Women are three to four times more likely than men to be afflicted with scleroderma, a chronic, autoimmune disease that most often strikes women during middle age. It can cause hardening and thickening of the skin and attack the heart, lungs, kidneys and gastrointestinal tract.

1. Scleroderma
If you’ve recently found out that you’re pregnant, you should learn as much as
possibleabout what it takes to have a healthy pregnancy and how to best care for
yourself and your baby during this time of physical and emotional change. Finding
a health care professional with whom you’re comfortable to care for you
throughout your pregnancy is the first step in a healthy pregnancy.
For most women, pregnancy lasts about 40 weeks, or 280 days. This time frame is
calculated from the first day of your last menstrual period. After you’ve missed a
menstrual period and confirmed your pregnancy with a home pregnancy test,
make an appointment with your health care professional.
You’re Pregnant: What Next?
Visit Your Doctor
Meeting with a health care professional early on (even before you get pregnant if
you are planning to conceive) is important for all women, but especially important
if you have any medical conditions or family health problems that could put you
or your baby at risk.
Certain conditions, such as diabetes or high blood pressure, can affect the health
of the fetus if you don’t have them under control before you get pregnant or in
the early stages of your pregnancy.
Start a Vitamin Regimen
The sooner you can plan ahead for pregnancy, the better. For example, you
should take 400 micrograms of folic acid (a B vitamin) at least a month before you
become pregnant and for the first three months of your pregnancy. If you have
already had a child with a neural tube defect, such as spina bifida, a type of birth
defect in which the baby’s spine doesn’t close all the way, you are at a higher risk
of having another child with the defect, and therefore, you should take 4,000
micrograms of folic acid (after clearing it with your health care professional) as an
extra precaution.

2. Consider Vaccinations
You should also be tested to make sure you have antibodies against rubella
(German measles) and varicella zoster virus (chicken pox). If you don’t have
sufficient antibodies against either of theses conditions and you’re not yet
pregnant, you should get vaccinated. Most health care providers and the Centers
for Disease Control and Prevention (CDC) recommend that you delay getting
pregnant for at least four weeks after receiving the vaccines.
If you’re already pregnant and don’t have enough antibodies against these
conditions, you shouldn’t get vaccinated because the vaccines contain weakened
forms of the viruses which could, in some cases, trigger an infection, and
contracting either during pregnancy could harmyour fetus. Instead, avoid contact
with anyone exhibiting symptoms of rubella and talk to your health care
professional about getting vaccinated after you deliver.
When it comes to chicken pox, if you’ve been exposed, treatments are available
that can prevent or minimize the illness in pregnant women. And remember to
ask about getting vaccinated after your baby is born.
Understand Emotional Changes
Aside from the physical changes you’ll face throughout your pregnancy, you will
also face many emotional issues and may find yourself on an emotional roller
coaster. If it’s any consolation, you should know that most pregnant women take
a similar ride; it doesn’t last forever, however, and there are many things you can
do to keep the ride as smooth as possible.
Diagnosis
Once your pregnancy is confirmed, you should make an appointment with your
health care professional, usually an obstetrician, nurse-midwife, family
practitioner or nurse practitioner.
This first visit will likely take much longer than other appointments over the next
few months. It should include:

3. A complete health and family history
A complete physical examination, including blood pressure, height and weight
measurements
Blood tests to check for your blood group, blood type, Rh factor, anemia,
immunity to rubella (German measles), hepatitis B virus and some sexually
transmitted diseases (STDs)
Rh factor is a protein that 85 percent of people have on red blood cells. These
people are called “Rh-positive.” If you belong to the 15 percent of the population
that doesn’t have the protein, you’re known as “Rh negative.” Since Rh positive
individuals are in the majority, it is likely that your baby’s father may be Rh
positive, so your baby may also be Rh positive.
If you have Rh-negative blood and your baby’s father is Rh-positive, you and your
baby may develop health problems. To reduce this risk, your health care provider
will offer you injections of Rho (D) immune globulin (RhoGAM) at or around 28
weeks of pregnancy. The drug prevents your body from recognizing Rh positive
cells so your body will not attack and destroy your baby’s blood cells. After the
baby is born, his/her Rh status will be determined and, if the baby is Rh positive,
you will be offered RhoGAM again. Receiving RhoGAM while pregnant will not
harmyou or your baby, even if, after delivery, the baby is found to be Rh negative
like you.
Your health care professional may ask whether you’ve been tested for HIV, the
virus that causes AIDS. If you haven’t been tested for HIV, he or she will likely
suggest you be tested, regardless of whether you are in a high-risk category.
Depending on your ethnic background, your health care professional may also
test your hemoglobin (a protein carried in your red blood cells) to look for genetic
conditions such as sickle cell disease or thalassemia that could be passed on to
your baby.
During this first visit, your health care professional will also do an internal pelvic
exam, likely the only one you’ll have until your final weeks of pregnancy. He or

4. she will examine your internal reproductive organs to check for changes in your
cervix and the size of your uterus.
A urine test is sometimes a routine part of every prenatal visit, so you should
drink a lot of water before your visit. These tests provide information about
glucose (sugar) and protein levels. A high glucose level may indicate gestational
diabetes, a form of diabetes that only occurs during pregnancy, while a high
protein level could signal potential kidney problems or urinary infection.
This first visit also may include a Pap smear to detect changes in your cervix that
could be an early sign of cancer. Other tests may be recommended depending on
your age and other risk factors. These include routine screenings for genetic
disorders such as cystic fibrosis and more specialized genetic tests, if your medical
history suggests them.
Prenatal visits after this one will be relatively brief, and most likely include the
following:
 Urine sample to check for glucose (sugar) and protein
 Blood pressure measurement to gauge whether your levels are normal
 Weigh-in to make sure you are gaining enough weight and let you know if
you’re gaining too much
 Checking the baby’s heartbeat
 Checking the size and position of your uterus and the baby by feeling your
stomach
 Providing information and education about what you can expect over the
next month and any signs of problems you should look for.
This might all sound a little scary, but don’t worry—most women in the United
States have healthy pregnancies that lead to healthy babies.
Still, throughout your pregnancy your health care professional will recommend a
handful of standard tests to check the health of your baby. These include:
Ultrasound. Also known as a sonogram, this test uses short pulses of high-
frequency, low-intensity sound waves to create images of the baby inside your

5. uterus. Unlike X-rays, there is no radiation exposure to you or the baby. This test
can be performed in a health care professional’s office or in an outpatient
diagnostic center.Ultrasound has been used safely in obstetrics for decades.
When performed early in the pregnancy, it can provide an accurate gestational
age and due date for your baby and is sometimes more reliable than calculating
your due date mathematically from your last period. Many expectant moms like
to get an ultrasound hoping to learn the child’s sex, but health care professionals
are much more focused on looking for possible birth defects. If they suspect any
problems with your baby, you may need other tests.
Most women experiencing a healthy pregnancy receive only one ultrasound,
usually around 18 to 20 weeks, though you may have more than one.
To perform the test, a technician rubs a thin layer of lubricating jelly on your belly
and passes a hand-held instrument called a transducer over that part of your
body.
Additionally, you may need a transvaginal ultrasound early in your first trimester
to confirm your pregnancy or to determine how healthy the pregnancy is if you’re
experiencing any bleeding, signs of preterm labor or other risks that require a
careful examination of your cervix. This type of ultrasound is similar to the kind of
internal exam you get during a Pap smear, only instead of a speculum inserted
into your vagina, the ultrasound wand is inserted.
Regardless of which type of ultrasound you have, during the test itself the
technician occasionally stops to take ultrasound images, which record the size of
certain body parts and other developmental features of the baby. Also, an
ultrasound can usually determine if you’re carrying more than one baby.
Multiple births (twins, triplets or more) have become much more common in the
United States over the past 20 years, according to the National Center for Health
Statistics. The dramatic rise, especially in triplets or higher births, is associated
with two related trends: advances in and greater access to assisted reproductive
therapies like in vitro fertilization and more women having children at an older
age (women in their thirties are more likely to have multiple births than younger

6. women, even without the use of fertility therapies). The rate of triplet and higher
births seems to be leveling off. Reasons include refinements in assisted
reproductive techniques that lower the risk of multiple births.
Amniocentesis. This screening enables your health care professional to examine
fetal cells in the amniotic fluid for any chromosomal abnormalities. If you are 35
or older when you’re due to have your baby, your health care professional will
likely discuss the risks of chromosomal abnormalities based on your age and
recommend this test.That’s becausewomen over 35 have a higher risk of having a
baby with Down’s syndrome. An amniocentesis is also recommended if you’ve
already had a child with certain birth defects, or if you have a family or personal
history that puts you at risk for certain inherited diseases. You might choose to
have this test if you had abnormal blood tests that suggest there might be a
problem.
Amniocentesis can diagnose numerous conditions, but only if the lab evaluating
the amniotic fluid knows which tests to conduct. These tests are very expensive,
so talk with your health care professional about which ones are necessary based
on your history and risk factors. It can take anywhere from a few days to a few
weeks to get the results.
During an amniocentesis, the doctor inserts a needle through your abdomen into
the amniotic sac and removes a small amount of amniotic fluid. The doctor uses
ultrasound to guide the needle and avoid inserting it into the placenta.
An amniocentesis has a complication rate of less than 1 percent, but there is a
small risk of miscarriage associated with this procedure. The test can be
performed on an outpatient basis in a health care professional’s office or in a
hospital. It can be done at any gestational age after 11 weeks, but when it’s
performed for genetic studies, amniocentesis is usually done between 15 and 17
weeks.
Chorionic villus sampling (CVS). During this test, a sample of chorionic villi, a
portion of the placenta, is removed and analyzed. It is usually offered to look for
certain kinds of birth defects.There are two types of CVS tests:

7. Transcervical. This is the most common method. The doctor uses ultrasound to
guide a thin catheter through your cervix to the placenta, suctioning the chronic
villi cells into the catheter.
Transabdominal. The doctor uses ultrasound to guide a long, thin needle through
your abdomen to the placenta, using a needle to draw a tissue sample. This is
similar to the amniocentesis.
CVS carries a higher risk of miscarriage than amniocentesis, but some women
prefer this test because it can be performed earlier than amniocentesis.
First trimester screening (FTS). This test, which can be done as a single combined
screening or a step-by-step process, involves an ultrasound scan between 11 and
14 weeks of pregnancy as well as blood testing. The ultrasound measures the
“nuchal translucency,” or thickness of skin on the back of the baby’s neck. This
measurement, in conjunction with levels of certain proteins found during the
blood test, can help predict the risk of chromosomal abnormalities in the
baby.First trimester screening allows women under 35 to get more information
about the health of their babies without having to undergo the more invasive
tests described earlier.
Second trimester screening. This test detects four to five substances in your blood
that come from the baby that could be a sign of a birth defect. All pregnant
women are offered this test between weeks 15 and 22 of pregnancy. The results
may indicate the need for further tests such as amniocentesis.One of the more
common substances tested is alpha-fetoprotein (AFP). High levels may be a sign
of a neural tube defect (such as spina bifida), in which the brain or spinal cord
doesn’t develop normally. Low levels could be a sign of Down’s syndrome, a
chromosomal defect that results in various developmental disabilities and
physical problems.
Don’t panic if the results of either test aren’t ideal, however. The tests are purely
a screening tool used to identify women who are at an increased risk for having a
baby with one of these conditions; other tests can provide more certain
information.

8. Other genetic screening tests identify individuals who “carry” genes for certain
genetic conditions and who may pass those genes onto their children. These
include Tay-Sachs and sickle cell disease, both of which are more common in
certain ethnic groups. If you belong to one of these groups, your health care team
may recommend you talk with a genetic counselor or have additional genetic
screenings.
Fetal heart rate monitoring. This test enables health care professionals to monitor
your baby’s heart rate and check his or her well-being before delivery. This test is
generally performed during the last 10 to 12 weeks of your pregnancy. It may be
performed earlier if a problem arises during the pregnancy, such as high blood
pressure in you, or if you don’t feel the baby moving.There are two types of fetal
monitoring—non-stress and contraction stress. During both, a device is strapped
to your abdomen and the results recorded on a tracing.
Non-stress test (NST). During this test, you sit quietly while the monitor records
any movement of the baby and records the baby’s heart rate. If the heart rate
goes up when the fetus moves, the test is normal. If the heart rate doesn’t
increase, the baby may be “sleeping.” Sometimes, the technician may wantyou to
“wake up” your baby, by rubbing your abdomen or making a loud noise above
your abdomen with a special device.
Contraction stress test (CST). This test is often recommended if you have an
abnormalnon-stress test. Uterine contractions are produced either by stimulating
the woman’s nipples or via an intravenous administration of pitocin.
Oxytocin/pitocin is a hormone that causes the uterus to contract. When your
uterus contracts, the baby is momentarily deprived of its usual blood supply and
oxygen. Most babies have no problem with this, but some aren’t healthy enough
to handle the stress, and they develop an abnormal heart rate pattern.It is
typically done to assess fetal well-being before you are in labor. By providing a
contraction similar to the stress to your baby during labor, your health provider
can better assess your baby’s health by his or her ability to tolerate stress.
If the baby’s heart rate slows down rather than speeds up after a contraction, the
baby may be in jeopardy, and you may need to have a cesarean section to get the

9. baby out quickly. The stress test is considered more accurate than the non-stress
test, but it’s not 100 percent accurate. Your health care professional might want
to repeat it to ensure accuracy. Most women describe this test as mildly
uncomfortable, but not painful.
Biophysical profile. If the baby doesn’t react during a non-stress test, your health
care professional may order a biophysical profile. This test uses a combination of
a non-stress test and a detailed ultrasound to evaluate the baby’s movement,
body tone and breathing efforts, as well as amniotic fluid volume.
Amniotic fluid index. This test is often performed weekly toward the end of
pregnancy in women with high blood pressure, diabetes or other medical
problems. It estimates the amount of amniotic fluid in the fetal sac to make sure
there isn’t too much (a condition called polyhydramnios) or too little (a condition
called oligohydramnios). Both conditions may cause problems for mom and baby
and can be a sign of other problems. If your health care provider suspects an
abnormal fluid level, he or she may perform an amniotic fluid index (AFI). During
an AFI, an ultrasound machine is used to scan the uterus and measure the
amniotic fluid around the baby.
Blood sugar screening. The American College of Obstetricians and Gynecologists
(ACOG) strongly suggest all pregnant women be screened for gestational
diabetes, a form of diabetes that occurs during pregnancy.Generally, the
screenings occur between the 24th and 28th weeks of pregnancy, which coincides
with the end of your second trimester or the beginning of your third trimester.
Screening is so important because intervention can make a big difference in the
health outcome of both a mother with gestational diabetes and her baby. For
women who have a body mass index (BMI) greater than 30, this is usually done
twice during the pregnancy, with the first test occurring in the first trimester.
Glucose loading test (GLT). Also called a glucose challenge test, this test is easy
and painless. You drink a super-sweet glucose liquid and one hour later your
blood sugar level are measured to see how your body handles the sugar. You
shouldn’t eat or drink anything (except water) during the one-hour waiting
period. If you’re scheduled for this test, ask your health care professional if you

10. have to fast beforehand or make any other special preparations.Most health care
professionals consider a woman to have gestational diabetes if her blood sugar
level is between 130 mg/dL to 140 mg/dL or higher.
However, since not all women with a positive screening have diabetes, further
testing is required with a three-hour glucose tolerance test (GTT), described
below.
Three-hour glucose tolerance test (GTT). This test usually occurs first thing in the
morning in your health care professional’s office or a laboratory. For 10 to 14
hours beforethe test, you shouldn’teat or drink anything except water.Theday of
the test, a technician draws your blood to measure your fasting blood sugar level.
Then you drink some more of the super-sweet glucose drink. Some women feel
nauseated when they drink this, but nausea should subside quickly. Then blood is
drawn every hour for three hours after the glucose drink. If two or more of your
blood sugar levels are higher than a certain threshold, you have gestational
diabetes.
Gestational diabetes is a form of diabetes that occurs because of pregnancy-
induced changes in the way your body processes sugar (glucose) from food,
leading to high blood sugar levels. An estimated 3 to 5 percent of all pregnant
women in the United States are diagnosed with the condition. It doesn’t cause
birth defects because women with the condition don’t experience abnormal
blood sugar levels during the first trimester, when most diabetes-related birth
defects occur. However, if your blood sugar remains high, the baby may grow too
large to pass easily through your birth canal.
You are at greater risk for developing gestational diabetes if you are obese; have a
family history of diabetes or have previously given birth to a very large infant; or
have had a stillbirth or a child with certain birth defects. One study showed a
strong relationship between a mother’s birth weight and her risk of getting
gestational diabetes during her first pregnancy—women with low or high birth
weights had an increased risk.

11. You also have a greater risk of developing the condition if you’re over 25,
Hispanic, African American, Native American, South or East Asian, Pacific Islander
or indigenous Australian.
Gestational diabetes almost always disappears after you deliver your baby,
although your risk for developing diabetes later will then be increased. A very
small percentage of women continue to have diabetes after delivery, so your
blood sugar will be assessed two to six weeks after the birth to make sure your
diabetes is gone.
The main concern with gestational diabetes is that the baby may develop a fetal
macrosomia, a condition in which it grows more than 9 pounds, 4 ounces before
birth, regardless of its gestational age. This occurs because the baby is getting
large amounts of glucose from the mother, which triggers the baby’s pancreas to
produce more insulin. The extra glucose, then, is converted to fat.
In some cases, the baby becomes too large to be delivered through the mother’s
vagina, requiring a cesarean delivery.
Gestational diabetes also increases the risk of hypoglycemia, or low blood sugar,
in the baby right after delivery. This medical problem typically occurs if the
mother’s blood sugar levels have been consistently high, leading to high blood
levels of insulin in the baby. After it’s born, the baby continues to have a high
insulin level but no longer has the high levels of glucose from the mother. So the
newborn’s blood sugar levels drop sharply and suddenly. Your baby’s blood sugar
levels will be checked in the newborn nursery, and if they’re too low, the baby
may receive oral or intravenous glucose.
Babies whose mothers have gestational diabetes or whose mothers had insulin-
dependent diabetes before they became pregnant are also at higher risk for
respiratory distress syndrome (RDS) after birth, a condition that makes it hard for
the baby to breathe.

12. Additionally, children whose mothers had gestational diabetes are at higher risk
for getting diabetes as they get older and are more likely to be obese as children
or adults, which can lead to other health problems.
Like other forms of diabetes, this condition can be managed once it is diagnosed.
The goal is to keep your blood sugar levels within normal ranges (less than 95
mg/dL when fasting, less than 130 to 140 mg/dL one hour after eating).
You can usually do this by following a specific diet high in complex carbohydrates
(such as whole-grain cereals) and low in simple sugars, such as found in cakes and
candies. Ask to meet with a nutritionist to develop the right diet for you.
You may also need to monitor your blood glucose yourself. Self-blood glucose
monitoring allows you to track your glucose levels at home without extra trips to
your health care professional. You may need to test your blood several times a
day, usually first thing in the morning before eating and one to two hours after
each meal.
You do this with a device that pricks your finger for a drop of blood. You put the
blood on a test strip, insert it into a small machine and the results appear on the
monitor.
If you can’t control your blood sugar levels through diet alone, you may need
insulin, a hormone you take via a shot that helps return your blood glucose levels
to normal.
There’s no cut-off point that automatically triggers the need for insulin. Many
health care professionals recommend insulin treatment when blood sugar levels
exceed 95 mg/dL first thing in the morning (the fasting sugar) or if post-meal level
exceeds 140 mg/dL on two separate tests. Others are stricter—recommending it if
fasting levels are higher than 90 mg/dL or if post-eating levels exceed 120 mg/dL.
Another fairly common but potentially serious complication of pregnancy is
preeclampsia, which is characterized by high blood pressure and excess protein in
the urine. Preeclampsia, previously referred to as toxemia, usually occurs during

13. the second half of pregnancy, although it may occur earlier and can continue after
the baby is born.
Itoccurs in at least 5 percent to 8 percent of pregnancies. Signs include high blood
pressure and higher-than-normal amounts of protein in your urine. Symptoms
include headaches, changes in your vision and upper right abdominal pain.
Rapid and excessive swelling in hands and face were at one time considered
possible symptoms of preeclampsia but are no longer regarded as symptoms.
Many women experience some swelling during pregnancy. If your rings or shoes
start feeling too tight, don’t panic. Talk to your health care provider about
measures to relieve the discomforts.
Preeclampsia is more likely to develop during your first pregnancy and if other
women in your family developed it during their pregnancies. It’s also more
common in women pregnant with more than one baby, those in their teens and
over 40 and those with high blood pressure or kidney disease.
Preeclampsia is dangerous for your baby because it can interfere with your
placenta’s blood supply. The placenta is the source of nutrition and oxygen for
your baby. Any problems with the blood supply can affect the amount of
nutrients and oxygen the baby receives and could lead to a low birth weight or
other problems. Additionally, a small number of women go on to develop
eclampsia, which includes dangerous seizures.
Unlike gestational diabetes, there really isn’t one test that can diagnose
preeclampsia. That’s why it’s so important that your blood pressure and urine be
checked during each prenatal visit. Blood pressure readings significantly higher
from one visit to the next could be an early sign of preeclampsia, as can high
levels of protein in your urine.
Other warning signs that could indicate preeclampsia include:
 Severe headache that doesn’t improve with acetaminophen (Tylenol)
 Abdominal pain in the upper right area just below your rib cage
 Double vision or blurred vision or persistent spots before eyes

14.  Sudden blindness (rare)
 Nausea or vomiting
We don’t know what causes preeclampsia, but there are several theories,
including:
 Not enough blood getting to the uterus
 Hormonal imbalances affect the size of blood vessels
 Damage or injury to blood vessel linings
 Too little calcium
Undiagnosed high blood pressure of other condition such as diabetes, lupus,
sickle cell disease, hyperthyroidism or kidney disease
 Immune system deficiency
 Too little or too much protein in the diet)
 Poor diet (not enough fruits and vegetables)
 High levels of body fat
 Too little magnesium and vitamin B6
There is some evidence that vitamin D deficiency may increase risk of
preeclampsia. A 2010 study published in the American Journal of Obstetrics and
Gynecology found that vitamin D levels were generally lower in women with early
severe preeclampsia compared with those of healthy pregnant women. Talk to
your health care professional about vitamin D and how to boost your intake with
food and/or supplementation.
Most women with preeclampsia give birth to healthy babies because the
condition is usually identified early enough in pregnancy for your health care
professional to intervene.
The single most important thing you should do is rest and reduce the stress in
your life. Also ask your health care professional about any dietary changes that
may help you stay healthy. Your health care professional may also want to see
you more often to monitor your blood pressureand weight gain. Additionally, you

15. may need a non-stress test, biophysical testing and fetal movement counts to
keep an eye on how your baby is doing in light of your high blood pressure.
If you are on or near your due date and have been diagnosed with preeclampsia,
discuss the risks and benefits of delivering early via induced labor or cesarean
section with your health care professional as a way to end the preeclampsia. A
cesarean is only necessary when the preeclampsia is severe.
Anemia. This fairly common pregnancy condition occurs when you have low levels
of hemoglobin in your blood. Hemoglobin carries oxygen to your body tissues
through red blood cells. Pregnant women often become anemic as a result of
normal changes in their bodies. Fortunately, in most cases, it’s not harmful to
either mother or baby.The most common cause of anemia is iron deficiency
because your body uses iron to make hemoglobin. Other common anemias are
related to folic acid deficiency, blood loss and genetic illnesses such as sickle cell
disease.
Anemia during pregnancy is diagnosed by assessing the percentage of red blood
cells/hemoglobin carriers to your total blood volume. Other laboratory tests may
be conducted to identify your particular type of anemia. Screening for the
condition is usually done early in the pregnancy, then again between the 24th and
28th weeks.
Signs and symptoms of anemia include:
 Tiredness, weakness or fainting
 Paleness and occasional breathlessness
 Headaches and nausea
 An inflamed or sore tongue
 Palpitations or an abnormal awareness of your heartbeat
Poor nutrition increases your risk of developing anemia, especially if you have
multiple vitamin deficiencies. Smoking also increases your risk because it reduces
your body’s ability to absorb important nutrients. Conversely, smokers may not
show the usual laboratory signs of anemia, because nicotine replaces hemoglobin

16. in the red blood cells. Yet these women’s bodies are starved for oxygen, which
stimulates the body to produce extra red blood cells, hurting the baby’s nutrition.
Excess alcohol consumption also increases your risk for anemia because it is
associated with poor nutrition. Other conditions and medications may place you
at risk for anemia. Your health care provider will discuss these with you if needed.
If you are anemic, your health care professional may prescribe iron and folic acid
supplements and recommend dietary changes, and urge you to increase rest.
Treatment
Now more than ever is the time to follow guidelines for a balanced, nutritious
diet. Early in pregnancy, your baby’s central nervous system and organs are
forming; later in pregnancy, the baby is growing longer and heavier. Your body
needs increased nutrients and protein to keep your baby healthy during
pregnancy.
As a basic guideline, nutrition experts who specialize in prenatal care recommend
you plan your meals and snacks to include foods from the following:
 Bread, cereal, rice and pasta, particularly whole-grains
 Fruit and vegetables
 Low-fat milk, yogurt and cheese
Meat, poultry, fish, dry beans, eggs and nutsA note about fish: Some fish contains
high levels of mercury that can harm your baby’s developing nervous system if
eaten regularly. However, a report released by the Institute of Medicine (IOM)
showed that the heart benefits of seafood outweigh the risks. The report showed
that omega-3 fatty acids found in fish promote healthy vision and brain
development in infants whosemothers consume seafood while they are pregnant
or nursing. Thesehealthy fats also appear to lower the risk of delivering a preterm
or low-birth-weight baby.
So does this mean you should eat fish or not? The answer is you should eat fish,
but you should make sure it’s the right kind. Guidelines issued jointly in 2004 by
the U.S. Food and Drug Administration (FDA) and the Environmental Protection

17. Agency (EPA) noted that pregnant women can safely eat up to 12 ounces (about
two servings) a week of a variety of cooked fish and shellfish with lower levels of
mercury, such as clams, oysters, catfish, crab, haddock and trout. If you choose
tuna, stay away from albacore, or white tuna, which contains higher levels of
mercury than regular canned tuna. The FDA and EPA also recommend that
women of childbearing age, pregnant women and breastfeeding women not eat
shark, swordfish, king mackerel or tilefish, which have high levels of mercury.
Fats, oils and sweets. Foods in this category lack nutrients and provide mostly
calories. They should be consumed in small amounts.
Weight Gain and Pregnancy
There is no magic number for how much weight you should gain during
pregnancy. Every woman is different when it comes to height, weight, physical
activity and metabolism. A healthy pattern of weight gain is about three to six
pounds during the first three months of pregnancy and about a pound a week for
the remainder of your pregnancy, but your health care professional will tell you
the appropriate amount for you.
General guidelines from the IOMrecommend that women who were underweight
before getting pregnant gain 28 to 40 pounds during pregnancy; normal weight
women gain 25 to 35 pounds; overweight women gain 15 to 25 pounds; and
obese woman gain 11 to 20 pounds.
Women who are pregnant with twins are given special guidelines from the IOM.
Those in the normal BMI category should aim to gain 37 to54 pounds; overweight
women, 31 to 50 pounds; and obese women, 25 to 42 pounds.
High weight gain during pregnancy is associated with a greater risk for cesarean
section and higher than normal birth weight and moderately associated with
weight retention later in life. On the flip side, low pregnancy weight gain can lead
to infants with lower than normal birth weights.
But gaining the appropriate amount of weight during pregnancy is easier said
than done, as most women know. That’s especially true if you suddenly have to
reduce your normal physical activity because of your pregnancy. To compensate,

18. limit snack foods high in calories and low in nutritional value, such as cookies,
doughnuts, chips, soft drinks and cakes. Choose fresh fruits, vegetables and skim
milk instead.
Also, if you’re obese during pregnancy you have a greater risk of having a
stillborn, premature or overly large baby, or a baby with neural tube defects. Your
baby also has a higher risk of being obese in childhood. Thus, the American
College of Obstetricians and Gynecologists (ACOG) recommends that obese
women planning to conceive get a preconception consultation, weight-loss
counseling and continuing nutritional counseling and exercise programs after
delivery.
Morning Sickness
If you’re concerned you’re not gaining enough weight or if your appetite is
decreased from morning sickness, discuss your concerns with your health care
professional. You may want to see a nutritionist to make sure you get enough
calories.
The good news is that the majority of women who suffer from morning sickness
will no longer have this problem after the third month of pregnancy. Your health
care professional can provide information on strategies to decrease nausea and
vomiting and, if these strategies don’t work, can offer medications for your
morning sickness. Here are some suggestions to help minimize this problem:
Eat saltine crackers or dry bread just before you go to bed at night and when you
first wake in the morning.
 Eat smaller, more frequent meals so your stomach never gets completely
empty.
 Avoid greasy or fatty food.
 Drink fluids between rather than during your meals.
 Get enough rest and take breaks when your energy level is low.
 Avoid highly seasoned foods, cream and strongly flavored vegetables such
as onions.

19. Take a total of 1 to 1.5 grams of powdered ginger in divided doses throughout the
day (after clearing it with your health care professional).
Take 25 mg three times a day of vitamin B6 alone or with the antihistamine
doxylamine (after clearing it with your health care professional).
If you have severe “morning sickness” that continues all day, every day, or lasts
beyond the first three months of pregnancy, discuss it with your health care
professional. You could have a condition called hyperemesis gravidarum that
affects up to 2 percent of pregnant women, causing extreme nausea and
vomiting.
Gastrointestinal problems
Heartburn. You may experience heartburn or indigestion during your pregnancy.
These problems typically show up later in the pregnancy and are caused when
stomach acid backs up into your esophagus, causing a burning sensation in your
throat and chest.
This occurs becauseduring pregnancy hormonal changes slow digestion and relax
the muscles that normally keep the stomach acids where they belong. Plus,
pressure from the baby tends to push on the stomach, causing acid reflux. Here
are a few things you can do to minimize discomfort from these feelings:
 Avoid large meals and eat more frequent, smaller meals.
 Avoid large spicy meals and fried or fatty foods.
 Avoid exercising or going to bed within two hours after eating.
 Ask your health care professional about antacids that might provide relief.
 Raise the head of your bed a couple of inches by putting the bed’s legs at
the headboard on a couple of bricks.
Constipation. You may also experience some constipation during your pregnancy.
This occurs partly because your baby puts pressure on your bowel, and partly
because of hormonal changes that slow the passage of food through your
digestive system.

20. To minimize constipation, eat foods that are high in fiber, exercise and drink lots
of nonalcoholic and noncaffeinated fluids.
Hemorrhoids. Sometimes your constipation may be accompanied by
hemorrhoids, enlarged veins near your anus. You may get hemorrhoids during
pregnancy even if you don’t have any problems with constipation. They occur, in
large part, because the growing baby puts pressure on these veins, causing them
to swell.
Try not to strain during bowel movements, because that could make your
hemorrhoids worse, leading to itching, soreness or even bleeding. If you have
hemorrhoids, increase your fluid and fiber consumption and check with your
health care professional before taking any medication.
Varicose Veins
Varicose veins are veins in your calves, thighs and vagina that become swollen
and painful during pregnancy. They get worse if you have to stand for long
periods.
The best remedy is to wear support stockings. Lying on your side or sitting with
your legs elevated can also help. If you must stand for a long time, move around
as much as possible and lift your heels or toes to increase circulation to your legs.
Sleeplessness
In the early months of your pregnancy, you may find you’re tireder than normal,
taking naps and sleeping longer. In later months, you may begin to experience
some sleep problems, including problems falling and staying asleep as the
growing baby makes lying down uncomfortable.
Some of these problems may get worse as you get closer to your delivery time,
and you may find you get your sleep in shorter stretches.
To help with pregnancy-related insomnia:
 Take warm baths before bed.

21.  Learn relaxation exercises.
 Lie on one side with a pillow between your legs or use a body pillow that
helps you stay in this position.
Emotions
In addition to the physicalchanges of pregnancy, you may also feel as if you’re on
an emotional roller coaster. During the first three months of pregnancy, you’re
still adjusting to the idea of being pregnant and the prospect of becoming a
mother (if it’s your first time) or adding another child to your family.
The middle part of your pregnancy may be more relaxing and calmer as you ease
into the routine of pregnancy and begin bonding with the baby.
During the last phase of your pregnancy, however, you may find yourself feeling
more anxious, fearing any complications during labor and delivery. Many women
experience nightmares or other disturbing dreams about their pregnancy, labor
and birth. Dreams are a way of expressing our anxieties.
Discussing your feelings with your partner and health care professional could help
allay some of your anxieties and make you feel more positive about the whole
experience.
Sexuality
Don’tbe surprised to find your feelings about sex with your partner change during
pregnancy. Some women report feeling increased sexual desire, during their
pregnancies, because of hormonal surges. At other times, you may feel a
decreased desire for sex.
Additionally, physical changes may interfere with your desire for sex, including
nausea, physical discomfort, fear of harming the baby and feeling less desirable
because of your weight gain and appearance changes.
In the absence of conditions such as vaginal bleeding and ruptured membranes,
sexual activity is safe during pregnancy. Don’t worry about hurting the baby
during sex; that won’t happen because of the cushion provided by the fluid in the

22. amniotic sac. Try different positions that don’t put pressure on your abdomen.
And if you’re concerned that sexual activity might interfere with or cause a
pregnancy complication, discuss the matter with your health care professional.
Your partner also may have a different sexual response to you during pregnancy.
Some women report their partner draws closer to them during pregnancy, while
others say their partners go through their own psychological changes and
withdraw from the relationship. If your relationship becomes strained, your
health care professional can refer you for counseling or other mental health
services.
The following discussion addresses treatment options for more serious medical
considerations during pregnancy that haven’t already been discussed in the
Diagnosis section.
HIV transmission. HIV is the virus that causes AIDS. About 25 percent of babies
born to untreated HIV-positive women become infected with the virus. But if
infected women take antiviral drugs during their pregnancy, this number can be
reduced to close to zero.
If you’repregnantand don’tknow if you haveHIV, you should get screened. If you
are HIV-positive, your health care professional can start you on drug treatment to
reduce the risk of transmitting the virus to your baby.
Miscarriage. Also known as a spontaneous abortion, a miscarriage is defined as
the loss of your pregnancy before 20 weeks’ gestation. It occurs in about 10 to 15
percent of all pregnancies.
Miscarriage usually happens in the first trimester—that is, during the first 12
weeks of pregnancy. After four months, it’s much less likely to occur. However,
the risk of miscarriage increases with age.
If you have a miscarriage, it’s important to know that it doesn’t necessarily mean
you won’t be able to carry a baby to full term in the future.
Early warning signs of a miscarriage include:

23.  Vaginal spotting of blood
 Pain in the lower back
 Cramps in the lower abdomen
 Heavy bleeding with clots
Most women who have bleeding or cramps during early pregnancy are
notmiscarrying, and the pregnancy usually progresses normally.
The loss of your baby through a miscarriage is emotionally traumatic. You should
discuss your feelings with your partner and others; your health care professional
can recommend a bereavement counselor if you want to consider this option for
helping you overcome your grief and loss.
Prevention
Throughoutpregnancy, you should avoid certain substances to keep your baby as
healthy as possible, before and after birth. They include:
Alcohol, drugs and tobacco. There is no known safe level of alcohol that you can
consume during your pregnancy. Heavy alcohol consumption can cause severe
defects in the brain and body development of your baby, known as fetal alcohol
syndrome(FAS). Even moderate drinking is associated with delayed growth of the
baby and causing spontaneous abortion or low birth-weight babies. The Surgeon
General warns pregnant women to avoid alcohol completely.
Prescription or over-the-counter medication. You may need to stop taking some
medications during your pregnancy or stop them for a while early in pregnancy
and then take them again later in pregnancy. Your health care professional will
discuss your options with you.Babies of mothers who use some illegal drugs, such
as heroin, are born addicted to these drugs. Other drugs that flow through the
mother’s bloodstream pass through the placenta into the baby’s bloodstream,
affecting the baby as well.
Cigarettes. If you smoke, ask your health care professional for help quitting.
Tobacco deprives your baby of oxygen during pregnancy and causes low birth
weight and increased respiratory and ear infections in infants and young children.

24. Caffeine. It is generally recommended that you avoid caffeine or limit your intake
during pregnancy and breastfeeding. If you do consume caffeinated drinks (such
as coffee, tea and soda), limit them to one to two cups or no more than 200
milligrams a day (the amount in one 12-ounce cup of coffee) or try decaffeinated
beverages. If you are a heavy caffeine user, remember that you may have
withdrawal headaches if you abruptly stop using caffeine. Discuss with your
health care provider how you can most comfortably and safely decrease your
caffeine intake.
Infections
Certain infections during pregnancy may be passed along to the baby during
pregnancy or birth, increasing your baby’s risk of birth defects. These infections
include:
Toxoplasmosis, an infection caused by a parasite in cat feces and raw meat. If you
have cats, assign someone else the duty of cleaning the litter box and wear gloves
if you garden in places where cats may frequent. Be sure to wash your hands and
all surfaces thoroughly after working with raw meat, and avoid eating raw meats.
Group B streptococcus (GBS). This is a type of bacterium that can cause bladder
infections and womb infections in pregnant women, and sepsis, meningitis and
pneumonia in newborns.About 10 to 30 percent of pregnant women carry GBS in
the rectum or vagina, but most don’t have any symptoms. These women are
considered “carriers.” The danger occurs if the baby comes in contact with GBS
before or during birth.
The Centers for Disease Control recommends screening all pregnant women
between 35 and 37 weeks gestation for the bacterium. If you have the bacteria,
you will likely receive intravenous antibiotics (e.g., penicillin or ampicillin) during
labor, which studies find can prevent most GBS disease in newborns.
Sexually transmitted diseases (STDs). Pregnant or not, be sure to use a condom if
you have sex with a partner who could havean STD so you can reduce your risk of
HIV/AIDS, syphilis, gonorrhea, hepatitis B, herpes and other STDs.If you are
diagnosed with an STD, make sure you take your medication as prescribed.

25. Depending on the STD, your partner may also need to be treated. Post treatment,
your provider may want to retest you to be sure that the infection is gone. Some
infections, such as HIV/AIDS and herpes, can’t be cured, but their effects on your
baby can be minimized or eliminated with treatment.
Workplace Hazards
Avoid on-the-job hazards that could be harmful to you or your baby, including
exposure to chemicals, gas, dust, fumes or radiation. Discuss all workplace
concerns with your health care professional. Employers that use potentially
dangerous chemicals should have material safety information/data sheets (MSDS)
to help you understand risks during pregnancy. The Occupational Safety and
Health Administration (OSHA) (www.OSHAsafety.com) is the federal agency that
provides information and regulates this area.
Exercise
If you’ve been exercising regularly before your pregnancy, chances are your
health care professional will encourage you to keep exercising with some slight
changes as your pregnancy progresses.
If you haven’t been exercising and want to start, your pregnancy is a good time.
Just be sure and discuss this matter with your health care professional first. And
remember to start slow and steady.
Exercise is important during pregnancy. It strengthens your muscles, eases some
discomforts of pregnancy and can help you prepare for delivery.
 Yoga can be particularly beneficial, helping with breathing and relaxing,
both of which come in handy during labor, childbirth and parenting. Some
precautions for yoga while pregnant:
 Avoid poses on your back after the first trimester.
 Avoid poses that stretch the stomach muscles.
Take care not to lose your balance; keep your heels to the wall or hold onto a
chair.

26. Bend forward from your hips, not your back.
Do twisting poses more from your shoulders and back to avoid pressure on your
stomach.
When exercising, don’t get overheated or extremely tired; drink a lot of water at
regular intervals; and slow down your overall workout.
Childbirth Education
Childbirth education and support can help ensure a joyful birth and transition to a
new family. Prenatal classes, usually offered at a local hospital approximately
three months before baby’s due date, help prepare you and your partner for
labor and delivery using proven relaxation, massage and breathing techniques.
The classes also provide discussion on important issues such as pain relief,
cesarean birth and breastfeeding. Plus, you usually get a tour of the labor,
delivery and postpartum areas.
Most childbirth classes follow a similar format: You and your partner join other
expectant couples for the course, which may meet one night a week for several
weeks, over an intensive weekend or as a private class taught in your home.
There are several, popular childbirth education programs available; some of the
most popular include the following:
The Lamaze method. Popularized in the early 1950s by French obstetrician Dr.
Ferdinand Lamaze, it emphasizes pain management through relaxation and
breathing exercises.
The Bradley method. Developed by Dr. Robert Bradley in the late 1940s, it
emphasizes a natural approach to childbirth, with few or no drugs and little
medical help during labor and delivery. The method stresses good diet and
exercise during pregnancy and teaches deep relaxation techniques to manage
pain. It also educates a woman’s partner so he or she can be an effective coach.
HypnoBirthing. HypnoBirthing, also called the Mongan Method, promotes using
deep relaxation, self-hypnosis and visualization to create a calm, serene,

27. comfortable birth. HypnoBirthing works both for women who want a natural
childbirth and those who require medical intervention during labor.
When looking for a childbirth class, you may want to look for an instructor who
has been certified by the International Childbirth Education Association (ICEA), an
organization that educates and trains childbirth instructors. The ICEA does not
promote any particular childbirth technique, so you should look for an instructor
who teaches the method you would like to use.
Here are some features to look for when choosing your class:
Instruction that supports birth as normal, natural and healthy and empowers
women to make informed choices
Class content that covers a broad range of topics, including positioning for labor
and birth; techniques to ease pain; labor support; communications skills;
postpartum care; and information about medical procedures, breastfeeding and
healthy lifestyles
At least 12 hours of instruction that includes practice for positioning and
relaxation and class discussion
Small classes with a maximum of 12 couples
Qualified instructors; look for certification from a nationally recognized program
Facts to Know
Most pregnancies last about40 weeks or 280 days, beginning from the first day of
your last menstrual period.
In the United States, 8 percent to 9 percent of women receive prenatal care from
midwives, 6 percent to 7 percent receive it from family physicians and the
remainder see obstetricians/gynecologists for pregnancy care.
About 3 to 5 percent of pregnant women in the United States are diagnosed with
gestational diabetes. This condition can be identified early in pregnancy and
managed to prevent complications.

28. Preeclampsia (also known as toxemia), a condition that may occur during the
second half of pregnancy, causes high blood pressure, swelling that doesn’t
subside and higher-than-normal amounts of protein in the urine.
Anemia during pregnancy occurs when you have a low level of hemoglobin, a
protein that carries oxygen to your body tissues via red blood cells. Anemia can be
caused by iron deficiency, folic acid deficiency, blood loss and hereditary diseases
such as sickle cell disease.
General guidelines from the IOMrecommend that women who were underweight
before getting pregnant gain 28 to 40 pounds during pregnancy; normal weight
women gain 25 to 35 pounds; overweight women gain 15 to 25 pounds; and
obese woman gain between 11 and 20 pounds.
Miscarriage occurs in about 8 percent to 20 percent of all known pregnancies,
usually during the first 12 weeks of pregnancy.
If you are HIV-positive, you can reduce your chances of transmitting the infection
to your baby by undergoing drug treatment while pregnant.
The rate of births delivered via cesarean section is increasing in this country. In
2007, about 68 percent of babies were delivered vaginally and 32 percent were
delivered via cesarean section.
Although episiotomy (an incision made between the vagina and the rectum—
called the perineum—to facilitate the birth) used to be routine during deliveries,
some studies have found that women who receive episiotomies do not have
significantly improved labor, delivery and recovery compared with women who
do not have one. Research has also shown that the adverse consequences of the
procedure, including a larger tear, dysfunction of the anal sphincter and painful
sex, are underestimated. As a result, the American College of Obstetricians and
Gynecologists (ACOG) now recommends limited use of episiotomies.
Key Q&A
How often should I see my health care professional during pregnancy?Every four
to five weeks until 28 weeks, every two to three weeks from 28 to 36 weeks, and

29. then weekly until you’reready to deliver. Of course, if you have any complications
you’ll see your health care provider more often.
What kinds of regular diagnostic tests can I expect to have during my
pregnancy?Your initial visit will include blood tests to check for your blood type,
Rh factor, anemia, immunity to rubella (German measles), hepatitis B virus and
some sexually transmitted diseases (STDs). You may also be tested for the HIV
virus. You will also have a Pap test to check for any possiblechanges in your cervix
that could lead to cancer. During other visits, you’ll always be weighed and have
your urine and blood pressure tested.
What diagnostic tests can I expect my health care professional to perform or to
order to check for abnormalities in the baby?An ultrasound, or sonogram, and a
maternal blood serum screening, which looks for certain fetal substances that
could be a sign of a birth defect, are fairly typical. Others you may be offered
include amniocentesis or chorionic villus sampling (CVS), which screen for
chromosomalabnormalities, and fetal monitoring, which checks your baby’s heart
rate and well-being before delivery.
I’m worried about the possibility of a miscarriage early in my pregnancy. What
warning signs should I look for?Early warning signs of a miscarriage include
vaginal spotting of blood, pain in the lower back, cramps in the lower abdomen
and heavy bleeding with clots. Miscarriage usually occurs in the first trimester, or
first 12 weeks of pregnancy.
What kind of diet should I follow during my pregnancy?Plan your meals to include
foods from the following groups:
 Bread, cereal, rice and pasta
 Fruit and vegetables
 Milk, yogurt and cheese
 Protein, including meat, poultry, low-mercury fish, beans, eggs and nuts
 Fats, oils and sweets (in small amounts only)

30. I’ve heard about morning sickness, but I have feelings of nausea at varying times
of the day. What is it and how can I alleviate this discomfort?Even if you are
taking good care of yourself and eating a healthy diet, you may have feelings of
nausea. This condition usually lasts only during the first three months of
pregnancy. There is no magic pill or vitamin to cure morning sickness, but you can
minimize it with certain lifestyle changes.
I’ve been exercising before my pregnancy, but now that I’m pregnant, how do I
know what is a safe level of exercise for me? If you’ve been exercising regularly
before your pregnancy, chances are your health care professional will encourage
you to keep exercising with some modifications as your pregnancy progresses. If
you haven’t been exercising and you want to start during your pregnancy, discuss
this with your health care professional and always remember to start slowly.
If I don’t have diabetes or any family history, do I still need to get tested for
gestational diabetes? The American College of Obstetricians and Gynecologists
strongly recommends that women with risk factors for diabetes have a blood
glucose screening at their first prenatal visit, and that all pregnant women get
screened for this condition between the 24th and 28th weeks of pregnancy.
What are some warning signs I should watch out for during pregnancy? If you
experience any of the following symptoms, report them to your health care
professional immediately: vaginal bleeding; leakage of fluid through your vagina;
uterine contractions; decreased fetal activity; or signs of preterm labor, such as
low, dull backache, increased pelvic pressure, vaginal bleeding or spotting,
menstrual-like cramps or diarrhea).
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