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Steven P. Shelov, M.D., M.S., F.A.A.P., pioneered and developed several of the parenting publications for the American Academy of Pediatrics, including Caring for Your Baby and Young Child, The First Year of Life, and A Guide to Your Child’s Symptoms. In 2002, he was presented with the Lifetime Achievement in Education Award by the AAP, its highest award for pediatric education. In 2009, Dr. Shelov received the Clifford G. Grulee Award, recognizing his outstanding service to the AAP.
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists, and pediatric specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults.
Preparing for a New Baby
Pregnancy is a time of anticipation, excitement, preparation, and, for many new parents, uncertainty. You dream of a baby who will be strong, healthy, and bright--and you make plans to provide her with everything she needs to grow and thrive. You probablyalso have fears and questions, especially if this is your first child, or if there have been problems with this or a previous pregnancy. What if something goes wrong during the course of your pregnancy, or what if labor and delivery are difficult? What if beinga parent isn't everything you've always dreamed it would be? These are perfectly normal feelings and fears to have. Fortunately, most of these worries are needless. The nine months of pregnancy will give you time to have your questions answered, calm your fears,and prepare yourself for the realities of parenthood.
Some of your initial concerns may have been raised and addressed if you had difficulty becoming pregnant, particularly if you sought treatment for an infertility problem. But now that you're pregnant, preparations for your new baby can begin. The bestway to help your baby develop is to take good care of yourself, since medical attention and good nutrition will directly benefit your baby's health. Getting plenty of rest and exercising moderately will help you feel better and ease the physical stresses ofpregnancy. Talk to your physician about prenatal vitamins, and avoid smoking, alcohol, and eating fish containing high levels of mercury.
As pregnancy progresses, you're confronted with a long list of related decisions, from planning for the delivery to decorating the nursery. You probably have made many of these decisions already. Perhaps you've postponed some others because your baby doesn'tyet seem "real" to you. However, the more actively you prepare for your baby's arrival, the more real that child will seem, and the faster your pregnancy will appear to pass.
Eventually it may seem as if your entire life revolves around this baby-to-be. This increasing preoccupation is perfectly normal and healthy and actually may help prepare you emotionally for the challenge of parenthood. After all, you'll be making decisionsabout your child for the next two decades--at least! Now is a perfect time to start.
Here are some guidelines to help you with the most important of these preparations.
Giving Your Baby a Healthy Start
Virtually everything you consume or inhale while pregnant will be passed through to the fetus. This process begins as soon as you conceive. In fact, the embryo is most vulnerable during the first two months, when the major body parts (arms, legs, hands,feet, liver, heart, genitalia, eyes, and brain) are just starting to form. Chemical substances such as those in cigarettes, alcohol, illegal drugs, and certain medications can interfere with the developmental process and with later development, and some caneven cause congenital abnormalities.
Take smoking, for instance. If you smoke cigarettes during pregnancy, your baby's birth weight may be significantly decreased. Even inhaling smoke from the cigarettes of others (passive smoking) can affect your baby. Stay away from smoking areas and asksmokers not to light up around you. If you smoked before you got pregnant and still do, this is the time to stop--not just until you give birth, but forever. Children who grow up in a home where a parent smokes have more ear infections and more respiratoryproblems during infancy and early childhood. They also have been shown to be more likely to smoke when they grow up.
There's just as much concern about alcohol consumption. Alcohol intake during pregnancy increases the risk for a condition called fetal alcohol syndrome (FAS), which is responsible for birth defects and below-average intelligence. A baby with fetal alcoholsyndrome may have heart defects, malformed limbs (e.g., club foot), a curved spine, a small head, abnormal facial characteristics, small body size, and low birth weight. Fetal alcohol syndrome is also the leading cause of mental retardation in newborns. Alcoholconsumption during pregnancy increases the likelihood of a miscarriage or preterm delivery, as well.
There is evidence that the more alcohol you drink during pregnancy, the greater the risk to the fetus. It is safest not to drink any alcoholic beverages during pregnancy.
You also should avoid all medications and supplements except those your physician has specifically recommended for use during pregnancy. _This includes not only prescription drugs that you may have already been taking, but also nonprescription or over-the-counterproducts such as aspirin, cold medications, and antihistamines. Even vitamins can be dangerous if taken in high doses. (For example, excessive amounts of vitamin A have been known to cause congenital [existing from birth] abnormalities.) Consult with your physicianbefore taking drugs or supplements of any kind during pregnancy, even those labeled "natural."
Fish and shellfish contain high-quality protein and other essential nutrients, are low in saturated fat, and contain fatty acids called omega-3's. They can be an essential part of a balanced diet for pregnant women.
At the same time, you should be aware of the possible health risks from eating fish while you're pregnant. You should avoid raw fish during pregnancy because it may contain parasites such as flukes or worms. Cooking and freezing are the most effectiveways to kill the parasite larvae found in fish. For safety reasons, the U.S. Food and Drug Administration (FDA) recommends cooking fish at 140 degrees Fahrenheit. The fish should appear opaque and flaky when done. Certain types of cooked sushi such as eel andCalifornia rolls are safe to eat when pregnant. The most worrisome contaminant in both freshwater and ocean fish is mercury (or more specifically, a form of mercury called methyl mercury). Mercury in a pregnant woman's diet has been shown to be damaging to the development of the brain and nervous systemof the fetus. The FDA advises pregnant women, women who may become pregnant, nursing mothers, and young children to avoid eating shark, swordfish, king mackerel, and tilefish due to high levels of mercury in these fish. According to the FDA, pregnant womencan safely eat an average of 12 ounces (two average meals) of other types of cooked fish each week. Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish: Albacore tuna tends to be high in mercury,so canned chunk light tuna is a better choice. If local health agencies have not issued any advisories about the safety of fish caught in your area, you can eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don't consumeany other fish during that week.
While no adverse effects from minimal caffeine intake (one cup of caffeinated coffee per day) have yet been proven, you may want to limit or avoid caffeine when you are pregnant. Remember, caffeine is also found in many soft drinks and foods such as chocolate.
Another cause of congenital abnormalities is illness during pregnancy. You should take precautions against these dangerous diseases:
German measles (rubella) can cause mental retardation, heart abnormalities, cataracts, and deafness. Fortunately, this illness now can be prevented by immunization, although you must not get immunized against rubella during pregnancy. If you're not surewhether you're immune, ask your obstetrician to order a blood test for you. In the unlikely event that the test shows you're not immune, you must do your best to avoid sick children, especially during the first three months of your pregnancy. It is then recommendedthat you receive this immunization after giving birth to prevent this same concern in the future.
Chickenpox is particularly dangerous if contracted shortly before delivery. If you have not already had chickenpox, avoid anyone with the disease or anyone recently exposed to the disease. You also should receive the preventive vaccine when you are notpregnant. Herpes is an infection that newborns can get at the time of birth. Most often, it occurs as the infant moves through the birth canal of a mother infected with genital herpes. Babies who get a herpes viral infection may develop fluid-filled blisters onthe skin that can break and then crust over. A more serious form of the disease can progress into a severe and potentially fatal inflammation of the brain called encephalitis. When a herpes infection occurs, it is often treated with an antiviral medicationcalled acyclovir. Women may reduce their risk of contracting the herpes virus by following safer sexual practices.
Toxoplasmosis is primarily a danger for cat owners. This illness is caused by a parasitic infection common in cats, but it also is found in uncooked meat and fish. The infected animal excretes a form of the parasite in its stools, and people who come incontact with infected stools could become infected themselves. To guard against this disease, see the box Protecting Against Toxoplasmosis on page 9.
Getting the Best Prenatal Care
Throughout your pregnancy, you should work closely with your obstetrician to make sure that you stay as healthy as possible. Regular doctor's visits up until the birth of your baby can significantly improve your likelihood of having a healthy newborn.During each doctor's visit, you will be weighed, your blood pressure will be checked, and the size of your uterus will be estimated to evaluate the size of your growing fetus. Here are some areas that deserve attention during your pregnancy.
Follow your obstetrician's advice regarding your use of prenatal vitamins. As mentioned, you should take vitamins only in the doses recommended by your doctor. Perhaps more than any other single vitamin, make sure you have an adequate intake (generally,400 micrograms a day) of folic acid, a B vitamin that can reduce the risk of certain birth defects, such as spina bifida. Your obstetrician may recommend a daily prenatal vitamin pill, which includes not only folic acid and other vitamins, but also iron, calcium,and other minerals, and the fatty acids docosahexaenoic acid (DHA) and arachidonic acid (ARA). Fatty acids are "good" fats, and DHA in particular accumulates in the brain and eyes of the fetus, especially during the last trimester of pregnancy. These fattyacids are also found in the fat of human breast milk. Make sure your doctor knows about any other supplements you may be taking, including herbal remedies.
Eating for Two
When it comes to your diet, do some planning to ensure that you're consuming balanced meals. Make sure that they contain protein, carbohydrates, fats, vitamins, and minerals. This is no time for fad or low-calorie dieting. In fact, as a general rule, youneed to consume about 300 more calories per day than you did before you became pregnant. You need these extra calories and nutrients so your baby can grow normally.
Physical activity is just as important when you're pregnant as at any other time of life. Discuss a fitness program with your doctor, including fitness DVDs or videotapes that you've found of interest. Particularly if you haven't been exercising regularly,your doctor may suggest a moderate walking or swimming regimen, or perhaps prenatal yoga or Pilates classes. Don't overdo it. Take it particularly slowly during the first few workouts--even just five to ten minutes a day is beneficial and a good place to start.Drink plenty of water while working out, and avoid activity with jumping or jarring movements.
Tests During Pregnancy
Whether your pregnancy is progressing normally or if concerns are present, your obstetrician may recommend some of the following tests.
An ultrasound exam is a safe procedure and one of the most common tests given to pregnant women. It monitors your fetus's growth and the well-being of his internal organs by taking sonograms (images made from sound waves) of him. It can ensure that yourbaby is developing normally and will help determine any problems or fetal abnormality. It also can be used if your doctor suspects that your baby is in the breech position. Although most babies are in a head-down position in the uterus at the time of delivery,breech babies are positioned so that their buttocks or feet will move first through the birth canal, before the baby's head. Although some breech babies can safely be delivered vaginally, the risk of complications may be higher in many breech deliveries, andthus your doctor may recommend delivery by Cesarean section. (For further discussion of breech babies and Cesarean births, see Delivery by Cesarean Section in Chapter 2, pages 51-54.)
A nonstress test electronically monitors the fetus's heart rate and movements. In this test, a belt is positioned around your abdomen. It is called a "nonstress" test because medications are not used to stimulate movement in your unborn baby or triggercontractions of the uterus.
A contraction stress test is another means of checking the fetus's heart rate, but this time it is measured and recorded in response to mild contractions of the uterus that are induced during the test. For example, an infusion of the hormone oxytocin maybe used to cause these contractions. By monitoring your baby's heart rate during the contractions, your doctor may be able to determine how your baby will react to contractions during the actual delivery; if your baby is not responding favorably during thesecontractions, the delivery of your baby (_perhaps by Cesarean section) might be scheduled prior to your due date.
A biophysical profile uses both a nonstress test plus an ultrasound. It evaluates the movement and breathing of the unborn baby, as well as the volume of amniotic fluid. Scores are given for each component of the profile, and the collective score willhelp determine whether there is a need for an early delivery.
Other tests may be recommended, depending on your own physical health and personal and family history. For example, particularly for women with a family history of genetic problems or for those who are age thirty-five or older, your obstetrician may advisetests that can detect genetic disorders. The most common genetic tests are amniocentesis and chorionic villus sampling, which are described in the box Detecting Genetic Abnormalities on pages 14-15.
Your doctor may recommend other screening tests. For example:
Glucose screening can check for high blood sugar levels, which could be an indication of gestational diabetes, a form of diabetes that can develop during pregnancy. To conduct the test, which is usually performed between the twenty-fourth and twenty-eighthweek of pregnancy, you'll be asked to drink a sugar solution and then a sample of your blood will be collected. If a high level of glucose (a type of sugar used for energy) is in the blood, then additional testing should be done. This will determine if youdo have gestational diabetes, which is associated with an increased likelihood of pregnancy complications.