, there are Health Department offices in Woodbridge and Manassas:

VA Health Dept in Prince William County (English)

VA Health Dept in Prince William County (Spanish)

For Fairfax County, the Health Department is in Fairfax City:

VA Dept of Health in Fairfax City

See also the Virginia Department of Health information on Zika: VA Dept of Health Zika Info

You can see how to protect yourself from mosquito bites, which insect repellent ingredients are approved, geographic areas with reported zika virus transmission, and how to prevent acquiring zika virus through sex. Symptoms of infection may not occur at all or may be mild. Fever, rash, joint pain, and pink eye are common; muscle pain and headache are possible.

Be aware: Infected partners may not show signs of illness but may still be capable of transmitting zika virus through semen for six months after exposure. Research continues; this information may change.

Talk to your midwife or doctor if you have any questions about zika virus.

 

 

Flu Vaccine (September through April)

We encourage influenza (flu) vaccines for pregnant women and their families. You can read why: CDC Flu Vaccine in Pregnancy

The CDC's influenza (flu) vaccine information statement has additional details: CDC Flu Vaccine Info

 

 

Warning Signs and how to reach us after hours

Please call us if you have:

  • Severe or Persistent nausea or vomiting
  • Vaginal bleeding
  • Abnormal vaginal discharge
  • Fever or Chills (Temperature 100.4 or higher)
  • Severe abdominal or lower back pain
  • Severe headache (or headache continuing after drinking water, taking Tylenol, & resting)
  • Pain or burning with urination
  • Unusual redness or pain in your legs (possible blood clot) 

And after 20 Weeks, also call if:

  • Blurred vision or spots before your eyes
  • Marked decrease in the amount of urine passed
  • Swelling of face or hands; marked swelling of feet or ankles after resting on your side
  • Sudden gush of fluid from the vagina
  • Leakage of vaginal fluid over 24 hours 

And after 24 weeks, also call for:

  •  Decreased fetal movement

 

If you experience one of these complications, you can reach us through any of our offices: Woodbridge (703) 491-7181 Fair Oaks (703) 391-1500 Gainesville (703) 753-0963

After hours or on weekends or holidays, select the prompt for emergency, and give your information to the individual answering for our practice. -Try to keep your phone line open for the return call by the midwife or doctor on call. -Disable any call blocking from an unidentified number so we can get through to you. -If you do not receive a call within 15 minutes, please call again.

If you are experiencing a life-threatening emergency, please go straight to the nearest hospital Emergency Department or call 911

 

 

Dental Care

Poor dental health can cause complications of pregnancy, so don't put off care.

Brush your teeth with a soft toothbrush, floss regularly, and keep up routine dental visits.

Bleeding gums are not uncommon, keep teeth and gums healthy to minimize this.

If dental procedures are needed, your dentist may want to consult with us about medications.

The American Dental Association has more information and a fun quiz for pregnant women: Dental Health in Pregnancy

 

 

Travel Plans

Many women and their families will travel by car or air during their pregnancies. Please discuss with us your travel plans to determine if it is wise to travel during that stage of your pregnancy.

Frequent stops or opportunities to walk around and keeping yourself hydrated are important considerations.

Be sure to consider your options for health care at your destination in case you have complications while you are away. We would be happy to provide you with a copy of your prenatal records to bring with you.

Travel to any area at high risk for Zika virus requires special consideration. (See Zika virus precautions above)

 

 

Sexuality

It is not uncommon to notice changes in your sex drive during pregnancy. The first trimester may be a time of decreased desire due to nausea and fatigue. The second trimester may be a time of greater sexual interest due to the blood flow changes in the vaginal area. There are no restirictions in sexual relations as long as you are not having bleeding or any other complication.

 

 

Prenatal Testing Options

Genetic Carrier Testing

This is a simple blood test to see if you have genes for recessive diseases that may be passed down from parent to child. The routine test screens for Cystic Fibrosis, Spinal Muscular Atrophy, and Fragile X Syndrome. For those with Ashkenazi Jewish heritage on either side of the family, testing may be done for a panel of diseases more likely in this population. Additionally, there are expanded panels to screen for over 100 inheritable diseases.

If a pregnant women tests positive as a carier, then genetic counseling is available and testing of the father is offered. Both parents usually must carry genes for the same disease before there is a 25% risk that a child could have that disease. (An exception is Fragile X. Because baby boys have an X and a Y chromosome, it is the mother's carrier status that determines if a male fetus is at risk for this particular disorder.)

If parents learn that they are carriers, there is an opportunity to become better informed about the disease trait in their genome. Also, diagnostic (invasive) testing can be considered, such as amniocentesis or Chorionic Villi Sampling, to determine if this baby has or does not have the disease.

The laboratory websites below explain genetic carrier testing more thoroughly.

NxGen Genetic Screening

Progenity Carrier Screening

 

Down Syndrome Screening

There are two screening tests for risk of Down Syndrome during the first trimester:

  1. First Trimester Screen
  2. Non-Invasive Prenatal Testing

Each test has benefits and limitations. You can read about each of them below. If you are already in the second trimester, then Quadruple Screen is an option for Down Syndrome screening. It can also be used in combination with a First Trimester Screen for greater accuracy.

You can review information about Down Syndrome, including age-associated risk, at:

What Is Down Syndrome?

The following website offers information to help you decide whether or not to be screened: Should I have a screening for Down Syndrome?

 

Non-Invasive Prenatal Test

This genetic testing is a blood test to determine fetal risk for the most common non-inherited chromosomal abnormalities: Down Syndrome, Edwards Syndrome, and Patau Syndrome (also called Trisomy 21, 18, and 13, respectively.) The test screens non-cell fetal DNA from a pregnant woman's blood sample (at >10 weeks gestation). While this test is highly accurate (e.g. over a 99% detection rate for Down Syndrome), it cannot confirm the presence or absence of a disorder. The analysis is complicated, and maternal age factors into the likelihood that a positive result can predict an affected baby. For women who test positive, diagnostic (invasive) testing is available, such as amniocentesis or Chorionic Villi Sampling, to determine if a baby truly has the disorder.

The American Congress of Obstetricians and Gynecologists provides additional testing information: Cell-Free DNA Prenatal Screening

 

First Trimester Screen/Nuchal Translucency

This test estimates the risk for Down Syndrome and Edwards Syndrome (also called Trisomy 21 and Trisomy 18, respectively). We refer women who desire this screening to a Maternal Fetal Medicine office to schedule the test between 11 and 13 weeks gestation. It involves an ultrasound measurement of the thickness of the neck of the fetus in combination with a blood test from the mother. It is generally considered a routine prenatal test for low risk women. For women who screen positive, Non-Invasive Prenatal Testing can provide additional screening. Diagnostic (Invasive) testing is available to determine if a baby truly has a disorder.

 

Screening for Open Neural Tube Defects

A Maternal Serum Alpha Fetoprotein (AFP) test is a simple blood test at 16 to 20 weeks gestation to screen for risk of Open Neural Tube Defects such as Spina Bifida.

The March of Dimes has information on Open Neural Tube Defects: Neural Tube Defects

 

Second Trimester/Quadruple Screen

This blood test at 16 to 20 weeks gestation can screen for Down Syndrome and Edwards Syndrome (if not previously tested or to confirm findings of a first trimester screen) and for Open neural Tube Defects (see prior entry).

 

Ultrasound Screening of Fetal Anatomy

This scan can be done in our office to evaluate fetal anatomy at 20 weeks.

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