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Prenatal Care: An Essential Component of A Healthy Pregnancy

Pregnancy is an exciting time in a woman’s life. It can also be a time of great anxiety and fear of the “unknown” as a new life is growing and developing inside the womb. To help ensure that things go as planned, it is essential that you receive proper prenatal care. Prenatal care is important for all women because it can help to identify conditions in the woman and/or fetus that may jeopardize the pregnancy.

Prenatal Care and African American Women

Prenatal care is especially important for the African American woman. We have the highest incidence of pre-term labor, low birth weight babies and other pregnancy-related complications. Also, certain diseases and illnesses that are frequent in our community (diabetes, hypertension, sickle cell) can cause significant problems in pregnancy. For this reason, early and frequent prenatal visits are essential to help ensure a healthy pregnancy and ultimately, a healthy baby.

How Long is a Normal Pregnancy?

On average, the normal pregnancy is 280 days. These days are divided into equal trimesters. The first trimester extends through the first 14 weeks of pregnancy, the second through weeks 15-28 and the third from 28- 42 weeks.

How Far Along Am I?

One of the goals of the first prenatal visit is to calculate how many weeks pregnant you are (gestational age) and to establish an approximate due date. Although the general public uses months to describe how far along the pregnancy is, your health care provider will talk in terms of weeks (weeks from the last menstrual period). Because the gestational age is based off your last period, it is important to know the first day of your last period. If it is unclear when your last period was or if you conceived while on birth control, your doctor may do an ultrasound early in pregnancy (first trimester) to accurately determine the gestational age of the pregnancy.

What Can I Expect on the First Prenatal Visit?

There are several goals of the first prenatal visit:

1. To evaluate the health status of the mother and fetus

2. Determine the gestational age of the pregnancy

3. Plan for continued care

Your provider will ask you many questions about your health, the health of the father of the baby, and the health of family members. This is used to help identify potential problems that may develop during the pregnancy.

You will also get a complete physical exam including a Pap smear. Also, if not already done, your provider will order laboratory studies.

What Conditions Should I Report To My Doctor?

There are certain conditions or symptoms that should be reported to your doctor immediately. These symptoms may be a warning sign of serious illnesses that may occur during pregnancy. The following is a list of some of these symptoms:

Vaginal bleeding or spotting

Abdominal pain

Painful urination

Severe or continuous headache

Fever or chills

Blurry vision or dimness

Fluid leaking from the vagina

Decreased fetal movement

Foul or irritating vaginal discharge

Persistent nausea or vomiting

What Happens At Each Follow Up Visit?

After the first prenatal visit, each subsequent visit will be scheduled based on your gestational age. Here are some general rules: until you reach 28 weeks you will have appointment every 4 weeks. From 28-36 weeks an appointment will be scheduled every 2 weeks, and from 36 weeks until delivery, weekly. Obviously if you have serious medical conditions, or if a condition develops during pregnancy, your provider may want to see you more frequently.

At each visit, the doctor will listen for the heartbeat of the fetus, evaluate the growth of the fetus by measuring your abdomen, check your blood pressure, and follow the changes in your weight. Also, any concerns or physical symptoms that you are experiencing will be addressed.

What Laboratory Tests Will I Have During The Pregnancy?

At certain times in your pregnancy, you will be evaluated with lab tests and diagnostic studies to make sure that you and your baby are doing well.

Complete Blood Count (CBC): At the time of prenatal registration and again around 24-28 weeks, you will have blood drawn to evaluate for the presence of anemia. Anemia refers to a reduction in the oxygen carrying substance hemoglobin in your blood. If you are anemic, you provider will recommend that you take iron supplementation.

Vaginal and Cervical Tests: At your first prenatal visit, vaginal/cervical cultures will be taken to evaluate for infections that may complicate your pregnancy. A urine test will also be done to look for a possible urinary tract infection. Your blood will be tested for syphilis and HIV (with your permission).

Glucose Challenge Test: Women at risk for diabetes (prior history of diabetes during pregnancy, family history of diabetes, or excess weight gain during pregnancy) are screened with a glucose challenge test between 24-28 weeks. This test may be done earlier if you have had diabetes during a prior pregnancy.

Triple Marker Screen: This is a recommended screening test done between 15-18 weeks. It is used to screen for spinal defects, abdominal wall defects and chromosomal abnormalities (i.e. Down’s Syndrome) in the fetus. If abnormalities are found on this screening blood test, an amniocentesis (inserting a needle into your abdominal wall to withdraw and test the fluid around the fetus) may be offered.

Ultrasound: In the second trimester, an ultrasound will be performed to evaluate the body parts of the fetus and to ensure that the fetus is growing appropriately.

How Much Weight Should I Gain During The Pregnancy?

For a healthy woman with “normal” pre-pregnancy weight, a 25-35 pound weight gain is expected. If you are under-weight, you should gain 28-40 pounds, and if you are over-weight, 15-25 pounds. Your provider will help determine if your weight gain is adequate to provide for your growing fetus.

Are There Any Extra-Vitamins I Should take, or Foods to Avoid During Pregnancy?

For the most part, women who eat a well balanced diet do not need vitamin supplementation. There are exceptions. For example, it is recommended that all women of childbearing age take Folic Acid supplementation (0.4mg daily) until the end of the first trimester. This protects against spinal defects in the fetus. In addition, most pregnant women will be advised to supplement their diet with iron tablets after the first trimester. If you are vegetarian, or restrict your diet in such a way that you do not get a full balance of vitamins and nutrients in your meals, you provider may recommend additional supplementation.

Because of the energy demands of the pregnancy, the Food and Nutrition Board recommends that all pregnant women increase their daily caloric intake by 300 kcals throughout the duration of the pregnancy. Increasing protein intake in the form of meat, mild eggs, cheese, poultry, and fish is an ideal way of getting these extra 300 kcals.

Most foods are acceptable during pregnancy. Avoid raw meat and raw dairy products. These products may carry harmful bacteria that may cause infection. Other substances you should avoid include alcohol, excess caffeine, and saccharin. Excess consumption of alcohol could lead to a syndrome called Fetal Alcohol Syndrome. This syndrome is characterized by facial and developmental abnormalities in the fetus. The exact amount of alcohol consumption that results in this syndrome is unknown. For this reason, alcohol consumption (at any level) is not recommended during pregnancy.

The Food and Drug Administration recommends limiting caffeine intake, although most studies have not shown any evidence that caffeine affects the pregnancy in deleterious ways (no increase in birth defects or low birth weight babies).

Are There Any Lifestyle Modifications I Should Make?

Sexual relations: Intercourse is acceptable in a normal, healthy pregnancy. It should be avoided in instances when abortion or pre-term labor threatens a pregnancy.

Smoking: Smoking should be avoided during the duration of the pregnancy. Women who smoke during pregnancy have smaller babies, and have an increased risk of spontaneous abortion, pre-term delivery, and fetal death.

Over the Counter Medications: Any drug has the potential to be harmful to the pregnancy. However, there are many medications for common ailments that are safe during pregnancy. For example, Tylenol is safe for headaches (avoid aspirin or ibuprofen unless recommended by your doctor), Robitussin and other selected cough medications are safe, as well as medications for diarrhea, constipation, nausea and vomiting. Check with your doctor before taking any medication. Also, let your doctor know of any medications (prescription and over the counter) that your are taking.

Illicit Drugs: Long term use of drugs during pregnancy is harmful to the fetus. The fetus may exhibit distress in the womb, low birth weight, and/or serious compromise as the consequence of drug withdrawal soon after birth.

Douching: Douching should be avoided during the pregnancy.

Exercise: Mild exercise is good for a pregnant woman and will not harm the pregnancy. If you did not have a vigorous exercise regimen before the pregnancy, do not start one now. Always talk with your provider before initiating an exercise regimen. In general, walking, swimming, and jogging are good forms of exercise. You should limit aerobic exercise to 20 minutes. Avoid exercising in hot weather, and drink plenty of fluids. After the fourth month, do not exercise lying flat on your back.

Travel: Travel by healthy, pregnant women has no harmful effect on the pregnancy. When traveling, prolong sitting or immobilization should be avoided. Every 2 hours, the pregnant woman should walk around to increase the circulation in her legs. Travel should be avoided within the last few weeks of pregnancy, in the event a complication develops and you are away from your doctor.

Letitia Spencer, M.D.