Navigating Pregnancy with MD Mom: 1st Trimester
By: Kristi Tough DeSapri, MD • Posted on September 25, 2014
Statistics show that 1 in 2 pregnancies are unplanned or mistimed. So chances are if you are pregnant, you belong to either the surprised or planned pregnancy group!
I have been a member of both cohorts and plan to share my personal experience and medical advice in a series of columns aimed to educate and empower new and seasoned mothers-to–be. My wisdom derives from my dedication and career as a doctor specializing in women's health and mother of a now 14-month old happy and always hungry son.
Nausea and Fatigue in the 1st Trimester of Pregnancy
The first trimester of pregnancy often brings many mixed emotions. Excitement and nervousness for the 10 lunar months ahead (the long haul of a full term pregnancy is 40 weeks and sometimes 41-42 weeks) combined with feelings of nausea and fatigue. You're not alone, as 75% of women experience nausea and vomiting from pregnancy that can last all day (not just 'morning sickness'). Nausea tends to peak at 8-9 weeks of pregnancy when hormone HCG levels are highest, most women find relief of symptoms by 14- 15 weeks. The unlucky 1% of women who have a serious medical condition called hyperemesis gravidarum become dehydrated or lose weight due to excessive vomiting and food aversion. Occasionally, these women are hospitalized for IV hydration.
Tips for Alleviating Nausea
Thankfully, there are newer 'morning sickness' medications and a few good lifestyle modifications that may alleviate nausea. These include:
- Eating every 3 hours. Eating small frequent meals high in proteins and complex carbohydrates. Think nut butter with whole grain bread, cheese and crackers, trail mix with cereal, dry fruits and nuts.
- Stay hydrated. I found water distasteful during the early weeks, but adding lemon or trying seltzer water or light juices quenched my thirst. Caffeine can increase stomach acids and worsen symptoms. But the general allowance on caffeine is 200 mg/day which translates to 12 ounces of regular coffee.
- Eight hours of sleep. Finally, I found my nausea increased with fatigue, so put yourself to bed earlier and allow for 8 hours of sleep.
- Vitamins. If the tips above don't help the nausea, you can try increasing vitamin B6 intake by taking B6 supplements, 25 mg twice daily.
- Medications. Talk with your obstetrician about effective, safe medications called Zofran (ondansetron) that is primarily prescribed for nausea associated with chemotherapy or a newer FDA-approved combination medication called Diclegis (doxylamine/pyridoxine) that helps severe pregnancy nausea.
Don't suffer these symptoms in silence.
The 1st Trimester Appointment
Despite being a physician myself, I was overwhelmed by the amount of information and counseling as a new obstetric patient. Particularly important to understand is the discussion around pre-natal screening for chromosomal abnormalities.
Screening Tests during the 1st Trimester
- Typically, you will undergo a first trimester blood test (to evaluate for trisomy 13 and 18 which cause serious, often fatal neonatal outcomes) combined with an ultrasound to evaluate the nuchal (neck) thickness that is an early marker for Down's syndrome.
- If screening tests are positive or equivocal or if a couple is high risk for certain birth defects, you will discuss CVS (chorionic villus sampling) or amniocentesis, which removes fetal cells from the placenta or amniotic fluid respectively to tell with more certainty if the baby will be born with a detectable birth defect.
Recently, the FDA approved a single blood test with increased sensitivity for chromosomal abnormalities that detects fetal cells in a maternal blood sample. Currently, this technology can be done as early as 10 weeks gestation, but it is expensive and is approved for higher risk women such as:
- Women who are 35 years at the time of delivery
- Women who have a personal or family history of chromosomal abnormalities
- If the screening tests of ultrasound or blood tests are concerning
Each trimester is unique and the 1st trimester is akin to the first day of school or a new job. The adjustment to a new you plus 1 (or more!) growing in utero takes a few weeks. Don't spend time worrying about whether you'll receive an epidural during delivery or pick the wall decals to decorate your nursery. You'll have plenty of time for that later! And I'll address those issues in later columns.
Important To Dos in the 1st Trimester
Here's my short checklist of important to dos in the 1st trimester:
- Prenatal vitamins. Make sure you have started a prenatal vitamin or at least 400 mcg of folic acid to prevent neural tube defects. Best to start this well before any possible pregnancy.
- Quit smoking. If you are smoking, quit for yourself and the health of your fetus. Abstain from all alcohol.
- Safe medications. Review your current medications with your doctor and ask or better get a list of which over-the counter medications are safe in pregnancy. Tylenol (acetaminophen) is the preferred analgesic.
- Miscarriage signs. Know warming signs for miscarriage and how to reach your doctor or midwife in case of heavy bleeding or cramps.
- Weekly updates. Find a reliable, concise, evidence-based resource to read about fetal developments and anticipated changes of each trimester. I trusted “Your Pregnancy and Childbirth: Month to Month" published by American College of Obstetrics and Gynecology. Even my husband, a finance guru, enjoyed reading his weekly updates to follow along with my pregnancy.
Lastly, my obstetrician calls the 1st trimester “survival mode." This analogy gave me relief when I devoured a juicy hamburger in minutes or when I fell asleep at 8PM or when nausea prompted me to excuse myself from important meetings. Be patient with yourself and remember these novel hormonal changes are growing that beautiful baby inside of you.
Dr. Tough-DeSapri delivered a healthy, baby boy in February 2015!
Be Strong, Be Healthy, Be in Charge!
Kristi Tough DeSapri, MD
Director, Gynecologic Specialists of Northwestern Comprehensive Bone Center
Clinical Instructor of Medicine, Feinberg School of Medicine
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- Age, Eggs and Fertility