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hello, baby A prenatal health and wellness guide Volume 1 Issue 1 What To Do About Morning Sickness 1, 2, 3 Baby Kicks Tests During Pregnancy Eating For Two Exercise While Pregnant 2011.09.0332_Prenatal_PP.indd 1 9/19/11 3:32 PM Congratulations, you’re pregnant Prenatal care is the care a woman gets before pregnancy and before her baby is born. Getting early and regular prenatal care is important for both the mother and the developing baby. Prenatal care is more than just health care while you are pregnant. Your health care provider may discuss many issues, such as nutrition and physical activity, what to expect during the birth process and basic skills for caring for your newborn. Your doctor or midwife will give you a schedule for your prenatal visits. You can expect to see your health care provider more often as your due date gets closer. A typical schedule includes visiting your doctor or midwife: • About once each month during your first six months of pregnancy • Every two weeks during the seventh and eighth month of pregnancy • Weekly in the ninth month of pregnancy If you are over 35-years-old or your pregnancy is high risk because of certain health problems like diabetes or high blood pressure, your doctor or midwife will probably want to see you more often. what to do about morning Sickness In the first trimester, hormone changes can cause nausea and vomiting. This is called “morning sickness,” although it can occur at any time of day. Morning sickness usually tapers off by the second trimester. 2 2011.09.0332_Prenatal_PP.indd 2 To avoid or reduce morning sickness, follow these simple steps: • Eat several small meals instead of three large meals to keep your stomach from being empty. • Don’t lie down after meals. • Eat dry toast, saltines, or dry cereals before getting out of bed in the morning. • Eat bland foods that are low in fat and easy to digest, such as cereal, rice, and bananas. • Sip on water, weak tea, clear soft drinks, or eat ice chips. • Avoid smells that upset your stomach. HELLO, BABY 9/19/11 3:32 PM GIFTS for you and your baby The BabySteps Rewards Program is an online program that rewards you for being healthy and attending all necessary medical appointments. Through this program, you will get the education and motivation you need to take care of yourself and have a healthy pregnancy and birth. educational videos, playing interactive games, reading and downloading educational materials, speaking to a nurse for advice, if needed, and connecting with other moms-to-be by posting questions and comments on the discussion board. The BabySteps Rewards Program gives you access to a personal “Milestone Tracker” where you are able to keep track of all your important medical appointments, plans for delivery, healthy decisions and activities. Besides tracking your healthy milestones, you will also be able to earn points by watching Best of all, you will earn points for each activity, and every point equals $1 worth of gift codes from Amazon Babies. You will receive a monthly email with a gift card code totaling the number of points you received that month; you can use that code to purchase items for your baby! 1, 2, 3 baby kicks After 28 weeks, keep track of your baby’s movement. This will help you notice if your baby is moving less than normal, which could be a sign that your baby is in distress and needs a doctor’s care. An easy way to do this is the “count-to-10” approach. Count your baby’s movements in the evening — the time of day when the fetus tends to be most active. Lie down if you have Volume 1 ISSUE 1 2011.09.0332_Prenatal_PP.indd 3 trouble feeling your baby move. Most women count 10 movements within about 20 minutes. But it is rare for a woman to count less than 10 movements within two hours when the baby is active. Count your baby’s movements every day so you know what is normal for you. Call your doctor if you count less than 10 movements within two hours or if you notice your baby is moving less than normal. If your baby is not moving at all, call your doctor right away. 3 9/19/11 3:32 PM tests during pregnancy Tests are performed during preg- • Personal or family health history • Ethnic background • Results of routine tests • Your blood type and Rh factor • Anemia (low iron) • Infections, such as toxoplasmosis and sexually transmitted infections (STIs), including hepatitis B, syphilis, chlamydia, and HIV • Signs that you are immune to rubella (German measles) and chicken pox Some tests are screening tests. They detect risks or signs of possible health problems with you or your baby. Based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems for you or your baby. nancy to check you and your baby’s health. At your first prenatal visit, your doctor will perform tests to check for a number of things, such as: Throughout your pregnancy, your doctor or midwife may suggest a number of other tests too. Some tests are suggested for all women, such as screenings for gestational diabetes, Down’s syndrome, and HIV. Other tests might be offered based on your: • Age eating for two nutrients for your baby. Sensible, balanced meals combined with regular physical fitness is still the best recipe for good health during your pregnancy. Weight Gain Eating healthy foods is more important now than ever! You need more protein, iron, calcium, and folic acid than you did before pregnancy. You also need more calories. But “eating for two” doesn’t mean eating twice as much. Rather, it means that the foods you eat are the main source of 4 2011.09.0332_Prenatal_PP.indd 4 The amount of weight you should gain during pregnancy depends on your body mass index (BMI) before you became pregnant. The Institute of Medicine provides these guidelines: • If you were at a normal weight before pregnancy, you should gain about 25 to 30 pounds. continued on page 5 HELLO, BABY 9/19/11 3:32 PM continued from page 4 • If you were underweight before pregnancy, you should gain between 28 and 40 pounds. • If you were overweight before pregnancy, you should gain between 15 and 25 pounds. • If you were obese before pregnancy, you should gain between 11 and 20 pounds. Check with your doctor to find out how much weight gain during pregnancy is healthy for you. You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester. Generally, doctors suggest women gain weight at the following rate: • Two to four pounds total during the first trimester • Three to four pounds per month for the second and third trimesters Calorie Needs Your calorie needs will depend on your weight gain goals. Most women need 300 more calories a day during at least the last six months of pregnancy than they do pre-pregnancy. Keep in mind that not all calories are equal. Your baby needs healthy foods that are packed with nutrients — not “empty calories” such as those found in soft drinks, candies, and desserts. Although you want to be careful not to eat more than you need for a healthy pregnancy, make sure not to restrict your diet during pregnancy either. If you don’t get the calories you need, your baby might not get the right amounts of protein, vitamins, and minerals. Low-calorie diets can break down a pregnant Volume 1 ISSUE 1 2011.09.0332_Prenatal_PP.indd 5 woman’s stored fat. This can cause your body to make substances called ketones. Constant traces of ketones can result in concerns for mom and baby. Your OB provider will check for ketones in your blood or urine throughout your pregnancy. Foods Good for Mom and Baby A pregnant woman needs more of many important vitamins, minerals, and nutrients than she did before pregnancy. Making healthy food choices every day will help you give your baby what he or she needs to develop. MyPyramid.gov can show you what to eat as well as how much you need to eat from each food group based on your pre-pregnancy BMI and activity level. Use your personal MyPyramid plan to guide your daily food choices. Talk to your doctor: • If you have diabetes – make sure you review your meal plan and insulin needs with your doctor. High blood glucose levels can be harmful to your baby. • If you are lactose intolerant – find out about low-lactose or reduced-lactose products and calcium supplements to ensure you are getting the calcium you need. • If you are a vegetarian – ensure that you are eating enough protein, iron, vitamin B12, and vitamin D. 5 9/19/11 3:32 PM i want to have a baby Many health care providers recommend that a woman who is thinking about becoming pregnant see a health care provider to ensure she is in good preconception health. There are steps a woman can take to reduce the risk of certain problems during pregnancy: 1. Folic acid – The U.S. Pub- lic Health Service recommends that women of childbearing age get at least 400 micrograms of folic acid every day, through food and/ or supplements. Many health care providers recommend supplementing the diet with folic acid for three months before getting pregnant and at least the first three months of pregnancy. 2. Proper immunizations for the mother – Women who are thinking about getting pregnant should make sure they have been properly vaccinated for certain diseases that could harm a developing fetus (such as chicken pox or rubella). It is impor- tant to get these vaccinations before becoming pregnant because they can harm a developing fetus. 3. Healthy behaviors – Having a healthy weight and diet and getting regular physical activity can help both the mother and fetus during pregnancy. Avoiding smoking, alcohol, or drug use is also important. In addition, certain medications and exposures in the environment can be harmful to the fetus and it is important to avoid them during pregnancy. For more information about preconception and prenatal care, talk to your health care provider. exercise while pregnant health doesn’t change and you talk to Fitness goes hand-in-hand with eating right to maintain your physical health and well-being during pregnancy. Healthy pregnant women should get at least two hours and 30 minutes of moderate-intensity aerobic activity a week. It’s best to spread your workouts throughout the week. If you regularly engage in vigorousintensity aerobic activity or high amounts of activity, you can keep up your activity level as long as your your doctor about your activity level throughout your pregnancy. If you do not already exercise, talk to your doctor before starting a new exercise program. Best Activities for Moms-to-Be Low-impact activities at a moderate level of effort are comfortable and enjoyable for many pregnant women. Walking, swimming, continued on page 7 6 2011.09.0332_Prenatal_PP.indd 6 HELLO, BABY 9/19/11 3:32 PM continued from page 6 dancing, cycling, and low-impact aerobics are some examples. These sports are also easy to take up, even if you are new to physical fitness. Some higher intensity sports are safe for some pregnant women who were already doing them before becoming pregnant. If you jog, play racquet sports, or lift weights, you may continue with your doctor’s approval. Tips for Safe and Healthy Physical Activity • When you exercise, start slowly, progress gradually, and cool down slowly. • You should be able to talk while exercising. If not, you may be overdoing it. • Take frequent breaks. • Drink a lot of fluids before, during, and after exercising. • Don’t exercise on your back after the first trimester. This can put too much pressure on an important vein and limit blood flow to the baby. • Avoid jerky, bouncing, and high-impact movements. Connective tissues stretch much more easily during pregnancy. So these types of movements put you at risk of joint injury. • Be careful not to lose your balance.. As your baby grows, your center of gravity shifts making you more prone to falls. For this reason, activities like jogging, using a bicycle, or playing Volume 1 ISSUE 1 2011.09.0332_Prenatal_PP.indd 7 racquet sports might be riskier as you near the third trimester. • Avoid activities in which you can get hit in the abdomen like kickboxing, soccer, basketball, or ice hockey. • Steer clear of activities in which you can fall like horseback riding, downhill skiing, and gymnastics. • Do not scuba dive during pregnancy • Do not workout in extreme heat or humidity. • If you feel uncomfortable, short of breath, or tired, take a break and take it easier when you exercise again. Stop exercising and call your doctor as soon as possible if you have any of the following: • • • • • • • • • • Dizziness Headache Chest pain Calf pain or swelling Abdominal pain Blurred vision Fluid leaking from the vagina Vaginal bleeding Less fetal movement Contractions 7 9/19/11 3:32 PM Johns Hopkins HealthCare LLC 6704 Curtis Court Glen Burnie, MD 21060 For pregnancy-related information, visit: www.ppmco.org and click the yellow A-Z Healthwise ® box. Additional Information on Pregnancy © 2011 Womenshealth.gov provides information to help advance women’s health research, services, and public and health professional education. The materials contained here are not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical professional. References to any non-governmental entity, product, service, or source of information that may be contained in this educational material should not be considered an endorsement, either direct or implied, by the Office on Women’s Health (OWH) in the Department of Health and Human Services (HHS). Neither OWH nor HHS is responsible for the content of any non-federal websites referenced on womenshealth.gov. more Tools To help you Manage your pregnancy HealthLINK@Hopkins allows you 24/7 access to your health information. This secure online website will help you track your medications, doctors visits, prior authorizations and referrals. You can also search for and select a primary care provider (PCP) or specialist near you. You also have access to secure email messaging with Customer Service, and a variety of information and resources. Text4baby provides totally free text messages three times a week with information to help you through your pregnancy and baby’s first year. Text BABY to 511411 to sign up! 24 Hour Nurse Chat is a free service that provides real time access to a registered nurse who can give medical advice. It’s free and available 24 hours a day, seven days a week. To reach the Nurse Chat, call Priority Partners 1-877-839-5414. To access the Health Information library, use Pin #380. Health Promotion and Wellness 1-800-957-9760 2011.09.0332_Prenatal_PP.indd 8 9/19/11 3:32 PM