Baby on Board? Tips to Keep You and Your Passenger Healthy

September 24, 2008

Elaine Zerio was about eight months into her first pregnancy when she felt contractions. Is this it? she wondered. Should she call her husband, Bryan, and get ready for the dash to the hospital? First she called her doctor, Gerard Roy, M.D., who listened to her symptoms, then prescribed … Water. “It turns out I was just a little dehydrated,”says Zerio, 30, of Newington.“I drank three or four glasses of water and was fine.” Zerio had experienced Braxton Hicks contractions, or “false labor.”

Unlike true labor, Braxton Hicks contractions are often irregular, don’t get closer together or stronger over time and sometimes go away with movement or position change. These kinds of subtleties are sometimes lost on the mother-to-be. “Being pregnant for the first time can be nerve-wracking,”Zerio says.“You feel something and you think, ‘Oh my God, this is it!’”

Drinking for two

“Drink plenty of water” is advice Roy, an obstetrician/gynecologist with New Britain Ob/Gyn Group, gives all his patients. Fluids are particularly important since blood volume increases dramatically during pregnancy. Sufficient fluid intake can help prevent problems like dehydration,hemorrhoids and constipation. The Centers for Disease Control and Prevention recommends at least six to eight glasses of liquids daily.You’re drinking enough if your urine is almost clear or very light yellow. Water is best, since juices contain excess calories and coffee and tea contain caffeine. While a recent study found that even one daily cup of coffee can increase miscarriage risk, numerous previous studies found no increased risk, says Richard Dreiss, M.D., an obstetrician/gynecologist with Grove Hill Medical Center. “Moderation is key,” he says.“One cup of coffee a day is probably OK.” Unfortunately, herbal teas might not be the best substitute for caffeinated tea. Unlike regular black or green tea, made from tea leaves, herbal teas are made from the roots,berries, flowers, seeds, and leaves of different plants. There aren’t a lot of data on how some of these affect a developing fetus. “The problem with herbal teas and supplements is you don’t always know what’s in them,” Roy says.

While even moderate amounts of alcohol can cause physical and mental birth defects, physicians disagree over whether the occasional, solitary glass of wine is OK. “Personally, I tell my patients ‘there are two things you shouldn’t do during pregnancy: Don’t drink and don’t smoke,’” Dreiss says.

Less fish, more folate

While water is good for pregnant women, what swims in it might not be. Fish are an excellent source of protein and omega-3 fatty acids, but women who are (or are planning to become) pregnant should limit consumption due to mercury and other contaminants, Roy says.In general, pregnant women should have no more than two meals a week of fish from supermarkets or restaurants (including canned tuna). Certain fish caught in Connecticut waters should be limited to once a month. High-mercury fish that should be avoided altogether include swordfish, shark, tilefish, king mackerel and striped bass. Pregnant women should also avoid sushi and other raw or undercooked meats and fish. For state Department of Public Health guidelines on fish consumption, visit www.dph.state.ct.us or call (860) 509-7742.

To ensure they get those important omega-3 fatty acids, pregnant women should daily take 200 mg of DHA (docosahexaenoic acid), important for the developing brain. DHA is found in fatty fish like tuna, salmon and mackerel. Since some of those are off-limits for pregnant women, it’s best to get DHA from supplements. Other good protein sources include dairy products, nuts and beans and other lean meats. Deli meats, hot dogs, unpasteurized milk,soft cheeses (feta, brie) and other foods can contain harmful Listeria monocytogenes bacteria and should be avoided.

In addition to protein, pregnant women and their babies need the nutrients in whole grains, fruits and vegetables. Among the most important nutrients is folate, a B vitamin the body uses to make new cells. Adequate folic acid (the synthetic form of folate)helps prevent spina bifida and other neural tube defects. Folate can also be found in whole-grain and enriched products like bread, rice, pasta, and breakfast cereals. “We recommend taking a folic acid supplement — 1 gram daily — from the start,” Roy says.“Since the neural tube forms in the first six to eight weeks of life, women who are planning to become pregnant should also take folic acid.”

Pineapple, ice cream and bagel sandwiches

Eat more fruits, vegetables and whole grains is excellent advice, but let’s face it: The words “craving” and “broccoli”don’t usually come up in the same sentence. So what do you do when less-than-healthy hankerings hit? Go ahead and indulge — within limits, says Adele Clay, a nurse practitioner with Grove Hill Medical Center Obstetrics and Gynecology.While pregnant with her first child,Clay craved (healthy) pineapple and(less-healthy) bagel sandwiches.“Pregnancy is a wonderful time,and you want to enjoy yourself,”Clay says.“Just remember, everything in moderation.” Zerio indulged her ice cream craving by eating small amounts two or three times a week. Many women worry about excessive weight gain, but dieting during pregnancy can rob you and your baby of important nutrients. The American Dietetic Association recommends pregnant women consume 2,500 to 2,700 calories daily from a variety of healthy foods.

How much weight should you gain? It depends on your height, prepregnancy weight and other factors. The American College of Obstetricians and Gynecologists recommends an average, gradual weight gain of 25 to 30 pounds for one baby. “I usually look for a 10-pound gain in the first 20 weeks and 15 to 20 pounds in the second 20 weeks,” Dreiss says.“The person you worry about is the one who starts putting on a lot of weight too early.”

Get moving, Mom!

Clay tells patients not to obsess about weight gain, as long as they’re eating a healthy diet and staying active.“Probably the most important message I can give patients is that how well you start off your pregnancy with diet and exercise, definitely affects you post-partum,” she says. In other words, move your feet — even if you can’t see them. Pregnant women do need to modify exercise. During pregnancy, the body produces relaxin, a hormone that helps lubricate joints tomake labor easier but can make you more susceptible to straining shoulders,knees and other joints.Your center of balance also changes during pregnancy, so be careful about exercises like skiing and biking.Up until her 39th week, Clay walked her dog two miles daily and did yoga (switching to prenatal yoga her second trimester). The pregnancy-specific stretches helped reduce discomfort and the abdominal exercises helped with pushing during labor, she says. She also recommends Kegel exercises to strengthen the pelvic floor muscles (those used to stop urine flow).

Along with yoga, massage therapy can alleviate some pregnancy discomforts, butcheck with your doctor before you try these or other therapies, says Carol Davis, R.N., a certified childbirth educator and coordinator of childbirth education at The Hospital of Central Connecticut. Practitioners/instructors should be certified in prenatal care.Zerio walked during pregnancy — until leg swelling forced her to slow down. Pregnancy taught the middle school Spanish teacher an important lesson:“Listen to your body. If you’re tired, take it easy.”

Raise your hand if you’re anxious

In addition to a good diet and exercise,knowledge is key to a physically and emotionally healthy pregnancy — for both parents, Davis says.“I get concerned when I hear someone say,‘I don’t need to learn about that funny breathing technique; I’m having an epidural,’” says Davis, who has 30 years experience in childbirth education.“If you don’t know what your options are, you don’t have any.” Her Prepared Childbirth Education classes cover stages and phases of labor and birth; relaxation, breathing and other coping skills; Cesarean birth options; post-partum family planning and early parenting; and a hospital tour. She encourages participants to ask lots of questions.“What reduces your anxiety better than having your questions answered?” Davis asks.

Among Davis’ recent graduates are Elaine and Bryan Zerio, who welcomed their first baby, a 9 pound, 14-ounce girl, Elise, on July 8.Clay and her husband, Christopher, also took Davis’ classes. Though she works in obstetrics, Clay found actually experiencing pregnancy different. She says the classes were beneficial for her and Christopher, wholearned how to help during labor. That training came in handy on Feb. 19, 2007, when daughter Linnea was born.Having been through a pregnancy, Clay can now give her patients additional advice:“Enjoy the experience. You don’t get this opportunity that often.”

Top five conception questions

Healthcare professionals say these are some of the most common questions women have about pregnancy:

1. Should I stop taking medications?
   Many prescription and over-the-counter medications are safe during pregnancy, but it can get confusing, says Richard Dreiss, M.D., obstetrician/ gynecologist. For example, pregnant women being treated for thyroid disease or high blood pressure need medications to protect their and their babies’ health. “All thyroid medications are safe during pregnancy, but some blood pressure medications aren’t,” Dreiss says. “If you need medication and can’t stay on your current prescription, we might be able to find alternatives.” Before you start or stop any medication, talk to your doctor!
2. Does bleeding mean miscarriage?
   Not necessarily. About 30 percent of pregnant women have bleeding throughout their pregnancy, especially the first trimester. If you have spotting that goes away within a day, tell your doctor at your next visit. If bleeding lasts more than a day, contact your doctor within 24 hours.
3. Why do miscarriages occur?
   “The first part of pregnancy is an ‘all or nothing’ phenomenon,” says Gerard Roy, M.D., obstetrician/gynecologist. “If the baby’s development is compromised, you’ll miscarry.” While miscarriage can be emotionally difficult, it’s the body’s natural way of ending an abnormal pregnancy.
4. Should I be on bed rest?
   Some conditions, including preeclampsia (pregnancy-induced high blood pressure), may require bed rest. But in most normal pregnancies, it’s good to stay active, and you can usually keep working if your job isn’t too strenuous. Sometimes, even in a normal pregnancy, bed rest may be ordered to alleviate uncomfortable symptoms.
5. Why am I gaining weight faster than my pregnant friend?
   Don’t try to compare yourself to other pregnant women, and don’t compare your current pregnancy to past pregnancies. “Every pregnancy is completely different,” says Adele Clay, obstetrics/gynecology nurse practitioner.