Download 1st Trimester Handout - Red Rocks Ob-Gyn

1st Trimester Handout
NUTRITION
All women know they should improve their diet in pregnancy, but how to go about it is
sometimes confusing. You do not need to know every nutritional requirement of
pregnancy. All you need is to keep track of the following and whether you have eaten the
prescribed portions from the food groups.
CALORIES
Eating for two doesn’t mean you need to take the number of calories you need to live on
and doubling it to accommodate the needs of your baby. Your baby is busily building
bones, organs, and other tissues—and accomplishes this by requiring only an additional
300 calories per day. For most pregnant women, those 300 calories are all that must be
added to the number of calories required to maintain their prepregnancy weight. Some
women, such as those who begin their pregnancy significantly underweight, who are
carrying multiple babies, or who are not gaining adequate weight, will need to add more
calories.
Remember the additional 300 calories are slotted for your baby’s growth, not for your
personal pleasure. Add two extra cups of skim milk to your daily diet, and you have
already consumed 180 of those 300 extra calories. Add the additional 50 grams or so of
protein you need, and you have exceeded your allotted bonus. All of this means that
instead of being able to add some fun frills to your diet during pregnancy, you’ll have to
trim most of them away.
Counting calories can be a tedious chore, and is not the most effective way of determining
whether your baby is getting enough calories for his or her growth. So many factors go
into whether a person loses or gains weight—for example, your level of activity and
exercise, individual metabolism (which increases in pregnancy), the amount of fiber in the
diet (fiber pushes some calories through the system before they can be burned for fuel)—
that the extra 300 calories pregnant women need can only be used as a rough guide.
Monitoring your weight gain, and keeping it within the limits of a steady and moderate
pattern is a much more effective way of keeping track of your baby’s calories. Expected
weight gain during pregnancy is 25-35 lbs.; this weight gain guideline will be adjusted if
you started your pregnancy over or underweight.
PROTEIN – four servings daily
No one material is more essential to the building of a baby than protein’s amino acids, the
building blocks of human tissue. In fact, inadequate protein intake during pregnancy
appears to be as closely connected to babies being born small as inadequate calorie intake.
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Though a growing baby doesn’t require that you double your intake of calories, it does
demand that you double your intake of protein. An average non-pregnant woman needs
about 45 grams of protein per day, but an average pregnant woman should take in no
fewer than 75 grams. Up to 100 grams of protein is acceptable. A vegetarian who eats no
animal proteins should have an extra protein serving each day. Since vegetarians are at
increased risk for decreased intake of Vitamin B12, it is also recommended they add a
serving of milk or cheese to each meal.
To fill your protein requirement without over filling your fat cells, try to choose high
efficiency protein sources-those with a high ratio of protein to fat or protein to
carbohydrate. Select chicken, with skin removed, over fatty cuts of pork, lamb, or beef;
broiled, baked, or poached fish over fried; low-fat cottage cheese over ricotta. Don’t rely
often on nuts (about 800 calories per protein serving), or exclusively on peas and beans
(unless you are a strict vegetarian, since the 300 to 350 calories they offer per protein
compares poorly to the 125 calories in a protein serving of codfish).
VITAMIN C – two servings daily
The body doesn’t store vitamin C, so intake of an adequate amount is necessary everyday.
Vitamin C is necessary for growth, tissue repair, wound healing, bone and tooth
development, and various metabolic processes, both fetal and maternal. Vitamin C is
found in foods such as citrus fruits, tomatoes, strawberries, melons, peppers, and potatoes.
Since you only need two vitamin C servings daily, chances are you shouldn’t have to
make any alterations in your diet to ensure adequate intake.
CALCIUM – for servings daily
For some women, this requirement is easier said than done in the form of milk.
Fortunately, intake of a calcium serving can be met in ways other than drinking a glass of
milk. You can also get calcium from other dairy products, particularly yogurt and hard
cheeses, or from non-dairy sources, such as canned fish and certain vegetables. Many
fruit juices that have a calcium supplement added to them are also available. You will
also get a small dose of calcium in your prenatal vitamin supplement.
GREEN LEAFY and YELLOW VEGETABLES and FRUITS – three servings daily
Use color as a guide in selecting your green and yellow vegetables; the deeper green or
yellow, the higher the vitamin levels. Deep green romaine or chicory is a much better
choice for your salad than barely green iceberg lettuce. Deep orange-yellow yams will
provide more vitamin A than paler sweet potatoes, a bright orange carrot more than a
faded one. Try to have three servings (preferably one raw) from the green leafy and
yellow vegetables and yellow fruits everyday, ideally including one green and one yellow.
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OTHER VEGETABLES and FRUITS – one to two servings daily
Though they do not contain significant quantities of a single nutrient (vitamins A or C, for
example), they do supply vital fiber, as well as a healthy dose of other vitamins and
minerals.
WHOLE GRAINS and CARBOHYDRATES – six or more servings daily
Grains (wheat, corn, rice, oats, rye, barley, millet, and triticale) and the breads, cereals,
pastas, and other dishes made from them as well as legumes (dried beans and peas),
contain a wealth of vitamins. They are rich in trace minerals such as zinc, selenium,
chromium, and magnesium. Also, possibly most significant to some women in early
pregnancy, their starchiness can provide a comfort to queasy stomachs.
Though millions of people around the world are sustained primarily on whole grains, no
one can live exclusively on refined grains (white rice, white wheat flour, de-germinated
cornmeal). A one ounce quarter cup serving of wheat germ contains 15% of the US RDA
for protein, vitamin E and iron; 30% for thiamin; 10% for riboflavin and vitamin B6; 20%
for folic acid and magnesium; 35% for phosphorous and 30% of zinc. All this nutrition
was taken out of all the refined breads, rolls, and cereals that most Americans eat. You can
make up for this by eating whole grain products and sprinkling wheat germ on cereals or
snacks.
IRON RICH FOODS – have some everyday
Iron is important when you have to manufacture extra blood, as is the case in pregnancy.
The iron requirement of pregnancy is so high, that it is impossible to fill it with diet alone.
Make sure yourpregnancy vitamin contains 30 to 60 mg of iron. Also, make sure you are
eating foods in which iron naturally occurs such as lean red meats and dark green
vegetables.
HIGH FAT FOODS – two servings daily
This should be no problem for almost every American diet. In fact, most pregnant women
will have to limit their fat intake to two servings daily.
FLUIDS – at least eight glasses a day
Water and fluids are very important in pregnancy. Between amniotic fluid, increased
blood volume in the mother, and additional fluids in maternal tissue, 10 pounds of an
average 30 pound pregnancy weight gain is compromised of liquids. Do not count
caffeinated beverages because they have a diuretic effect.
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SUPPLEMENTS – a daily vitamin
The vitamin formula you take should be especially designed for pregnancy. Do not take
any additional supplements without your doctor’s approval. Some may be toxic in large
doses.
WHAT TO EXPECT NOW THAT YOU ARE PREGNANT
Pregnancy should be a pleasant time for you, but some body changes and discomforts may
arise. Here are some examples:
Your breasts will get larger and firmer. The nipples will get darker and may develop
bumps on them.
Veins in the breasts may become more noticeable. At the 4th or 5th months your nipple
may start giving off a clear or cloudy liquid.
You make feel nauseous during the first half of your pregnancy. Sometimes this is worse
in the morning. You may also have heartburn. These discomforts can be helped by eating
more often. For example, rather than eating three regular meals a day, try eating six small
meals each day. Also, try to snack on plain crackers, especially early in the morning
before getting out of bed. For heartburn, try not to lie down for at least one hour after
eating.
Your moods may change. It is not unusual for a pregnant woman to feel happy one
minute, then sad soon after without an apparent reason.
You may notice pains in your lower belly and hip areas. These are caused by the growth
of your uterus. Abdominal support binders made for pregnancy may help alleviate some
of the lower abdominal stretching pains. You may also experience changes in your legs
such as mild swelling, leg cramps, and even possibly develop enlarged blood vessels in
your legs (varicose veins). Getting off your feet and elevating your legs whenever possible
may help. Pregnancy support hose may also help these symptoms.
You may notice skin changes, such as stretch marks later in the pregnancy. Creams,
lotions, and oils do not prevent these changes. However, after the pregnancy the marks
tend to fade and become less noticeable. Trying to gain no more than the recommended
amount of weight in your pregnancy may help reduce the amount or severity of stretch
marks. You may also get acne and an increase in body hair. These are usually normal
results of changes in the body’s hormones during pregnancy.
You may get become constipated and have to strain to have a bowel movement.
Hemorrhoids may develop. Constipation is best prevented or relieved by including more
fiber in your diet. Foods such as fresh fruits, fresh vegetables, and bran cereal are often
helpful. Do not take laxatives unless this is first discussed with your care provider. You
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may have to urinate more often. Urinary frequency may lessen during the middle months
of pregnancy and then become more frequent toward the end of pregnancy.
If you have any questions or concerns about these and other body changes or conditions
that may arise for you, please discuss them with your health care provider.
TOBACCO, ALCOHOL, DRUG USE
Smoking during pregnancy is hazardous. Women who smoke in pregnancy have a higher
rate of miscarriage. Smoking can also increase the risk of a wide variety of pregnancy
complications. These can include preterm birth, premature rupture of membranes, vaginal
bleeding, and placental abruption. It is a proven fact that women who smoke during their
pregnancy give birth to babies whose birth weights are lower than average. Smoking is not
good for your health, and it is not good for your baby’s health. If you are a smoker, this is
the perfect time to quit.
You should avoid alcohol while you are pregnant. Drinking alcohol when you are
pregnant can cause birth defects, learning disabilities, behavioral problems, and mental
retardation in your baby. These effects of drinking depend on the amount of alcohol
consumed, the stage of pregnancy, and certain susceptibilities of the mother and baby.
The use of illicit drugs during pregnancy has proven adverse effects. Infants born to
addicted mothers may suffer withdrawal symptoms immediately following birth.
Newborns can suffer permanent damage, or even death, from drug use in pregnancy.
EXERCISE
You can keep up any pre-pregnancy exercise routine you may have, unless you have a
medical problem and the doctor has advised you otherwise. If you did not exercise much
before getting pregnant, start your workout routine with slow, low-impact activities such
as walking. Avoid sports where you might get hit in the belly. Try not to push yourself to
the point of becoming overtired. Make sure you stay well hydrated, and do not overheat
while working out. You may find that you have less strength and energy than before you
became pregnant, but exercise is still good for you.
SEXUAL ACTIVITY
Regular sexual relations can be continued as long as it is not causing you to have pain or
bleeding. There is typically no reason to interrupt your normal sex life. For certain
problems or conditions, you may be told to avoid having sex. These conditions can
include vaginal bleeding, preterm labor, and placenta previa. Feel free to ask any
questions about sexual relations during your prenatal visits.
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TRAVEL/HIGH ALTITUDE
You can travel during pregnancy. There are generally no problems with riding in a plane
or taking car trips. For longer trips, it is a good idea to take a copy of your prenatal records
with you. Please discuss any travel plans at your prenatal visits, so you can be given
specific information and advice regarding travel in pregnancy.
Travel to higher altitude in pregnancy, such as mountain towns, is generally not felt to be
a concern. Do not over exert yourself and take cues from your body. We will be happy to
discuss any concerns you may have with you.
SEATBELTS
Seatbelts protect you and your baby in case of a car accident. Wearing your seatbelt
makes you 60% less likely to be injured or killed in an accident. It is best to fasten the belt
below your belly, across your hips and thighs, for maximum safety and minimal
discomfort. The amniotic fluid around your baby cushions him or her against the pressure
of an abrupt stop.
TOXOPLASMOSIS
Cats may carry a disease called toxoplasmosis. The problem is rare but important, as it is
rather easy to prevent. Toxoplasmosis has been known to cause serious problems for
newborn babies including growth failure, mental retardation, blindness, and deafness. To
prevent it, avoid changing or cleaning the cat’s litter box since the disease is usually
spread to humans by cat droppings. Ask someone else to change the litter box for you.
Raw or poorly cooked meat (especially beef) is another cause for toxoplasmosis infection.
Cook all meat until it is well done and avoid eating raw beef in any form while you are
pregnant. It is also important to wash your hands after handling raw meat. Other ways to
prevent this problem are to wash fruits and vegetables before eating them, and also wear
gloves while gardening.
BLEEDING DURING PREGNANCY – FIRST TRIMESTER
Bleeding in pregnancy is not uncommon. It occurs in 15% of pregnancies. When someone
bleeds in early pregnancy, it is called a threatened miscarriage. Approximately half of
threatened miscarriages will eventually miscarry and half will go to term without
problems. The amount of bleeding does make a difference--the more you bleed, the more
likely you are to miscarry. If your blood type is negative, you should have a Rhogam shot
with any early pregnancy bleeding.
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Two other much less common causes of early bleeding include ectopic pregnancy and
molar pregnancy. An ectopic pregnancy is when the fetus implants somewhere other than
the uterus. This is most commonly in the fallopian tube. A molar pregnancy occurs when
the embryo does not develop, but abnormal tissue grows in the uterus instead. Both of
these conditions are evaluated by an ultrasound. If you have had an ultrasound that
showed a fetus in your uterus, you do not have an ectopic pregnancy or a molar
pregnancy.
When should you call you doctor for bleeding in early pregnancy? Please notify us if you
have any bleeding. You may need to come into the office for evaluation.
CAN A WOMAN WORK DURING PREGNANCY?
The answer to this question depends on your own health, the health of your baby, and the
type of job you have. If you and your baby are healthy and your job presents no greater
risks than those found in daily life, you probably can work right up until labor begins and
resume work several weeks after giving birth. Some jobs may present a danger to you or
your developing baby—such as jobs where you work around certain types of chemical or
x-rays. If you have any questions, ask us.
If you have a medical condition such as diabetes, kidney disease, heart disease, or high
blood pressure, your doctor may want you to restrict your activity both on and off the job.
For example, bed rest may be necessary for a pregnant woman with high blood pressure.
Pregnant women can usually do the same things they were used to doing before their
pregnancy. However, some activities may become harder or risky for your safety or health
in pregnancy. These include heavy lifting, climbing, standing for prolonged periods of
time, and activities that involve balance.
During pregnancy, working women have special concerns. With the advice of your doctor
and cooperation from your employer, you should be able to avoid undue risks while you
are working and provide for any periods of disability.
As we have already discussed, it is important to eat well during pregnancy. If possible,
keep some nourishing snacks near your workstation. Drink plenty of water and try to rest
during breaks at work or after work.
Total disability during pregnancy occurs for very few women. Others may be disabled for
only a short time before, during, or after delivery. Most women recover quickly after
delivery and can soon return to their daily routines.
Talk with your health care provider about your concerns related to working while you are
pregnant. Tell him or her about any work-related conditions that worry you.
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