Obstetrics Questions

Is It Safe to Use an Artificial Sweetener?

• According to the Food & Drug Administration (FDA), sucralose (eg. Splenda) and aspartame (eg. Equal or Nutrasweet) is safe during pregnancy and lactation. Both sucralose and aspartame consumption should be limited to a moderate level.
• Aspartame is not safe for everyone – particularly not for those people with PKU (a rare metabolic disorder), certain liver diseases, or high levels of phenylalanines in their blood.
• However, the FDA notes that the safety of saccharin (eg. Sweet-n-Low) in pregnancy remains questionable so advises to avoid it in pregnancy.

Can I Have Caffeine While I Am Pregnant?

• Pregnant women should reduce caffeine intake or cut it out entirely. If you decide to have some caffeine, try to consume less than 200 mg of caffeine (equivalent to 10-12 oz of coffee) per day from all sources. Be aware of other sources of caffeine other than coffee, such as soft drinks and some over the counter medications.
• Check out the following link – A list of popular coffees, teas, soft drinks and energy drinks and how much calories they have
  http://www.energyfiend.com/the-caffeine-database

Can I Go to the Dentist While I Am Pregnant?

• Always notify your dentist that you are pregnant. Routine dental cleaning is safe and recommended during pregnancy. Delay non-emergency dental work until the 2nd trimester or until after delivery if possible.
• Routine X-rays and elective dental work should be delayed until after the birth. If X-rays are needed for emergency dental work, ensure your abdomen is shielded.
• Local anesthetics and most antibiotics (these include penicillin, amoxicillin, and clindamycin) are fine in pregnancy.
• After 20 weeks, try not to lie flat on your back for extended periods of time.
• For more information, go to http://www.ada.org/3019/?currentTab=1#radiograph where the American Dental Association has a section on Pregnancy and Dental care.

Can I Exercise During Pregnancy?

• If you have been active and exercising prior to pregnancy, you may continue similar levels of activity. Swimming and running are acceptable as long as you are used to doing them and feel comfortable. Horseback riding, waterskiing, snow skiing, or wakeboarding are not recommended.
• According to the American College of Obstetrician & Gynecology, the extra weight you are carrying will make your body work harder than before you were pregnant. Exercise increases the flow of oxygen and blood to the muscles being worked and away from other parts of your body. So, it’s important not to overdo it.
• Try to exercise moderately so you don’t get tired quickly. If you are able to talk normally while exercising, your heart rate is at an acceptable level.
• Avoid lying on your back after 20 weeks. Exercising at least 30 minutes a few times per week may decrease your risk of gestational diabetes, reduce backache and stress, help you sleep better, and improve muscle tone.
• Stop exercising and call your doctor if you get any of these symptoms: vaginal bleeding, dizziness or feeling faint, increased shortness of breath, chest pain, headache, muscle weakness, calf pain or swelling, uterine contractions, decreased fetal movement, fluid leaking from the vagina

Why Do I Feel Tired All the Time? Is That Normal?

• Feeling tired improves after 14 weeks. If you feel that the fatigue has worsened, discuss this with your doctor and possible tests can be run such as checking for hypothyroid or anemia.

How Do I Have to Alter My Diet Now That I Am Pregnant?

• Eat 3-6 meals daily selecting from each of the four food groups.
• Drink adequate fluids (e.g. 6-8 glasses of water) daily.
• Caloric intake: You need approximately 300 calories more per day in pregnancy. Your recommended daily total caloric intake in pregnancy will depend on your pre-pregnancy weight, body type, and activity level. (see above for more information)
• Avoid sweets, starchy foods, fried foods, and extra salt intake.
• Protein intake should consist of lean meats, cheese, eggs, legumes, fish, and cooked seafood.
• Minimize mercury consumption in fish & seafood: Certain fish accumulate high levels of mercury – therefore, avoid eating shark, swordfish, king mackerel, or tilefish. Tuna steak should be limited to 6 ounces per week. You can eat up to 12 ounces (2 to 3 meals) of other varied fish, shellfish, or canned light tuna per week.
• Unpasteurized dairy products and deli meats can carry the bacteria Listeria. While Listeria is quite uncommon in the USA, it is wise to avoid regular intake of unpasteurized milk, cheese and juices; raw or undercooked meats, poultry, and shellfish; prepared meats, such as cold deli meats. Deli meats heated until steaming are safe.
• Raw fish and meat may carry parasites and other microbes and therefore should also be avoided. All fish should be cooked thoroughly to avoid bacteria that can harm your pregnancy. Some fish are high in mercury and should be eliminated from your diet: Mackerel, Shark, Swordfish, and Tilefish. Lower mercury fish is safe to eat in moderation.
• Foods to Avoid: We know some foods actually carry risks in pregnancy but the risks are very small, and even if you do eat some of these foods, perhaps without realizing, you are very unlikely to harm yourself or your baby in any way. However, it makes sense to avoid them when you can.

Foods to Avoid

• Unpasteurized milk
• Soft, ripened cheeses made with unpasteurized milk (imported varieties such as brie, camembert, and similar blue-veined cheeses. Cheeses made with pasteurized milk or domestic brands should be fine)
• Custard” style ice-cream made with raw eggs (wrapped or block ice-cream is fine)
• Patés of all types
• Raw and undercooked eggs (thoroughly cook eggs until both the white and yolk are solid)
• Liver and liver products
• Mayonnaise (homemade containing raw eggs)
• Shark, marlin, and swordfish should be avoided and tuna restricted to two medium cans or one fresh steak per week. This follows concerns about mercury in these fish and also applies to women who are breastfeeding or intending to become pregnant.
• Peanuts: If you or members of your close family suffer from peanut allergy or allergic diseases such as atopic eczema, asthma or hay fever, it is recommended that you avoid eating peanuts or food containing peanut products during pregnancy and while breastfeeding.

What About Diet Drinks?

• Are diet drinks okay? Yes, after the first trimester (13 weeks), but try not to drink more than one a day. If given a choice, use products with Nutrisweet, also known as Aspartame.

What Are Some Things I Can Do to Help With Nausea and Vomiting?

• Nausea and vomiting symptoms are extremely common during the 1st three months of pregnancy due to changing hormones. The following are some suggestions to help with these symptoms.
  • Symptoms seemed more pronounced when the stomach is empty. Eating frequently (every 1 1/2 – 2 hours) in small amounts will keep nausea to a minimum.
  • Separate liquids from solid foods – if you drink something, don’t eat for at least 30 minutes.
  • Carbohydrates and starches are the most popular foods.
  • High fat, spicy, or gaseous foods are not tolerated well

What Is Toxoplasmosis?

• Toxoplasmosis is a disease caught from contact with uncooked or undercooked meat, contaminated vegetables and fruit, and in cat feces. If toxoplasmosis is contracted in pregnancy, it can be passed to the baby and cause severe problems such as blindness or mental disabilities. You should avoid handling cat feces or the cat litter tray. Wash your hands after handling a cat, and after preparing meat and other foods. Make sure cats stay away from all surfaces where food is eaten or prepared. Toxoplasmosis can be tested for during pregnancy, if necessary.

How Does Smoking Affect Pregnancy?

• Smoking increases your risk of a miscarriage, placental abruption, and a small baby (which raises the baby’s chances of problems at delivery), and the likelihood of your baby’s health problems during infancy including SIDS and asthma. The chemicals in tobacco (nicotine and carbon monoxide) pass through the placenta to the baby. If you are smoking now, quit smoking for you and the baby. By quitting, you will help give your baby a healthy start and decrease your own chances of getting heart disease and cancer. If you can’t quit, reduce the amount you smoke as much as possible. Smoking may change the taste of your breast milk. Also, your infant may suffer increased throat and ear infections, asthma, and bronchitis from “re-breathing” your cigarette smoke.

How Does Alcohol and Drugs Affect Pregnancy?

• All alcohol and drugs pass from your blood, through the placenta to the baby. Alcohol, narcotics, marijuana, and cocaine have long term effects on your developing baby. These may include problems at delivery, learning disabilities and mental problems. Alcohol and drugs of any type should be avoided during pregnancy. Even a small amount is harmful.

What Vaccines Should I Get During Pregnancy?

• If a pregnant woman gets the flu, she is more likely to become very sick. The American College of Obstetrics and Gynecology (ACOG) recommends that all women who will be pregnant during the flu season (October through mid-May) be offered the vaccine. According to ACOG, flu vaccination is an essential part of prenatal care that provides protection to both women and their babies. No adverse side effects have been shown in pregnant women. The flu vaccine is a “passive” vaccine and no live or dead virus is injected, and there are no known fetal risks to passive immunization. Breastfeeding women can also safely get the vaccine.
• There are two types of flu vaccines. Only receive the injectable form while pregnant. Do not receive the FLU MIST, which is a live version of the vaccine. Live vaccines are contraindicated in pregnancy!
  • Flu
  • Hepatitis B
  • Tetanus
• Women with egg allergies should not get the vaccine as the vaccine-making process can include chicken eggs.

Can I Dye My Hair or Get Perms While I Am Pregnant?

• Coloring your hair during pregnancy is probably safe. If you are concerned, then hold off coloring hair with permanent dyes during the first trimester and consider highlights instead of coloring your whole head of hair.

How Safe Are Herbal Remedies During Pregnancy?

• There is little known about the safety of herbal medicine and nontraditional medications during pregnancy. Many women don’t consider herbal remedies to be medicine and when pregnant don’t report their use to their obstetricians. Before starting or continuing herbal medications, be aware that the FDA does not regulate them and that they may have side effects or interactions with other medications, which could be even more concerning if you are pregnant.

Can I Use the Hot Tub or Sauna?

• No sauna. You can harm your baby if you raise the temperature of his/her environment over 100 degrees for prolonged periods of time. So avoid hot tubs while you’re pregnant. If you have to get in, it is permitted after 12 weeks for 5-10 minutes, but drink plenty of cool fluids.

Can I Swim If I Am Dilated?

• Swimming is okay as long as you are not leaking and suspect that you may have broken your water bag.

Is It Okay to Be Around Paint or Insecticide?

• Avoid excess exposure to oil-based paints, lead, and mercury. You should minimize your exposure to latex paints that contain ethylene glycol and biocides. Avoid removing old paint used prior to the 1970s due to the possible risk of lead exposure.

When Can I Not Travel While I Am Pregnant?

• Many factors determine when you should stop traveling. Generally, 28 – 32 weeks gestation is a time when you should become more cautious. This is a subject that must be individualized with your physician depending on any complications or risk factors that you may have with your pregnancy.
• If you are traveling far from home, it is recommended that you be familiar with a nearby healthcare facility in the event problems or concerns arise while away.
• If you are traveling by car or plane:
  • Walk around every 2 hrs to maintain circulation and decrease your risk of leg clots
  • Try to stay adequately hydrated by drinking 8-10 glasses of water a day.
• You may want to check with your travel carrier ahead of time to see if they require a note from your obstetrician that indicates that you are under the care of an obstetrician, any risk factors (or lack of), and the number of weeks gestation.
• Please be aware that there are risks involved with travel during pregnancy and a note will not signify permission to travel as this is a patient’s free will. An obstetrician can only advise and educate a pregnant woman about the risks of travel.

Can I Tan?

• Tanning beds will not hurt your pregnancy but are not good for you in general regardless of whether or not you are pregnant.

Is There a Special Way to Sleep While I Am Pregnant?

• Early in your pregnancy, try to get into the habit of sleeping on your side. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses and also makes your heart’s job easier because it keeps the baby’s weight from applying pressure to the large vein (called the inferior vena cava) that carries blood back to the heart from your feet and legs. Some doctors specifically recommend that pregnant women sleep on the left side but in most cases, lying on either side should be fine and help take some pressure off your back. If you do find you rolled onto your back while sleeping, don’t panic, simply roll back onto one of your sides and go back to sleep. Some women will also find they need added support while sleeping which may be accomplished through the use of additional pillows, body pillows, or specially made pillows such as the Snoogle.

When Is Swelling Worrisome During Pregnancy?

• A certain amount of swelling, or edema, is normal during pregnancy, especially during the summer. Swelling occurs most often in the legs and mainly in the third trimester.
• How to reduce swelling:
  • Try to rest and elevate your legs more
  • Avoid prolonged standing or sitting
  • Do not take “water pills”, or diuretics, during pregnancy unless directed by your obstetrician
• Let us know if you have swelling in your hands or face.

Is Sex Safe During Pregnancy?

• For a healthy woman with a normal pregnancy, intercourse is safe during pregnancy. You and your partner may want to experiment with different positions that may be more comfortable for you. If you are having problems in your pregnancy, such as bleeding, premature labor or ruptured membranes, your obstetrician may advise you to limit or avoid intercourse.

I Have Young Kids in Daycare, What If I Am Exposed to Parvovirus?

• Parvovirus is a common virus that many of us have been exposed to in the past, especially if we have or work with school-age children. An infection with parvovirus, also known as Fifth’s Disease, causes a bright red rash and fever in children and little to no symptoms in most adults, although adults may get significant joint pain. Once you have been exposed and develop antibodies to the virus, you are no longer at risk of getting it again nor passing it to your baby in-utero.
• If you have a new exposure during pregnancy and are unaware of your immunity, please call your physician’s office to have a blood test done to look for antibodies. If this is negative, we may want to repeat it in a few weeks to see if you develop new antibodies since the time of exposure. If your test turns positive, it may be necessary to follow your baby with ultrasound testing for a few months. It is rare for your baby to develop a problem from this infection.

What Should I Expect Differently If I Am Having Twins?

• Twins can make you more uncomfortable and tired than usual during pregnancy because the uterus becomes much larger sooner. Consider resting more during the day. Discuss your activity level at home and at work with your doctor. Some women with twins may need to restrict their activity.
• You will need to increase your caloric intake more when you are carrying twins. If you are of average weight, you will need to eat about 2,700 to 2,800 calories per day and you should expect to gain up to 45 pounds.
• The risk of certain complications is higher with a twin pregnancy. You are more likely to develop high blood pressure, anemia, gestational diabetes, preterm labor, and/or growth problems with the babies. Sometimes these problems can be prevented with early detection and care and this is why you have more frequent prenatal visits and ultrasounds when you are carrying twins.
• Be certain to report any problems or concerns to your doctor early when you are carrying twins.
• In some instances, twins may deliver vaginally but your chance of cesarean section is increased when you have twins. To be considered for a trial of vaginal birth, the first twin (called “twin A”) must be head down. On rare occasions, the first twin (“twin A”) is delivered vaginally and the second twin (“twin B”) is born by cesarean section. Twins are usually delivered in the operating room which is larger than our traditional birthing rooms. This is to accommodate for the extra medical staff & equipment and also the ability to convert to a cesarean birth if necessary.
• Breastfeeding is still encouraged and preferred when you have twins. Your milk supply will increase to meet the demands of your twins. If the babies are born prematurely, then consider pumping and storing the milk until they are able to feed on the breast.
• For more information, please see ACOG’s patient pamphlet on “Having Twins”.

What Can I Do About Spider Veins?

• Varicose veins, “varicosities,” are caused when the veins in your legs get weak and enlarge with blood. They have to work harder to carry blood back up your legs to your heart. Sometimes pregnancy can aggravate this problem. The enlarging uterus partially cuts off circulation from your legs.
• Exercise will help. Short walks at different times during the day will help pump your blood faster Support stockings may significantly help and are available over-the-counter at maternity stores or by prescription.
• The vulvar area can also suffer from varicosities during pregnancy. Again, rest periods spread out during your day will help and consider placing a pillow under your buttocks to elevate your hips and aid circulation during rest periods and sleep.

What Vitamins Should I Take or Not Take?

• Prenatal vitamins are recommended throughout your pregnancy and while breastfeeding. Consider taking a supplement containing 200-300mg of DHA (from fish oil or flax seed oil) as Omega-3 fatty acids may help fetal eye and brain development.
• If you are taking a prenatal vitamin there is no need to take any additional vitamins, such as a multivitamin. Doing so may cause an overdose on certain vitamins that are not good for the pregnancy such as Vitamin A.
• Your doctor may suggest additional iron supplements or folic acid depending on your pregnancy.

What Are Other Ways I Can Prepare for Childbirth?

• We encourage you and your partner to enroll in a Child Birth Education class. Information is available in your 1st OB packet about locations and time of classes. Classes tend to fill up quickly so we recommend enrollment at around 20 weeks. Partners are encouraged to be with you during labor & delivery.
• We have information on prenatal cases at St Joseph’s Medical Center, Houston Methodist, Texas Children’s Hospital and Memorial Hermann Hospital. Please ask us if you are interested.

What Medications Are Safe During Pregnancy?

• During the first trimester, it is extremely important to avoid all medications, including suppositories and vaginal creams. During this time there is rapid development of the fetus and it is felt that certain medications could produce harmful effects, especially during this period. If you are already on medication prescribed by another doctor, please let us know on your first visit. We will work with your primary care physician and/or specialist to ensure that the medication is appropriate before taking it. We recommend avoiding medications throughout your pregnancy, but it is understood there are times when the benefits outweigh the risks posed by the condition requiring medication. The following is a list of common over the counter (OTC) medications that can be used if needed. Please remember you are asked to avoid all medications in the first trimester unless prescribed for you. Please call the office during working hours if you have any questions regarding medications.
• The following information is not meant to be a substitute for professional medical advice. Please discuss with your doctor if you have any concerns before starting any of the following or if you see no improvement in your symptoms.

Allergies

Safe medications include Benadryl, Sudafed, Claritin, Claritin-D, Zyrtec (after 20 weeks), Tylenol Cold & Sinus

Backache

As your pregnancy progresses, you may experience backaches due to the additional weight gain. Furthermore, as your progress, your pelvic bone joints relax, which also can cause back pain. Comfortable shoes may help a little, good posture may help too, but exercise will probably relieve your backache more than anything else. Strong muscles can take more stress without hurting.

A heating pad on medium heat four times per day for 15 minutes may help with the pain.

Try to avoid heavy lifting and if necessary, wear a maternity belt.

Constipation

Drink 6-10 10oz glasses of water daily. Increase your fiber intake; eat plenty of fruits and raw vegetables. You can also add 1tbs-unmilled bran to your cereal or food daily or add Metamucil. Exercise every day.

Stool softeners, Docusate sodium (Colace), Milk of Magnesia are fine.

Cough, Cold, Flu

For fever/aches: try Tylenol; Tylenol Cold is also fine.

For congestion: first, try inhaling steam, salt water gargles, saline nasal spray. If these are not helpful, you may try Sudafed or Actifed, Pseudoephedrine, “Sudafed” (after 12 weeks), Phenylephrine, “Sudafed PE” (after 12 weeks), Diphenhydramine, “Benadryl” Chlorpheniramine, Tylenol Cold & Sinus

** Talk to your doctor before taking any products that contain Sudafed if you have high blood pressure issues during your pregnancy**

For cough: Robitussin plain or DM (dextromorphan), Cough drops, Guaifenesin, “Mucinex”

Increase clear fluids to avoid dehydration. Suggested clear liquids include soft drinks without caffeine, weak tea, Gatorade, Jell-O, and popsicles. Plain water may be nauseating to an upset stomach.

Diarrhea

Pepto Bismol is not recommended as it may be metabolized to aspirin.

Avoid milk products & spicy or greasy foods.

Try the BRAT diet: Bananas, Rice, Applesauce, and Toast.

You may take Kaopectate or Imodium as directed on the package.

Fever

If you feel hot, sweaty, or chills, please take your temperature. If > 100.4, call the office or on-call doctor.

Gas

Use Mylicon, Mylanta, Maalox. Be warned, however, that flatulence is a natural part of being pregnant and is not necessarily preventable.

Headache

Headaches are fairly common during pregnancy and usually are not a sign of a serious problem. How often they occur and how bad they are may vary. Discuss with your obstetrician what medications you can use for your headache.

If the headache is severe or if it is associated with blurry vision or spots in front of your eyes, fever, or excessive nausea or vomiting, call the office

Heartburn

Heartburn is another common complaint of pregnant women. It is alright to use antacid preparations: Tums, Maalox, Pepcid, Zantac 75, and Tagamet are fine.

Do not use sodium bicarbonate preparations for your heartburn – for example, Pepto Bismol or Alka-Seltzer is not recommended as it may be metabolized to aspirin.

Avoid spicy foods. Remain sitting up (try not to recline or lie down) for 1/2 hour after meals. In severe cases of heartburn, you might want to elevate the head of your bed to encourage your stomach fluids to stay put! (Add 4″ of books beneath the head posts to elevate the head of the bed temporarily).

Hemorrhoids

Prevention is the word here! In particular, try and avoid constipation and straining and prolonged sitting on the toilet. Eat correctly and add fruits, raw vegetables, bran products and lots of water to your diet every day.

Anusol HC, Preparation H and/or Tucks Medicated pads can be used for the temporary relief of external itching, burning and irritation associated with hemorrhoids. Stool softeners may assist with preventing constipation

Itching

Benadryl, as directed on package

Leg Cramps

Leg cramping may increase in the second and third trimesters. Try stretching your legs before you go to bed and consider increasing calcium intake (eat more dairy foods or use a supplement).

Nausea & Vomiting

Nausea and vomiting may occur until around the 14th week of pregnancy. It may be worse in the morning but unless it is excessive or interferes with adequate food retention, it should not be cause for alarm.

It is best to eat smaller, more frequent meals. Eat bland foods, such as toast or crackers, when you first get up in the morning. Avoid fatty, greasy, fried, highly acidic and spicy foods. Take your prenatal vitamin during the day when nausea is less of a problem. Try to increase fluid intake to stay hydrated. Consider clear cool liquids such as carbonated beverages (not cola), popsicles, juice-flavored Jell-O.

Over-the-counter options include Vitamin B6 (Pyridoxine / 200mg up to three times a day), ginger capsules, Dramamine, Unisom (50mg daily), or Seabands (acupressure wristbands).

If nausea and vomiting persist or you are unable to keep any food or liquid down, call us. Sometimes prescription medication or intravenous hydration is necessary.

Sore Throat

Throat lozenges or cough drops

Skin Irritation

1% Hydrocortisone cream, Calamine lotion

Spotting

Call the office to speak to our nurses regarding this symptom

Urinary Tract Infection

If you have to burn with urination, urinary frequency increases or if you notice blood in your urine, call the office.

Vaginal discharge

It is best to mention this at your office visit so that cultures can be taken. If you have been diagnosed with a yeast infection, then Monistat is safe in pregnancy. The symptoms should improve in several days.

If the symptoms do not respond to the Monistat treatment, call the office to schedule an appointment.

Recommended Reading

Some book suggestions for newborn and infant care from our local pediatricians:

• “What to Expect the First Year,” Arlene Eisenberg, Heidi Markoff, Sandee Hathaway
• “First Feelings: Milestones in the Emotional Development of Your Baby and Child,” Stanley Greenspan and Nancy Thorndike Greenspan
• “Taking Care of Your Child,” Robert Pantell, James Fries, and Donald Vickery
• “Solve Your Child’s Sleep Problems,” Richard Ferber
• “Caring For Your Baby and Young Child,” Steven Shelov
• “Your Child’s Health,” Barton Schmidt

Books & Websites for Breastfeeding:

• The Womanly Art of Breastfeeding (La Leche League International Book) by Diane Wiessinger, Diana West and Teresa Pitman
• The American Academy of Pediatrics New Mother’s Guide to Breastfeeding by American Academy Of Pediatrics, Joan Younger Meek M.D. and Winnie Yu

Recommended Websites:

• http://3dpregnancy.parentsconnect.com/
• http://www.parents.com/