Diosa Ara Pregnancy Curriculum:

Part 1: Unraveling the Roots of Maternal Health Disparities

Begin with an in-depth exploration of the origins of disparities in maternal healthcare. This section presents a historical and contemporary examination of perceptions surrounding the Black female body. It offers a critical lens to view how the regulation of Black women's bodies has become entwined with American racism, and how this history plays out in present-day maternal healthcare.

Part 2: Reality Check: Maternal Outcomes Today

This part provides a hard-hitting examination of maternal outcomes within the contemporary US healthcare system, focusing on the disproportionate effect on Black women. By evaluating current statistics and studies, it emphasizes the urgent need to address and rectify these disparities.

Part 3: Roadmap to a Healthy Pregnancy

This section is your comprehensive guide to a healthy pregnancy, starting with preconception planning. It underscores that a healthy mom forms the foundation of a healthy pregnancy and covers key aspects like understanding pregnancy physiology and prenatal care. It also helps foster essential conversations with your OB/GYN and focuses on building a supportive network for a stress-free pregnancy journey.

Part 4: The Final Countdown: Preparing for Delivery

As you approach the finish line, this section prepares you for your baby's delivery. It assists you in making necessary preparations, understanding the process, and setting up your expectations so you can welcome your bundle of joy with open arms.

Part 5: Handling the Unexpected: Preparing for Pregnancy Complications

While we always hope for the best, preparing for possible pregnancy complications is crucial. This section walks you through the pathophysiology of potential issues like preterm labor, pre-eclampsia, and premature rupture of membranes, among others. We'll equip you with the knowledge and resources to create a robust plan, helping you focus on the joy of your journey, even in the face of potential difficulties.

Part 6: The Forgotten Year: Refocusing on Postpartum

Postpartum is more than just a period of recovery; it's a time of significant physiological changes. This part challenges the societal expectations for immediate 'return to normal' after childbirth, offering a comprehensive guide for navigating the physical and emotional changes during this overlooked year. It provides tangible steps for returning to work based on flow research, helping you embrace your new identity as a mother.

Part 7: Charting Your Course: Navigating the US Healthcare System

This concluding section leaves you with practical tools to navigate the US healthcare system throughout your pregnancy. It offers a simplified week-by-week guide of pregnancy, equipping you with key questions to ask your healthcare provider, and advice on creating a plan tailored to address the unique challenges faced by Black women in maternal healthcare.

This curriculum is crafted to empower, inform, and support you on your journey to motherhood, ensuring you feel prepared, confident, and cared for every step of the way.

In our present day, the maternal mortality crisis has become a glaring issue, particularly in the United States. With a long history of poor maternal outcomes, the US leads its peer countries with the highest rate of maternal mortality, experiencing 24 maternal deaths for every 100,000 live births. This alarming rate is three times higher than that of other comparable nations. In 2019, for instance, there were no maternal deaths reported in Norway. The crisis disproportionately impacts Black women, who face the worst mortality outcomes, as they are three times more likely to die from pregnancy-related complications than white women. Tragically, these disparities have only intensified during the COVID pandemic, with maternal mortality rates climbing 33% since its onset.

Two fundamental questions punctuate the discourse surrounding the maternal health crisis: why haven't we made more significant strides in improving outcomes, and why is an understanding of the historical context of slavery imperative in exploring potential solutions? The answers, though seemingly disparate, are intrinsically intertwined. Progress remains elusive due to an inadequate exploration of the crisis's root causes. To devise efficacious solutions, we must grapple with its origins, stretching back to the era of slavery and its widespread ramifications.

The pursuit of health equity poses a complex challenge, demanding a profound understanding of the root causes and the delicate intersection of biology and social context. It is not enough to merely address the symptoms of the problem. We must dig deeper to untangle the underlying causes that fuel this crisis, and in doing so, recognize the historical influences that persist in the present day.

This endeavor is not purely academic. It is both a moral and practical imperative. Morally, acknowledging this historical context is a step towards reparative justice, recognizing the generations of trauma borne by Black Americans. Practically, it provides the necessary groundwork to inform and shape effective health interventions, policy-making, and advocacy.

Moreover, our scientific endeavors are only as robust as the tools we employ. Developing the right instruments to investigate and mitigate this crisis requires us to accurately identify the issue. A nuanced understanding of the past and its links to the present is an essential tool in this respect. It offers a lens through which we can discern patterns, draw parallels, and formulate interventions that are not just well-intentioned, but well-informed.

The challenge is monumental, but so too is the potential for change. By drawing upon history and employing its lessons, we can foster a healthcare system that is not only cognizant of its past failures, but also committed to a more equitable future. Understanding the history of slavery, its enduring impacts, and its intersection with modern maternal health outcomes is not simply an academic exercise; it is a fundamental step towards rectifying systemic health inequities.

The echoes of slavery still reverberate in today's world, affecting the descendants of slaves in countless ways. To understand this, we must trace the timeline from slavery to the present day, acknowledging the lasting impact of systemic oppression.

Just a single generation ago, the civil rights movement was in full swing, testament to the recentness of the struggle for equality and justice. Its impacts are still palpable in our societies today. Highlighting this temporal proximity, the last child of a known American slave passed away as recently as November 2022, underscoring our closeness to this historical era.

The trauma and repercussions of slavery and its systemic oppression extend into various aspects of life, not least of which is the ongoing maternal mortality crisis. To unravel the complexities of this crisis, we must probe its root causes, linking the present situation with its historical antecedents. This comparative analysis can provide invaluable insights into disparities and guide us to specific intervention points aimed at addressing the enduring effects of this profound trauma.

Over the past few decades, the maternal mortality rate among Black women has been disproportionately high. Though Black Americans and advocates have been aware and vocal about these issues for some time, wider societal acknowledgment and action have been disappointingly slow.

However, a significant shift is emerging. In the last three to five years, we've begun to see a meaningful change in outcomes. This progress coincides with broader societal conversations and realizations about racial disparities in healthcare, as the dialogue moves from the fringes to mainstream awareness.

Despite this, it's imperative to remember that understanding the problem and recognizing its historical roots is just the starting point. The ultimate goal lies in leveraging this awareness to mitigate the maternal mortality crisis and to promote health equity for all.

As we move forward, we must keep this history in focus, using it as both a lens to understand present inequities and a guide to shape future interventions. We are responsible for translating awareness into action, transforming a legacy of pain into a future of equality, justice, and health for all.

While the existence of slavery was not a novel phenomenon, the institution as it evolved in the United States represented a unique configuration that still reverberates in modern America. The American slave system was marked by four particularly distinct aspects: breeding, heritability, permanence, and chattel principles. Each of these played a crucial role in shaping the nature and legacy of American slavery, and together, they created a uniquely horrific and dehumanizing system that has had long-lasting effects on the nation and its people.

The breeding of enslaved people in the United States was a horrifying but integral part of the institution. This practice allowed the enslaved population to grow without the need for continued slave imports. It involved the systematic and forced reproduction of enslaved people, often under brutal and inhumane conditions. The bodies of black women, in particular, were treated as mere commodities in this process, objectified and exploited to increase the enslaved population. This was a unique feature of American slavery that became deeply intertwined with the burgeoning system of market capitalism.

Another distinctive aspect of American slavery was the principle of heritability. Unlike in many other societies where slavery was practiced, in America, the condition of enslavement was inherited from the mother. This meant that the children of enslaved women were born into slavery, regardless of their father's status. This created an unbroken chain of bondage that passed from generation to generation, effectively ensuring a steady supply of enslaved laborers.

Slavery in America was also marked by its permanence. It was a lifelong condition that enslaved individuals could rarely escape. This notion of permanence extended to the entire group of people of African descent, transforming slavery from a social status into a racial construct. Enslaved people were stripped of their individual identities and reduced to their racial status, marking them as property for life. This racialized concept of slavery has had lasting effects, contributing to entrenched racial prejudices and divisions that persist to this day.

The final distinctive aspect of American slavery was the principle of chattel slavery. Enslaved people were viewed and treated as commodities or property that could be bought, sold, and inherited. This principle dehumanized enslaved individuals, reducing them to the same status as livestock or furniture. This reinforced the perception of enslaved people as objects to be used and discarded at will, further entrenching the inhumanity of the system.

The American slave trade uniquely entwined these four dimensions into a brutal system codified by law and developed in sync with market capitalism. What was initially a social classification was reinvented as a racial construct, cementing its permanence and effectiveness. This historical fact is pivotal in understanding the enduring legacy of American slavery. The bodies of black women were central to this system of capitalism, and the regulation of their bodies formed the foundation of the institution of slavery.

This legacy is still palpable today. The racialized nature of slavery and the codification of the bodies of black women as commodities have left an indelible mark on American society. Understanding this history and its enduring impact is critical for grappling with present-day racial disparities and working towards a more equitable society.

Slavery has left an indelible mark on the complex identities of black women, not only defining their historical experiences but also shaping their contemporary realities. This system hinged on dehumanizing stereotypes, which were instrumental in justifying the brutality that was necessary to sustain it.

The paradox of the slavery system was that it was a social and economic institution built on the suppression of the humanity of an entire race of people, a feat achieved through a careful balance of equal and opposite forces. On the one hand, slave masters were intellectually aware of the humanity, value, and capabilities of the enslaved individuals. On the other hand, they also understood the moral conflicts inherent in a system that treated human beings as property.

To reconcile these contradictions, slave masters relied on racist ideologies that provided the necessary psychological distance to facilitate the inhumane treatment of enslaved people. This involved creating and reinforcing negative stereotypes about black women, depicting them as less than human and outside of the conventional idea of 'womanhood.' These stereotypes served as a means for slave masters to justify their control over black women's behavior, shaping our understanding of reproductive rights and fundamentally influencing the identities of black women.

The capitalist system underlying slavery viewed people, especially black women, as capital. This perspective turned the womb of a black woman into a financial asset because the products of her womb - her children - were seen as potential laborers and thus, money.

A brief history of the capitalist system underlying slavery reveals its foundational role in the Southern economy. Starting with the initiation of the transatlantic slave trade, the Southern infrastructure came to be profoundly based on this cruel form of human capitalism. This economic structure created a tension between different regions, as evidenced by the conflict between Virginia and South Carolina over the relative value of breeding versus importation of slaves.

The year 1808 is significant in the history of American slavery because of the abolition of the transatlantic slave trade. This event had two major impacts. First, it necessitated the expansion of the domestic slave trade within the US, as the demand for slave labor remained high even after the importation of new slaves was banned. Second, it led to an increased emphasis on 'breeding' enslaved people, turning every birth into an "addition to the capital," as Thomas Jefferson aptly described it.

This era is captured chillingly in the book 'The American Slave Coast,' which points out that by 1860, a few hundred thousand Africans had given way to four million African Americans. The South was not only producing tobacco, rice, sugar, and cotton for sale; it was also producing people. Every enslaved woman's womb became a source of capital, and her children became the fuel for the Southern economy.

The legacy of slavery and the capitalized womb is a deeply ingrained part of black women's identity. The system of slavery, built on a foundation of cruelty, dehumanization, and capitalist exploitation, has profoundly shaped the experiences and perceptions of black women, affecting their roles, rights, and identities. Recognizing this history is crucial in understanding the complex identity of black women and the ongoing challenge

To fully comprehend the legacy of chattel slavery, we must construct a framework that delves deeper than mere horror. It should allow us to explore its historical footprint while drawing correlations to present times.

In the era of slavery, every facet of a black woman's body was committed to service. As workers, black women's physical strength and hardiness were exploited, stripping them of any control over their labor. This generated a stereotype of dominance and indestructibility associated with black women.

In the eyes of the oppressor, black women were sexually promiscuous beings, deserving no respect. This degrading perception effectively stripped them of control over their bodies, giving birth to the stereotype of the Jezebel.

Black women, seen as lascivious "sluts," were subjected to common indignities. Historians like Gerda Lerner have described how the practice of assigning a single toilet to both black males and females, coupled with the denial of honorifics to black women, reified the idea that they were unworthy of the same respect as white women. Historian Philip A. Bruce went further to assert that without the moral discipline imposed by slave masters, free blacks were regressing to their naturally immoral state. This belief perpetuated the notion that black men could not understand sexual violation or consent because their women were always wanting for sex.

As mothers, black women were painted as poor caretakers, undeserving of sovereignty over their children. This narrative saw the rise of contrasting stereotypes: the Mammy and the young welfare mother.

The glorified Mammy character, exemplified by Hattie McDaniel in "Gone with the Wind," allowed white Americans to ignore the horrifying realities of slavery. This archetype fostered a paradox, suggesting that black women loved white children more than their own, thereby reinforcing notions of white supremacy.

The Stereotype of the Dominant Black Woman

The dominant black woman emerged as a strong, commanding figure. This image further served to perpetuate the distorted understanding of black women in society.

The Corrupted Black Family: Blame on Black Women

The degradation of the black family unit has been historically blamed on black women, marking another lasting consequence of the legacy of slavery.

Conclusion: Deciphering the Legacy of the Capitalized Womb

The shadows of slavery and the capitalized womb continue to inform black women's identities, their roles, rights, and experiences. Understanding this complex history and its ramifications is fundamental to addressing the ongoing challenges faced by black women today.

Biological Racism and the Legacy of Slavery: Tracing the Impact on Black Women

Biological Definitions of Race: The Legacy of Slavery

The biological definitions of race, particularly as they pertain to black women, have their roots in the perpetuation of slavery. It may not appear obvious, but the treatment of black women during slavery significantly influenced these definitions. English common law traditionally linked inheritance to the father, but slavery prompted a reversal of this concept due to the financial incentives it presented. Slave status was inherited from the mother, essentially enabling the mother's womb to produce socially disadvantaged offspring. By controlling the womb, slave owners managed to transform disorder into order.

Eugenics and the Threat of the Black Woman's Womb

Under the banner of eugenics, black women's wombs were perceived as biological threats. This perspective necessitates a cautious approach to the issue of contraception, as it led to blaming black women for genocide. The narrative framing white mothers has differed vastly, with society showing sympathy for white mothers while branding black mothers as criminals. It's worth exploring whether the racialization of pain treatment contributed to this damaging narrative.

Representations of Fertility and the Use of Gene Editing

Traditionally, fertility is depicted through the imagery of white babies. However, women of different races are now being recruited for gene editing practices, under the guise of producing 'better' babies.

Welfare, Foster System, and the Prison System: Another Layer of Injustice

The welfare, foster, and prison systems present another set of challenges for black women. The removal of children is used as a form of punishment, adding another facet to the injustices faced by black women. The struggle for reproductive justice is intrinsically interwoven with other justice movements, necessitating coordinated efforts. The Trust Black Women Campaign stands as an example of such an effort.

Maternal Mortality Rates During Slavery

Historical records indicate a high maternal mortality rate among enslaved women, with estimates suggesting a death rate of 1 in every 10 births. This high mortality rate is attributed to the lack of adequate medical care provided to pregnant women, leading to increased risks of infection, hemorrhaging, and other complications. The physically taxing labor demanded from women even when nearing their due dates further exacerbated the situation. The harsh conditions of slavery, including malnutrition and poor living conditions, coupled with inadequate medical care, increased the death risks for African American women during childbirth. The physical and emotional trauma associated with slavery also heightened the risk of death during pregnancy or labor.

Post-Slavery Conceptions of Black Women

Following the Emancipation Proclamation in 1863, African Americans were technically freed from the chains of chattel slavery. However, the realities of emancipation fell far short of the promises made. Even in the absence of legal slavery, African Americans continued to grapple with substantial barriers to economic, political, and social equality. Racism, discrimination, and segregation persisted, limiting access to resources, opportunities, and services.

Black women, in particular, faced extensive violence, exploitation, and abuse in the decades following emancipation. This included sexual violence, often leading to forced pregnancies and elevated infant mortality rates. The lack of access to healthcare services meant that African American women had limited prenatal care options and inadequate support during labor and delivery.

The Maternal Mortality Crisis in Contemporary America: An Examination and Path Forward

Epidemiological Trends in Maternal Mortality: A Snapshot

This section discusses the current epidemiological trends in maternal mortality, providing a comprehensive overview of the extent of the crisis.

Geographical Variations in Maternal Mortality: A State-by-State Analysis

This portion details the variations in maternal mortality rates across different states and regions. It attempts to understand correlations with historical practices and perceptions that may explain why some areas fare better or worse.

Unveiling the Drivers of Maternal Mortality

Here, we delve into the epidemiological drivers behind the high maternal mortality rates. It includes an exploration of systemic and societal factors contributing to this crisis.

Poor Outcomes for Mothers and Babies: Unraveling the Relationship

This section examines the connection between adverse outcomes for mothers and babies, with a specific focus on infant mortality and the conditions contributing to poor outcomes like Hypertension, Gestational Diabetes Mellitus (GDM), and Preterm Delivery (PTD).

Health Care System and Abortion Policy: Impact and Influence

This part analyzes the current health care system's practices, focusing on the impact of abortion policy on maternal mortality rates.

## Reproductive Health Care in the US: Future Prospects

This section speculates on the future of reproductive health care in the United States, exploring possible directions and potential improvements, as well as factors that may exacerbate the crisis.

## Interventions and Clinical Models: Charting a Way Forward

Here, we discuss successful interventions and different clinical models, such as midwives, community-based care, and educational initiatives that could potentially improve maternal outcomes.

## Policy and Maternal Mortality: An Interconnected Relationship

This section examines the role of policy, including insurance regulations and social drivers, in maternal mortality. The impact of abortion policies on the maternal health landscape is also explored in detail.

## The Promise of Innovation and Technology

This portion explores the potential role of innovation and technology in tackling the maternal mortality crisis. It includes discussions on cutting-edge medical advancements, digital health tools, and the use of data analytics in predicting and preventing maternal deaths.

## Entrepreneurship: An Untapped Potential

Here, we explore the potential role of entrepreneurship in improving maternal health outcomes. This includes discussions on innovative start-ups and the role of private sector investments in driving maternal health improvements.

## Responsibilities and Role of Current Healthcare Infrastructure

In this section, the responsibilities of our current healthcare infrastructure are examined. It also discusses the potential for collaboration with other non-profit organizations, for-profit entities, and stakeholders to contribute to resolving this crisis.

I. Introduction

A. Overview of the maternal mortality crisis

Provide a comprehensive overview of the current state of maternal mortality USA, emphasizing the severity of the issue and its impact on individuals, families, and communities.

B. Significance of addressing maternal mortality

Discuss the importance of prioritizing maternal health as a fundamental human right, a critical public health concern, and an indicator of the overall well-being of societies.

I. Maternal health as a fundamental human right

a. Universal Declaration of Human Rights: Highlight how maternal health is recognized as a fundamental human right by international agreements and declarations.

b. Right to life and healthcare: Discuss the importance of protecting the lives and well-being of pregnant individuals, emphasizing their right to accessible, safe, and high-quality healthcare services.

II. Maternal health as a critical public health concern

a. Impact on population health: Explain how maternal mortality affects population health indicators, such as life expectancy and infant mortality rates.

b. Intersections with other health issues: Discuss the interconnections between maternal health and other public health concerns, such as reproductive health, child health, and infectious diseases.

c. Economic implications: Highlight the economic costs associated with maternal mortality, including lost productivity and increased healthcare expenses.

III. Maternal health as an indicator of overall well-being

a. Maternal health as a reflection of societal progress: Illustrate how the status of maternal health reflects the overall development and progress of a society.

b. Gender equality and women's empowerment: Discuss the role of maternal health in promoting gender equality, women's rights, and empowerment.

c. Inter-generational impact: Emphasize how improving maternal health outcomes contributes to better health outcomes for future generations.

IV. Importance of preventive and comprehensive care

a. Focus on preventive measures: Discuss the significance of investing in preventive care, early interventions, and evidence-based practices to reduce maternal mortality rates.

b. Comprehensive approach to maternal health: Highlight the need for a holistic approach that addresses not only medical care but also social, economic, and cultural factors impacting maternal health outcomes.

c. Maternal health as an indicator of healthcare system performance: Explain how maternal health outcomes can serve as a measure of the effectiveness and equity of healthcare systems.

V. Call to action for policy and advocacy

a. Policy reforms and investments: Advocate for policy changes, increased funding, and targeted interventions to improve maternal health outcomes.

b. Strengthening healthcare systems: Emphasize the importance of strengthening healthcare systems, ensuring equitable access to quality care, and addressing systemic barriers and disparities.

c. Empowering women and communities: Encourage initiatives that empower women, enhance health literacy, and promote community engagement in maternal health promotion.

II. Understanding Maternal Mortality

A. Definition and measurement of maternal mortality

Explain the definition of maternal mortality, which typically refers to the death of a woman during pregnancy, childbirth, or within a specified period after delivery. Describe the different measures and indicators used to track and analyze maternal mortality rates.

B. Key factors contributing to maternal mortality

Explore the multifactorial nature of maternal mortality, discussing the various factors that contribute to maternal deaths.

Lack of access to quality healthcare

Examine how limited access to healthcare services, including skilled birth attendants, emergency obstetric care, and essential maternal health interventions, contributes to maternal mortality.

Socioeconomic and cultural factors

Discuss the influence of socioeconomic disparities, poverty, inadequate education, cultural beliefs, and gender inequalities on maternal health outcomes.

Maternal health complications and pre-existing conditions

Explore the impact of maternal health conditions, such as hypertensive disorders, hemorrhage, and infections, on maternal mortality rates. Discuss how pre-existing health conditions can exacerbate the risk.

Inadequate prenatal and postnatal care

Highlight the importance of comprehensive and timely prenatal care, postnatal care, and follow-up services in preventing maternal deaths.

III. Maternal Outcomes in the US Healthcare System (here we can add stats research)

A. Disproportionate effect on Black women

Focus on the significant disparities in maternal outcomes experienced by Black women in the United States.

Current statistics on maternal mortality rates among Black women

Factors contributing to the disparities

a. Racial bias and discrimination in healthcare

Explore how racial bias and discriminatory practices within the healthcare system can result in inadequate care, delayed diagnoses, and increased maternal risks for Black women.

b. Socioeconomic and structural inequalities

Discuss how socioeconomic disadvantages, systemic racism, and social determinants of health contribute to poorer maternal outcomes among Black women.

c. Implicit biases in medical decision-making

Address the impact of implicit biases held by healthcare providers, which may result in disparities in treatment and management of maternal complications for Black women.

B. Impact on Black women's health and well-being

Higher rates of maternal complications and poor outcomes

Explore the increased likelihood of experiencing maternal complications and adverse outcomes among Black women, including severe morbidity and long-term health consequences.

Intersections of race, gender, and socioeconomic status

Discuss how the intersections of race, gender, and socioeconomic factors further compound the challenges faced by Black women, potentially leading to cumulative health risks and disparities.

Before embarking on the journey of pregnancy, it is crucial for women to prioritize their health and well-being. One essential step towards ensuring a healthy pregnancy is undergoing a prepregnancy care checkup. This checkup serves as a vital opportunity for healthcare professionals to assess your overall health, identify any potential risks or concerns, and provide guidance to optimize your chances of a successful pregnancy. Understanding the importance of this checkup will empower you to take proactive steps towards a healthy and fulfilling pregnancy experience.

Assessing Your Health Status:

During the prepregnancy care checkup, your healthcare provider will conduct a thorough evaluation of your general health. This includes reviewing your medical history, assessing chronic conditions or previous complications, and examining any medications or supplements you may be taking. By understanding your health status before conception, your healthcare provider can address any underlying issues and develop an individualized care plan tailored to your needs.

Identifying and Managing Risk Factors:

The checkup plays a critical role in identifying and managing potential risk factors that may affect your pregnancy. Through comprehensive screenings and tests, your healthcare provider can identify conditions such as diabetes, hypertension, thyroid disorders, or infections that may require treatment or special care during pregnancy. By addressing these factors beforehand, you can significantly reduce the risks associated with pregnancy complications and ensure the well-being of both you and your baby.

Optimizing Your Health and Lifestyle:

Prepregnancy care checkups provide an opportunity to optimize your health and lifestyle choices. Your healthcare provider can offer guidance on nutrition, exercise, and achieving a healthy weight, all of which contribute to a smooth and healthy pregnancy. Additionally, discussions on smoking cessation, alcohol and substance use, and managing stress can help you make positive changes that will benefit your overall well-being and enhance your chances of a successful pregnancy.

Family Planning and Reproductive Health:

Beyond assessing your physical health, prepregnancy care checkups also allow for discussions on family planning and reproductive health. Your healthcare provider can address any concerns you may have regarding fertility, contraception, or previous reproductive issues. They can also provide guidance on timing conception to increase the likelihood of successful pregnancy outcomes.

Significance of identifying potential pregnancy-affecting factors

Primary care practitioner vs. obstetrician-gynecologist (ob-gyn)

Chapter reference: "Choosing Your Care Team”

A. Diet and lifestyle

Importance of maintaining a healthy lifestyle during pregnancy

The section "A Healthy Lifestyle" in this chapter

B. Medical and family history

Identifying potential health risks during pregnancy based on medical and family history

C. Medications

Discussing current medications and their risks during pregnancy

D. Past pregnancies

Learning from previous pregnancies and identifying potential risks for a future pregnancy

E. Vaccinations

Reviewing current vaccinations and discussing recommended vaccines

F. Sexually transmitted infections (STIs)

Discussing STI risks and prevention methods

G. Genetic disorders

Screening for genetic disorders in the patient and/or partner's families

A. Diseases and Surgeries

B. Chronic Conditions

Depression

Diabetes Mellitus

Eating Disorders

Hypertension

Seizure Disorders

C. Risk of Problems for Baby

D. Changes to Bring Condition Under Control

A. Genetic Disorders

B. Family History Form - of particular importance are

C. Carrier Screening

D. Genetic Counseling

A. Genetic Disorders:

Explanation of Genetic Disorders:

In this section, patients should be provided with an overview of common genetic disorders that can affect pregnancy. Information on conditions such as Down syndrome, cystic fibrosis, sickle cell anemia, and Tay-Sachs disease can be included. Explain the nature of these disorders, their inheritance patterns, and the potential impact on pregnancy and the baby's health.

2. Risks and Prevalence:

Educate patients about the risks associated with genetic disorders and their prevalence in different populations. Provide statistics and data to help them understand the likelihood of having a child with a genetic disorder based on their ethnic background and family history. This information will empower patients to make informed choices and consider appropriate screenings and interventions.

B. Family History Form - of particular importance are:

Collecting Family Health History:

Highlight the importance of gathering comprehensive family health history information. Provide patients with a family health history form that they can use to document and organize information about genetic conditions, chronic diseases, and other relevant health issues in their immediate and extended family. Explain how this information can help identify potential genetic risks and guide further screening and interventions.

2. Identifying Red Flags:

Teach patients how to identify red flags or patterns in their family health history that may indicate an increased risk of certain genetic disorders. Emphasize the significance of close relatives affected by genetic conditions, multiple family members with the same disorder, or a history of pregnancy complications. By recognizing these red flags, patients can proactively seek appropriate genetic screenings and consultations.

C. Carrier Screening:

Explanation of Carrier Screening:

Introduce the concept of carrier screening, which involves testing individuals for genetic mutations that may not cause health problems in themselves but can be passed on to their children. Explain that carrier screening can identify carriers of genetic disorders, providing insight into the risk of having a child with the condition. Emphasize that carrier screening is a personal decision, but it can help individuals make informed choices about family planning and potential interventions.

2. Screening Options and Timing:

Provide an overview of the different types of carrier screening available, such as blood tests or genetic panels. Explain when carrier screening should ideally be conducted, whether before pregnancy or during early pregnancy. Discuss the importance of discussing screening options with healthcare providers to determine the most appropriate approach based on individual circumstances.

D. Genetic Counseling:

Role of Genetic Counseling:

Explain the role of genetic counseling as a valuable resource for individuals and couples considering pregnancy or dealing with genetic risks. Describe how genetic counselors can provide personalized information, support, and guidance regarding genetic disorders, carrier screening, and reproductive options. Emphasize the importance of seeking genetic counseling to address concerns, make informed decisions, and alleviate anxiety.

2. Accessing Genetic Counseling:

Provide information on how to access genetic counseling services, including referrals, clinics, and online resources. Explain the benefits of involving partners or family members in genetic counseling sessions to ensure a comprehensive understanding of genetic risks and facilitate shared decision-making.

Prepregnancy Carrier Screening: Ensuring Genetic Compatibility and Family Planning

F. Prepregnancy Carrier Screening

1. Tests to determine if you are a carrier of a genetic disorder

2. Options if you are a carrier

3. Diagnostic tests that can tell whether a baby has certain genetic disorders

A. Prescription Medications

Communication with Healthcare Provider:

Emphasize the importance of open and honest communication with healthcare providers regarding current prescription medications. Encourage patients to schedule a consultation with their healthcare provider to review their medication regimen, discuss any potential risks or concerns, and explore alternative options if necessary.

2. Evaluation of Medication Safety:

Educate patients about the process of evaluating the safety of prescription medications during pregnancy. Explain the categories (e.g., A, B, C, D, or X) used to classify the potential risks associated with specific medications. Provide examples of commonly prescribed medications in each category and discuss the importance of balancing the benefits of the medication against the potential risks to the developing fetus.

B. Over-the-Counter Medications

Cautionary Approach:

Highlight the need for caution when considering over-the-counter medications during pregnancy. Explain that even seemingly harmless medications may have potential risks. Encourage patients to consult with their healthcare provider or a pharmacist before taking any over-the-counter medications to ensure they are safe for use during pregnancy.

2. Common Over-the-Counter Medications:

Provide a list of commonly used over-the-counter medications, such as pain relievers, cough and cold remedies, and antacids. Explain which medications are generally considered safe for use during pregnancy and which ones should be avoided or used with caution. Empower patients to read labels carefully, follow dosing instructions, and seek professional advice when in doubt.

C. Vitamin Supplements

Importance of Prenatal Vitamins:

Emphasize the importance of prenatal vitamins containing essential nutrients like folic acid, iron, and calcium. Explain that these nutrients play a crucial role in the development of the baby and can help prevent certain birth defects. Encourage patients to start taking prenatal vitamins even before conception to ensure an adequate supply of nutrients during early pregnancy.

2. Evaluating Other Supplements:

Discuss the need for caution when considering other vitamin or mineral supplements. Inform patients that not all supplements are safe for use during pregnancy. Encourage them to consult with their healthcare provider or a registered dietitian to evaluate the safety and necessity of additional supplements based on their individual nutritional needs.

D. Herbal Supplements

Potential Risks:

Educate patients about the potential risks associated with herbal supplements during pregnancy. Explain that herbal supplements are not regulated in the same way as prescription medications and may not undergo rigorous safety testing. Emphasize the importance of discussing the use of herbal supplements with healthcare providers to ensure they are safe and appropriate for pregnancy.

2. List of Unsafe Herbs:

Provide a list of commonly used herbs that are known to pose potential risks during pregnancy. Examples may include black cohosh, blue cohosh, and dong quai. Encourage patients to carefully read labels and consult with healthcare providers before using any herbal supplements.

E. Discuss Safety During Pregnancy

Safety Precautions:

Discuss general safety precautions during pregnancy, such as avoiding alcohol, tobacco, and illicit drugs. Explain the potential risks associated with these substances and how they can impact the developing fetus. Encourage patients to seek support and resources if they need help quitting these substances.

2. Environmental Exposures:

Highlight the importance of minimizing exposure to harmful substances, such as chemicals, pesticides, and certain occupational hazards

F. Stop or Switch Medications

Consulting with Healthcare Provider:

Explain the significance of consulting with a healthcare provider before making any decisions regarding the use of medications during pregnancy. Encourage patients to schedule an appointment to discuss their current medications and the potential risks and benefits associated with each one.

2. Medication Evaluation:

During the consultation, healthcare providers will assess the necessity of each medication and evaluate its safety for use during pregnancy. They may consider factors such as the medication's potential effects on fetal development, available alternatives, and the patient's specific health condition.

3. Risks versus Benefits:

Patients should understand that the decision to stop or switch medications during pregnancy involves weighing the risks versus benefits. Sometimes, the benefits of continuing a medication outweigh the potential risks, especially if the medication is essential for managing a chronic condition. In other cases, it may be necessary to switch to a safer alternative or explore non-pharmacological treatments.

4. Gradual Discontinuation:

Abruptly stopping certain medications can have adverse effects on the body. If a decision is made to discontinue a medication, healthcare providers will typically provide guidance on gradually tapering off the medication to minimize any potential withdrawal symptoms or rebound effects.

5. Collaborative Decision-Making:

Highlight the importance of engaging in collaborative decision-making with healthcare providers. Patients should feel empowered to ask questions, voice their concerns, and actively participate in the treatment decision process. This collaborative approach ensures that the best possible decisions are made, taking into account both the health of the mother and the potential risks to the developing baby.

6. Regular Medication Reviews:

Stress the importance of regular medication reviews throughout pregnancy. As the body undergoes changes, medication needs may evolve. Healthcare providers will monitor the patient's health and adjust medications as necessary to ensure optimal management of any conditions while minimizing potential risks to the developing fetus.

7. Ongoing Communication:

Encourage patients to maintain open and ongoing communication with their healthcare provider throughout pregnancy. If new symptoms or concerns arise or if there are changes in medication needs, patients should promptly consult their healthcare provider for further evaluation and guidance.

1. Certain infections during pregnancy can cause birth defects or pregnancy complications

Certain infections during pregnancy can cause birth defects or pregnancy complications. Many infections can be prevented with vaccination. You should get all the shots recommended for your age group before you try to get pregnant.

Certain vaccines should not be given to pregnant women because they contain live, attenuated viruses. “Attenuated” means that the virus has been weakened so that it cannot cause disease in a healthy person.

The vaccines that women should not get during pregnancy include live, attenuated influenza ( flu) vaccine given as a nasal spray (but the u shot is safe) measles–mumps–rubella (MMR) vaccine varicella (chickenpox) vaccine If you need the MMR vaccine or the chickenpox vaccine, get these shots at least 1 month before getting pregnant. During this month, keep using birth control.

Most other vaccines contain killed versions of the viruses or bacteria that cause disease. ese killed versions do not cause the disease itself when given as a vaccine. ese shots are safe to get during pregnancy. the CDC recommends that everyone 6 months and older get the u shot each year. If you are pregnant or planning to get pregnant, it is especially important to get a u shot as soon as the vaccine is available. the flu season is from October to May, and the flu vaccine is normally available shortly before it starts. A pregnant woman who gets the flu can get much sicker than a non-pregnant woman who gets the flu. the flu shot offers you the best protection. the shot also helps protect your baby from the flu until he or she can get a flu shot at 6 months

Protection Against Sexually Transmitted Infections

Other infections that can be harmful during pregnancy are those passed through sexual contact. STIs can affect your ability to get pregnant. STIs also can harm your baby if you become infected while you are pregnant. Before pregnancy, take steps to reduce your risk of getting an STI. Using a male or female condom every time you have sexual intercourse is important. Urinating after sexual intercourse can reduce the chance of developing a urinary tract infection (UTI) but does not protect against STIs. You are at higher risk of getting an STI if you have sex with more than one partner. You also are at higher risk if your partner has sex with someone else.Because many STIs have no symptoms in the early stages, prepregnancy testing for the following is recommended:

You should be tested for chlamydia if you are 25 or younger, or if you are over 25 with risk factors. Risk factors include having a new sex partner or multiple partners.

You should be tested for gonorrhea if you are 25 or younger and you have certain risk factors. Risk factors include having gonorrhea or another STI in the past, having new or multiple sex partners and not using condoms every time, and living in an area where gonorrhea rates are high.

All women should be tested for HIV. HIV cannot be cured, but if you know your HIV status, you can make important decisions about pregnancy. You also can learn about treatment options that may make it less likely you will pass the infection to your baby.

Vaccines not recommended during pregnancy

According to the Centers for Disease Control and Prevention (CDC), the following vaccines are not recommended during pregnancy:

MMR (measles, mumps, rubella)

Varicella (chickenpox)

Zoster (shingles)

HPV (human papillomavirus)

Live attenuated influenza vaccine (LAIV)

These vaccines contain live viruses that could potentially harm the developing fetus. However, it's important for pregnant women to receive other recommended vaccines, such as Tdap (tetanus, diphtheria, and pertussis) and flu shots, to protect themselves and their babies from preventable diseases. Pregnant women should always consult with their healthcare provider before receiving any vaccines.

3. Vaccines that are safe to get during pregnancy

4. Flu shot

5. Tdap shot

Protection Against Sexually Transmitted Infections: Safeguarding Reproductive Health Prior to Pregnancy

E. Protection Against Sexually Transmitted Infections

1. Reduce risk of getting an STI

2. STIs that do not have cures

3. STIs that can be treated with medication

Proper nutrition in pregnancy is critical for your health and the health of your baby.

During pregnancy, the mother's body changes to help the baby grow. It's important for the mother to eat enough good nutrients so the baby can develop normally. If the mother doesn't eat enough or eats too much, it can cause problems for her and the baby. The things that happen to the baby while it's growing can affect its health later on in life. We know this from studies of babies born during a famine in World War II and from more recent studies of obese mothers. We can help reduce the risk by making sure pregnant women eat well, but we still need more information.

The 2020 Dietary Guidelines for Americans included nutritional guidance for pregnant individuals for the first time, incorporating evidence from recent research and prior sources. Recommended dietary allowances (RDAs) are based on extensive evaluation of available scientific evidence and adjusted to meet the needs of 97 percent of the population.

What is my engergy intake in pregnancy?

Macronutrients

Protein —

Carbohydrate and fiber

●Recommended intake – Carbohydrate requirements increase to 175 g/day in pregnancy, up from 130 g/day in nonpregnant females [

18,27⁠

]. The Dietary Guidelines for Americans recommend 45 to 65 percent of kcals from carbohydrate for both pregnant and nonpregnant individuals (

table 2⁠

) [

18⁠

] since the increase in the carbohydrate requirement is proportional to the increase in pregnancy caloric requirements.

Fiber intake of 28 to 36 g/day is recommended in pregnancy (

table 2⁠

), which, along with adequate fluid intake, may help prevent or reduce constipation [

18⁠

]. High fiber consumption prior to conception was associated with a decreased risk of preeclampsia and dyslipidemia in an observational study [

35⁠

]. High fiber intake may also have favorable effects on blood glucose. (See

"Healthy diet in adults", section on 'Fiber'⁠

.)

●Sources – The focus should be on consuming several servings of whole foods: fruits, vegetables, and whole grains. Highly processed carbohydrates should be minimized to help manage weight gain and avoid high postprandial blood glucose levels, particularly among those with or at high risk of diabetes.

Fat

●Recommended intake – The Dietary Guidelines for Americans set daily nutritional goals for pregnant individuals as 20 to 35 percent of total energy intake from fats, <10 percent of total energy from saturated fat, and daily goals for essential fatty acids of 13 g/day of linoleic acid (18:2) and 1.4 g/day of linolenic acid (18:3) (

table 2⁠

) [

18⁠

]. These goals are consistent with a healthy dietary pattern.

Approximately 75 percent of pregnant people exceed the recommended limit for saturated fat (that from animal products such as meat and dairy, and coconut, palm, and palm kernel oil) [

18⁠

], which may have negative metabolic consequences.

●Sources – Consumption of healthy fats and limiting of saturated fats are recommended. Dietary patterns that provide a healthy profile of fats consistent with the Dietary Guidelines for Americans include the Mediterranean diet (see

"Healthy diet in adults", section on 'Mediterranean diet'⁠

) and the Dietary Approaches to Stop Hypertension (DASH) diet (see

"Healthy diet in adults", section on 'DASH diet'⁠

). In these diets, plant-derived fats, such as olive oil and nuts, and two to three servings per week of fish comprise the majority of fat intake.

Long-chain polyunsaturated fatty acids — Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are two n-3 (also known as omega-3) long-chain polyunsaturated fatty acids (n-3 LCPUFAs) derived primarily from fish or marine-based sources. DHA is necessary for normal development of the fetal brain and retina, and seafood consumption during pregnancy has also been associated with favorable cognitive development in offspring [

36⁠

]. N-3 PUFAs have anti-inflammatory effects, which have been associated with a reduction in preterm birth and an increase in mean duration of gestation [

37⁠

].

●Recommended intake – The Dietary Guidelines for Americans recommend that pregnant individuals consume 8 to 12 ounces of seafood per week [

18⁠

]. The number of weekly servings of fish needed to achieve the DHA intake goal of 200 to 300 mg/day depends on the type of fish, as shown in the table (

table 3⁠

). Importantly, pregnant people (and those planning to conceive) should choose fish that are low in mercury and other contaminants; a chart to help consumers make appropriate choices is available

online⁠

. (See

"Nutrition in pregnancy: Assessment and counseling", section on 'Guidelines for safe seafood consumption'⁠

.)

●Sources – Consumption of fish and other marine-based sources is recommended. For pregnant people who are not able or willing to consume fish or adequate amounts of fish, supplementation with n-3 LCPUFAs and consumption of other food sources of n-3 LCPUFA are recommended to achieve an intake of 200 to 300 mg/day of DHA. A number of foods fortified with DHA are available, including yogurt, milk, and eggs. DHA supplements are available either from fish oil or synthesized by algae. Some prenatal vitamins also contain DHA/EPA. (See

"Fish consumption and marine omega-3 fatty acid supplementation in pregnancy"⁠

.)

Lipid-based nutrient supplements are a good source of macro- and micronutrients and have been used to address nutrient requirements in areas where maternal undernutrition is prevalent. (See

"Undernutrition in pregnancy: Evaluation, management, and outcome in resource-limited areas", section on 'Lipid-based nutrient supplements'⁠

.)Macronutrients

Protein — The fetal/placental unit utilizes approximately 1000 g of protein, with most of this requirement in the last six months.

●Recommended intake – The Dietary Guidelines for Americans recommend a minimum daily nutritional goal of 71 g/day (1.1 g/kg/day) (

table 2⁠

), which is higher than the recommendation for nonpregnant people (46 g/day or 0.8 g/kg/day) [

18,27⁠

]. The increase in protein consumption should be proportional to total calories, as the percent of calories from protein remains at 10 to 35 percent total kcal for both pregnant and nonpregnant individuals. Some experts have recommended keeping protein consumption below 25 percent kcal [

28⁠

].

Reported total protein intake among pregnant individuals in resource-abundant countries is between 14.7 and 16.1 percent, thus falling within these recommendations.

●Sources – Healthy protein sources include lean meats, poultry and eggs, seafood, beans, peas, lentils, nuts, seeds, and soy products. Highly processed meats are not recommended. In the United States, pregnant individuals typically consume excess meats, poultry, and eggs, while consumption of seafood, beans, peas and lentils are below recommendations [

18⁠

].

We discourage use of special protein powders and high-protein supplements. In pregnant people, especially those who likely have adequate protein intake, high-protein supplements have no measurable benefits and may have harmful effects, such as lower birth weight and higher risk of small for gestational age, although data are not definitive [

6,29⁠

]. For example:

•In analyses of randomized trials of undernourished pregnant people, protein supplementation alone (in contrast to balanced energy and protein supplementation) did not improve clinically important pregnancy outcomes [

30-32⁠

].

•In an observational study of >91,000 pregnant people in Japan, maternal protein intake had an inverse U-curve: Birth weight was highest and risk of small for gestational age was lowest when protein consumption was approximately 12 percent of kcals [

33⁠

].

•In a study of >120,000 pregnant people in Denmark and Norway, high-protein intake did not appear to affect mean birth weight or incidence of low birth weight; however, it was associated with a modest increased risk of preterm birth [

34⁠

]. (See

"Undernutrition in pregnancy: Evaluation, management, and outcome in resource-limited areas", section on 'Balanced energy and protein supplementation'⁠

.)

Carbohydrate and fiber

●Recommended intake – Carbohydrate requirements increase to 175 g/day in pregnancy, up from 130 g/day in nonpregnant females [

18,27⁠

]. The Dietary Guidelines for Americans recommend 45 to 65 percent of kcals from carbohydrate for both pregnant and nonpregnant individuals (

table 2⁠

) [

18⁠

] since the increase in the carbohydrate requirement is proportional to the increase in pregnancy caloric requirements.

Fiber intake of 28 to 36 g/day is recommended in pregnancy (

table 2⁠

), which, along with adequate fluid intake, may help prevent or reduce constipation [

18⁠

]. High fiber consumption prior to conception was associated with a decreased risk of preeclampsia and dyslipidemia in an observational study [

35⁠

]. High fiber intake may also have favorable effects on blood glucose. (See

"Healthy diet in adults", section on 'Fiber'⁠

.)

●Sources – The focus should be on consuming several servings of whole foods: fruits, vegetables, and whole grains. Highly processed carbohydrates should be minimized to help manage weight gain and avoid high postprandial blood glucose levels, particularly among those with or at high risk of diabetes.

Fat

●Recommended intake – The Dietary Guidelines for Americans set daily nutritional goals for pregnant individuals as 20 to 35 percent of total energy intake from fats, <10 percent of total energy from saturated fat, and daily goals for essential fatty acids of 13 g/day of linoleic acid (18:2) and 1.4 g/day of linolenic acid (18:3) (

table 2⁠

) [

18⁠

]. These goals are consistent with a healthy dietary pattern.

Approximately 75 percent of pregnant people exceed the recommended limit for saturated fat (that from animal products such as meat and dairy, and coconut, palm, and palm kernel oil) [

18⁠

], which may have negative metabolic consequences.

●Sources – Consumption of healthy fats and limiting of saturated fats are recommended. Dietary patterns that provide a healthy profile of fats consistent with the Dietary Guidelines for Americans include the Mediterranean diet (see

"Healthy diet in adults", section on 'Mediterranean diet'⁠

) and the Dietary Approaches to Stop Hypertension (DASH) diet (see

"Healthy diet in adults", section on 'DASH diet'⁠

). In these diets, plant-derived fats, such as olive oil and nuts, and two to three servings per week of fish comprise the majority of fat intake.

Long-chain polyunsaturated fatty acids — Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are two n-3 (also known as omega-3) long-chain polyunsaturated fatty acids (n-3 LCPUFAs) derived primarily from fish or marine-based sources. DHA is necessary for normal development of the fetal brain and retina, and seafood consumption during pregnancy has also been associated with favorable cognitive development in offspring [

36⁠

]. N-3 PUFAs have anti-inflammatory effects, which have been associated with a reduction in preterm birth and an increase in mean duration of gestation [

37⁠

].

●Recommended intake – The Dietary Guidelines for Americans recommend that pregnant individuals consume 8 to 12 ounces of seafood per week [

18⁠

]. The number of weekly servings of fish needed to achieve the DHA intake goal of 200 to 300 mg/day depends on the type of fish, as shown in the table (

table 3⁠

). Importantly, pregnant people (and those planning to conceive) should choose fish that are low in mercury and other contaminants; a chart to help consumers make appropriate choices is available

online⁠

. (See

"Nutrition in pregnancy: Assessment and counseling", section on 'Guidelines for safe seafood consumption'⁠

.)

●Sources – Consumption of fish and other marine-based sources is recommended. For pregnant people who are not able or willing to consume fish or adequate amounts of fish, supplementation with n-3 LCPUFAs and consumption of other food sources of n-3 LCPUFA are recommended to achieve an intake of 200 to 300 mg/day of DHA. A number of foods fortified with DHA are available, including yogurt, milk, and eggs. DHA supplements are available either from fish oil or synthesized by algae. Some prenatal vitamins also contain DHA/EPA. (See

"Fish consumption and marine omega-3 fatty acid supplementation in pregnancy"⁠

.)

Lipid-based nutrient supplements are a good source of macro- and micronutrients and have been used to address nutrient requirements in areas where maternal undernutrition is prevalent. (See

"Undernutrition in pregnancy: Evaluation, management, and outcome in resource-limited areas", section on 'Lipid-based nutrient supplements'⁠

.)

Micronutrients

Overview — Requirements for most micronutrients increase during pregnancy. Requirements for several nutrients (calcium, magnesium, phosphorus, potassium, zinc, and vitamins A, C, and K) vary by maternal age. Recommendations for daily intake of vitamins and minerals during pregnancy for specific age groups are shown in the table (

table 2⁠

).

Ideally, all or most nutrients can be obtained by eating a diet consisting of nutrient-dense and fortified whole and unprocessed foods and beverages. However, some nutrients (eg, calcium, vitamin D, potassium, fiber, folate/

folic acid⁠

, iron, iodine, choline) are consistently under-consumed in the United States population.

Multiple-micronutrient supplements

●Evidence – In a Cochrane meta-analysis of randomized trials conducted in low- and middle-income countries where the prevalence of micronutrient deficiencies is high, multiple-micronutrient (MMN) supplements in pregnancy appeared to modestly reduce rates of low birth weight (risk ratio [RR] 0.88, 95% CI 0.85-0.91) and small for gestational age (RR 0.92, 95% CI 0.88-0.97), and possibly preterm birth (RR 0.95, 95% CI 0.90-1.01) compared with iron supplementation with/without

folic acid⁠

[

38⁠

]. Maternal anemia was reduced when compared with placebo but not when compared with iron supplementation with/without folic acid. There were no demonstrable benefits for several other maternal and pregnancy outcomes: miscarriage, congenital anomalies, maternal mortality, perinatal mortality.

●Candidates for MMNs – Most trials of MMNs have been conducted in low-income countries and are not generalizable to high-income countries. Because of a lack of high-quality evidence of the efficacy of MMNs in well-nourished pregnant people, recommendations in high-income countries vary [

39⁠

]. In the absence of a careful evaluation by a nutritionist, we believe that it is prudent to recommend MMN supplement: Prenatal vitamins are the standard approach.

•National health authorities in the United Kingdom do not recommend routine prescription of MMNs for pregnant persons but do recommend specific supplements, such as

folic acid⁠

and vitamin D [

40⁠

].

•In the United States, the National Academy of Medicine (formerly the Institute of Medicine [IOM]), American College of Obstetricians and Gynecologists (ACOG), and the Centers for Disease Control and Prevention (CDC) recommend MMN supplements for pregnant people who do not consume an adequate diet [

41-43⁠

]. In high-income countries, such as the United States, groups at increased risk for micronutrient deficiencies include those carrying a multiple gestation, heavy smokers, adolescents, complete vegetarians (ie, vegans), substance abusers, and individuals who have had bariatric surgery or who have gastrointestinal conditions that cause malabsorption (eg, Crohn disease, bowel resection) [

44-47⁠

]. These groups can benefit from consultation with dietitians who specialize in maternal nutrition. (See

"Nutrition in pregnancy: Assessment and counseling", section on 'Indications for referral to a nutrition professional'⁠

.)

Well-nourished individuals may not need MMN supplements to satisfy daily requirements; instead, specific supplements would be prescribed to meet individual needs. For example, United States data indicate that while 10 to 48 percent of pregnant people taking MMNs had a total usual intake that was less than the estimated average requirement for some micronutrients, 3 to 48 percent exceeded the adequate intake or the tolerable upper intake level for some micronutrients [

48⁠

].

•World Health Organization (WHO) guidelines recommend use of MMNs in pregnant people receiving antenatal care in any healthcare facility or community-based setting, in the context of rigorous research [

49⁠

]. Because the evidence for this recommendation was mainly derived from low- and middle-income countries, they state that applicability to high-income countries or to populations not at risk of micronutrient (eg, adequate diet, food fortification programs) is unclear. The evidence was derived from trials using MMNs containing 13 to 15 micronutrients (including iron and

folic acid⁠

) and the widely available United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP), which contains 15 micronutrients (folic acid: 400 mcg,

vitamin A⁠

: 800 mcg, vitamin D: 200 international units,

vitamin E⁠

: 10 mg, vitamin B1: 1.4 mg,

vitamin B6⁠

: 1.9 mg,

vitamin B12⁠

: 2.6 mcg, niacin: 18 mg, vitamin C: 70 mg, zinc: 15 mg, iron: 30 mg,

selenium⁠

: 65 mcg, copper: 2 mg, iodine: 150 mcg [

50⁠

]).

●Recommended intake and source – Prenatal vitamins and UNIMMAP account for the majority of MMN supplements taken by pregnant people. The content varies depending on the product used. At a minimum, the daily supplement should contain key vitamins/minerals that are often not met by diet alone, such as iron, calcium,

folic acid⁠

, vitamin D, and iodine (

table 2⁠

). In addition to these key vitamins/minerals, the supplement should contain adequate amounts of vitamins A, E, and C; B vitamins; and zinc.

Specific micronutrients are discussed in more detail below.

Iron

●Evidence – Iron is necessary for fetal brain and placental development and to expand the maternal red cell mass. Iron deficiency, which is the most prevalent single-nutrient deficiency worldwide [

51⁠

] and a major cause of anemia, is estimated to occur in 19 percent of pregnant people in the United States, ranging from 7 percent in the first trimester to 30 percent in the third trimester [

52⁠

].

Although systematic reviews have observed that routine iron supplementation in pregnancy consistently results in a reduction in the frequency of iron deficiency anemia at term (eg, RR 0.29, 95% CI 0.17-0.49) [

53⁠

], clear benefits for mothers or offspring have not been consistently demonstrated for a variety of other outcomes [

53,54⁠

], even among pregnant people with iron deficiency anemia [

55⁠

]. However, available evidence is generally of low quality. (See

"Anemia in pregnancy", section on 'Treatment of iron deficiency'⁠

and

"Anemia in pregnancy", section on 'How to screen for iron deficiency'⁠

.)

●Recommended intake – Dietary reference values for iron in pregnancy vary worldwide [

56⁠

]. The CDC recommend iron intake of 27 mg/day during pregnancy (up from 18 mg/day in nonpregnant/non-lactating people) to prevent iron deficiency anemia (

table 2⁠

) [

57⁠

]. The WHO recommends daily oral iron supplementation with 30 to 60 mg of elemental iron [

58⁠

]. This amount is readily met by most prenatal vitamin formulations and is adequate supplementation for non-anemic individuals. European and United Kingdom authorities have concluded that additional dietary iron is not needed during pregnancy, provided that iron stores at conception are adequate [

59-61⁠

]. Of note, in the United States, mean dietary iron intake among pregnant individuals is 17 mg/day from foods alone, and 38 mg/day from foods plus supplements [

48⁠

]. Importantly, 36 percent of pregnant people consume less than the requirement.

For pregnant people with iron deficiency anemia (first- or third-trimester hemoglobin [Hb] <11 g/dL or second-trimester Hb <10.5 g/dL and low serum ferritin [<40 ng/mL]), an additional iron supplement (30 to 120 mg/day) is required until the anemia is corrected [

58,62⁠

]. One option is 65 mg of elemental iron (325 mg

ferrous sulfate⁠

) every other day [

63⁠

]. Iron absorption decreases with increasing dose, thus larger supplementation amounts are best split into several doses during the day. Intermittent iron supplementation (one to three times per week) appears to be as effective as daily supplementation for preventing anemia at term and is better tolerated and may result in better compliance [

60,64⁠

]. The tolerable upper limit of 45 mg/day set by the National Academy of Medicine (formerly the Institute of Medicine [IOM]) based on gastrointestinal side effects is much lower than international recommendations [

65⁠

] and has been challenged [

66⁠

]. Of note, iron absorption increases substantially with advancing gestational age [

67,68⁠

]. Evidence suggests, however, that this increase is blunted in overweight mothers [

69⁠

].

For individuals who do not tolerate oral iron, iron can be administered safely and effectively intravenously [

70-72⁠

]. (See

"Anemia in pregnancy", section on 'Treatment of iron deficiency'⁠

.)

●Dietary sources – Dietary sources of iron are shown in the table (

table 4⁠

). There are two dietary forms of iron: heme and non-heme. The most bioavailable form is heme iron, which is found in meat, poultry, and fish. Non-heme iron, which comprises 60 percent of iron in animal foods and all of the iron in plant foods, fortified grains, and supplements, is less bioavailable. Absorption of non-heme iron is enhanced by vitamin-C-rich foods or muscle tissue (meats, poultry, and seafood) [

73⁠

], and inhibited by consumption of dairy products and coffee/tea/cocoa. (See

"Overview of dietary trace elements", section on 'Iron'⁠

.)

Calcium and vitamin D

●Calcium

•Evidence – Low calcium and vitamin D levels have been associated with adverse health outcomes in mother and child, but it is unclear whether low levels are the causal factor or a marker of poor maternal health. These issues are discussed in detail separately. (See

"Vitamin D and extraskeletal health", section on 'Pregnancy outcomes'⁠

and

"Vitamin D deficiency in adults: Definition, clinical manifestations, and treatment", section on 'Pregnancy'⁠

and

"Clinical manifestations, diagnosis, and treatment of osteomalacia", section on 'Pregnancy'⁠

.)

Fetal skeletal development requires approximately 30 g of calcium across pregnancy, primarily in the last trimester. This total is a relatively small percentage of total maternal body calcium and is easily mobilized from maternal stores, if necessary. Intestinal absorption and renal retention of calcium increase progressively throughout gestation [

74⁠

].

For pregnant people with low baseline dietary calcium intake (particularly in non-United States populations), high-dose calcium supplementation may reduce the risk of developing a hypertensive disorder of pregnancy [

75⁠

]. Calcium supplementation does not appear to reduce this risk in healthy, nulliparous pregnant people in whom baseline dietary calcium intake is adequate. Although there may be a benefit for preeclampsia prevention in high-risk populations, further study is required since available information is based upon small numbers of patients and heterogeneity in study populations. These data are reviewed separately. (See

"Preeclampsia: Prevention", section on 'Calcium supplementation'⁠

.)

Calcium supplementation does not appear to reduce the risk of spontaneous preterm birth or low birth weight [

76⁠

].

•Recommended intake – In the United States, the recommended daily allowance for calcium is 1000 to 1300 mg/day in pregnant and lactating individuals, depending on age (

table 2⁠

) [

77⁠

].

Of note, average calcium consumption among pregnant people in the United States is 1090 mg/day from foods and 1300 mg/day from foods plus supplements. An estimated 21 percent of pregnant people consume less than 800 mg/day from foods alone [

48⁠

].

•Sources – Calcium content of selected foods can be found

online⁠

from the USDA National Nutrient Database.

●Vitamin D

•Evidence – In addition to its role in calcium and bone homeostasis, vitamin D potentially regulates many other cellular functions. Poor vitamin D status in the perinatal period may have short- or long-term consequences on bone, the immune system, and general health, but the precise threshold for optimal vitamin D status during pregnancy and the effects of high-dose supplementation (4000 to 5000 international units daily) on pregnancy outcomes are not well defined [

78-82⁠

]. These data are reviewed in detail separately. (See

"Vitamin D and extraskeletal health", section on 'Pregnancy outcomes'⁠

.)

•Recommended intake – The Dietary Guidelines for Americans recommend daily intake of 600 international units per day during pregnancy [

18⁠

]. Vitamin D deficiency is estimated to affect between 40 and 98 percent of pregnant individuals worldwide [

83⁠

].

Most prenatal vitamins contain 400 international units of vitamin D, but some preparations contain as little as 200 or as much as 1000 to 1200 international units. The safe upper limit of vitamin D has not been well studied but was conservatively set at 4000 international units in a 2011 guideline [

84⁠

]. (See

"Vitamin D deficiency in adults: Definition, clinical manifestations, and treatment", section on 'Pregnancy'⁠

.)

•Sources – Supplements often specify the type of vitamin D they contain. Most prescription prenatal vitamins contain

cholecalciferol⁠

(D3), but some contain

ergocalciferol⁠

(D2), and some contain a mixture. Many commercial nonprescription products labeled "vitamin D" (multivitamin supplements, fortified milk, and bread) contain D2 rather than D3. D3 is more readily converted to active forms of vitamin D and is more effective at increasing serum 25-hydroxyvitamin D.

Dermal synthesis after exposure to sunlight is the major natural source of the vitamin. Very few foods naturally contain vitamin D (fatty fish livers are the exception). (See

"Overview of vitamin D", section on 'Sources'⁠

.)

Folate/folic acid

●Evidence – The body of evidence supports the efficacy of

folic acid⁠

supplementation and dietary fortification to decrease the occurrence and recurrence of neural tube defects (NTDs) by at least 70 percent. These data are reviewed in detail separately. (See

"Preconception and prenatal folic acid supplementation", section on 'Folic acid supplementation for preventing NTDs'⁠

.)

●Recommended intake – The Dietary Guidelines for Americans recommends 0.6 mg/day of folate for pregnant people (

table 2⁠

) [

18⁠

]. In addition to consuming a diet rich in folate, the United States Preventive Services Task Force (USPSTF) recommends a supplement containing 0.4 to 0.8 mg of

folic acid⁠

one month before and for the first two to three months after conception to reduce the risk of open NTDs [

85,86⁠

]. An RDA of 0.6 mg is recommended thereafter to meet the growth needs of the fetus and placenta [

41⁠

]. Continuing folic acid supplementation after the first trimester prevents the decline in serum folate and rise in homocysteine concentrations that occur when supplementation is discontinued [

87⁠

]. (See

"Preconception and prenatal folic acid supplementation", section on 'Administration'⁠

.)

For pregnant people at high risk (eg, history of NTD, use of some antiseizure medications),

folic acid⁠

recommendations are higher (4 mg/day) and are reviewed separately. (See

"Preconception and prenatal folic acid supplementation", section on 'Which pregnancies are at increased NTD risk?'⁠

.)

●Sources – Dietary sources of

folic acid⁠

(fortified foods) and folate are shown in the table (

table 5⁠

). While intake of folate from foods on average meets the recommended daily intake, food folate intake is inadequate in at least 36 percent of pregnant individuals [

48⁠

], which supports routine supplementation of all females of reproductive age. (See

"Preconception and prenatal folic acid supplementation", section on 'Sources'⁠

.)

Other micronutrients

Choline

●Evidence – Choline is a component of acetylcholine, sphingomyelin, and phosphatidylcholine, thus it is important in the development of the fetal central nervous system and cognition [

88⁠

]. In a systematic review of studies on the relationship between choline, neurological development, and brain function during the first 1000 days of life (38 animal studies, 16 human studies), choline supplementation was associated with faster information processing in infants and improvement in memory tasks [

88⁠

]. The authors suggested that choline supplementation supported normal brain development, and high doses may protect against neural and metabolic insults, such as fetal exposure to alcohol.

●Recommended intake – In the United States, pregnant people should consume 450 mg/day of choline from food and supplemental sources (

table 2⁠

) [

89⁠

]. US National Health and Nutrition Examination Survey (NHANES) data indicate that usual choline intake among pregnant individuals was 319 mg/day, and only 8.5 percent consumed at or above the recommended amount [

90⁠

].

●Sources – Most prenatal supplements contain between 0 and 50 mg of choline, which is substantially less than the recommended daily amount. Thus, the daily requirement is best met by consumption of good choline sources, such as eggs, meats, poultry, seafood, and dairy. Plant sources, such as navy beans, Brussels sprouts, broccoli, and spinach contain lower amounts of choline; therefore, vegetarians and vegans should seek out supplemental sources of choline.

Zinc

●Evidence – Zinc has a role in many biological functions, including normal fetal growth and neuronal development. However, in a 2021 systematic review of 25 randomized trials of zinc versus no zinc/placebo supplementation in pregnancy (>18,000 pregnant people and their offspring), zinc supplementation did not significantly improve any maternal, fetal, or newborn outcome (eg, preterm birth, stillbirth, neonatal death, birthweight, low birthweight, small for gestational age), but the evidence was generally low quality [

91⁠

].

●Recommended intake – In the United States, the recommended daily allowance for zinc is 11 to 12 mg/day during pregnancy (

table 2⁠

) [

92⁠

]. Data from the National Health and Nutrition Examination Survey (2011 to 2014) indicate that mean zinc intake among pregnant individuals is 10.3 mg/day from food alone and 18.4 mg/day from food plus supplements [

93⁠

]. However, an estimated 11 percent of pregnant people consume less than recommended [

48⁠

].

Management of pregnant people who are at risk for severe zinc deficiency (eg, active inflammatory bowel disease, acrodermatitis enteropathica, pica) is discussed separately. (See

"Zinc deficiency and supplementation in children"⁠

and

"Pica in pregnancy"⁠

.)

●Sources – Food sources of zinc include meat, poultry, and certain types of seafood (oysters, crab, lobster). Whole grains, cereals, and legumes are also good sources of zinc, but bioavailability is lower due to phytates that bind to and decrease its absorption [

94⁠

].

Iodine

●Evidence – Iodine is an essential mineral necessary for production of thyroid hormones. Deficiency has potentially harmful effects, such as maternal and fetal/neonatal hypothyroidism. A 2017 systematic review that examined routine iodine supplementation found insufficient data to reach any clinically useful conclusions on its benefits and harms of preconception, during pregnancy, or postpartum [

95⁠

]. A 2020 systematic review came to a similar conclusion regarding iodine supplementation for pregnant people residing in areas of mild to moderate iodine deficiency [

96⁠

], presumably because they are able to physiologically adapt to mildly low iodine intakes and draw from intrathyroidal iodine stores to maintain fetal euthyroidism and enable normal neurodevelopment [

97⁠

].

●Recommended intake – The National Academy of Medicine recommends daily iodine intake of 220 mcg during pregnancy (

table 2⁠

) and 290 mcg during lactation [

98⁠

]; the WHO recommends daily iodine intake of 250 mcg for both pregnant and lactating people [

99⁠

]. The American Thyroid Association recommends that individuals who are planning pregnancy, are pregnant, or are lactating supplement their diet with a daily oral multivitamin supplement that contains 150 mcg of iodine in the form of potassium iodide [

100⁠

].

Excessive intake can be harmful [

101⁠

]. (See

'Supplements and dietary intake that can be harmful'⁠

below.)

●Sources – Many prenatal vitamins contain no iodine since requirements are often met with dietary sources, such as iodized salt. In the United States, data suggest that 23 to 56 percent of pregnant people have intake below recommended levels based on urinary iodine concentrations [

102,103⁠

]. Similar findings have been reported in the United Kingdom and in Sweden [

104⁠

]. Declining intakes of iodine may be related to increased intake of non-iodized salt from processed foods and in the home (such as sea salt, which contains less iodine than iodized salt). Although pregnant individuals should not be encouraged to start using table salt if they do not already do so, pregnant people should be encouraged to use iodized salt (contains 95 mcg iodine per one-quarter teaspoon) rather than non-iodized, and/or consume cooked seafood that is naturally rich in iodine to attain adequate intake.

Vitamin B12

●Evidence –

Vitamin B12⁠

functions closely with folate and homocysteine and is involved in DNA synthesis and cellular metabolism. Few randomized trials have examined the effects of B12 supplementation in pregnancy on maternal or neonatal outcomes. One systematic review of longitudinal cohort studies reported that lower maternal vitamin B12 plasma levels were associated with higher risk of preterm birth, particularly with vitamin B12 deficiency [

105⁠

]. No association was found with birth weight. However, a randomized trial of vitamin B12 supplementation (50 mcg daily) during pregnancy conducted in Nepal in which 71 percent of 800 participants were vitamin B12 deficient or marginally deficient (<221 pmol/L [300 pg/mL]) found no benefit from supplementation [

106⁠

]. Gestational age at birth, birth weight, preterm birth rate, and infant growth and neurodevelopment were similar for both groups despite improved B12 status in mothers and infants.

●Recommended intake – In the United States, the recommended daily allowance for

vitamin B12⁠

is 2.6 mcg/day in pregnancy and 2.8 mcg/day during lactation (

table 2⁠

) [

107⁠

]. The majority of pregnant people in the United States meet vitamin B12 requirements, with mean intake from foods of 5.6 mcg/day (more than two times RDA). For individuals with vitamin B12 deficiency, supplemental vitamin B12 is indicated for maternal health. It is administered parenterally if malabsorption is the cause and orally to those with dietary deficiency and normal absorption. (See

"Clinical manifestations and diagnosis of vitamin B12 and folate deficiency"⁠

and

"Causes and pathophysiology of vitamin B12 and folate deficiencies"⁠

and

"Treatment of vitamin B12 and folate deficiencies"⁠

.)

●Sources – Only animal source foods, such as fish, meat, poultry, eggs, and dairy products, contain

vitamin B12⁠

; thus, individuals who consume a vegetarian or vegan diet are at higher risk of B12 deficiency and should take a supplement [

108⁠

].

Vitamin A

●Evidence –

Vitamin A⁠

is important in cell division, fetal organ and skeletal growth, maintenance of the immune system, fetal visual development, and maintenance of maternal vision [

109⁠

]. However, supplementation in nondeficient subjects has not been shown to improve pregnancy outcomes and may increase risk of toxicity.

A pregnant person with moderate deficiency is at higher risk for night blindness, particularly in the third trimester when fetal growth is accelerated, because the fetus will obtain sufficient

vitamin A⁠

at the expense of maternal stores [

109-111⁠

]. In some resource-limited countries, vitamin A deficiency is a concern; in addition to maternal night blindness, deficiency puts pregnant people at risk of xerophthalmia, anemia, and susceptibility to infection [

112⁠

]. By contrast, in resource-abundant countries, excessive intake of vitamin A is the primary concern.

●Recommended intake –

Vitamin A⁠

utilization increases slightly during pregnancy; thus, recommended intake is increased to 750 to 770 mcg retinol equivalents (2500 to 2560 international units) per day in pregnancy (versus 700 mcg retinol equivalents [approximately 2330 international units] per day in nonpregnant females) (

table 2⁠

) [

113⁠

]. Supplements containing high doses of preformed vitamin A should be avoided (see

'Preformed vitamin A in supplements'⁠

below). In the United States, mean daily intake of vitamin A among pregnant individuals is 696 mcg retinol equivalents from foods alone and 1283 mcg retinol equivalents from foods plus supplements [

48⁠

]. An estimated 15 percent of pregnant people consume less than recommended.

Where

vitamin A⁠

deficiency is endemic, such as Southeast Asia and sub-Saharan Africa, a daily supplement containing less than 3000 mcg retinol equivalents (10,000 international units) or a weekly supplement less than 8500 mcg retinol equivalents (25,000 international units) appears to have some maternal and fetal/neonatal health benefits (eg, reduction in maternal anemia and night blindness) with no evidence of teratogenicity [

114,115⁠

], but does not reduce maternal or perinatal mortality [

116⁠

], which was suggested by some early studies.

●Sources –

Vitamin A⁠

is found in moderate amounts (300 to 770 mcg retinol equivalents) in many prenatal vitamins, often in the form of

beta-carotene⁠

(provitamin A).

The use of self-prescribed over-the-counter supplements is commonplace and has led to numerous case reports of vitamin or mineral toxicities due to overuse. Excessive maternal consumption of some foods can also be potentially toxic to the fetus.

Preformed vitamin A in supplements — Consumption of vitamin supplements containing high doses of preformed

vitamin A⁠

(greater than 10,000 international units per day [1 international unit = 0.3 retinol equivalents]) appears to be teratogenic [

114,117⁠

]. In the absence of severe deficiency, pregnant people should avoid consuming multivitamin or prenatal supplements that contain more than 5000 international units (1500 mcg retinol equivalents) of vitamin A. Most supplements contain

beta-carotene⁠

rather than retinol; high beta-carotene intakes have not been associated with an increased risk for congenital anomalies [

118⁠

].

Vitamin A in liver — Some foods are fortified with

vitamin A⁠

and others are rich in vitamin A (eg, liver). For this reason, some groups (eg, Finnish Food Safety Authority Evira,

National Health Service⁠

) recommend avoiding liver consumption during pregnancy [

119-124⁠

]. Limiting the intake of liver and liver products during the first trimester is likely prudent, particularly in high-income countries where vitamin A deficiency is rare.

For pregnant people who commonly consume liver, we advise checking local food composition databases as

vitamin A⁠

content of livers from different animals vary. For example, in the United States Department of Agriculture (USDA) Nutrient Database [

125⁠

], vitamin A content of liver and liver products varies from 4900 international units in one raw chicken liver to 59,500 international units in 3 ounces of cooked New Zealand beef liver.

Iodine in nutritional supplements and seaweed — Excessive intake of iodine can cause fetal goiter [

126-128⁠

], but the safe upper limit of iodine intake in pregnancy is unclear. Congenital hypothyroidism has been reported in offspring of pregnant people ingesting 2.3 to 12.5 mg iodine daily (greater than 10 times the recommended dietary allowances [RDA] of 220 mcg, and greater than two times the upper limit of 1100 mcg) (

table 2⁠

) [

126,128⁠

]. The cases from the United States were related to excess iodine ingestion from nutritional supplements, and those from Japan were related to diets containing large quantities of kombu, other seaweeds, and instant kombu soups. Nevertheless, excessive iodine intake in the United States is uncommon (<1 percent) [

103⁠

].

Processed trans fatty acids — Processed trans fatty acids (TFAs) should be minimized or preferably avoided. They may have adverse effects on fetal growth and development by interfering with essential fatty acid metabolism, by direct effects on membrane structures or metabolism, or by replacing maternal intake of the cis essential fatty acids [

129⁠

]. (See

"Dietary fat", section on 'Trans fatty acids'⁠

.)

TFAs were previously ubiquitous in processed foods in the United States food supply, but are no longer considered "Generally Recognized As Safe" (GRAS) by the FDA and no longer permitted for use in the United States [

130⁠

]. They are still present in some items with long shelf-lives, and they are still used in some countries. The World Health Organization (WHO) set a goal to eliminate TFAs from the world's food supply by 2023 [

131⁠

].

Vitamin E — In a systematic review of randomized trials,

vitamin E⁠

supplementation during pregnancy in combination with vitamin C or other supplements or drugs did not improve rates of stillbirth, preterm birth, preeclampsia, or low birth weight [

132⁠

]. Prior evidence [

133⁠

] suggested that vitamin E increased self-reported abdominal pain and prelabor rupture of membranes at term; however, preterm prelabor rupture of membranes was not increased [

132⁠

].

Vitamin C — In a systematic review of randomized trials, vitamin C supplementation during pregnancy either alone or in combination with other supplements had no beneficial or harmful effects [

134⁠

]. No effects were observed on prevention of stillbirth, preterm birth, preeclampsia, or low birth weight. Vitamin C supplementation alone resulted in a decreased risk of preterm prelabor rupture of membranes; however, the quality of evidence was poor.

Vitamin B6 — Vitamin B6 (

pyridoxine⁠

) is a coenzyme for more than 100 enzymes in the body, including those involved in metabolism of amino acids, carbohydrates, and lipids and synthesis of neurotransmitters. The majority of pregnant individuals consume an adequate amount of B6 through foods and safely exceed the requirement through a combination of foods plus supplements [

48⁠

]. A 2015 Cochrane review that included four small trials that examined B6 supplementation during pregnancy found no evidence of clinical benefits [

135⁠

]. Vitamin B6 has been shown to improve mild to moderate nausea during pregnancy. (See

"Nausea and vomiting of pregnancy: Treatment and outcome", section on 'Pyridoxine (vitamin B6) monotherapy'⁠

.)

Probiotics — Consumption of probiotic supplements is increasingly popular. Some evidence suggests that probiotic use (combinations of certain

Lactobacillus⁠

and Bifidobacterium strains) during pregnancy may have beneficial maternal effects, such as reduced risk of inflammatory events and preeclampsia and improved maternal glucose metabolism [

136,137⁠

]. However, a 2020 Cochrane review of probiotic treatment for patients with gestational diabetes concluded available evidence was too limited to inform practice due to the high variability of products used and small sample sizes in trials [

138⁠

].

Studies of probiotic use during pregnancy have not reported increased risk of adverse fetal outcomes, but these data are also limited. A 2018 Cochrane review of maternal oral probiotic supplementation for prevention of morbidity and mortality in preterm infants did not find appreciable benefit or harm to neonates as a result of supplementation of pregnant people at low risk for preterm birth or mothers of preterm infants after birth [

139⁠

].

Water and other fluids — During pregnancy, adequate fluid intake from consumption of beverages (water and other liquids) is estimated to be approximately 2.3 L/day (76 fluid ounces or approximately 10 cups) [

140⁠

]. Additional water is consumed in foods other than beverages to meet the total adequate intake of 3 L/day. Numerous factors (eg, ambient temperature, humidity, physical activity, exercise influence) also influence total water needs.

Fluoride —

Fluoride⁠

supplementation during pregnancy is unnecessary, even though pregnant people who live in areas where water is not fluoridated or who consume only unfluoridated bottled water may not achieve adequate intake of fluoride. (See

"Nutrition in pregnancy: Assessment and counseling", section on 'Consumption of nonfluoridated bottled or tap water'⁠

.)

Multiple gestation — Nutritional requirements and weight gain recommendations are higher in multiple gestations. Guidelines are provided separately. (See

"Twin pregnancy: Routine prenatal care", section on 'Nutrition and supplements'⁠

and

"Twin pregnancy: Routine prenatal care", section on 'Gestational weight gain'⁠

and

"Triplet pregnancy", section on 'Weight gain'⁠

.)

Pregnant patients with diabetes — Medical nutritional therapy for patients with pregestational or gestational diabetes are reviewed separately. (See

"Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Medical nutrition therapy'⁠

and

"Gestational diabetes mellitus: Glucose management and maternal prognosis", section on 'Medical nutritional therapy'⁠

.)

Postpartum and breastfeeding — An adequate, balanced diet is believed to be important for replenishment of maternal stores that are expended during the pregnancy, for promoting loss of excess weight, and for nourishing the breastfed infant. Maternal nutrition in the postpartum period, including during lactation, are discussed separately. (See

"Maternal nutrition during lactation"⁠

and

"Overview of the postpartum period: Disorders and complications", section on 'Postpartum weight retention'⁠

.)

Pregnant people with undernutrition living in resource-limited areas — Pregnant people with potentially severe undernutrition living in resource-limited areas require careful assessment and a different approach to treatment, which is reviewed separately. (See

"Undernutrition in pregnancy: Evaluation, management, and outcome in resource-limited areas"⁠

.)

Pregnant people with self-imposed dietary restraints and other dietary issues — (See

"Nutrition in pregnancy: Assessment and counseling", section on 'Issues regarding self-imposed dietary restraints'⁠

and

"Nutrition in pregnancy: Assessment and counseling", section on 'Other dietary issues'⁠

.)

Getting Regular Exercise: Boosting Fertility and Preparing for Pregnancy

The Menstrual Cycle: A Key to Fertility and Conception

The changes that happen during the menstrual cycle are caused by changing levels of hormones called estrogen and progesterone. Each month, hormones signal your uterus to build up a blood-rich lining called the endometrium. ese hormones also send a signal to an egg, causing it to mature in a follicle in one of your ovaries. When an egg is ready, it is released from the ovary and moves into a fallopian tube, one of a pair of tubes that lead from the ovaries to the uterus.

⁠

Around the time an egg is released you also may notice

breast tenderness

an increase in vaginal discharge (the fluid that comes out of your vagina)

an increase in sexual desire

Decoding Pregnancy Tests: What You Need to Know

If you’ve missed your period and have some of the symptoms of pregnancy, you may want to take a pregnancy test. ere are several brands of home pregnancy tests you can buy. All of them are easy to use and can be done at home. Results are ready in a few minutes. With home pregnancy tests, you urinate on a stick that detects the hormone hCG in your urine. About 6 to 7 days after fertilization, the blastocyst (fertilized egg) starts to make hCG as it moves down the fallopian tube toward the uterus. After the blastocyst implants in the uterus, production of hCG increases rapidly. Home pregnancy tests measure hCG as milli-international units per milliliter (mIU/mL). Depending on the brand, home pregnancy tests can detect 20 mIU/mL, 50 mIU/mL, or 100 mIU/mL of hCG in the urine. It’s important to read the label on the test, because not all tests can detect the same level of hCG. In general, the lower the level of hCG that the test can detect, the better the test is at accurately detecting pregnancy. Many home pregnancy tests claim to be around 99 percent accurate in detecting pregnancy on the rst day after your missed period. But in research studies of these tests, it was found that most brands of tests do not consistently detect pregnancy that early. A false-negative result is a result that says you are not pregnant when you actually are pregnant. Most false negative results are caused by taking the test too early, when there is not enough hCG in the urine. If you get a negative result and you have some pregnancy symptoms, you may want to take the test again when your period is at least 1 week late. Also, make sure that you follow the directions for taking the test exactly. Doing so may lead to more accurate results. For example, most tests say to take the test with the first urine of the day, when hCG levels are highest. Home pregnancy tests also can give a false-positive result. this means that the test says you are pregnant even though you are not pregnant. e most common reasons for a false-positive home pregnancy test result are not following the test’s directions or reading the results incorrectly. If you have a positive home pregnancy test result or if your result is negative and you really want to be sure, you can see your ob-gyn to have a blood test and a physical exam. e blood test for pregnancy is more sensitive than most urine tests for two reasons: 1. It can detect low hCG levels of 5 to 10 mIU/mL. 2. More hCG is present in the blood than in the urine. ese two factors allow the blood test to detect pregnancy 6 to 10 days after ovulation. For many women, this is before a period is missed. By the end of week 2, you probably don’t know that you are pregnant. You may notice a little spotting. is spotting, known as implantation bleeding, can occur when the fertilized egg attaches to the lining of the uterus. e spotting is very light, and not all women have it. Some women mistake it for menstrual bleeding. Implantation bleeding is normal and usually doesn’t signal a problem.

⁠

⁠

Decoding pregnancy tests can be an important step for individuals who are trying to determine whether they are pregnant or not. Understanding how these tests work and how to interpret their results accurately is crucial. Here's what you need to know:

Types of Pregnancy Tests:

a. Urine tests: These are the most common type of pregnancy tests available over the counter. They detect the presence of human chorionic gonadotropin (hCG), a hormone produced during pregnancy, in urine samples.

b. Blood tests: These tests are conducted at a medical facility and can detect hCG in the blood earlier than urine tests. They are more sensitive and accurate, but also more expensive.

Timing:

Pregnancy tests are most effective when taken after a missed period. However, some early response tests claim to provide accurate results a few days before your expected period. It's important to read the instructions provided with the specific test you are using.

Reading the Results:

a. Positive: If two lines appear (one control line and one test line), even if the test line is faint, it usually indicates a positive result. This means hCG is detected, indicating pregnancy. A positive result should be confirmed with a healthcare professional.

b. Negative: If only one line appears (control line) or the test line is absent, it typically indicates a negative result. This means hCG is not detected, indicating no pregnancy.

c. Invalid: If no lines appear or there is an issue with the control line, the test may be invalid. This could be due to improper usage or a faulty test. In such cases, it's advisable to repeat the test with a new one.

Test Accuracy:

Pregnancy tests, when used correctly, are generally accurate. However, false negatives can occur if the test is taken too early or if the urine is too diluted. False positives are rare but can occur due to certain medications or medical conditions.

Confirming Results:

If you receive a positive result on a home pregnancy test, it's important to consult a healthcare professional to confirm the pregnancy and begin appropriate prenatal care. They may conduct a blood test or ultrasound for confirmation.

Remember, home pregnancy tests are reliable tools for detecting pregnancy, but they are not infallible. If you have any doubts or concerns, it's always best to consult a healthcare professional for further guidance and support.

Hormones at Play: Understanding the Body's Changes During Pregnancy

Hormones are the chemical messengers that guide the body’s functions. the following hormones play a leading role in reproduction, pregnancy, and birth: Estrogen and progesterone—these hormones are produced by the ovaries. they trigger the lining of the uterus to thicken during each menstrual cycle and to be shed if pregnancy doesn’t occur. After an egg is fertilized, higher estrogen and progesterone levels stop the ovaries from releasing any eggs until the end of the pregnancy. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—these hormones are made by the pituitary gland, a small organ at the base of the brain. FSH causes an egg to mature in one of the ovaries. LH triggers the egg’s release. Gonadotropin-releasing hormone (GnRH)—this hormone is made in a part of the brain called the hypothalamus. It signals the pituitary gland to produce FSH and LH. Human chorionic gonadotropin (hCG)—this hormone causes the body to increase estrogen and progesterone. this is the hormone that is detected by pregnancy tests.

⁠

Identifying Your Optimal Conception Window

Sperm can live inside a woman’s body for 3 days and sometimes up to 5 days. An egg’s life span is much shorter—just 12 to 24 hours after ovulation. So pregnancy can happen if an egg is already in the fallopian tubes when you have sex. Or it can happen if you ovulate within a day or two after you have sex. is means that you are fertile anywhere from 3 to 5 days before ovulation until up to 1 day after ovulation.

Smartphone apps also are available to help you keep track of your fertile times

there is no foolproof way to calculate your fertile days.

One way to figure out your fertile days is to keep a menstrual calendar.

If your cycle is between 26 and 32 days long, days 8 through 19 are the days when you are most likely to get pregnant.

Preparing for Pregnancy and Conception

How pregnancy occurs. Each month during ovulation, an egg is released (1) and moves into one of the fallopian tubes. If a woman has sex around this time, and an egg and sperm meet in the fallopian tube (2), the two may join. If they join (3), the fertilized egg then moves through the fallopian tube into the uterus and attaches there to grow during pregnancy (4).

Preparing for pregnancy and conception involves taking steps to optimize your health and increase your chances of a healthy pregnancy. Here are some important considerations:

1. Preconception Health: Start by scheduling a preconception appointment with your healthcare provider. They can assess your overall health, review your medical history, and provide personalized advice based on your specific needs. During this visit, discuss any medications you are taking and ensure they are safe to continue during pregnancy.

2. Nutrition and Diet: Focus on a well-balanced diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats. Incorporate foods rich in folate (such as leafy greens and legumes) to reduce the risk of neural tube defects. Avoid high-mercury fish and limit caffeine and alcohol intake.

3. Folic Acid Supplement: Taking a folic acid supplement is recommended for women planning to conceive. It helps reduce the risk of certain birth defects. Ideally, start taking 400-800 micrograms of folic acid daily at least one month before conception.

4. Exercise and Fitness: Engage in regular physical activity to maintain a healthy weight and improve overall fitness. Consult with your healthcare provider to ensure that your exercise routine is appropriate for preconception and pregnancy.

5. Vaccinations: Ensure that your vaccinations are up to date. Rubella (German measles) and varicella (chickenpox) can be harmful during pregnancy, so if you are not immune, get vaccinated before conceiving. Check with your doctor to see if any other vaccinations are recommended.

6. Lifestyle Factors: Avoid smoking, recreational drugs, and excessive alcohol consumption, as these can negatively impact fertility and increase the risk of complications during pregnancy. Minimize exposure to environmental toxins and hazards.

7. Managing Chronic Conditions: If you have any chronic medical conditions, such as diabetes or hypertension, work with your healthcare provider to optimize your management plan before becoming pregnant. Properly controlled conditions are important for a healthy pregnancy.

8. Emotional and Mental Well-being: Address any emotional or mental health concerns and develop healthy coping mechanisms. Consider seeking counseling or support if needed. Pregnancy can bring about various emotions, and it's important to have a strong support system.

9. Timing Intercourse: Understanding your menstrual cycle and tracking ovulation can help increase the chances of conception. There are various methods available, such as tracking basal body temperature or using ovulation predictor kits.

Remember that it can take time for conception to occur, and it's normal for healthy couples to take several months to conceive. If you have been actively trying to conceive for a year without success, it may be appropriate to consult a fertility specialist for further evaluation and guidance.

Navigating Towards the Arrival: Determining Your Estimated Due Date

Because most women know when their last menstrual period (LMP) occurred, and because babies typically are born 40 weeks later, ob-gyns usually count pregnancy from the first day of your LMP. the day your baby is due is called the estimated due date (EDD).

Determining your estimated due date (EDD) is an important milestone in pregnancy. It helps you plan and prepare for the arrival of your baby. Here are a few methods commonly used to calculate the EDD:

Last Menstrual Period (LMP) Method:

The most common method is based on the first day of your last menstrual period. It assumes that conception occurs around day 14 of your menstrual cycle. Add 280 days (40 weeks) to the first day of your last period to estimate your due date. Keep in mind that this method assumes a regular 28-day cycle, so adjustments may be needed if your cycle is longer or shorter.

2. Ultrasound Scans:

Early ultrasound scans are highly accurate for determining the gestational age of the fetus. During the first trimester, an ultrasound can measure the size of the embryo, which helps estimate the due date. The earlier the ultrasound is performed, the more accurate the estimation.

Your ob- gyn may use an ultrasound exam in your rst trimester to calculate your EDD

if you are not sure of the first day of your LMP

your periods are not regular

you were using hormonal birth control when you got pregnant

your menstrual cycles are very short or very long

3. Combination Method:

Sometimes, healthcare providers use a combination of the LMP method and ultrasound measurements to determine the estimated due date. The initial due date estimation from the LMP method may be adjusted based on the findings of an early ultrasound scan.

Your ob-gyn will use your EDD to calculate the baby’s gestational age. Gestational age is measured in weeks, months, and trimesters. Ob-gyns also divide the weeks of pregnancy into days. For example, “24 and 3/7 weeks” means “24 completed weeks plus 3 days of pregnancy.” Remember that women typically ovulate about 2 weeks after the beginning of their LMP. So, from the rst day of your LMP through about day 14, the body is preparing for pregnancy, but you aren’t pregnant yet. is means that pregnancy can last up to 10 months because of these extra weeks.

Here’s how the trimesters are defined:

First trimester (first day of LMP to 13 weeks and 6 days): the time when fertilization and major organ development occurs.

Second trimester (14 weeks and 0 days to 27 weeks and 6 days): e time of rapid growth and development. ere is some chance of survival if the baby is born in the later weeks of the second trimester.

third trimester (28 weeks and 0 days to 40 weeks and 6 days): e time when the baby’s weight increases and the organs mature so they will be ready to function after birth.

Prenatal care is crucial for the health and well-being of both the mother and the baby during pregnancy. Regular check-ups with your healthcare provider help monitor the progress of the pregnancy, identify any potential issues, and ensure that appropriate care is provided. Here's a simplified guide to the common components of prenatal check-ups:

Ultrasound exam

Ultrasound exams are a common part of prenatal care. They use sound waves to create images of the developing fetus. Ultrasounds can be performed at different stages of pregnancy to:

Confirm pregnancy and estimate gestational age.

Monitor fetal growth and development.

Assess the position of the placenta.

Identify any structural abnormalities or birth defects.

Determine the baby's sex (if desired and feasible).

lab test

Various laboratory tests are conducted during prenatal visits to gather important information about the mother's health and to screen for any potential issues. These tests may include:

Blood tests: Check blood type, Rh factor, anemia, immunity to certain diseases, and screen for infections like syphilis, hepatitis B, and HIV.

Urine tests: Monitor kidney function, screen for urinary tract infections, and check for the presence of protein or sugar in the urine.

Glucose screening: Assess for gestational diabetes, usually performed around 24-28 weeks of pregnancy.

Genetic screening: Offered to determine the risk of certain genetic disorders or chromosomal abnormalities. These tests may include carrier screening, non-invasive prenatal testing (NIPT), or other specialized tests based on individual circumstances and family history.

screening for birth defects

Screening for birth defects helps identify the risk of certain conditions or abnormalities in the fetus. These screenings may involve:

Nuchal translucency ultrasound: Performed around 11-14 weeks to assess the thickness of the back of the baby's neck, which can indicate the risk of certain chromosomal abnormalities.

Maternal serum screening: Blood tests that measure certain markers in the mother's blood to assess the risk of chromosomal abnormalities, such as Down syndrome.

Cell-free DNA testing: A type of genetic screening that analyzes fetal DNA in the mother's blood to detect chromosomal abnormalities with high accuracy.

It's important to note that not all tests and screenings are mandatory. The specific tests offered may vary based on factors such as maternal age, medical history, and individual preferences. Your healthcare provider will guide you through the recommended tests and screenings based on your unique situation.

Remember, prenatal care extends beyond these specific components. Regular check-ups also involve monitoring blood pressure, weight gain, fetal movements, discussing any concerns or discomforts, and providing guidance on nutrition, exercise, and overall well-being. Open communication with your healthcare provider is key to ensuring a healthy pregnancy and a positive prenatal experience.

Although it’s normal for pregnant women to worry about complications, most women have healthy pregnancies and give birth to healthy babies. But it’s best to be alert to signs and symptoms that may signal a problem. Often, the earlier you see your ob-gyn, the more likely that the complication can be managed successfully. Miscarriage the loss of a pregnancy before 20 completed weeks is called miscarriage. About 1 in 5 or 6 pregnancies ends this way. Some miscarriages take place before a woman misses her period or even knows that she is pregnant. e most common sign of a miscarriage is bleeding. Call your ob-gyn if you have spotting or bleeding without pain heavy or persistent bleeding with abdominal pain or cramping a gush of uid from your vagina but no pain or bleeding passed fetal tissue Most miscarriages are caused by a problem with the chromosomes of the fertilized egg. these problems occur by chance and are not likely to happen again in a later pregnancy. In most cases, there is nothing wrong with the woman’s or man’s health. Most women who have a miscarriage go on to have healthy pregnancies. Ectopic Pregnancy An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies—more than 90 percent—occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding. is can be a lifethreatening emergency that needs immediate surgery. At first, an ectopic pregnancy may feel like a typical pregnancy with some of the same signs, such as a missed period, tender breasts, or an upset stomach. Other signs may include abnormal vaginal bleeding low back pain mild pain in the abdomen or pelvis mild cramping on one side of the pelvis At this stage, it may be hard to know if you are experiencing a typical pregnancy or an ectopic pregnancy. Call your ob-gyn if you have abnormal bleeding and pelvic pain. As an ectopic pregnancy grows, more serious symptoms may develop, especially if a fallopian tube ruptures. Symptoms may include sudden, severe pain in the abdomen or pelvis shoulder pain weakness, dizziness, or fainting If you have sudden pain that is severe, shoulder pain, or weakness, go to an emergency room.

A Safe Workplace

Most women can continue working throughout their pregnancies. But small changes may be needed depending on the work that you do. Jobs that require heavy lifting, climbing, carrying, or standing may not be safe during pregnancy. at’s because the dizziness, nausea, and fatigue common in early pregnancy can increase the chance of injury. Later on, the change in body shape can throw off balance and lead to falls.

Remember, every pregnancy is unique, and the advice and guidance of a healthcare provider are essential. They can address your specific needs and provide personalized care throughout your pregnancy journey. Being exposed to harmful substances on the job is rare. But it makes sense to think about the things you have contact with during your workday. Some substances found in the workplace pose a risk during pregnancy. these substances include

lead

mercury

arsenic

pesticides

some solvents

ionizing radiation

certain drugs used for cancer treatment (chemotherapy)

Working During Early Pregnancy

Working when you have nausea and fatigue can be difficult. To cope, try the following: Take advantage of flex time—If your workplace has ex time, use this benefit to your advantage. What is the time of day when you feel the most energized? Consider coming in later if the early morning is bad for you. If afternoons are a problem, arrive earlier so that you can leave earlier. Bring snacks with you—Healthy snacks throughout the day may help keep nausea at bay and give you energy. Crackers, raw vegetables, or fruit and cheese are good choices. Nap, if you can—If you have an office, you can shut the door and rest during your lunch hour. Stay hydrated—Being dehydrated can make you feel worse. Make sure you are drinking enough fluids throughout the day.

Essential Prenatal Care: Making the Most of Your Visits

Questions to Ask

Do you accept my health insurance? Are you in practice alone, or is there a group? If it is a group, how often will I see the same person when I come for my prenatal care visits? If you are in solo practice, who covers when you are not available? How can I get in touch with you during business hours? Do you have an after-hours phone number that I can call in case of an emergency or if I have concerns? Who takes the after-hours calls? Which hospital will I go to when I give birth? Who will deliver my baby? What are your views on anesthesia during labor, episiotomy, alternative birthing positions, cesarean birth, and assisted vaginal delivery? Who can be with me during delivery?

You’ll have regular prenatal care appointments throughout your pregnancy. What happens during a visit, and how often you have appointments, will depend on factors such as how far along you are in your pregnancy your health your baby’s health.

How Often Should You See Your Ob-Gyn? How often you will see your ob-gyn for prenatal care depends on your health history, pregnancy history, and other factors: If this is your first pregnancy and you do not have any complications, you likely will see your ob-gyn every 4 weeks for the first 28 weeks of pregnancy, every 2 weeks until 36 weeks, and then weekly. If you’re healthy and you have had a successful pregnancy before, you may be able to have fewer visits as long as you can see your ob-gyn on an as-needed basis. If you have health issues or pregnancy complications, you may need to see your ob-gyn more often, and you may need to have extra tests.

Can I bring another person with me to the appointment?

Yes, you can bring a partner, friend, or family member as your advocate. Make sure you're comfortable sharing private information with them. Arrange for someone to take care of young children if needed.

What if I need an interpreter?

Ask the office staff if they can provide an interpreter who knows medical terms. Inquire if medical translation via phone is available. Notify the office in advance for scheduling and sign-language interpreter requests. Friends or family members may not be ideal interpreters.

What if I have vision or hearing problems?

Bring your eyeglasses and ensure your hearing aid is working. Inform your ob-gyn about any visual or hearing difficulties. Request slower speech if needed. How should I talk with my ob-gyn?

Ask questions and voice any concerns you have. You have the right to ask questions about your healthcare. Seek simple, clear explanations and ask for visual aids if helpful. Take notes or have someone accompany you to take notes. Remember, you and your ob-gyn have the same goal: a healthy pregnancy.

Group B Streptococcus: Screening for a Common Pregnancy Infection

Group B Streptococcus (GBS) is a type of bacteria that can be present in the vagina or rectum of healthy individuals. While GBS is generally harmless to adults, it can pose a risk to newborns during childbirth. To prevent GBS infection in newborns, healthcare providers routinely screen pregnant women for GBS colonization. Here's what you need to know about GBS screening:

1. Timing of GBS Screening: GBS screening is typically performed between weeks 35 and 37 of pregnancy. This timing allows for the detection of GBS colonization close to the time of labor and delivery.

2. How the Test is Performed: GBS screening involves taking a swab from the vagina and rectum. It's a quick and simple procedure that can be done by your healthcare provider during a regular prenatal visit.

3. Purpose of GBS Screening: The main purpose of GBS screening is to identify women who are carriers of GBS. Knowing your GBS status helps your healthcare provider determine if you need preventive measures during labor and delivery to protect your baby.

4. Prevention of GBS Transmission: If you test positive for GBS, your healthcare provider will recommend intravenous antibiotics (usually penicillin or an alternative if you have an allergy) during labor. Antibiotics help prevent the transmission of GBS to the baby and reduce the risk of early-onset GBS infection.

5. Impact of GBS on Newborns: Newborns exposed to GBS during delivery can develop serious infections, such as pneumonia, bloodstream infections, or meningitis. Prompt identification and treatment are essential in preventing complications.

6. GBS Status and Future Pregnancies: It's important to note that GBS colonization can vary from pregnancy to pregnancy. Even if you tested negative for GBS in a previous pregnancy, it's recommended to be retested in subsequent pregnancies as GBS status can change over time.

7. Consultation with Your Healthcare Provider: If you have questions or concerns about GBS screening or its implications, consult with your healthcare provider. They can provide personalized guidance based on your specific situation.

GBS screening is a routine part of prenatal care, and the majority of pregnant women who test positive for GBS have healthy babies with appropriate preventive measures in place. By following your healthcare provider's recommendations, you can help ensure the best possible outcome for both you and your baby.

In addition to Group B Streptococcus (GBS) screening, there are several other important screening tests during pregnancy that help monitor your health and the well-being of your baby. Here are some of these tests:

1. Blood Pressure Monitoring: Regular blood pressure measurements are essential to screen for conditions like gestational hypertension or preeclampsia. High blood pressure during pregnancy can have serious implications and requires close monitoring.

2. Blood Tests: Various blood tests are performed throughout pregnancy to assess your overall health and identify any potential risks or complications. These tests may include: - Complete blood count (CBC): Checks for anemia and other blood disorders. - Blood type and Rh factor: Determines your blood type and Rh status. - Antibody screening: Determines if you have any antibodies that could affect your baby's blood. - Glucose screening: Tests for gestational diabetes. - Sexually transmitted infections (STIs): Screens for infections like syphilis, hepatitis B, HIV, and others.

3. Anemia Screening: Anemia, a condition characterized by low levels of red blood cells or hemoglobin, can be harmful during pregnancy. Screening is done through a blood test to check your iron levels and identify anemia.

4. Genetic Screening and Testing: Genetic screening and testing help assess the risk of certain genetic disorders or chromosomal abnormalities. These tests may include: - Carrier screening: Identifies if you carry genes for certain genetic conditions. - Non-invasive prenatal testing (NIPT): Screens for chromosomal abnormalities, such as Down syndrome, by analyzing fetal DNA in your blood. - Diagnostic testing: Invasive tests, such as amniocentesis or chorionic villus sampling (CVS), may be recommended if there are concerns about genetic conditions.

5. Fetal Anatomy Ultrasound: This detailed ultrasound, typically performed around 18-20 weeks of pregnancy, evaluates the baby's anatomy and screens for any structural abnormalities or birth defects.

It's important to discuss these screening tests with your healthcare provider, understand their purpose, and make informed decisions based on your individual circumstances. These tests aim to detect potential issues early on, allowing for appropriate management and interventions to ensure the best possible outcomes for you and your baby.

week by week progression of the baby

WEEK 1 The countdown of your pregnancy begins this week, but not because you’re pregnant. This is the week of your last menstrual period (LMP) before getting pregnant. Because most women know the date of their LMP, obstetrician–gynecologists (ob-gyns) generally calculate the estimated due date (EDD) as 40 weeks from the first day of the LMP.

WEEK 2 During this week, eggs are maturing in the ovaries, and the lining of the uterus is thickening. At the end of this week, ovulation takes place. This is the release of a mature egg from an ovary. After its release, the egg begins to travel down a fallopian tube.

WEEK 3 This is the week of fertilization, the union of an egg and a sperm. When the egg and sperm come together, they form a single cell called a zygote. Fertilization takes place in one of the woman’s fallopian tubes. After fertilization, the zygote divides, forming two cells. These cells then divide, forming four cells, and then eight cells, and so on. At the same time, the mass of dividing cells continues to move down the fallopian tube toward the uterus.

WEEK 4 About 8 to 9 days after fertilization, the rapidly dividing group of cells, now called a blastocyst, enters the uterus. The blastocyst has started to make an important pregnancy hormone called human chorionic gonadotropin (hCG). The endometrium, or uterine lining, has prepared itself for pregnancy. The blastocyst burrows deep into the uterine lining. This is called implantation. This week, the blastocyst is about the size of a single poppy seed.

WEEK 5 This week begins the embryo stage of development. The brain and spine have begun to form. Cardiac muscle also starts to develop. This week, the embryo is about the size of a single sesame seed.

WEEK 6 Parts of the face are taking shape now, including the eyes and nostrils. Cardiac activity can sometimes be seen during an ultrasound exam this week. The neural tube, from which the brain, spinal cord, and backbone will form, is completing its development. This week, the embryo is about the size of a single pea.

WEEK 7 This week the mouth and face continue to develop. Arm and leg buds appear. The lungs start to develop the tubes that will carry air in and out after birth. The long tube that will become the digestive tract has taken shape. This week, the embryo is about the size of a single blueberry.

WEEK 8 Webbed fingers and toes are now poking out from the developing hands and feet. The inner ear begins to develop. Muscles of eyes, nose, and mouth are developing. This week, the embryo is about the size of a single raspberry. Mother and baby: Weeks 1 to 8 By the end of week 8, the baby—called an embryo at this stage—is about half an inch long.

Week 9:

The fetus' head is larger, and facial features become more distinct.

External genitals begin to differentiate, but it may not be visible on ultrasound yet.

Week 10:

The fetus' vital organs, such as the heart, liver, and kidneys, are functioning.

Limbs lengthen, and joints form.

The tail-like structure starts to disappear.

Week 11:

The fetus' facial features become more refined.

Tooth buds and nail beds start to develop.

The fetus can move its limbs, but the movements are not felt by the mother yet.

Week 12:

The fetus is fully formed and about the size of a plum.

All major organ systems are present.

The fetus can swallow and make reflexive movements.

Week 13:

The fetus continues to grow rapidly.

The face looks more human-like, and the head is in proportion to the body.

The fetus can make sucking motions with its mouth.

From weeks 14-40, the remaining weeks of pregnancy, the fetus grows and develops further, with organs maturing, bones hardening, and fat layers increasing. Throughout this period, the fetus gains weight, grows in length, and prepares for life outside the womb.

It's important to note that the exact timing of developmental milestones may vary slightly between pregnancies. The provided timeline offers a general overview of fetal development.

1. Haematological Changes: - Plasma volume increases progressively throughout pregnancy. - Fall in haemoglobin concentration, haematocrit, and red blood cell count. - Platelet count tends to fall progressively but usually remains within normal limits. - Increased requirement for iron, folate, and vitamin B12. - Physiological hypercoagulable state increases the risk of venous thrombosis.

2. Cardiac Changes: - Cardiovascular system undergoes profound changes during pregnancy. - Increase in cardiac output, primarily due to peripheral vasodilatation. - Peripheral vasodilation leads to a fall in systemic vascular resistance. - Changes in maternal position affect haemodynamic profile and blood flow. - Increased cardiac output during labor and postpartum period.

3. Renal Changes: - Marked fall in systemic vascular resistance and arterial under-filling. - Increase in renal blood flow and glomerular filtration rate. - Renal plasma flow and GFR increase by 40-65% and 50-85%, respectively. - Increase in renal size and dilation of the urinary tract. - Changes in tubular handling of glucose, protein, and uric acid.

4. Respiratory Changes: - Increased oxygen demand and minute ventilation. - Mild respiratory alkalosis due to hyperventilation. - Diaphragmatic elevation and changes in lung volumes. - Subjective feeling of breathlessness is common in the third trimester.

5. Alimentary Tract Changes: - Nausea and vomiting are common during pregnancy. - Mechanical changes due to the growing uterus may lead to reflux and gastrointestinal symptoms. - Increased prolactin levels and alterations in gastric neural activity and smooth muscle function.

6. Endocrine Changes: - Thyroid: Increased production of TBG, leading to increased T4 and T3 levels. - Adrenal Gland: Hypercortisolism, increased aldosterone levels, and decreased insulin sensitivity. - Pituitary Gland: Enlargement, increased prolactin levels, and suppression of FSH and LH. - Glucose Metabolism: Insulin resistance and alterations in glucose and lipid metabolism. - Calcium Metabolism: Decrease in total serum calcium concentration but maintenance of ionized calcium.

These changes are normal physiological adaptations during pregnancy and play a crucial role in supporting the developing fetus.

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Unveiling the Signs and Symptoms of Pregnancy

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Pregnancy symptoms differ from woman to woman and pregnancy to pregnancy; however, one of the most significant signs of pregnancy is a missed period. The surest way to know you’re pregnant is to take a pregnancy test.

Missed period. If you’re in your childbearing years and a week or more has passed without the start of an expected menstrual cycle, you might be pregnant. However, this symptom can be misleading if you have an irregular menstrual cycle.

Tender, swollen breasts. Early in pregnancy hormonal changes might make your breasts sensitive and sore. The discomfort will likely decrease after a few weeks as your body adjusts to hormonal changes.

Nausea with or without vomiting. Morning sickness, which can strike at any time of the day or night, often begins one month after you become pregnant. However, some women feel nausea earlier and some never experience it. While the cause of nausea during pregnancy isn’t clear, pregnancy hormones likely play a role.

Increased urination. You might find yourself urinating more often than usual. The amount of blood in your body increases during pregnancy, causing your kidneys to process extra fluid that ends up in your bladder.

Fatigue. Fatigue also ranks high among early symptoms of pregnancy. During early pregnancy, levels of the hormone progesterone soar — which might make you feel sleepy.

You may experience pregnancy symptoms within a week of conception. Some women report that they did not experience any symptoms for a few weeks.

Click here⁠

if you need a free test or ultrasound.

Mood Swings. Expecting mothers frequently experience mood swings. This is primarily caused by the hormonal changes that affect the neurotransmitters of the brain. Some may experience elevated highs and lows, and others alternate between states of happiness and depression or anxiety. Mood swings are normal; but, if you’re struggling with depression or extended periods of sadness, please contact your healthcare provider. Some women prefer to go directly to a counselor or mental health professional.

Backaches. Lower backaches are common. It can occur with the onset of pregnancy, but it’s usually experienced later as the pregnancy progresses, around pregnancy week 27 to week 34.

Headaches. Experts believe the sudden rise of hormones and/or blood flow in your body leads can cause headaches. There is an approximate 50% increase in the volume of blood flowing during your pregnancy.

Food cravings or food aversions. The food expecting women crave or seek to avoid varies and is quite sporadic. It is alright to allow yourself the freedom to pursue those cravings and avoid the things you don’t want as long as you are getting the

nutrition⁠

you need for a healthy pregnancy. These cravings or aversions can occur early in pregnancy or anytime throughout your pregnancy.

Darkening of the Areolas. It’s normal if the areolas, area around your nipples will darken.

Bloating. Hormonal changes during early pregnancy can cause you to feel bloated, similar to how you might feel at the start of a menstrual period.

Light spotting. Sometimes a small amount of light spotting is one of the first signs of pregnancy. Known as

implantation bleeding⁠

, it happens when the fertilized egg attaches to the lining of the uterus — about 10 to 14 days after conception. Implantation bleeding occurs around the time of a menstrual period. However, not all women have it.

A missed or delayed period, the most commonly reported first sign of pregnancy, could be caused by:

Pending menstruation

Excessive weight gain or loss

Fatigue or exhaustion

New workout regimen

Hormonal imbalance

Tension or stress

Change in birth control usage

Various illnesses

Breastfeeding

Nausea or morning sickness, the second most frequently cited symptom of pregnancy, might be explained by:

Food poisoning

Tension or stress

Anxiety

Change in hormonal birth control

Other stomach ailments

Tender or changing breasts, the third most noted pregnancy symptom, might be triggered by:

Hormonal imbalance

Change in hormonal birth control

Impending menstruation

Fatigue or tiredness can be brought on by:

Tension or stress

Exhaustion from working too hard

Depression or other mental health struggles

Common cold or flu

New workout regimen

Allergies or other ailments

Lack of sleep

Improper nutrition

Pending menstruation

Morning Sickness Morning sickness is not just a feeling that happens before noon. e nausea and vomiting that dene morning sickness can strike at any time of day— morning, afternoon, or night—and may last all day long. As many as 8 in 10 pregnant women have morning sickness during their rst trimester. e nausea usually starts between 4 and 9 weeks of pregnancy. Most women who experience nausea and vomiting usually feel complete relief by about 16 weeks of pregnancy. But for some women, nausea and vomiting continue for several weeks or months. And for a few women, morning sickness lasts throughout the entire pregnancy. If you have morning sickness, there are a few things that you can try to help make it more bearable and to make sure you are getting enough nutrients and fluids: Take a prenatal vitamin—Taking a prenatal vitamin before and during pregnancy may reduce the risk of severe morning sickness. Keep snacks by the bed—Try eating crackers in the morning before you get out of bed. is avoids moving around on an empty stomach. Drink uids—Your body needs more water in the early months, so aim to drink uids often during the day. Not drinking can lead to dehydration, which can make nausea worse. If you are having trouble drinking water because of a bad taste in your mouth, try chewing gum or eating hard candies. Avoid smells that bother you—Foods or odors that may never have bothered you before may now trigger nausea. Do your best to stay away from them. Use a fan when cooking. Have someone else empty the trash. Eat small and often—Make sure your stomach is never empty. Eat ve or six small meals each day. Try bland foods—the “BRATT” diet (bananas, rice, applesauce, toast, and tea) is low in fat and easy to digest. If these foods don’t appeal to you, try others that do. e goal is to nd foods that you can eat and that stay down. If you can, try to add a protein food at each meal. Good nonmeat sources of protein are dairy foods (milk, ice cream, yogurt), nuts and seeds (including nut butters), and protein powders and shakes. Try ginger—Ginger ale made with real ginger, ginger tea made from fresh grated ginger, ginger capsules, and ginger candies may help settle a queasy stomach. If you try these remedies and they don’t work, your ob-gyn may recommend medication. A combination of vitamin B6 with or without another medication called doxylamine usually is recommended rst. If this does not work, other medications may be tried. About 1 in 50 women who have morning sickness have a severe form called hyperemesis gravidarum. No one knows what causes this condition, and it can be serious if it is not treated right away. Call your ob-gyn if you have any of the following signs or symptoms: You have not been able to keep any food or uids down for 24 hours or more. Your lips, mouth, and skin are very dry. You are urinating less often (less than three times a day), you are not producing much urine, or your urine is dark and has an odor. You are not gaining weight or have lost 5 or more pounds over a 1- to 2-week period. Your ob-gyn most likely will examine you to rule out other causes of your symptoms. If hyperemesis gravidarum is diagnosed, you may be given medication to help control your nausea and vomiting. If you have a severe case of hyperemesis gravidarum, you may need to get uids through an intravenous (IV) line. Fatigue During your rst trimester, you may feel totally wiped out. You may nd it hard just to get out of bed in the morning. is is normal. Being pregnant puts a strain on your entire body, which can make you feel very tired. Your hormone levels have increased. Your metabolism is running high and burning energy, even while you sleep. Women who are pregnant for the second time or more may experience even more fatigue than during their rst pregnancy because of the need to take care of the other children as well as other demands on their time. To help with fatigue, listen to your body. Slow down and get the rest you need. Try going to bed earlier than usual or take a 15-minute nap during the day. Don’t forget that during these rst couple of months, getting enough rest is important. So, if need be, let some things go undone until you have the energy to do them, or get help from your partner, friends, or family members. A healthy diet and exercise also may help boost your energy. Fatigue usually begins to go away after the first trimester. By your fourth month of pregnancy, most of your energy will come back. But many women begin to feel tired again in the last months of pregnancy.

Nausea Most women start to feel relief from nausea this month. If there are remedies that help you, keep them handy. Remember to drink as much uid as you can during the day. If you still have severe nausea and vomiting, talk with your obstetrician–gynecologist (ob-gyn). Fatigue and Sleep Problems You may still be tired during the day from all the changes happening in your body. But as time goes on, it may be more difficult to get a good night’s sleep. As your belly grows larger, it will be harder to nd a comfortable position. To help you get the rest you need, you may nd the following suggestions helpful: Try sleeping on your side with a pillow under your belly and another pillow between your legs. A full-body pillow is another option. Take a warm (not hot) shower or bath at bedtime to help you relax. Exercise daily. Aerobic exercise during the day, such as walking and swimming, helps with sleep at night. Yoga and meditation also are good. These can be done right before bed to help clear your mind and relax. Make your bedroom relaxing. e bed should be comfortable, and the room should not be too hot, cold, or bright.

Acne Acne is common during pregnancy. If you are prone to acne, you may notice that it is getting worse. If you’ve never had it, you may find yourself dealing with acne breakouts during these months. If you get acne during pregnancy, you can take the following steps to care for your skin: Wash your face twice a day with a mild cleanser and lukewarm water. If you have oily hair, shampoo every day and try to keep your hair off your face. Avoid picking or squeezing acne sores to lessen possible scarring. Choose oil-free cosmetics and sunscreens. Many medications can be used to treat acne. Some are available as the active ingredients in over-the-counter products. Others are available only by prescription. Ask your ob-gyn before trying any over-the-counter product. Also, tell any health care practitioner who is treating you for acne that you are pregnant. Most over-the-counter acne products are applied directly on the skin (topical). e amount of medication absorbed through the skin is very low. For this reason, these products are considered safe to use during pregnancy. Over-the-counter products with the following ingredients can be used during pregnancy: Topical benzoyl peroxide Azelaic acid Topical salicylic acid Glycolic acid If you want to use an over-the-counter product that has an ingredient not on this list, talk with your ob-gyn before buying it. Some acne medications can seriously harm your baby. e following medications should not be used while you are pregnant: Hormonal therapy Isotretinoin Oral tetracyclines Topical retinoids Some topical retinoids are available by prescription (tretinoin). But some also can be found in some over-the-counter products. Read labels carefully. If you are concerned about which products to use to treat your acne, talk with your dermatologist or ob-gyn. Together you can decide which option is best for you. See Chapter 24, “Reducing Risks of Birth Defects.” Skin Color Changes During pregnancy, higher estrogen levels cause your body to make more melanin—the pigment that gives color to skin. is increase in melanin is the reason your nipples become darker, for example. It also causes the skin condition known as melasma during pregnancy. Melasma causes brown patches on the face around the cheeks, nose, and forehead. Spending time in the sun can make melasma worse. Protect yourself from the sun by wearing sun block and a hat. Also, limit your exposure to direct sunlight. e good news is that melasma usually fades on its own after you give birth. Some women, though, may have dark patches that last for years. Some women also notice a faint, dark line that runs from their belly button to their pubic hair. is is called the linea nigra. is line is always there, but before you get pregnant it is the same color as the skin around it. Breast Changes Early in pregnancy, your breasts begin changing to get ready for feeding the baby. By now, your breasts may even have grown a whole bra-cup size. ey may be very sore. Many changes are taking place: Fat builds up in the breasts, making your normal bra too tight. Milk glands expand as your body prepares for making milk. e nipples and areolas (the pink or brownish skin around your nipples) get darker. Your nipples may begin to stick out more, and the areolas will grow larger. Your breasts may keep growing in size and weight during these first 3 months. If they are making you uncomfortable, switch to a good maternity bra. these bras have wide straps, more coverage in the cups, and extra rows of hooks so you can adjust the band size. Consider a special sleep bra for nighttime support. When you exercise, wear an athletic bra with good support.

Constipation Rising levels of hormones cause your digestive system to slow. this may lead to constipation. e iron in prenatal vitamin supplements also can cause constipation. To help ease this problem, exercise regularly and increase your intake of fiber. Fiber is found in fruits, vegetables, and whole grains. Staying hydrated helps with constipation too. You should drink 8 to 12 cups (64 to 96 ounces) of water a day during pregnancy. Unfortunately, a side effect of increased fiber consumption is gas formation. To combat this problem, try eating your meals more slowly. Avoid anything that causes you to swallow air, such as gum chewing and carbonated drinks. Your body eventually will adjust to the dietary changes. Talk with your ob-gyn if these approaches don’t ease constipation. Emotional Changes Your body is going through big changes now, and so are your emotions. You may feel down or moody. e emotions you are feeling—happy or sad—are normal. Ask loved ones to support you and be patient. If your emotions are affecting your work or personal relationships and you’re concerned about these issues, talk with your ob-gyn.

Lower Abdominal Pain As the uterus grows, the round ligaments (bands of tissue that support the uterus on both sides) are pulled and stretched. You may feel this stretching as either a dull ache or a sharp pain on one side of your belly. e pain may be most noticeable when you cough or sneeze. Not moving for a short time or changing position may help relieve the pain.

If abdominal pain doesn’t go away or gets worse, call your ob-gyn. It could be a sign of a problem. Mouth and Dental Changes Another surprising thing that you may not have expected during pregnancy are changes in your mouth, teeth, and gums. Pregnancy can cause a variety of changes, including swelling or bleeding gums (gingivitis) sores in your mouth (granuloma gravidarum) looser teeth caused by hormone changes tooth erosion, especially if you have been vomiting often It’s important to continue your usual dental routine during pregnancy. is includes brushing with a soft-bristled brush and fluoride toothpaste flossing between your teeth every day eating healthy foods without too many sugary foods and drinks See your dentist for routine checkups every 6 months. If you have mouth irritation, rinsing with saltwater and switching to a softer toothbrush may help. A saltwater rinse can be 1 teaspoon of salt in 1 cup of warm water. If you vomit, don’t brush your teeth right away. Instead, rinse your mouth with 1 teaspoon of baking soda dissolved in 1 cup of water. this neutralizes the acid and helps protect your teeth. Good dental health is good for you. It also may reduce your baby’s risk of cavities in the future. If needed, procedures like filling cavities, tooth extractions, and root canals should all be done as soon as possible. Dental care is safe throughout pregnancy. is includes mouth X-rays and local anesthesia. If you will need general anesthesia for a dental procedure, your dentist should consult with your ob-gyn. Some dentists require a letter from your ob-gyn that says it is safe for you to have dental care. e letter also may say what procedures and medications to avoid. Check with the dentist’s office ahead of time and ask your ob-gyn for a letter if needed. If you do not have a dentist, ask your obgyn if he or she can refer you to one. Excessive Salivation Some women notice that they have extra saliva during pregnancy, especially when they’re nauseated. is is more common among women who have severe morning sickness. e exact cause of excessive salivation is not known. Hormonal changes may be a cause. Also, nausea might make some women try to swallow less, causing saliva to build up in the mouth. If this is a problem for you, talk with your ob-gyn. Pregnancy-Related Stress It is normal to worry about your pregnancy and whether you are doing all the right things for the baby. e changes happening in your life can be stressful. So can thoughts about how your life will change after the baby arrives. But it’s important to make sure this type of normal stress doesn’t lead to making you anxious or upset every day. If you think your stress is becoming too much to handle, talk with your family, friends, and especially your ob-gyn. You will need help to ease your feelings. Know that you can’t do everything and may need to ask for help sometimes—from your partner, family, and friends. Here are a few more tips that can help reduce your stress: Let the household chores go undone sometimes. Use that time to do something relaxing. Take advantage of sick days or vacation whenever possible. Spending a day, or even an afternoon, resting at home will help you get through a tough work week. Get regular exercise. Yoga especially helps to reduce stress. Go to bed early. Your body is working overtime to nourish your baby. You need all the sleep you can get. Depression is common in pregnant women. It’s important to get help if you need it. Talk with your ob-gyn if it seems like more than just stress or if you have any warning signs of depression.

Spider Veins You may have tiny red veins that show up under the skin of your face or legs. Spider veins are a normal part of the changes in your circulation. these veins usually fade after you give birth. As your pregnancy goes on, you may develop varicose veins. these are swollen veins in the lower legs. For some women, varicose veins shrink or go away after giving birth. In the meantime, prop up your legs when you can. If you must sit or stand for long periods, move around often. is will help reduce swelling. Strange Dreams It’s normal to have unusual dreams that may be vivid and scary. Experts believe these types of dreams may provide a way for your subconscious to cope with any fears and doubts you have about pregnancy and becoming a mother. Urinary Problems It’s normal to urinate often while you’re pregnant. But some urinary problems may be a sign of a urinary tract infection (UTI). Be alert to the signs and symptoms of a UTI, which include pain when you urinate urge to urinate right away urine that is cloudy or has blood in it urine that has a strong smell fever back pain Call your ob-gyn if you have any of these symptoms. If you have a UTI, your ob-gyn may prescribe an antibiotic that is safe for you to take during pregnancy. Vaginal Discharge Vaginal discharge (the fluid that comes out of your vagina) often increases during pregnancy. is is caused by normal changes in the vagina and cervix. A sticky, clear, or white discharge is normal, and it’s usually nothing to worry about. But some changes could mean you have an infection, such as bacterial vaginosis (BV) or a yeast infection. Call your ob-gyn if you have symptoms, including discharge that has changed from its normal color discharge that has a bad smell pain, soreness, or itching in the vaginal area If an infection is diagnosed, your ob-gyn may prescribe medication for treatment. Even if you have had a yeast infection before, talk with your obgyn before using an over-the-counter medication.

Congestion and Nosebleeds During pregnancy, some of your hormone levels increase, and your body makes extra blood. Both of these changes cause the mucous membranes inside your nose to swell up, dry out, and bleed easily. is may cause a stuffy or runny nose. You also may get nosebleeds from time to time. Here are some remedies: Try saline drops or a saline rinse to relieve congestion. (Do not use other types of nose drops, nasal sprays, or decongestants until you talk with your ob-gyn.) Drink plenty of liquids. Use a humidifier to moisten the air in your home. Dab petroleum jelly around the edges of your nostrils to keep the skin moist. Dizziness Early in your second trimester, it’s normal to feel dizzy or lightheaded at times. Your blood circulation is changing. ere can be less blood ow to your head and upper body, especially when you first sit or stand or if you stand for a long time. To prevent dizziness, move slowly when you stand up or change positions. Drinking a lot of fluids may help. Also, avoid standing for a long time or getting too hot. If you feel dizzy, lie down on your side.

Memory Changes If you’re nding it harder to remember things these days, you’re not alone. Many women have memory changes during pregnancy. Some women refer to this as “pregnancy brain.” You may be forgetful or absentminded. You also may have trouble concentrating or reading. Researchers are still learning why pregnancy causes memory changes. In the meantime, don’t be worried. It may help to keep lists of things to do at work or home. Sleeping Positions You may be nding it hard to get comfortable for sleep. Your belly has grown, which means sleeping face down is uncomfortable. Sleeping on your back may not be good for you either because it puts the weight of your uterus on your spine and back muscles. In the second and third trimesters, lying on your back may compress a major blood vessel that takes blood to your uterus, making you feel dizzy and possibly reducing blood ow to your baby. Sleeping on your side during your second and third trimesters may be best. Keep one or both knees bent. It may also help to place a pillow between your knees and another under your belly. You also can try a full-length body pillow. Trust your body. Some pregnant women find that their bodies automatically find the best positions for sleep.

Lower Back Pain Backache is one of the most common pregnancy problems, especially in the later months. You can blame your growing uterus and hormonal changes for your aching back. Your expanding uterus shifts your center of gravity and stretches out and weakens your abdominal muscles. is changes your posture and puts a strain on your back. e extra weight you’re carrying means more work for your muscles and increased stress on your joints, which is why your back may feel worse at the end of the day. Here are some tips to help lessen back pain: Wear low-heeled (but not at) shoes with good arch support, such as walking shoes or athletic shoes. Avoid high heels—they tilt your body forward and strain your lower back muscles. Do exercises to stretch and strengthen your back muscles. Many of the exercises in this book are designed to do just that.

If you must list something, squat down, bend your knees, and keep your back straight. Do not bend at the waist to pick up things. Get off your feet. If you need to stand for a long time, rest one foot on a stool or a box to take the strain off your back. Sit in chairs with good back support or tuck a small pillow behind your lower back. Use an abdominal support garment (for sale in maternity stores and catalogs). It looks like a girdle and helps take the weight of your belly off your back muscles. Also, some maternity pants come with a wide elastic band that fits under the curve of your belly to help support its weight. Apply a heating pad or warm-water bottle. Heating pads should be set at the lowest possible temperature setting. Wrap your heating pad or warm-water bottle in a towel to help prevent burns. Cold compresses also can help ease pain.

Heartburn Heartburn is pain or a burning feeling in the throat and chest and is common among pregnant women. Pregnancy hormones, which relax the valve between your stomach and esophagus (the tube leading from the mouth to the stomach), are a main cause of heartburn. When the valve between your esophagus and stomach doesn’t close, stomach acids leak into the esophagus. As your uterus grows, it adds to the problem by pressing up against your stomach. If you are bothered by heartburn, try these remedies: Eat six small meals per day instead of three big ones. Eat slowly and chew your food well. Do not drink a lot of liquid with your meals. Drink liquid between meals instead. Do not eat or drink within a few hours of bedtime. Do not lie down right after meals. Try raising the head of your bed. Place a few extra pillows under your shoulders or put a couple of books or wood blocks under the legs at the head of the bed. Avoid foods that are known to make acid reflux worse. these include citrus fruits, chocolate, and spicy or fried foods. Several antacids are available over-the-counter. these typically contain aluminum, calcium, and magnesium. these products are considered safe to use during pregnancy, but do not overdo it. If you have tried these remedies and your acid reflux continues or gets worse, see your ob-gyn. Hot Flashes If you’re feeling hot and sweaty when everyone else says they feel fine, blame your pregnancy hormones and your increased metabolism. You are burning more calories and generating more heat. Try to stay cool just as you would on the hottest summer days: Wear loose clothing. Drink plenty of water. Stay close to a fan or air conditioner for a blast of cool air.

Aches and Pains It is normal for the extra weight of your growing belly to cause aches and pains as you move around during the day or when you’re trying to rest. You may not be able to take the medications you normally would for pain, but you can take acetaminophen. To be sure that you don’t take too much acetaminophen, check with your ob-gyn. Together you can review whether you are taking any other medications that contain acetaminophen. Avoid taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, during pregnancy. Some studies have suggested that they may increase the risk of certain birth defects when they are taken in the third trimester. ere may be other ways to relieve the pain. If your muscles are sore and aching, try a warm bath or massage. A heating pad or a heat wrap may help. For mild headaches, try lying down with a cool pack on your head. If you have a severe headache or if a headache doesn’t go away, call your ob-gyn right away. Fast or Racing Heartbeat You may notice throughout your pregnancy that your heart is beating faster. is is normal. It happens because your heart is pumping more blood faster than normal. As your pregnancy goes on, your heart pumps up to 30 to 50 percent more blood than when you aren’t pregnant. these increases in heart rate and blood volume help deliver oxygen and nutrients to the baby through the placenta. Another reason for the faster heartbeat may be sensitivity to caffeine. Pregnant women may be more sensitive to the effects of caffeine. If you notice that your heart rate stays fast or if you also have shortness of breath, call your ob-gyn right away.

Pelvic Bone Pain e two halves of your pelvis are connected at the front by a joint called the pubic symphysis. is joint normally is stiff and hardly moves. e hormone relaxin also affects the pubic symphysis, making it more exible during and just after pregnancy. Sometimes, the increased movement in this joint can cause pain in the pelvis. Avoid heavy lifting and standing for a long time. Exercises for abdominal and pelvic muscles also can help.

Constipation Even if you didn’t have constipation early in your pregnancy, you most likely will have it now. Constipation is when you do not have bowel movements often and your stools are rm or hard to pass. It can happen for many reasons. High levels of progesterone may slow down digestion. Iron supplements can make constipation worse. Toward the end of pregnancy, the weight of the uterus puts pressure on your rectum, adding to the problem. Although there is no miracle cure for constipation, the following tips may help: Drink plenty of liquids, especially water. Eat high-fiber foods, such as fruits, vegetables, beans, whole-grain bread, and bran cereal. Walk or do another safe exercise every day.

Eat several smaller meals each day instead of larger, less frequent meals. Smaller amounts of food eaten more often may be easier to digest. You also can ask your ob-gyn about over-the-counter remedies for constipation: Bulk-forming agents absorb water in the intestines. is creates a more liquid-like stool that’s easier to pass. If you take these agents, you need to drink plenty of water. Stool softeners add liquid to the stool to soften it. Stimulants trigger the intestines to contract and move stool through. Talk with your ob-gyn before taking any over-the-counter remedy.

Braxton Hicks Contractions As early as the second trimester, many women have “practice contractions” called Braxton Hicks contractions. Sometimes Braxton Hicks contractions are very mild. they can barely be felt or feel like a slight tightness in your belly. Other times, they can be painful. these contractions help your body get ready for birth but do not open the cervix. these contractions often happen in the afternoon or evening after physical activity after sex they are more likely to happen when you are tired or dehydrated, so be sure to drink plenty of fluids. Braxton Hicks contractions tend to happen more often and get stronger as you get closer to your due date.

Shortness of Breath In these later weeks of pregnancy, you may have shortness of breath from time to time. Your uterus is now starting to take up more room in your belly, pressing the stomach and the diaphragm (a at, strong muscle that aids in breathing) up toward the lungs. Although you may feel short of breath, your baby is still getting enough oxygen. To help make breathing easier, move slowly and sit or stand up straight to give your lungs more room to expand. If there is a major change in your breathing or if you have a cough or chest pain, call your obstetrician– gynecologist (ob-gyn) right away.

Leg Cramps Cramps in the lower legs are another common symptom in the second and third trimesters. You may experience sharp, painful cramps in your calves that can awaken you from a sound sleep. Experts are not sure what causes leg cramps late in pregnancy. e following tips may help: Stretch your legs before going to bed. If you get a cramp, ex your foot upward and then back down, which often brings immediate relief. Massage the calf in long downward strokes.

Varicose Veins and Leg Swelling Many pregnant women develop varicose veins. ey are caused by the weight of your uterus pressing down on a major vein. these veins also can appear near your vagina, vulva, and rectum. In most cases, varicose veins do not cause significant problems. they are more of a cosmetic issue. Varicose veins are more likely to develop if you’ve been pregnant before. Varicose veins also tend to run in families. Although there is nothing you can do to prevent these sore and bulging veins, there are ways to relieve swelling and perhaps help stop them from getting worse:

If you must sit or stand for long periods, be sure to move around often. Try to limit the time you sit with one leg crossed over another. Raise your legs and rest them on a couch, chair, or footstool as often as you can. Wear support hose that do not constrict at the thigh or knee. Do not wear stockings or socks that have a tight band of elastic around the legs. Hemorrhoids Pregnant women often have hemorrhoids—painful, itchy varicose veins in or around the anus. Hemorrhoids usually get worse right after delivery, then slowly get better during the postpartum period. Talk with your ob-gyn about using over-the-counter creams and suppositories. You also can try these tips for relief. Some of these tips may help you avoid the problem too: Eat a high-fiber diet and drink plenty of liquids to help avoid constipation. Keep your weight gain within the limits your ob-gyn suggests. Get up and move around to take weight off the veins of your pelvic area. Sitting for a long time puts pressure on these veins. Apply an ice pack or witch hazel pads to hemorrhoids. Witch hazel helps relieve pain and reduce swelling. Try soaking in a warm (not hot) tub a few times a day. Itchy Skin Some women find that their skin is very itchy during pregnancy, especially the skin over the belly and breasts. If you’re bothered by itchy skin, try these tips: Drink plenty of fluids to stay hydrated. Apply a moisturizer to your skin in the morning and at night. Add cornstarch to your bath water. If your itching is severe or you have a rash, talk with your ob-gyn. Some skin conditions that can happen during pregnancy should be treated.

Frequent Urination In the nal weeks of your pregnancy, you’ll feel more pressure on your bladder as the baby moves deeper into your pelvis. You will urinate much more often during the day. You also may have to go several times during the night. Some women also leak urine during these later weeks, especially when laughing, coughing, sneezing, or even just with simple bending and lifting. this, too, is caused by the baby pressing on your bladder.

Leg Swelling and Pain Most pregnant women have some swelling in their legs and feet. Try not to stand for long periods of time. When sitting, prop up your legs on a pillow or use a footrest. Supportive shoes may help you feel more comfortable. Pelvic Pressure e baby will soon settle into a deeper position in your pelvis to get ready for birth. You may feel this settling as the baby “dropping” in your pelvis. When your baby drops, it can increase pressure in the pelvis, bladder, and hips. On the upside, you may feel less pressure against your diaphragm and lungs. ere is not much you can do about the pressure other than try to stay off your feet when you are uncomfortable. Soaking in a warm bath may help. Bath water temperature should be no more than 100°F (37.8°C). Numbness of Legs and Feet Numbness and tingling in the hands and feet are normal in late pregnancy. Some women may develop carpal tunnel syndrome. is is discomfort in the hand caused by the compression of a nerve within the carpal tunnel, a passageway of bones and ligaments in the wrist. these symptoms usually go away after you give birth and the tissues return to normal. But if you have these symptoms, mention them to your ob-gyn. Wrist splints and resting the affected hand are often used to treat these symptoms during pregnancy.

Snoring If your partner says you’ve been snoring more than usual, blame it on normal changes in breathing during pregnancy. If your snoring is a real problem, try sleeping with nasal strips across the bridge of your nose. A humidier in your bedroom also may help. But you should talk with your ob-gyn about snoring because it could be a sign of obstructive sleep apnea.

Vaginal Spotting If you have light spotting between 37 and 40 weeks, it could be a sign that labor is starting. Pink or slightly bloody vaginal discharge may be caused by the cervix starting to dilate (open) the loosening of the thick mucus plug that seals off the cervix during pregnancy If vaginal bleeding is heavy—as heavy as a normal menstrual period—it could be a sign of a problem. Call your ob-gyn and go to the hospital right away if you have heavy bleeding.

Pregnancy Dos and Don'ts: Making Healthy Choices for You and Your Baby

In the first 2 months of pregnancy, you may have a lot of questions to ask and decisions to make. e decisions facing you now may include making important lifestyle changes and deciding when to tell others your news. If you haven’t already done so, you’ll also want to choose a practitioner who will care for you during your pregnancy (see Chapter 2, “Choosing Your Care Team”). ings to Avoid During Pregnancy It’s normal to be anxious about what you can and cannot do while you are pregnant. e list of “don’ts” may seem long, but most are easy to remember. Using Tobacco. Cigarette smoke contains thousands of harmful chemicals, including lead, tar, nicotine, and carbon dioxide. When you smoke, these toxins increase the risk of pregnancy complications, including vaginal bleeding preterm birth low birth weight stillbirth sudden infant death syndrome (SIDS) It is best to stop smoking before pregnancy or as soon as you nd out you are pregnant. If you are pregnant and you smoke, tell your ob-gyn. He or she can help you nd support and quitting programs in your area. You also can call the national “quit line” at 1-800-QUIT-NOW. To nd out more about quitting programs in your area, to get information about quitting, or to nd support, see the “Resources” section at the end of this chapter. Also, electronic cigarettes (known as “e-cigarettes”) contain many harmful substances, including nicotine. Using them is called “vaping.”

Ecigarettes are not safe substitutes for cigarettes and should not be used during pregnancy. Being Around Secondhand Smoke. Smoke from cigarettes smoked by other people can be harmful as well. Breathing secondhand smoke during pregnancy increases the risk of having a smaller baby. Babies who are exposed to secondhand smoke have an increased risk of SIDS. they also are more likely to have respiratory illnesses than those not exposed to secondhand smoke. If you live or work around smokers, take steps to avoid secondhand smoke. You may want to ask family members who smoke to smoke outside or quit altogether. Drinking Alcohol. It’s best to stop drinking before you get pregnant. If you did have some alcohol before you knew you were pregnant, it most likely will not cause serious harm to your baby. e important thing is to avoid alcohol once you know you’re pregnant. When a pregnant woman drinks alcohol, it quickly reaches the baby. Alcohol is much more harmful to a baby than it is to an adult. In an adult, the liver breaks down the alcohol. A baby’s liver is not fully developed and is not able to break down alcohol. Fetal alcohol spectrum disorder (FASD) is a term that describes different effects that can occur in a baby when a woman drinks during pregnancy. ese effects may include physical, mental, behavioral, and learning disabilities that can last a lifetime. Even moderate alcohol use during pregnancy (defined as one alcoholic drink per day) can cause lifelong learning and behavioral problems in a child. It is not known how much alcohol it takes to harm the baby. e best course is not to drink at all during pregnancy. Also, there are no types of drinks that are safe. One beer, one shot of liquor, one mixed drink, or one glass of wine all contain about the same amount of alcohol. Talk with your ob-gyn about your drinking habits. If you are dependent on alcohol, you may need specialized counseling and medical care. Your obgyn can help you connect with these resources

Using Marijuana. Recreational marijuana use is legal in some states, and even more states have legalized medical marijuana. But both are illegal under federal law, and neither should be used during pregnancy. When marijuana is smoked or eaten, the chemicals reach the baby by crossing the placenta. Research is limited on the harms of marijuana use during pregnancy. But there are possible risks of marijuana use to your baby, including problems with brain development and increased risk of stillbirth and preterm birth. If you use medical marijuana, talk with your ob-gyn. He or she should recommend other treatments you can try that are safe to use during pregnancy. Using Opioids. Opioids are a type of medication that relieves pain. ey also release chemicals in the brain that have a calming effect. Doctors may prescribe opioids for people who have had surgery, dental work, or an injury.

Most people who use a prescription opioid have no trouble stopping their use, but some people develop an opioid use disorder. Pregnant women with opioid use disorder have an increased risk of serious complications, including placental abruption growth problems for the baby preterm birth stillbirth When you are pregnant and have an opioid use disorder, you should not stop using the drug without medical help. Quitting without a doctor’s help, especially when done suddenly, often leads to relapse (return to drug use). is can be dangerous for you and your baby. e best treatment for opioid use disorder during pregnancy includes opioid replacement medication, behavioral therapy, and counseling. e medications that are given are called methadone and buprenorphine. they reduce cravings but do not cause the good feelings that other opioids cause. Behavioral therapy and counseling may help people avoid and cope with situations that might lead to relapse. Using Other Substances. Substance use is the use of illegal drugs such as heroin, cocaine, and methamphetamines, or prescription drugs used for a nonmedical reason. Use of these substances during pregnancy increases the risk of several problems, including birth defects miscarriage preterm birth growth problems for the baby stillbirth e bottom line is that you should make all substance use off-limits while you are pregnant. If you are addicted to any drugs, tell your ob-gyn that you need help. Some states have substance use treatment programs tailored for pregnant women. these programs offer prenatal care, counseling and family therapy, nutritional education, and other services. Your ob-gyn can help you enroll in one of these programs. To find a program in your area, contact the Substance Abuse and Mental Health Services Administration’s website

What Should I Do About Medications? Most medications do not cause harm during pregnancy. But it is a good idea to tell your ob-gyn about all of the medications that you are taking. is includes prescription medications, over-the-counter drugs, and herbal remedies. Do not stop taking a medication prescribed for you until you have talked with your ob-gyn. e risks of taking some medicines during pregnancy may be outweighed by the effects of not taking them. If a medication you are taking poses a risk, your ob-gyn may recommend switching to a safer drug while you are pregnant. You also should check with your ob-gyn before taking over-the-counter pain relievers, laxatives, cold or allergy remedies, and skin treatments. But you don’t have to go through the discomfort of headaches or colds without relief. Your ob-gyn can give you advice about medicines that are safe for pregnant women to use.

Nurturing Your Mental Health During Pregnancy: Self-Care and Support

Pregnancy is a transformative and emotionally charged period in a woman's life. It is essential to prioritize mental health during this time to ensure a positive pregnancy experience. This essay will explore the importance of understanding mental health during pregnancy, the hormonal and physiological changes that occur, self-care strategies for maintaining mental well-being, seeking support and professional help when needed, and preparing for postpartum mental health.

Understanding Mental Health During Pregnancy: During pregnancy, mental health encompasses emotional, psychological, and social well-being. It is crucial to recognize that mental health can fluctuate and impact the overall pregnancy journey. Understanding mental health involves acknowledging the range of emotions experienced during pregnancy, such as joy, anxiety, and mood swings. Recognizing these emotional experiences as normal can help alleviate unnecessary worry and stress.

Hormonal and Physiological Changes: Hormonal fluctuations during pregnancy play a significant role in a woman's mental health. Hormones such as estrogen and progesterone increase dramatically, affecting neurotransmitters and impacting mood regulation. These hormonal changes can lead to emotional ups and downs, heightened sensitivity, and changes in sleep patterns. Additionally, the physical changes that occur, such as weight gain and bodily discomfort, can also influence mental well-being. Understanding these hormonal and physiological changes helps individuals normalize their experiences and seek appropriate support.

Self-Care Strategies for Mental Well-Being: Self-care is vital for maintaining mental well-being during pregnancy. It involves taking intentional steps to nurture oneself physically, emotionally, cognitively, and socially. Physical self-care includes regular exercise tailored to pregnancy, promoting proper nutrition, and ensuring adequate rest and sleep. Emotional self-care involves identifying and expressing emotions effectively, practicing relaxation techniques like deep breathing and meditation, and engaging in creative outlets. Cognitive self-care focuses on managing negative thought patterns, fostering positive self-talk and affirmations, and utilizing stress management techniques. Social self-care emphasizes maintaining healthy relationships, setting boundaries, seeking social support from loved ones and support groups, and nurturing a support network.

Seeking Support and Professional Help: It is essential to recognize when additional support is needed during pregnancy. Open communication with healthcare providers is crucial in identifying and addressing mental health concerns. Seeking support from loved ones, including partners, family, and friends, can provide emotional and practical assistance. Moreover, it is important to know that professional help is available when required. Mental health professionals, such as therapists and counselors specializing in perinatal mental health, can offer guidance and therapeutic interventions. Support groups specifically designed for pregnant individuals can also provide a sense of community and understanding.

Preparing for Postpartum Mental Health: While focusing on mental health during pregnancy, it is equally important to prepare for postpartum mental health. Understanding the prevalence of postpartum mental health issues, such as postpartum depression and anxiety, helps individuals recognize the signs and symptoms. Building a postpartum support plan involves creating a network of support, including partners, family, friends, and healthcare professionals. It is essential to educate loved ones about postpartum mental health and the challenges individuals may face during this time. Additionally, emphasizing self-care during the postpartum period helps individuals prioritize their mental well-being as they adjust to the demands of motherhood.

Pregnancy is a transformative and emotional journey, but it can also be accompanied by anxiety and stress. Addressing and managing these emotions is essential for the well-being of both the expectant mother and the developing baby. This essay aims to provide comprehensive guidance on addressing anxiety and stress during pregnancy by offering coping strategies and highlighting available resources for support.

1: Understanding Anxiety and Stress in Pregnancy

1.1 The Impact of Anxiety and Stress on Pregnancy This section explores the potential effects of anxiety and stress on the expectant mother's physical and mental health. It emphasizes the importance of managing these emotions to promote a healthy pregnancy. Participants will learn about the potential impact on fetal development and the importance of maintaining a calm and balanced environment for the baby.

1.2 Common Triggers and Causes of Anxiety and Stress Identifying common triggers and causes of anxiety and stress during pregnancy helps participants understand their own experiences. Topics covered may include fears about labor and delivery, concerns about parenting, financial worries, changes in relationships, and adjusting to physical and emotional changes. Understanding these triggers can help individuals develop targeted coping strategies.

2: Coping Strategies for Anxiety and Stress

2.1 Relaxation Techniques This section focuses on teaching relaxation techniques as effective coping strategies. Participants will learn about deep breathing exercises, progressive muscle relaxation, and guided imagery. Step-by-step instructions will be provided to facilitate practice and application in daily life. The goal is to help individuals reduce stress levels and induce a sense of calm and relaxation.

2.2 Mindfulness and Meditation Mindfulness and meditation have been shown to be powerful tools in managing anxiety and stress. Participants will learn about the benefits of mindfulness and meditation during pregnancy. Guided exercises and practices suitable for pregnant women will be introduced. The emphasis will be on cultivating present-moment awareness, reducing rumination, and fostering a sense of inner peace.

2.3 Physical Activity and Exercise Regular physical activity is known to improve mental well-being during pregnancy. Participants will be educated about the positive effects of exercise on anxiety and stress reduction. Safe and appropriate exercises for pregnant women will be recommended, taking into account individual fitness levels and any medical considerations. Participants will be encouraged to consult with their healthcare providers before initiating or modifying an exercise routine.

3: Resources for Support

3.1 Healthcare Provider Guidance Participants will be encouraged to seek guidance from their healthcare providers, such as obstetricians, midwives, or mental health professionals specializing in perinatal care. Providers can offer personalized support, monitor mental health, and recommend appropriate interventions if needed.

3.2 Supportive Networks and Peer Groups Engaging with supportive networks and peer groups can provide a sense of community and understanding. Participants will be introduced to local or online support groups specifically designed for pregnant individuals. These groups offer a platform for sharing experiences, gaining insights, and receiving emotional support.

3.3 Mental Health Resources Participants will be informed about available mental health resources, such as therapists or counselors specializing in perinatal mental health. Online platforms, helplines, and websites dedicated to providing information and support will be highlighted. The importance of seeking professional help when needed and overcoming the stigma associated with mental health will be emphasized.

there are now many ways to screen for certain birth defects and genetic disorders during pregnancy, and to provide diagnostic testing for those who desire it. Your ob-gyn can explain the options and help you decide which tests are best for you. See Table below, “Prenatal Screening and Diagnostic Tests,” for a comparison of tests. Deciding if you want to be tested—and if so, what types of tests to have —depends on a lot of factors. Here are some important things to consider: Getting results in the first trimester from a diagnostic procedure is appealing to many parents-to-be because it gives more time to make decisions. First-trimester screening tests can detect about 85 percent of cases of Down syndrome. Second-trimester screening tests can detect about 80 percent of cases of Down syndrome.

Combining results of first trimester and second-trimester screening tests provides a Down syndrome detection rate of 94 to 96 percent. Diagnostic testing has a detection rate of more than 99 percent for many disorders. Some parents want to know if their child will have a birth defect so that they can be prepared. Knowing also gives you the opportunity to learn about the disorder and to organize the care that the child will need. Some parents may decide to end the pregnancy in certain situations. Ending a pregnancy carries less risk of complications if it is done before 13 weeks of pregnancy. this timing may affect which tests a woman chooses to have. Your personal beliefs and values are important factors in any decision. e choice that’s right for one woman may not be right for another. A genetic counselor or physician with special training in genetics can help you understand whether you are at risk of having a child with certain genetic disorders. In genetic counseling, the counselor asks you and the baby’s father for a detailed family history. If a family member has a problem, the counselor may ask to see that person’s medical records. You also may be referred for additional physical exams or tests. Using all the information gathered, the counselor will assess the baby’s risk of having a disorder. e counselor then will discuss the options for prenatal testing. It is your choice whether you want to have testing

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Birth Places the safest places to give birth are thought to be: A hospital that offers various levels of care A birth center within the hospital complex that meets the standards outlined by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) An accredited freestanding birth center that meets the standards of the Accreditation Association for Ambulatory Health Care, the Joint Commission, or the American Association of Birth Centers Some things to keep in mind: Women with low-risk, uncomplicated pregnancies may be able to give birth at a freestanding birth center staffed by qualied ob-gyns. Women with complicated pregnancies (carrying more than one baby, for example) or health problems (like preeclampsia) need more advanced care, either in a hospital or in a birth center attached to a hospital. Your ob-gyn will let you know about the choices available in your area. You also may discuss where he or she does deliveries and what your health insurance will cover. You can tour the hospitals in your area to see which settings appeal to you. See Chapter 12, “Preparing for Birth.” Home Birth What about giving birth at home? Complications during labor and delivery can happen to anyone, even women with healthy pregnancies. If problems happen, a hospital setting offers the expert staff and equipment to give you and the baby the best care in a hurry. For this reason, ACOG says that the safest place for you and your baby during labor, delivery, and the days after is a hospital, hospital-based birth center, or accredited freestanding birth center.

Revealing the Gender: Discovering Your Baby's Sex during Pregnancy

Title: Revealing the Gender: Discovering Your Baby's Sex during Pregnancy

Introduction: The anticipation of knowing the gender of your baby is an exciting part of the pregnancy journey for many expectant parents. While some parents choose to wait until birth to discover the baby's sex, others opt for early gender reveal. This essay aims to explore the various methods available to determine the baby's sex during pregnancy, including non-invasive prenatal testing, ultrasound, and other traditional methods. It will discuss the benefits and considerations of each approach, as well as the emotional impact of finding out the gender before birth.

1: Understanding Gender Determination during Pregnancy

1.1 The Difference Between Gender and Sex This section clarifies the distinction between gender and sex. It explains that gender is a social construct while sex refers to biological characteristics. Understanding this difference helps expectant parents approach the topic of gender determination with open-mindedness and respect for their child's identity.

1.2 Biological Basis of Gender Determination Participants will learn about the biological processes that determine the sex of a baby. This includes the role of chromosomes, specifically the presence of X and Y chromosomes, in determining whether the baby will be male or female. Explaining these processes helps demystify the scientific aspect of gender determination.

2: Methods of Gender Determination during Pregnancy

2.1 Non-Invasive Prenatal Testing (NIPT) This section introduces the concept of NIPT, which involves a blood test to analyze fetal DNA. Participants will learn about the accuracy, timing, and safety of NIPT in determining the baby's sex. Benefits, limitations, and potential ethical considerations surrounding this method will be discussed.

2.2 Ultrasound Gender Determination Ultrasound is a widely-used method to determine the baby's sex during pregnancy. Participants will gain insight into the timing and reliability of ultrasound in identifying gender markers. They will also learn about the role of the ultrasound technician in providing accurate information and any limitations or potential errors associated with this method.

2.3 Traditional Methods Traditional methods, such as gender prediction based on old wives' tales or folklore, will be discussed in this section. Participants will learn about common beliefs and practices, including those based on the mother's physical appearance, cravings, and the Chinese gender prediction calendar. While these methods are not scientifically validated, they can add a fun and cultural aspect to the gender reveal experience.

3: Emotional Impact and Considerations

3.1 Emotional Connection and Parental Bonding This section addresses the emotional impact of finding out the baby's gender during pregnancy. It discusses the potential for increased bonding and emotional connection between parents and the baby when they know the gender beforehand. Participants will explore how knowing the gender can influence their preparations and expectations for the baby's arrival.

3.2 Managing Expectations and Gender Disappointment Expectant parents may have specific expectations or preferences regarding the baby's gender. This section addresses the potential for gender disappointment if expectations are not met. Participants will learn strategies for managing and navigating these emotions, emphasizing the importance of focusing on the health and well-being of the baby.

3.3 Gender Reveal Celebrations and Ethical Considerations Gender reveal parties or celebrations have become popular in recent years. This section explores the ethical considerations associated with such events, including potential reinforcement of gender stereotypes and the importance of creating an inclusive and respectful environment. Participants will be encouraged to approach gender reveal celebrations with sensitivity and awareness.

Now is a good time to decide who will care for your baby after birth. Most parents choose a pediatrician, a doctor who specializes in the health care of children from birth until young adulthood. Other parents use a family practice doctor who treats the entire family. Not sure how to find a doctor for your baby? Talk with friends and family members who are parents. Ask your ob-gyn for a referral. You also can search your health insurance plan’s network of practitioners. Make sure the doctor you want is accepting new patients has an office near your home accepts your health insurance is on staff at the hospital or birth center where you plan to deliver Some pediatricians will meet with parents-to-be for brief interviews to answer questions. During the interview, ask yourself whether you feel comfortable with the doctor. Do you like his or her manner and communication style? Here are some other questions you might ask: When will the doctor see your baby for the rst time? Will he or she come to the hospital to see your newborn? How often will your baby be seen for checkups? Is the doctor available by phone or email for questions? If not, is there a nurse who can answer your questions without an office visit? Does the doctor take calls after hours (nighttime or weekends), or do you need to visit an urgent care center or emergency room? Are there extra fees for sick visits, routine exams, and vaccinations?

Planning and making decisions may seem like all you are doing these days. But rest assured, planning can make your life less stressful. ere is a lot you can do now to help labor and delivery go as smoothly as possible. is includes learning about the types of pain relief that are available and touring the hospital or birth center where you plan to give birth. Checklist for Delivery You should have the answers to the following questions well before your delivery day: Have I filled out all the paperwork needed to begin my maternity leave and collect disability pay? Do I need to register at the hospital before I check in for delivery? If so, have I done this? At what point in my labor should I leave for the hospital? Should I go straight to the hospital or call my ob-gyn’s office rst? What hospital number do I call if I have questions? Have I arranged for the care of my other children and pets while I’m in the hospital? When can family and guests visit me after I have the baby? What friends and family do we need to spread the news to once the baby arrives? Do I have their phone numbers or email addresses? Have I purchased a baby car seat, and do I know how to install it? Some hospitals offer a service to check that your car seat is installed correctly. Ask if this is available. See Chapter 12, “Preparing for Birth,” for a suggested packing list for the hospital. Pain Relief During Labor Now is a good time to think about whether you would like medications for pain relief during labor and delivery. You don’t have to decide now, but it’s good to know your options. Even if you do make a decision now, you may change your mind once you’re in labor. Each woman’s labor experience is unique. No two women feel labor pain the same way. Also, if you’ve had a baby before, your pain may be different from the last time you were in labor. Pain depends on many factors, including the size and position of the baby the strength of contractions how you handle pain Many women take classes to learn breathing and relaxation techniques to manage the pain of childbirth (see Chapter 13, “Pain Relief During Childbirth”). Some women use these techniques along with pain medications. ere are two types of pain-relieving drugs. An analgesic lessens pain. An anesthetic can block all feeling, including pain. Anesthesia can work in different ways: Regional anesthesia removes pain or sensation from certain parts of the body while you stay awake. Epidural blocks and spinal blocks are forms of regional anesthesia. General anesthesia creates a sleep-like state. You are not aware of your surroundings and feel no pain. General anesthesia usually is not used for vaginal births. Not all hospitals and birth centers are able to offer all types of pain-relieving drugs. But at most facilities, an anesthesiologist will work with you and your health care team to choose the best method. See Chapter 13, “Pain Relief During Childbirth.” Childbirth Classes Childbirth classes can teach you how to cope with pain and discomfort during labor and delivery. e most common classes—Lamaze, Bradley, and Read—are based on the theory that much of the pain of childbirth is caused by fear and tension. ese childbirth classes focus on support, relaxation, paced breathing, and touch. See Chapter 13, “Pain Relief During Childbirth,” for a description of childbirth preparation methods and tips on choosing a class. You don’t have to take childbirth classes. ey are not a requirement for giving birth. Your labor nurses and ob-gyn will give you the instructions and information you need while you’re at the hospital. If you do attend a childbirth class, you and your childbirth partner should practice the exercises you learn. is will help both of you remember them during labor. Hospital Tour Most hospitals offer tours of where you’ll give birth. Take advantage of this opportunity if it’s available. In fact, if you’re taking childbirth classes at the hospital or birth center where you’ll be giving birth, you may get a tour at some point during the course. If this will be your rst time at the hospital, going for a tour also will give you a chance to learn the quickest route there and where to park the car when it’s time for the birth. e tour also will give you a chance to ask the following: When your partner can be in the room during labor and delivery (even for cesarean births) Whether your partner can stay overnight in the room with you and the baby Whether your partner can take pictures or videos of the birth

Creating Your Birth Plan: Personalising Your Delivery Experience

Some childbirth education classes will help you draft a birth plan, which is a written outline of what you would like to happen during labor and delivery. A birth plan might include where you want to deliver whether you plan to use pain medications the people you want to have with you A birth plan is a way for you to share your wishes with those who will care for you during labor and delivery. this plan tells them what type of labor and birth you would like to have, what you want to happen, and what you would like to avoid. Keep in mind, though, that having a birth plan does not guarantee that your labor and delivery will go according to that plan. Changes may need to be made based on how your labor progresses. Remember that you and your ob-gyn have a common goal: the safest possible delivery for you and your baby. A birth plan is a great starting point, but you should be prepared for the unexpected. Review your birth plan with your ob-gyn well before your due date. Together, you can discuss how your plan ts with his or her policies and the hospital’s policies. Not every hospital or birth center can accommodate every request. Still, a plan can help make your wishes clear. Talking about your expectations up front can help reduce surprises and disappointments later

Exploring Cord Blood Banking: Options and Considerations for Your Baby's Future

Cord blood is blood from the baby that is left in the umbilical cord and placenta after birth. is blood contains stem cells that can be used to treat some diseases, such as disorders of the blood, metabolism, and immune system. It’s now possible to collect some of this cord blood after birth and store it. If you plan to collect and store your baby’s cord blood, let your ob-gyn know far in advance of your due date (at least 2 months). If you have chosen a private bank, arrange for the collection equipment to be sent to your obgyn.

Also, there usually is a fee charged by your ob-gyn for collecting cord blood. this fee may not be covered by health insurance. there are other things to consider if you plan to store cord blood.

Creating a Safe Environment for Conception

1. Understanding the Importance of a Safe Environment: - A safe environment plays a crucial role in supporting the overall reproductive health and fertility of both partners. - Creating a safe environment for conception involves minimizing potential risks and maximizing factors that promote reproductive well-being.

2. Assessing Your Physical Health: - Schedule a preconception check-up with your healthcare provider to evaluate your overall health and address any underlying medical conditions that may affect fertility. - Ensure you are up to date on vaccinations, including rubella and varicella, as certain infections can pose risks during pregnancy. - Adopt a healthy lifestyle by maintaining a balanced diet, engaging in regular physical activity, and avoiding harmful substances such as tobacco, alcohol, and recreational drugs.

3. Understanding Fertility Window: - Learn about your menstrual cycle and identify your fertile window, which is the time when you are most likely to conceive. - Track your menstrual cycles, including the length and regularity, to help pinpoint your fertile days. - Consider using ovulation prediction kits or fertility tracking apps to assist in determining your most fertile days.

4. Optimizing Sexual Health: - Practice safe and protected sex to reduce the risk of sexually transmitted infections (STIs), which can negatively impact fertility. - Discuss any concerns or questions about sexual health with your healthcare provider. - Maintain open and honest communication with your partner about sexual desires, preferences, and any potential challenges that may arise.

5. Reducing Environmental Exposures: - Minimize exposure to environmental factors that can potentially affect fertility, such as toxins, chemicals, and pollutants. - Avoid or limit exposure to harmful substances, including pesticides, lead, mercury, and radiation. - Make conscious choices to create a clean and healthy living environment by using natural and eco-friendly cleaning products, minimizing indoor air pollution, and ensuring proper ventilation.

6. Managing Stress Levels: - Chronic stress can impact fertility and decrease the chances of conception. - Practice stress management techniques, such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities that promote relaxation. - Seek support from your partner, family, and friends, and consider professional help if needed to manage stress effectively.

7. Creating Emotional Support: - Conception can be an emotional journey, and having a strong support system is essential. - Share your feelings and concerns with your partner, and together, develop strategies to navigate any emotional challenges that may arise. - Seek support from support groups, online communities, or fertility counselors who can provide guidance and understanding throughout the conception process.

8. Seeking Professional Help: - If you experience difficulties conceiving or have concerns about your fertility, consult with a fertility specialist or reproductive endocrinologist. - They can conduct comprehensive fertility evaluations, provide guidance on optimizing fertility, and discuss potential treatment options if necessary.

By creating a safe environment for conception, you are taking proactive steps to enhance your chances of conceiving and promoting overall reproductive health. Remember that each individual's journey is unique, and seeking professional guidance when needed can provide valuable insights and support along the way.

Navigating Prenatal Lead Exposure: Protecting Your Baby's Health

Prenatal Lead Exposure Lead is a heavy metal that is used in certain industries (battery manufacturing, construction, and printing). Until the late 1970s, lead also was used in paint. Today, the United States strictly regulates the use of lead in industry. Standards are in place to help reduce workers’ exposure. But older houses may still contain lead in paint, pipes, and xtures. Areas of some cities still have lead water mains. Some things made in other countries also may have lead in them, including pottery and jewelry. Certain folk remedies and medicines used in other cultures also may contain high levels of lead. Lead can be inhaled in dust, absorbed through the skin, or swallowed. It easily crosses the placenta in pregnant women. e risks of lead exposure during pregnancy include miscarriage low birth weight preterm birth Studies show that children exposed to high levels of lead before birth have an increased risk of learning and behavioral problems. A blood test that measures the level of lead in your body is available. is test can be used to see how much lead you have been exposed to. Pregnant women who have at least one risk factor for lead exposure should have this blood test. If any of the following apply to you, tell your ob-gyn: You are renovating an older home without lead hazard controls in place. It’s very easy to accidentally absorb lead from paint chips or paint dust. Your home has lead pipes or water sources that are lined with lead (this is more likely in houses built before 1986). Your neighborhood has lead water mains. You have recently relocated from a country or area where lead is common, such as countries where leaded gasoline is still being used (or was recently phased out) or where pollution is not well controlled. You live near a source of lead (even if it is closed), such as a lead mine, smelter, or battery recycling plant. You work in an industry that uses lead (lead production, battery manufacturing, paint manufacturing, ship building, ammunition production, or plastic manufacturing). You have a hobby that may expose you to lead (stained glass production or pottery making with certain leaded glazes and paint). You live with someone who works with lead or who has a hobby with potential lead exposure. You cook, store, or serve food in lead-glazed ceramic pottery made in a traditional process. You use imported spices, foods, ceremonial powders, herbal remedies, or cosmetics (kohl or surma). Items at highest risk of containing lead come from East India, India, the Middle East, West Asia, and some areas of Latin America. You have pica (a condition in which a pregnant woman eats things that are not food, such as soil). You have a history of lead exposure or elevated lead level, or you live with someone with an elevated lead level. If your lead level is elevated, steps may need to be taken to identify the source of lead exposure and to avoid future exposure. Depending on how much lead is found in your body, you may need ongoing follow-up testing of your lead levels for the rest of your pregnancy. You also may need treatment to prevent problems for you and your baby

Workplace Safety and Pregnancy: Tips for a Healthy and Productive Journey

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Most women can continue working throughout their pregnancies. But small changes may be needed depending on the work that you do. Jobs that require heavy lifting, climbing, carrying, or standing may not be safe during pregnancy. at’s because the dizziness, nausea, and fatigue common in early pregnancy can increase the chance of injury. Later on, the change in body shape can throw off balance and lead to falls. Being exposed to harmful substances on the job is rare. But it makes sense to think about the things you have contact with during your workday. Some substances found in the workplace pose a risk during pregnancy. these substances include lead mercury arsenic pesticides some solvents ionizing radiation certain drugs used for cancer treatment (chemotherapy) You also may come into contact with harmful substances through a hobby. If you think your job may bring you into contact with something harmful, find out for sure by asking your personnel office, employee clinic, or union. Let your ob-gyn know right away if you think you and your baby are at risk. Workplace hazards and safety tips can be found at the websites of the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH).

X-Rays and Other Radiation

Ionizing radiation is the type of radiation used in X-rays. ere is a belief that exposure to any amount of ionizing radiation will cause birth defects. is is not true. e risk of birth defects is related to the dose. So the higher the dose of radiation, the higher the risk of birth defects. If you are pregnant or think you might be pregnant, tell the radiology center. e amount of radiation used in a standard X-ray is well below the level needed to harm a baby during pregnancy. In fact, you are exposed to more radiation from a day at the beach or the pool than from a standard Xray. If you need an X-ray or other type of imaging test while you are pregnant, it is safe to do so provided that certain guidelines are followed: e lowest dose of radiation is used (this guideline applies to everyone, not just pregnant women). If you need an X-ray that doesn’t involve your pelvis, your uterus should be shielded from radiation with a special cover. If multiple X-rays or a computed tomography (CT) scan are needed, ask if magnetic resonance imaging (MRI) is an option for you. MRI does not use radiation. Contrast agents are substances that are injected into the body during some X-ray or MRI procedures. ese agents make it easier to see organs and structures. Contrast agents are not likely to harm the baby. But because not much is known about this, these agents should be used only when the benets of doing so outweigh the risks. ere is some concern about contrast agents that contain iodine. In theory, these agents can damage the baby’s thyroid gland. ese agents should be used during pregnancy only if the potential benet justies the potential risk to the baby. Radioisotopes are chemicals that give off radiation. ey are used in certain tests and treatments. e amount of radiation given off by radioisotopes in these tests is low. Also, most of them leave the body quickly, so they usually are not dangerous to the baby. But iodine-131 should not be used. High doses of iodine-131 can cause defects in the baby’s thyroid gland. Talk with your ob-gyn about the risks and benets of procedures that need radiation. Remember that if you do not get a test that you need, it may not be possible to make an important diagnosis. Missing a diagnosis can be harmful to you and your baby, especially if you need treatment. Also, many pregnant women wonder about radiation during air travel. Radiation exposure increases at higher altitudes, but the level of exposure generally isn’t a concern for pregnant women. If you are a frequent ier, talk with your ob-gyn about how much ying is safe for you.

Involving Your Other Children in Your Pregnancy: Including Siblings in the Journey

If you already have children, they may have many different feelings about your pregnancy and a new baby. Some children may have questions about where babies come from. Others may not want to talk about the baby at all. Some children are eager to be a big brother or sister. Others resent losing center stage to the new baby. A busy teenager with his or her own hobbies and friends may show little interest in your pregnancy and the baby. When is the best time to share the news about your pregnancy? It really depends on your child. You may want to tell your school-aged children before you tell people outside your family. is way, they will hear the news from you, and not others. With young children, it may be a good idea to wait until they ask about your changing body. e idea of a baby growing inside of you may be too hard for small children to understand before they can see your bigger belly.

Nurturing Your Mental Health During Pregnancy: Self-Care and Support

Introduction to Mental Health During Pregnancy

Importance of Mental Health During Pregnancy: Pregnancy is a transformative period that brings physical, emotional, and psychological changes. It is crucial to prioritize mental health as it directly impacts the well-being of both the mother and the developing baby. Good mental health during pregnancy contributes to a positive pregnancy experience, better coping with stress, improved overall health, and a healthier transition to motherhood. Research suggests that maternal mental health has a direct influence on the baby's development, including cognitive, emotional, and behavioral outcomes later in life. Common Mental Health Challenges During Pregnancy: Pregnancy can be accompanied by various mental health challenges, such as anxiety, depression, and mood swings. These challenges may be influenced by hormonal fluctuations, physical discomfort, and changes in social roles and relationships. It is essential to recognize that experiencing mental health challenges during pregnancy is common and does not indicate personal failure or weakness. Other common mental health challenges include obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders. These conditions may require specialized support and treatment. Effects of Mental Health on Both Mother and Baby: Maternal mental health directly affects the well-being of the mother. Poor mental health can lead to increased stress, difficulty in coping with pregnancy-related challenges, and a higher risk of developing postpartum depression. Maternal stress and anxiety can impact fetal development, potentially leading to preterm birth, low birth weight, and long-term health consequences. A positive and supportive mental health environment during pregnancy promotes healthy maternal-infant bonding, better self-care practices, and positive parenting behaviors after birth. Promoting Mental Health During Pregnancy: Nurturing mental health during pregnancy is a holistic process that involves self-care, seeking support, and professional guidance when needed. Throughout this curriculum, we will explore various strategies and techniques to support mental well-being during pregnancy, including physical self-care, emotional self-care, building a support network, and seeking professional help. It is important to cultivate a non-judgmental and supportive environment that encourages open conversations about mental health, reduces stigma, and promotes self-compassion and self-acceptance.

Emotional Self-Care During Pregnancy

Understanding Emotional Changes During Pregnancy:

Pregnancy is accompanied by hormonal changes that can impact your emotional state. It is common to experience a range of emotions, including joy, excitement, anxiety, fear, and even sadness. Mood swings are also common during pregnancy, where you may experience rapid shifts in emotions. Understanding that these emotional changes are normal can help alleviate any unnecessary worry or guilt. Relaxation Techniques for Emotional Self-Care:

Engaging in relaxation techniques can be highly beneficial for managing stress and promoting emotional well-being during pregnancy. Deep breathing exercises, meditation, progressive muscle relaxation, and visualization techniques are effective relaxation techniques that can help you calm your mind, reduce anxiety, and promote a sense of inner peace. Incorporating these techniques into your daily routine can provide you with a dedicated space to relax, reflect, and connect with your inner self. Stress Management Strategies:

Pregnancy can bring about increased stress due to physical discomfort, changes in lifestyle, and the anticipation of becoming a parent. Developing effective stress management strategies is essential for emotional self-care. Identify stress triggers and implement coping mechanisms such as engaging in hobbies, practicing mindfulness, talking to a supportive friend or partner, or seeking professional counseling if needed. Prioritize self-care activities that help you unwind and reduce stress, such as taking warm baths, listening to soothing music, reading, or engaging in creative outlets. Journaling and Expressing Emotions:

Journaling is a powerful tool for emotional self-care during pregnancy. It allows you to express and process your thoughts, emotions, and experiences. Set aside regular time to journal and reflect on your pregnancy journey. Write about your hopes, fears, dreams, and any concerns you may have. This process can provide clarity, release pent-up emotions, and help you gain insights into your emotional well-being. Additionally, consider sharing your feelings with your partner, friends, or a support group. Talking openly about your emotions can provide validation and support. Nurturing Positive Relationships:

Surrounding yourself with positive and supportive relationships is crucial for emotional well-being during pregnancy. Maintain open communication with your partner, family, and friends. Express your needs and concerns, and actively listen to their support and reassurance. Seek out pregnancy support groups or classes where you can connect with other expectant mothers who are going through similar experiences. Sharing and learning from one another can foster a sense of belonging and understanding.

Social Support and Community

Understanding the Importance of Social Support:

Social support plays a vital role in maintaining mental well-being during pregnancy. It provides emotional validation, practical assistance, and a sense of connection to others who understand and empathize with your experiences. Research has shown that individuals with strong social support systems have lower levels of stress, improved coping mechanisms, and increased overall well-being. Building a Support Network:

Identify individuals in your life who can offer support during your pregnancy journey. This can include your partner, family members, friends, and even healthcare professionals. Communicate your needs and concerns to your support network. Let them know how they can best support you, whether it's through listening, helping with household tasks, or accompanying you to medical appointments. Consider joining pregnancy support groups or classes. These provide an opportunity to connect with other expectant mothers who are going through similar experiences. Sharing stories, advice, and concerns can foster a sense of camaraderie and reduce feelings of isolation. Communicating Needs and Seeking Help:

It's important to be open and honest about your emotions and needs with your support network. Communicate any specific challenges you are facing or areas where you require additional assistance. Don't hesitate to ask for help when needed. Pregnancy can be physically and emotionally demanding, and accepting help does not indicate weakness. Remember, seeking support is a sign of strength and self-care. Online Communities and Resources:

In addition to in-person support networks, there are numerous online communities and resources available for expectant mothers. Join online forums or social media groups dedicated to pregnancy and parenting. These platforms provide opportunities to connect with individuals worldwide, share experiences, and gather information. However, be mindful of the information you consume online and ensure it comes from reputable sources. Seek evidence-based information and consult with healthcare professionals for personalized advice. Attending Supportive Classes and Workshops:

Many communities offer prenatal classes and workshops that provide education and support for expectant parents. Consider enrolling in childbirth education classes, breastfeeding support groups, or prenatal yoga classes. These not only provide valuable knowledge but also allow you to connect with other parents-to-be in a supportive environment.

Partner and Family Support

The Importance of Partner and Family Support:

Pregnancy can bring about various physical and emotional changes, and having the support of your partner and family members can make a significant difference in how you navigate these changes. Research has shown that strong support from partners and family members is associated with lower levels of stress, increased emotional well-being, and improved birth outcomes. Effective Communication within Relationships:

Open and honest communication is key to maintaining a supportive relationship during pregnancy. Share your feelings, concerns, and needs with your partner and family members. Expressing your emotions and discussing your expectations can help foster understanding and empathy. Encourage your partner and family members to share their thoughts and concerns as well. Creating a safe and non-judgmental space for open dialogue strengthens the bond between all parties involved. Balancing Responsibilities:

Pregnancy often brings about changes in roles and responsibilities within relationships. It is important to find a balance that works for both you and your partner. Discuss and negotiate household tasks, financial responsibilities, and other practical matters to ensure a supportive and equitable partnership. Remember that pregnancy can be physically and emotionally demanding, and it's okay to ask for help and delegate responsibilities when needed. Nurturing Relationships:

Pregnancy is an opportunity to deepen your bond with your partner and family members. Find ways to nurture your relationships during this time. Spend quality time together, engage in activities that bring joy and relaxation, and celebrate milestones and achievements. Explore new ways to connect, such as attending prenatal appointments together, participating in childbirth education classes, or preparing for the arrival of the baby as a team. Seeking Professional Help:

In some cases, additional professional support may be necessary to address complex emotional or relationship issues. Encourage your partner to participate in prenatal visits or seek counseling together if needed. Remember, seeking professional help is a proactive step towards maintaining the well-being of both you and your relationship. Module 7: Seeking Professional Help

Recognizing when professional support is needed Types of mental health professionals and services available Overcoming barriers and seeking help without stigma

Creating a Personalized Self-Care Plan

Understanding the Importance of Self-Care:

Self-care is essential for maintaining your mental, emotional, and physical well-being during pregnancy. Taking care of yourself allows you to recharge, reduce stress, and better cope with the challenges that may arise. Prioritizing self-care also sets a positive example for your baby and promotes a healthy lifestyle. Assessing Your Needs and Preferences:

Start by reflecting on your current self-care practices and identifying areas that need improvement or require more attention. Consider your physical, emotional, and social needs. What activities or practices make you feel rejuvenated, relaxed, and fulfilled? Take into account your personal preferences, such as your hobbies, interests, and activities that bring you joy. Setting Realistic Self-Care Goals:

Set achievable and realistic self-care goals that align with your available time, resources, and energy levels. Break down your goals into smaller, actionable steps that can be integrated into your daily routine. Remember that self-care doesn't have to be extravagant or time-consuming. Small, consistent acts of self-care can have a significant impact. Identifying Self-Care Activities:

Explore various self-care activities that cater to your specific needs and preferences. Physical self-care: Engage in activities like prenatal yoga, gentle exercise, walking in nature, or practicing deep breathing exercises. Emotional self-care: Journaling, practicing mindfulness or meditation, engaging in creative outlets, or seeking therapy or counseling. Social self-care: Connect with supportive friends and family, join pregnancy support groups or classes, or participate in community events. Creating a Self-Care Routine:

Design a self-care routine that integrates your chosen activities into your daily or weekly schedule. Consider allocating specific time slots for self-care and treat them as non-negotiable appointments with yourself. Be flexible and adaptable, as your self-care routine may need adjustments as your pregnancy progresses. Enlisting Support:

Communicate your self-care goals and needs to your partner, family members, and friends. Seek their understanding and support in ensuring you have the time and space for self-care. Enlist their help in managing responsibilities or arranging childcare, if needed, to create dedicated self-care time. Evaluating and Adapting:

Regularly assess your self-care plan to determine its effectiveness and make necessary adjustments. Be mindful of any changes in your needs or circumstances and modify your self-care activities and routine accordingly. Remember that self-care is an ongoing process, and your plan can evolve as your pregnancy progresses and even beyond.

Understanding and Managing Depression During Pregnancy

the signs of depression can seem like the normal ups and downs of pregnancy. A blue mood now and then is normal. But you may have depression if you are sad most of the time or if you have any of these symptoms for at least 2 weeks: Depressed mood most of the day, nearly every day Loss of interest in work or other activities Feeling guilty, hopeless, or worthless Sleeping more than normal or lying awake at night Loss of appetite or losing weight (or eating much more than normal and gaining weight) Feeling very tired or without energy Having trouble paying attention and making decisions Women who have severe depression during pregnancy may have trouble taking care of themselves. ey may not eat well or get enough rest. For these reasons, it’s important to tell your ob-gyn if you have any signs or symptoms of depression. Your ob-gyn also may ask you questions about your mood during prenatal care visits. See the box “Depression Screening Test” later in this chapter. Your answers will help your ob-gyn understand if you need help. Treatment of depression may include medication and counseling. Support from your partner, family members, and friends also can be helpful. In addition to providing support, these people may be able to see if your symptoms are getting worse. You may not be the rst to notice. If your ob-gyn prescribes an antidepressant, you will discuss which drug is best for you. e benets of taking an antidepressant during pregnancy need to be weighed against the risks. Studies suggest that selective serotonin reuptake inhibitors (SSRIs) do not increase the risk of birth defects. But researchers are still learning whether other antidepressants can cause certain birth defects. Your ob-gyn can recommend a medication that is best for you and your baby. Keep in mind that not treating depression can have negative effects on your baby. Babies born to women with untreated depression are at risk of growth problems during pregnancy preterm birth low weight at birth complications after birth If your ob-gyn prescribes an antidepressant, the type and the dosage should be specic for you. Anxiety and Stress Other problems that can affect pregnant women are anxiety and stress. Anxiety disorders are common—nearly 1 in 5 adults have one. Pregnancy also can trigger a specic anxiety disorder called obsessive–compulsive disorder. Anxiety and stress have been linked to some pregnancy problems and a more difficult delivery. If you have anxiety and stress, tell your ob-gyn so that you can get the help you need. Treatment may include therapy to help you learn coping strategies and relaxation techniques. Sometimes medication is prescribed.

Addressing Anxiety and Stress in Pregnancy: Coping Strategies and Resources

Exploring VBAC: Vaginal Birth After Cesarean Delivery

Your Weight Is Important: Obesity and Pregnancy

Pregnancy After Weight-Loss Surgery

Eating Disorders and Pregnancy

Blood Pressure

Hypertension

Chronic Hypertension

Gestational Hypertension

Preeclampsia

Asthma

Autoimmune Disorders

Blood Clotting and Bleeding Disorders

Digestive Disorders

Epilepsy and Other Seizure Disorders

Heart Disease

Kidney Disease

Mental Illness

Physical Disabilities

Thyroid Disease

Early Pregnancy Loss: Miscarriage, Ectopic Pregnancy, and Gestational Trophoblastic Disease

Late Pregnancy Loss: Stillbirth

During your stay at the hospital or birth center, it's crucial to rest and regain your strength. You can usually resume your normal diet soon, unless directed otherwise by your ob-gyn or nurse. Every woman's recovery is different, so don't worry if your experience is not the same as others.

It's recommended to try to urinate soon after delivery, although it may be challenging at first. Your care team will assist you in ensuring that you are urinating properly during the first 24 hours post-birth. To reduce the risk of deep vein thrombosis, walking is encouraged, but please check with your nurse before leaving the bed and always make sure to have someone assist you the first time.

During this time, your care team will help you learn how to take care of your baby and any post-delivery physical changes such as tears or incisions. Never hesitate to ask your caregivers any questions.

A woman who undergoes a normal vaginal delivery may be able to leave the hospital within 1-2 days, while those who undergo cesarean delivery will likely stay between 2-4 days. You may be required to stay longer if the need arises.

We wish you and your new family all the best during this special time!

Finally, it's important to note that everyone's postpartum experience is different. It's crucial to listen to your body and take care of your physical and mental health during this period. If you have any concerns, don't hesitate to reach out to your healthcare provider. They're there to support you and your baby during this new chapter of your life.

### Vaccinations: Protecting You and Your Baby

Vaccinations are not only about you; they're about protecting your little one too. If there were certain vaccinations you didn't receive before or during pregnancy, you should consider getting them post-delivery. It's also beneficial for family members who'll be in close contact with your baby to receive the Tdap vaccination at least two weeks before meeting the little bundle of joy.

### Pain Post-Delivery: Let's Ease It Together

Experiencing some discomfort or pain post-delivery is fairly common. Whether it's engorged breasts, uterine contractions, perineal discomfort after vaginal delivery, or incision pain after a cesarean birth, it's important to communicate openly with your care team. If the pain persists, they can guide you to safe medication options that provide relief.

As you get ready to leave the hospital with your baby, confidence is key. You should feel secure about feeding and caring for your newborn, recognizing emergency situations, and knowing the details of your baby's next appointment. Don't forget to ensure your car has a securely fitted approved car seat, and you've scheduled your follow-up appointments.

### Embracing the "Fourth Trimester"

### Building Your Postpartum Care Team

### After Childbirth: The Road to Healing

Childbirth is a significant event, and your body needs time to recover, irrespective of how your labor and delivery journey unfolded. In this healing process

, you might encounter symptoms that are new, some lasting a few days, others persisting for several weeks. Understanding which symptoms are typical for the postpartum period, knowing how to care for yourself, and recognizing when to call your ob-gyn are crucial for a smoother journey through this transformative time in your life.

The Apgar test assesses newborn health. Developed by Dr. Apgar in 1952, it evaluates heart rate, breathing, muscle tone, reflexes, and skin color, with a maximum score of 10. A score of 7+ at 5 minutes is typical, but doesn't predict future health. The test is helpful to check your baby's condition after delivery and ensure they receive proper care.

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After your baby is born, the healthcare team's priority is to ensure your newborn is healthy, warm, and breathing properly. During pregnancy, your baby received oxygen through the umbilical cord and placenta. Upon birth, however, they must take their first breath of air, activating body parts like the muscles around the lungs and airways leading from the mouth and nose. Consequently, your baby's breathing will be closely monitored. If there are any issues with breathing, the staff will take necessary measures, like rubbing the baby's body or providing supplemental oxygen, to assist your little one.

Skin-to-skin care is highly recommended for newborns. It is advised that a healthy baby be placed skin-to-skin on the mother's chest and belly immediately after birth, for at least the first hour of life. This is possible even after a cesarean birth. To keep your baby warm, you should hold them on your bare chest and belly, covering them with a blanket. Over the following days, monitor your baby's environment and ensure they're dressed warmly, with one more layer than what you are wearing.

When you first meet your baby, their appearance may surprise you. Newborns can look very different from what we typically see on television. For instance, they might appear contracted or have slightly swollen faces. Their head could be elongated and swollen for a few days or weeks, and their genitals may also be swollen. This swelling is usually due to extra fluid in the baby's body. It's normal and temporary, so don't worry!

Every baby has their unique personality right from the start. How one baby behaves and interacts can be vastly different from another. Some babies are calm, while others are bundles of energy. Hospitals usually allow "rooming-in", which means your baby stays with you in your room instead of in the nursery. This arrangement promotes breastfeeding and helps you bond with your baby.

In a hospital setting, your newborn will undergo a thorough physical examination. This includes checking typical newborn reflexes, examining the belly, listening to the breathing and heartbeat, and checking the pulse. To ensure your baby's well-being, several preventative measures are taken:

1. Vitamin K shot: Administered via injection, it aids in blood clotting and offers protection against a rare but serious bleeding disorder.

2. Antibiotic ointment or solution for the eyes: This helps protect the newborn from any serious bacterial infection potentially contracted during birth.

3. Hepatitis B vaccination:Given in three doses, the first one is administered before you leave the hospital or birth center.

By law, all newborns must undergo screening tests to detect any underlying health problems not immediately visible. These tests involve a blood sample drawn from your baby's heel, a hearing test, and checking blood oxygen levels using a painless skin sensor method called pulse oximetry. Low blood oxygen levels might indicate a heart issue.

Test results will be shared with you by your baby’s pediatrician or family doctor. If an abnormal test result is found, you'll be contacted for further testing. An abnormal result does not necessarily mean your baby has a health issue, but further tests will help confirm or rule out any potential problems. Make sure you maintain open communication with your baby's doctor to understand all the procedures and results better.Circumcision

Circumcision refers to the removal of the foreskin that covers the tip of the penis. If you decide to circumcise your baby boy, this can be performed by an obstetrician, your baby's doctor, or your family medicine doctor before the baby is discharged from the hospital. The procedure is carried out under local anesthesia and for religious reasons, it can be performed outside the hospital. If you're uncertain about the decision, consider discussing it with your ob-gyn or your baby's doctor.

These questions include identifying the team members, discussing the care plan for both mother and baby, and understanding what will happen during the postpartum period.

Breastfeeding is the optimal choice for feeding your baby. Within the first hour after birth, most healthy newborns are ready to breastfeed. Should your baby have skin-to-skin contact, they may naturally seek out the breast and latch on by themselves. Rest assured, our dedicated care team will support you to ensure a good start with breastfeeding.

Feeding your newborn is an important decision that involves various options, including breastfeeding, bottle feeding, formula feeding, or a mix. Always feel free to discuss these options with your ob-gyn or your baby's doctor.

Breastfeeding offers numerous benefits for both the baby and the mother, but it may not always be recommended. While most infections don't interfere with breastfeeding, some may make it unsafe.

In light of the COVID-19 pandemic, remember it's generally safe to feed your baby breast milk even if you have COVID-19. The virus hasn't been found in breast milk, and it's still the best source of nutrition for most babies.

Substance use during breastfeeding can be harmful to your baby. Most medications are safe, but always consult with your ob-gyn if you have any concerns.

If you decide to breastfeed, it's helpful to gather information during your pregnancy. You can also seek support from various resources, including hospitals with a Baby-Friendly® designation.

If you're breastfeeding, understanding the process of "latching on" is crucial. Over time, you'll notice your body responding to your baby's needs, adjusting milk production as required.

While breastfeeding, remember that most medications, including those for postpartum depression, are safe to use. However, it's crucial to consult your healthcare provider before starting any new medication to ensure it's safe for your baby.

The decision to breastfeed is a personal one, and should always take into account your health and the health of your baby. Whatever decision you make, know that you're doing what's best for you and your little one.

Chapter 5: Nurturing Your Baby: A Guide to Successful Breastfeeding

**I. Understanding the Fundamentals of Breast Milk**

As a new mother, your baby's nourishment begins with you. The initial stages of breastfeeding provide your baby with what is known as "foremilk." This milk is thin, sweet, and packed with essential sugar, proteins, and minerals. After the baby has consumed the foremilk, your milk then becomes thick and creamy, satisfying the baby's hunger and delivering the necessary nutrients for healthy growth.

Remember, the quantity of milk you produce is directly related to your baby's consumption - the more your baby feeds, the more milk your body will produce.

**II. Achieving a Successful Latch**

Breastfeeding starts with a successful latch, which is when your baby attaches to your breast correctly. The appropriate breastfeeding position can be determined with the help of your ob-gyn, a nurse, or a lactation specialist. You can stimulate your baby's rooting reflex, an instinct to turn towards the nipple and suck, by stroking your baby's lower lip with your nipple.

Your baby's mouth should open wide, and your nipple should be directed towards the roof of the baby's mouth as you draw them closer to your breast. The baby-led latch technique can also be employed, wherein the baby, lying belly-down on your chest, finds the nipple and latches on naturally.

**III. The Baby’s Breastfeeding Technique**

Ensure your baby has all of your nipple and most of the areola in their mouth during feeding. The baby’s nose should touch your breast, the lips should curl out on your breast, and the sucking should be smooth and even. If you feel discomfort or your baby's mouth is not wide open, insert a clean finger between your breast and your baby’s gums to gently break the suction. If the pain persists, consult with your ob-gyn or a lactation specialist.

Your baby's nursing pattern should dictate the feeding schedule. It is normal for newborns to feed up to 12 times a day in the initial few weeks, usually nursing for at least 10 to 15 minutes on each breast. Some babies may prefer feeding from one breast per feeding, while others might prefer both.

Signs your baby wants to feed include nuzzling against your breast, smacking their lips, or extending their fingers and arms. Crying is usually a late sign of hunger. You should typically breastfeed at least 8 to 12 times in 24 hours during the first weeks of your baby's life.

All babies need 400 international units (IU) of vitamin D each day for bone growth. Breastfed or partially breastfed babies need supplementation starting in the first few days after birth. From around six months of age, these babies also require an iron supplement. Formula-fed babies should be on a formula that includes iron. Always consult your baby's doctor for precise requirements.

While pacifiers can provide comfort to your baby, it is beneficial for babies to suckle at the breast during the initial weeks to stimulate milk-producing hormones. Pacifiers may be useful for pain relief or to soothe a fussy baby, especially if your nipples are sore or cracked. However, they should ideally be introduced only after breastfeeding is well established, usually around 3 to 4 weeks after starting. After this period, giving your baby a pacifier when they are lying on their back before sleep may help reduce the risk of SIDS.

# Chapter: Comprehensive Guide to Breastfeeding: Food, Drinks, and Medication

## Introduction

When you are pregnant, your body stores extra nutrients and fat to prepare for breastfeeding. However, post childbirth, additional food and nutrients are required to fuel milk production. Simultaneously, hydration is essential due to the large fluid usage in breastfeeding, necessitating at least eight glasses of liquid per day to prevent dehydration and ensure adequate milk supply. It's crucial to remember that substances consumed by the breastfeeding mother may reach the baby, similar to during pregnancy.

## Medication While Breastfeeding

While most medications are safe to consume during breastfeeding, there are some exceptions. Medications ingested by the mother can occasionally make their way into breast milk, but the medication levels are typically lower than those found in the mother's bloodstream.

For detailed information about medications and their effects on breastfed infants, refer to the LactMed database. If a prescription medication is required, a conversation with your ob-gyn and the baby's doctor will help identify the safest drug during breastfeeding. In certain cases, the drug's amount reaching the breastfeeding baby can be minimized by consuming the medication post-feedings.

## Nutritional Needs During Breastfeeding

Breastfeeding women require 1,000 milligrams (mg) of calcium per day, sourced from dairy products like milk, yogurt, and cheese or calcium supplements if dairy intolerant. Additionally, a daily intake of at least 400 micrograms (mcg) of folic acid is vital to maintain good health and ensure adequate folic acid stores.

Consuming fish and shellfish 2 to 3 times a week provides excellent sources of protein, vitamins, and minerals for both mother and baby.

## Alcohol and Tobacco

Regardless of the consumption frequency or quantity, alcohol passes into breast milk. If drinking, a waiting period of approximately 2 hours per serving is recommended to allow the alcohol to leave your body. Heavy drinking can lead to problems for the baby, including drowsiness, weakness, and weight gain issues.

Quitting smoking is the most beneficial action for the health of both the mother and the baby due to the risk of SIDS posed by secondhand smoke.

## Overcoming Breastfeeding Challenges

Breastfeeding can sometimes pose challenges, especially for new mothers. It's normal to face difficulties initially, but many problems can be overcome with support. If there are concerns about the baby receiving enough milk or if help is needed, consider reaching out to your ob-gyn or a lactation specialist.

### Issues with Sore Nipples

Many women experience nipple tenderness or pain in the first few weeks of breastfeeding. Ensuring a proper latch and position of the baby during breastfeeding can alleviate discomfort. Expressing a little milk onto the nipple after breastfeeding or using a barrier ointment, such as coconut oil, can provide relief.

### Engorgement

Engorgement occurs when the breasts feel full and tender due to the milk coming in post-delivery. The following measures can bring relief: feeding the baby more frequently, expressing a little milk before nursing, applying warm packs before and cold packs after feedings.

### Delayed Milk Production

For some women, milk production can be delayed, a condition called "delayed lactogenesis". Increased breastfeeding sessions and using a breast pump to express milk after breastfeeding can be helpful in such situations.

### Low Milk Supply

The most common cause of low milk supply is not removing milk effectively or often enough. Newborns generally feed 8 to 12 times a day, and less frequent feeding or pumping may signal the breast to produce less milk. In some cases, supplemental feedings with expressed breast milk, formula, or donor milk may be recommended.

### Inverted or Flat Nipples

to: ChatGPT.AI Assistant<|im_sep|>**Chapter 1: Breastfeeding and Your Diet**

_Subsection 1.1: Nutrient Intake and Liquid Consumption_

During pregnancy, your body reserves extra nutrients and fat, preparing for breastfeeding. Post-birth, your food and nutrient intake needs to increase to fuel milk production. Adequate hydration is also essential, given that breastfeeding consumes a lot of fluids. A minimum of eight glasses of liquid per day is recommended to prevent dehydration, which could reduce your milk supply.

_Subsection 1.2: Breastfeeding and Medication_

When breastfeeding, the substances you ingest can pass on to your baby, much like during pregnancy. While most medications are safe to take during breastfeeding, some are not.

_Subsection 1.3: Daily Nutrient Requirements_

Breastfeeding women need a daily intake of 1,000 milligrams (mg) of calcium and at least 400 micrograms (mcg) of folic acid. Consuming dairy products such as milk, yogurt, and cheese can provide you with enough calcium, while an ob-gyn may suggest a daily prenatal vitamin supplement for folic acid.

Fish and shellfish are excellent protein sources and provide vitamins and minerals for both you and your baby.

**Chapter 2: Substance Use While Breastfeeding**

_Subsection 2.1: Smoking_

Quitting smoking is the best choice for both your health and your baby's. Secondhand smoke increases the risk of SIDS, but breastfeeding is still preferable to formula feeding, even if you continue to smoke.

_Subsection 2.2: Alcohol Consumption_

Alcohol passes into breast milk, no matter the quantity or frequency of your consumption. For every serving of alcohol, you should wait about 2 hours for it to leave your system before breastfeeding.

**Chapter 3: Breastfeeding Challenges**

_Subsection 3.1: Sore Nipples_

Sore nipples are common among new mothers, especially in the first few weeks of breastfeeding.

_Subsection 3.2: Engorgement_

Engorgement is when your breasts become full and tender. This condition often occurs when your milk first comes in a few days after delivery.

_Subsection 3.3: Delayed Milk Production_

If milk production takes more than 72 hours after birth, it's referred to as "delayed lactogenesis." This delay can cause stress and anxiety, which can affect the natural let-down reflex.

_Subsection 3.4: Low Milk Supply_

The most common cause of low milk supply is not removing milk effectively or often enough.

_Subsection 3.5: Inverted or Flat Nipples_

Inverted or flat nipples can present challenges during the initial breastfeeding sessions.

**Chapter 4: Breastfeeding Post-Breast Surgery**

_Subsection 4.1: After Cyst and Benign Lump Removal_

If you've undergone surgery to remove cysts or other benign breast lumps, it shouldn't pose a significant problem for future breastfeeding.

_Subsection 4.2: After Breast Enlargement_

Most women with breast enlargement can nurse their babies, especially if the implant is placed behind the chest muscles.

_Subsection 4.3: After Breast Reduction_

Breast reduction surgery can pose challenges for breastfeeding.

_Subsection 4.4: After Breast Cancer Treatment_

If you've had breast cancer treatment, you can often still nurse effectively on the unaffected breast.

**Chapter 5: Breast Conditions During Breastfeeding**

_Subsection 5.1: Blocked Ducts_

Blocked ducts can form when milk is not adequately drained, causing a hard and tender lump in your breast.

_Subsection 5.2: Mastitis_

Mastitis, a breast infection, can result from an untreated

**Chapter: Feeding Your Baby With Expressed or Pumped Breast Milk**

**Section 1: Introduction**

Feeding a baby with expressed or pumped breast milk offers a practical solution for mothers in various circumstances. This approach often benefits mothers with premature or ill babies admitted to the neonatal intensive care unit (NICU), mothers returning to work or school, or when temporary separation from the baby is unavoidable. Even when exclusively breastfeeding at home, knowing how to express milk is advantageous, allowing partners or caregivers to assist with feeding duties.

**Section 2: Expressing Milk**

**Subsection 2.1: Expressing Milk by Hand**

Expressing milk by hand provides a simple solution for short absences from your baby and can help alleviate engorgement. The process, which can take 20-30 minutes for both breasts, involves forming a "C" around the areola with your fingers, pressing inwards towards your chest, and rolling your thumb and fingers towards the nipple. Regularly reposition your hand around the areola during this process. This skill also proves helpful in emergencies, such as when without electricity or unexpectedly separated from your baby.

**Subsection 2.2: Using a Breast Pump**

Under the Affordable Care Act, health insurance providers must cover the cost of a breast pump and breastfeeding counseling. Depending on the specific needs and circumstances, mothers can choose from manual, battery-operated, or electric breast pumps. Pump cleanliness is vital to prevent germs from contaminating the milk.

**Section 3: Storing and Using Breast Milk**

Store breast milk in clean glass or plastic bottles or milk-collection bags. For efficient use, divide the milk into small amounts (2 to 4 oz). Follow proper warming, freezing, and thawing procedures to maintain the quality of the milk. Breast milk can be kept at room temperature for up to 4 hours, refrigerated for up to 3 days, or frozen for up to 6 months.

**Section 4: Expressing Milk as the Primary Feeding Method**

For some women, expressing breast milk for bottle-feeding is the primary choice for feeding their babies. Reasons can vary, including difficulty establishing breastfeeding, recurring breastfeeding problems, concerns about public feeding, or the desire to share feeding responsibilities. Challenges include regulating milk production, increasing the number of pumping sessions to match growth spurts, and maintaining the pump and bottles while ensuring safe storage of the milk.

**Section 5: Bottle and Nipple Choices**

An array of bottle and nipple systems are available for feeding expressed breast milk. Some babies may readily accept any bottle, while others may show preferences. Starting with less expensive models before trying deluxe versions is a recommended strategy. Proper sanitization before initial use and thorough cleaning after each use is crucial to prevent bacterial transmission.

# Chapter: Navigating Breastfeeding and Formula-Feeding at Work

## Preparing to Breastfeed at Work

Breastfeeding upon your return to work requires preparation. Prior to your maternity leave, discuss your plans with your supervisor, including arrangements for expressing milk and storage. As your return nears, remind your supervisor and Human Resources (HR) department about your need for daily breaks to express milk for your baby. Employers are legally obligated to provide safe, clean, non-bathroom spaces for lactating employees to express milk up to a year post-birth. Note that businesses with 50 or fewer employees may be exempted from this law.

## Ensuring Proper Facilities for Expressing Milk at Work

Upon your return to work, check that the designated space for milk expression is clean and private. Essential facilities should include a chair, a small table, and an electrical outlet for an electric pump, along with a secure storage area for the expressed milk. Ideally, you should express milk during your lunch or other breaks. A double breast pump can help you pump enough milk during these breaks, and it’s also faster. Hands-free pumping bras can further facilitate this process. If your employer does not provide the necessary time and space, consider discussing this issue with your baby's doctor, who can write a letter of medical need for your HR department.

## Choosing Formula Feeding

Should you decide not to or be unable to breastfeed or express milk, formula feeding is a viable option. Formula is used by some women to supplement breast milk when they can't produce enough. There are several reasons mothers may choose formula feeding:

## Advantages of Formula Feeding

1. Formula-fed babies generally get their recommended daily dose of vitamin D, eliminating the need for additional supplements. 2. As formula digests slower than breast milk, these babies might feed less frequently. 3. Formula-feeding mothers need not worry about their medications passing to the baby via breast milk. 4. Any caregiver can feed the baby a bottle at any time, providing flexibility.

## Choosing the Right Formula

Once you decide on formula feeding, you'll have to select a formula. Modern formulas are nutritionally balanced for babies. The three primary types available are:

1. Cow's milk formulas 2. Soy formulas 3. Protein hydrolysate formulas

Additionally, you'll need to choose between powdered, liquid concentrated, or ready-to-use formulas, based on cost, convenience, and storage requirements.

## Formula Feeding: Practice and Precautions

When formula feeding, you will need to prepare the bottles with sterile water, especially for babies under six months old. You'll need a steady supply of formula, bottles, and nipples, which must be kept clean. The Centers for Disease Control and Prevention (CDC) recommend heating water to at least 158ºF when preparing powdered formula. Warming bottles before feeding is optional, and if preferred, avoid using a microwave due to the risk of uneven heating. Instead, use a bottle warmer or hot water bath.

## Breastfeeding Duration and Weaning

The length of breastfeeding is a personal decision, with any amount beneficial to both mother and baby. Setting short-term goals can help manage the process. When you're ready to stop breastfeeding or pumping, the transition should be slow to avoid physical discomfort or emotional distress for both you and the baby. Gradually replace nursing sessions with bottle or cup feeding, reducing your milk supply slowly.

## Conclusion: Making the Right Feeding Choice

Whether you choose to breastfeed or formula feed, remember that there are ample resources and support available. Ultimately, the best feeding method will be the one that fits you, your baby, and your family best.

After childbirth, you'll likely still look pregnant for a while as your belly muscles need time to regain their shape. Your body stores up fat during pregnancy to supply the extra calories needed for breastfeeding. While breastfeeding burns around 500 to 700 calories a day, leading to weight loss in some women, this isn't universal. Keep in mind that everyone's bodies respond differently, and the most important thing is to maintain a healthy lifestyle rather than focusing on the scale.

Your breasts may feel full, tight, and tender a few days post-delivery when your milk comes in. Regular breastfeeding or pumping can help alleviate this discomfort, which should typically subside within a couple of days. Even if you choose not to breastfeed, your body will still produce milk initially, which can lead to discomfort. Over time, your milk supply will decrease and your breasts will return to their pre-pregnancy size.

During pregnancy, hormonal changes might have given you a thicker head of hair. Post-delivery, your hair growth cycle returns to normal, which might seem like you're losing an excessive amount of hair, but it's a normal part of the post-pregnancy transition. It might take up to a year to regain your pre-pregnancy hair thickness.

As for skin changes, you might notice dark patches on your cheeks, forehead, nose, or upper lip, known as melasma or the "mask of pregnancy." These should fade a few months post-delivery. However, if they persist, consult with a dermatologist.

It's advisable to wait at least four to six weeks before resuming sexual intercourse to allow your body time to heal. This timeline may vary based on the type of delivery you had and your personal comfort level. Remember to discuss birth control options with your ob-gyn to prevent an unplanned pregnancy.

The "baby blues" are common during the first two weeks post-delivery, characterized by mood swings, anxiety, sadness, irritability, and difficulty sleeping. However, if these symptoms persist or intensify, you may be experiencing postpartum depression. It's crucial to seek help from your healthcare provider if you're feeling depressed, as treatment can be highly effective.

You should continue with your vaccination schedule after childbirth. Certain vaccines, like the MMR vaccine, which may not have been given during pregnancy due to potential risks to the fetus, can now be administered. Additionally, getting vaccinated with Tdap can protect your newborn from pertussis, as infants aren't vaccinated for this until they're 2 months old.

Your first post-delivery check-up should ideally be within the first 3 weeks. The follow-up appointments would depend on your personal health and the type of delivery you had. If you had a cesarean birth, an early check-up around one week post-delivery might be needed to inspect your incision.

Your post-delivery care should include the routine screenings and health checks that you were used to before your pregnancy. These include Pap tests, breast exams, blood pressure checks, cholesterol checks, and screenings for cervical cancer, breast cancer, and osteoporosis.

Generally, it's safe to start mild exercise, such as walking, a few days after a normal vaginal delivery, or as soon as you feel ready. However, for more strenuous activities, or if you had a cesarean birth, it's best to wait until your healthcare provider gives the green light, typically around the 6-week mark.

With childbirth behind you, your body begins the journey of healing and recovery. One of the first signs of this transition is postpartum bleeding, or lochia - an entirely normal process where your body sheds the blood and tissue that lined your uterus during pregnancy. At first, lochia can be heavy and bright red, potentially with a few small clots. It's crucial to use sanitary pads during this time - tampons can wait. As your body recovers, the flow will gradually lighten. A week after birth, you may see your lochia turn pink or brown. Don't be alarmed if you notice a gush of blood during breastfeeding - that's just your uterus contracting. By two weeks postpartum, lochia often takes a light brown or yellow color and typically fades away by 6 to 8 weeks. Until then, stick with your sanitary pads.

The duration of this discharge can vary among women. For some, it may persist for a few weeks after birth, while for others, it could extend up to a month or more. Please call your ob-gyn if you notice unusually heavy bleeding, like soaking through two sanitary pads an hour for more than an hour or two.

It's not uncommon for new moms to experience painful urination, often caused by the pressure applied on your bladder and urinary tract during vaginal childbirth. If you're having trouble urinating or experiencing pain and burning sensations when you do, try a soothing warm sitz bath. You might also find it helpful to spray warm water over your genitals while on the toilet and drink plenty of fluids. Typically, these discomforts ease within a few days of delivery. If the pain persists or worsens, don't hesitate to contact your ob-gyn.

You may also experience urinary incontinence, or involuntary leakage of urine, which usually resolves over time as your pelvic muscles regain their strength. Using sanitary pads can provide temporary relief. Performing Kegel exercises is also an excellent way to strengthen pelvic muscles. If the leakage is substantial, seek professional help from your ob-gyn or a pelvic floor physical therapist.

### Bowel Problems: Moving Past Discomfort

New moms might also face difficulties with bowel movements and painful gas after delivery. Simple remedies such as taking short walks, maintaining a high fiber diet, drinking plenty of fluids, and discussing a stool softener with your ob-gyn can help manage these issues.

If you experience loss of bowel control or accidental bowel leakage, it's important to communicate with your ob-gyn. There are various treatments available, including lifestyle changes, physical therapy, medications, and occasionally, surgery.

### Kegel Exercises: Your Postpartum Superpower

As you navigate your postpartum journey, consider embracing Kegel exercises if you haven't already. These exercises are like a superhero for the muscles supporting your urethra, bladder, uterus, and rectum, improving bladder control and rejuvenating vaginal muscles stretched from childbirth.

### Hemorrhoids: Navigating the Discomfort

Intense straining during labor may lead to varicose veins in your vulva or hemorrhoids around the anus. While these might be uncomfortable, rest assured they usually shrink or disappear over time. If you're dealing with hemorrhoids, consider trying medicated sprays or ointments, sitz baths, or cold witch-hazel compresses. To avoid making hemorrhoids worse, discuss using a stool softener with your ob-gyn.

### Perineal Pain: Easing the Discomfort

During vaginal childbirth, the perineum (the area between your vagina and anus) undergoes a lot of stress. This stretching, and sometimes tearing,

can lead to discomfort or pain. Applying cold packs, using over-the-counter pain relievers, or trying a sitz bath can all help provide relief.

### Healing after a Cesarean Birth

If you've had a cesarean birth, your abdominal incision might be sore for the first few weeks. There are various ways to manage this discomfort, from using a heating pad to wearing an abdominal binder, or trying breastfeeding positions that put less pressure on your incision. Your ob-gyn can provide further guidance on pain management.

### The Return of Your Menstrual Cycle

Your body's journey back to its non-pregnant state includes the reinitiation of your menstrual cycle. If you're not breastfeeding, your periods may return six to eight weeks post-delivery, sometimes even sooner. However, if you are breastfeeding, your periods may take longer to return, often only after you've fully weaned your baby. Initially, your periods might not be what you were used to pre-pregnancy, but they will gradually find their rhythm again.

Keep in mind that you could ovulate before your first period post-childbirth, making it possible to conceive again sooner than you might think. If you're not ready for another baby quite yet, it's wise to discuss suitable birth control options with your ob-gyn. After all, every step in this postpartum journey is about caring for you and your new little bundle of joy.

After delivery, your breasts will fill with milk, leading to fullness, hardness, and tenderness. This usually occurs two to four days post-delivery. Regular breastfeeding can alleviate this discomfort, which should typically subside within 36 hours. If you're formula-feeding, your breasts will slowly reduce in size over seven to ten days.

Your post-delivery journey involves emotional recovery alongside the physical. Keep a check on your mood swings and always feel free to discuss any emotional concerns with your ob-gyn. Issues such as "baby blues" or postpartum depression are common and completely treatable.

Post-pregnancy is the time to uphold the healthy habits you embraced during pregnancy. This includes getting enough rest, regular exercise, eating a balanced diet, and continuing to abstain from smoking if you quit during your pregnancy.

The post-pregnancy period can be physically demanding, and your newborn's sleep patterns can add to your fatigue. Remember, it's perfectly okay to seek help from your partner, family, or friends.

Continuing good eating habits post-pregnancy can aid in your healing and boost your energy levels. A balanced diet, coupled with regular exercise, will help you return to a healthy weight gradually.

When it comes to exercise, it's generally safe to start soon after childbirth if you had a healthy pregnancy and normal delivery. However, the resumption of sexual activity after childbirth varies per individual and should always prioritize your comfort.

Planning your next pregnancy is a deeply personal decision that should consider your physical, emotional, and financial readiness. Always consult your ob-gyn about potential risks and benefits.

After childbirth, it's essential to prioritize your health. Monitor your health, stay up-to-date with your vaccinations, and maintain regular check-ups with your healthcare practitioners.

Certain conditions during pregnancy may influence your future health, and hence require postpartum health care measures. Continue seeing your healthcare practitioners after childbirth, especially if you have chronic health problems.

After your postpartum health care visits are over, transition to regular well-woman health care visits. These check-ups play a critical role in maintaining your overall health and conducting routine screenings.

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Do you homework

Trust your instincts

We are stronger in numbers: bring support

Don’t let yourself be bullied —- you are not wrong data is on your side

Invest in a plan

Weeks 1 to 8

Weeks 9 to 12

Weeks 13 to 16

Weeks 17 to 20

Weeks 21 to 24

Weeks 25 to 28

Weeks 29 to 32

Weeks 33 to 36

Weeks 37 to 40

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Part 1: Unraveling the Roots of Maternal Health Disparities⁠

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Canva:

https://www.canva.com/design/DAFpLOek2TI/YgNUt95MZCiMbbw12LRizw/edit⁠

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Part 2: Reality Check: Maternal Outcomes Today⁠

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Canva:

https://www.canva.com/design/DAFpvmSjU6E/DMGab0mDEFo8nYdnnxEUHg/edit⁠

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Part 3: Roadmap to a Healthy Pregnancy⁠

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Canva:

https://www.canva.com/design/DAFqgDrwhHM/Ie4-Kjh8SnwviiMEQblT1w/edit⁠

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Part 4: The Final Countdown: Preparing for Delivery⁠

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Part 5: Handling the Unexpected: Preparing for Pregnancy Complications⁠

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Part 6: The Forgotten Year: Refocusing on Postpartum⁠

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Part 7: Charting Your Course: Navigating the US Healthcare System⁠

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Canva Slides:

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Part 1: Curriculum⁠

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Draft Slides (Google):

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Conclusion⁠

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Part 7⁠

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Part 5⁠

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Part 6⁠

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Part 4⁠

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Part 3⁠

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Part 2⁠

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Part 1⁠

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Date of Event: July 29, 2023

Summary of Event

Part 1: Unraveling the Roots of Maternal Health Disparities

Maternal Mortality Crisis: Present State and Impact

Tracing Back the Origins: Understanding the Maternal Health Crisis through History

Historical Context: Lingering Effects of Slavery

The Unique Configuration of American Slavery: Breeding, Heritability, Permanence, and Chattel Principles

Slavery, the Capitalized Womb, and the Shaping of Black Women's Identity

Slavery and the Complex Identity of Black Women

Negative Stereotypes and the Justification of Cruelty

Capitalized Womb: Supply, Demand, and the Commodification of Reproduction

The Capitalist System Underlying Slavery and the Infrastructure of the South

The Impact of 1808 and the Concept of 'Breeding'

Tracing the Legacy of the Capitalized Womb: The Lasting Impact of Slavery on Black Women's Identity

The Historical Shadow of Slavery and its Impact on Black Women

Chattel Slavery and Its Lingering Effects on Maternal Mortality

Black Women as Property: The Subjugation of the Body

Black Women as Objects: Devoid of Respect and Control

The Jezebel Stereotype: Degradation and Dehumanization

The Mother Stereotype: The Mammy and the Welfare Mother

The Mammy Figure: Masking the Horrors of Slavery

Part 2: Reality Check: Maternal Outcomes Today

Part 3: Roadmap to a Healthy Pregnancy

The Pre-pregnancy Visit: A Vital Step in Planning for Parenthood

I. Introduction

II. Choosing a healthcare provider for the visit

III. Discussion topics during the visit

IV. Managing Preexisting Health Conditions for a Healthy Pregnancy

V. Family Health History: Understanding Genetic Risk Factors Before Pregnancy

VI. Medications and Supplements: Navigating Safe Choices for Prepregnancy

Vaccinations: Protecting Mother and Baby Before Conception

Healthy Mom is the Foundation of a Healthy Pregnancy

Nutrition: Nourishing your body before, after and during pregnancy

SUPPLEMENTS AND DIETARY INTAKE THAT CAN BE HARMFUL

SUPPLEMENTS WITH NO OR UNCERTAIN PREGNANCY BENEFITS

FLUID REQUIREMENTS

SPECIAL POPULATIONS

Exercise

Getting Pregnant: Understanding the Journey to Parenthood

Prenatal Care Simplified: Your Guide to Regular Check-ups

Pregnancy: Special Considerations and Expert Advice

Beyond the Basics: Understanding Other Important Screening Tests

Your Growing Baby

Pregnancy physiology: How your body changes?

Early Signs of Pregnancy

What are the Most Common Early Signs of Pregnancy?

When Do Pregnancy Symptoms Start?

Other pregnancy signs and symptoms during the first trimester may include:

What Else Could It Be?

Pregnancy Discomforts: A Guide to Managing and Finding Relief

Addressing Anxiety and Stress in Pregnancy: Coping Strategies and Resources

Conversations to have with you OB-GYN

Understanding Prenatal Genetic Screening and Diagnosis: Making Informed Choices

Exploring Birth Options: Choosing the Right Birth Place

Selecting Your Baby's Healthcare Provider: Making the Right Choice

Preparing for Labor and Delivery: Important Considerations

Safety

Safe and Effective Fitness for Expecting Mothers: Staying Active During Pregnancy

Part 4: The Final Countdown: Preparing for Delivery

Hospital Bag Essentials: Packing for Your Delivery

Creating a Baby-Friendly Home: Preparing for Your New Arrival

On the Move: Choosing and Installing the Right Car Seat

Group B Streptococcus: Screening for a Common Pregnancy Infection

Beyond the Basics: Understanding Other Important Screening Tests

Finding Comfort: Exploring Different Positions for Labor and Birth

Your Baby's Stay in the Hospital: What to Expect

Nourishing Your Newborn: A Guide to Feeding Your Baby

Essential Checklist for a Smooth Delivery

Managing Labor Pain: Options for Comfort During Childbirth

Pharmaceutical Options for Pain Management

Alternative Techniques for Pain Management

Addressing Pain: Systemic Analgesics

The Power of Nitrous Oxide in Pain Relief

Local Anesthesia: Numbing the Pain

Regional Analgesia and Anesthesia: Targeted Relief

General Anesthesia: Inducing Deep Sleep

Managing Pain with Opioid Use Disorder during Labor

Holistic Approaches to Pain Relief

Movement as a Pain Relief Technique