Medical Concerns during the First Trimester

During the first trimester, you are will want to eat healthy and take your prenatal vitamins to ensure you and your baby are getting the proper nutrients. The first trimester will also require doctor’s visits and plenty of tests, exams, and screenings. Here, we look at medical concerns during the first trimester.

Finding a Medical Care Provider

If the doctor you visit for annual gynecological exams is an OB–GYN, you may have already chosen a medical care provider. If not, or you want to look at other options, now is the time to do your research. Here are a few healthcare professionals who can offer care throughout pregnancy:

  • Obstetrician: doctor who specializes in the care of pregnant women, including delivery of the baby (or babies). It is what the “OB” stands for. They receive specialized education regarding the female reproductive system and surgical care and focus on the detection and management of gynecological and obstetrical complications.
  • Perinatologist: obstetrician who specializes in high-risk pregnancies. Ask your current healthcare provider if you will need to see a specialist especially if you are concerned about past health conditions.
  • Family practitioner: doctors who may serve as an internist, pediatrician, gynecologist and obstetrician in small communities. If you choose a family practitioner for you medical care but complications arise or you require a Cesarean section for delivery, he or she may refer you to an obstetrician.
  • Certified nurse–midwife: registered nurse who has received additional training to deliver babies and provide prenatal and postpartum care. Not all midwives are certified nurse-midwives. Check credentials if you are considering someone with this title for care.
  • Advance-practice nurse or nurse practitioner: medical professional who has received postgraduate education in a medical specialty and holds either a master’s degree or a doctorate. NPs focus on individual care and how your health affects your life. They may also have more time to spend answering questions than a physician.
  • Physician assistant: qualified healthcare professional licensed to practice medicine in association with a licensed doctor. A PA can provide many healthcare services and may have more availability than your physician.

Whichever type of provider you choose, it is imperative you are comfortable with them. You will rely heavily on them as questions about pregnancy arise and you progress through this experience.

First Trimester Doctor Visits

During your first visit, expect to spend some time with your care team as they ask you questions that will help them determine care for your individual pregnancy. Try to pinpoint the first day of your last period if possible and bring that information to the appointment. Also bring a list of any questions you or your partner have regarding your care while pregnant.

A nurse or doctor will likely ask about the following:

  • Medical history/family medical history
  • Date of last menstrual period
  • Birth control methods
  • Pregnancy history
  • Current medications/allergies

He or she will also measure your blood pressure, height and weight and perform a breast and cervical exam, pap smear and cervical cultures. An ultrasound can help confirm your due date.

Your physician should spend some time discussing certain areas of your care to ensure you are comfortable. If you doctor skips this step, you may want to look for a new provider. He or she may cover diet, exercise, weight gain, steering clear of cat litter boxes, OTC medications during pregnancy [LINK to Week 5], prenatal vitamins and his or her office schedule—but don’t hesitate to ask questions of your own, too. Make sure you have the number to a nurse line and know when your next prenatal visit will be.

At the end of your appointment, your provider will likely put in an order for a blood test. This screening covers many conditions including the following:

  • Rubella screen
  • History of chickenpox, rubella and hepatitis vaccine
  • Cystic Fibrosis screen
  • Hepatitis B surface antigen
  • Tay Sach’s screen
  • Sickle Cell prep screen
  • HIV and other STDs
  • Hemoglobin levels
  • Hematocrit levels
  • Rh Factor and blood type (if Rh negative, rescreen at 26-28 weeks)
  • Specific tests depending on your medical history

Ultrasounds During Pregnancy

Ultrasounds, also known as sonograms, are often portrayed on television or in movies as the quintessential pregnancy doctor visit. This is because it provides the first visual representation of your baby, which can be an emotional experience. Here’s what is actually happening during an ultrasound: a trained professional uses a plastic transducer to transmit high-frequency sound waves through your uterus. The sound waves communicate signals back to the machine, which then converts them into images of your baby.

Ultrasounds are used to track growth, detect abnormalities, confirm your due date and number of embryos, and even determine the sex of the baby (or babies). Later on, doctors will use ultrasound to see the position of the placenta.

Ultrasounds are safe for both mom and baby, are performed without radiation and are painless. They should always be performed by a trained medical professional—avoid any ultrasounds you see advertised as a sneak peek at the sex of your baby. These are often inaccurate and not worth the risk.

A common ultrasound timeline includes:

  • 6 to 8 weeks: This initial ultrasound is used to confirm your due date, determine the number of embryos implanted and rule out ectopic pregnancy.
  • 11 to 13 weeks: If you choose to have a nuchal translucency (NT) test, you will require an ultrasound, which looks for Down syndrome. This test also requires a blood test.
  • 18 to 20 weeks: This detailed ultrasound called an anatomy scan is used to assess the baby’s growth and ensure all organs are developing properly. While a technician may perform the test, a doctor will review the images for abnormalities in the brain, heart, kidneys and liver. He or she will examine the placenta and check for birth defects. If baby cooperates, they may be able to determine the sex of baby so let them know ahead of time if you don’t want to know. The test will last 20 to 45 minutes for one baby and longer for multiples.

If your physician is having a difficult time seeing your baby via normal ultrasound (jelly on the belly), he or she may perform the test transvaginally. This simply means they will place a thin, wand-shaped transducer in your vagina. It will transmit high-frequency sound waves through your uterus and provide a more clear picture.

Your physician may also choose to perform more ultrasounds if he or she feels it is necessary during the third trimester. Talk to them about why they are performing extra ultrasounds and check with your insurance company to see if they are covered.

Tip: If your partner cannot join you for an ultrasound, record the baby’s heartbeat so he or she can enjoy this special moment, too.

Pregnancy Over 35

If you are pregnant over the age of 35, you may have heard unflattering terms like “elderly,” “geriatric” or “high risk” to describe your pregnancy. While this is how the medical industry describes pregnancies over 35, it is not aligned with current times. As humans’ life expectancies continue to rise and priorities shift, many women are waiting longer to have children. According to the Centers for Disease Control and Prevention (CDC), the first birth rate for women aged 35 to 39 rose dramatically—between 20 and 40 percent—across all U.S. states between 2000 and 2012.

While you may hear the term “high risk” during pregnancy, try not to let it bother you. Doctors now know turning 35 does not automatically mean you will have a difficult pregnancy. If you are healthy, active, of normal weight and don’t smoke, you can have an uneventful, healthy pregnancy. It just means you may have a bit more monitoring throughout the process.

Your doctor will look for signs of premature delivery, diabetes, placenta previa or preeclampsia as women over 35 are at higher risk for these conditions.

Additionally, the odds of having a baby with Down syndrome do increase with age. While a 20-year-old woman’s risk is 1 in 2,000, a 35-year-old’s risk is 1 in 350.

This is why women over 35 are offered further chromosomal screening tests, such as a quad screen test during the second trimester. There is also a newer blood test that screens fetal DNA in the mother’s blood and identifies chromosomal disorders with a high rate of accuracy. These tests are just screenings, meaning they show the likelihood of the condition, not a definitive yes or no. If your screenings show high odds, you can opt for more invasive testing that can determine if your baby has a chromosomal disorder.

During the first trimester, you can also expect several medical tests and screenings including:

  • Pelvic examination(s) to document the size and position of the uterus, check pelvic size and structure and perform a Pap smear to check for abnormal cells.
  • Urine tests to screen for bacteria, sugar and protein
  • Blood tests to determine blood type, Rh incompatibilities, and the presence of certain diseases and conditions
  • Genetic tests to detect inherited diseases
  • Screening tests to determine the odds of Down syndrome

Vaccinations and Immunizations

Since your baby can not yet protect itself from disease, he or she is counting on you to keep them safe. That means you should be up-to-date on all vaccines and immunizations. It is likely you are already vaccinated for measles, mumps, rubella, tetanus and diphtheria if you live in the United States or Canada. Talk to your doctor to determine if your immunity should be checked via a blood test.

During pregnancy, it is recommended that you receive a Tdap (tetanus, diphtheria, pertussis) immunization, which can help protect you from whooping cough. It is also recommended all pregnant women get the flu vaccine, which is safe any time during pregnancy. Pregnant women often have a lowered immune system, so catching the flu can lead to complications including pneumonia. Talk to your healthcare professional about your options.

Testing for Down Syndrome

One of the decisions you and your partner will need to make during pregnancy is whether you will test for Down syndrome. It is the most common chromosome abnormality and the most common cause of mental retardation, occurring in about 1 in 800 births. Some women are at higher risk of having a baby with this condition, including those over 35, those who have previously given birth to a baby with Down syndrome and those who have the disease themselves.

There are many tests available to screen for Down syndrome, including:

  • Maternal alpha-fetoprotein test
  • Triple-screen test
  • Quad-screen test
  • Nuchal translucency screening
  • Ultrasound

To diagnose Down syndrome, doctors use amniocentesis and chorionic villus sampling (CVS).

If you are interested in receiving these tests to screen for (and to later diagnose) Down syndrome, talk to your doctor right away, as some tests can only be performed during the first or early second trimesters.

If you are on the fence about running these tests, it is important to know they are available to you and can help you plan specialized care for your baby upon delivery if they do have Down syndrome. Ask your medical care team any questions you may have and work together to develop a screening plan.

The first trimester is a good time to learn the basics about cord blood banking and begin to decide what is best for your family

Morning Sickness

Morning sickness occurs in 50 to 75 percent of pregnant women and is caused by extra hormones being produced in the body as well as other factors. It is not harmful for you or your baby and should subside after the first trimester.

If vomiting becomes so severe you cannot keep food down, tell your care provider. You may have hyperemesis gravidarum, which can be harmful to your baby due to the lack of nutrients.

To relieve morning sickness, try to eat small meals throughout the day and drink fluids about 30 minutes before your meal instead of with it. You can also eat crackers first thing in the morning. And be sure to get enough rest and exercise.

Avoid becoming too warm or being around odors that bother you. And don’t lie down immediately after eating.

However, certain foods have also been known to help, including ginger, lemonade, watermelon and salty potato chips.

Ectopic (Tubal) Pregnancies

Seven in every 1,000 pregnancies is diagnosed as an ectopic pregnancy. This is when the egg implants outside the uterine cavity, usually in the Fallopian tube. Sometimes it is referred to as a tubal pregnancy for this reason.

Researchers believe these pregnancies are the result of several conditions, including STDs (specifically chlamydia and gonorrhea). The risk also increases when there is damage to the Fallopian tubes from pelvic inflammatory disease infections, endometriosis or surgery. Smoking may also increase your risk.

Symptoms of an ectopic pregnancy may include:

  • Cramps or low back pain
  • Tenderness in the lower abdomen
  • Bleeding or brown spotting
  • Shoulder pain
  • Weakness, dizziness or fainting caused by blood loss
  • Nausea
  • Low blood pressure

If you have any of these symptoms, let your physician know, as communication is the best way to lead to diagnosis. But try not to worry, as many of these symptoms (like nausea) can be caused by something else, like morning sickness.

It is best to diagnose a tubal pregnancy before it ruptures and damages the tube. Surgery or medications may be used to end the pregnancy.

Toxoplasmosis

If you have a cat, you may have heard that you should not change its litter or empty the litter box while pregnant. That is because toxoplasmosis, an infection that can cause a miscarriage or lead to an infected baby at birth, is easily spread by infected cat feces. While the mother does not suffer any symptoms of the disease, an unborn baby often does.

Antibiotics can be used to treat toxoplasmosis, but it is ideal to prevent the infection in the first place. Ask your partner or a family member to change the cat litter for you, wash your hands after petting your cat, and keep your cat off counters, tables and furniture as much as possible.

It should also be noted that toxoplasmosis can be caused by eating raw, infected meat. Wash your hands after handling raw meat and avoid cross-contamination of other foods while preparing meals.

Headaches During Pregnancy

Some women experience frequent headaches during pregnancy, especially women carrying twins or multiples. If you can identify what type of headache you are experiencing, you may be able to more easily remedy the situation.

    • Tensions headaches are caused by stress, fatigue, heat, noise, thirst, hunger, certain foods, loud music and bright lights. Try to relax as much as possible and ensure your environment is comfortable. Make sure you eat small meals throughout the day and are getting enough water. Also, be mindful of what you eat; peanuts, chocolate, cheese and even some meats can trigger a headache.
    • Cluster headaches come in groups and can last about an hour. Unfortunately these headaches can keep coming back for weeks or even months. Acetaminophen is safe [LINK to Week 5] to use for relief from these headaches. If you prefer not to take medication, try a shoulder massage or exercise to loosen up tight muscles.
    • Migraines are usually considered an inherited condition, but 1 in 5 pregnant women will experience a migraine during her pregnancy. These extreme headaches often last from a few hours up to three days. Fluctuating hormone levels can cause more migraines in some woman. Ginger is often recommended for migraines. If you feel one coming on, mix .33 teaspoon powdered ginger in a cup of water and drink three to four times a day for three days. You can also talk to your doctor about other safe ways to fight off migraines during pregnancy.

Other Strange Pregnancy Symptoms

You may be experiencing morning sickness, and you’ve likely heard enough about it. But there are plenty more odd ways pregnancy affects the body. Here are just a few to ponder:

  • Sense of smell: Any array of smells, from meat to trash, can turn your stomach; prepare for at least one stench to make you sick.
  • Fatigue: While hardly anyone else knows you’re pregnant, your body is working overtime to create a new life; you will be extra tired all the time. (Unfortunately, that doesn’t end once the baby is born…hello 2 a.m. feedings!)
  • Frequent urination: Your little one isn’t big enough to push on your bladder yet but you will still be peeing all. the. time.
  • Acne: Your hormones are all over the map, so prepare for acne in strange places across your body.
  • Hair growth: Your hormones and prenatal vitamins may cause your hair to grow in extra luscious during pregnancy, but it may also cause it to grow elsewhere on your body, too.
  • Belly changes: Not only is your belly expanding at a quick rate, your belly button may “pop” and a dark line will appear, extending from your belly button to crotch.
  • Stretch marks: Your body is a miracle worker, but it may come out the other side with some permanent reminders of the miracle it produced.

Over-the-Counter Medications during Pregnancy

It is important you take caution when considering OTC medication while pregnant. While several are safe (see list below) for a pregnant woman to take, others are not, or have not been tested for safety.

Here are some guidelines:

  • Do not take cold remedies that contain iodine
  • Avoid sudafed during your first trimester
  • Primatene Mist should not be used while pregnant
  • Be mindful with antacids, as it can interfere with iron absorption
  • Speak with your doctor before using a treatment for yeast infections

Here is a list of medications considered safe to take while pregnant:

  • Pain relievers and analgesics—acetaminophen (Tylenol)
  • Decongestants—chlorpheniramine (Chlor-Trimeton)
  • Nasal spray—oxymetazoline (Afrin)
  • Cough medicine—dextromethorphan (Vicks or Robitussin)
  • Stomach relief—antacids (Maalox)
  • Throat relief—lozenges
  • Laxatives—bulk fiber (Metamucil)

Your medical team should provide an exhaustive list of medications available to you during pregnancy. And if you are ever questioning one, call your doctor or ask a pharmacist.

If you are experiencing headaches during pregnancy, click to Week 9 to learn more about why they occur and how you can relieve them.

Bleeding and Spotting During Your First Trimester

Any sort of bleeding or spotting during pregnancy can be alarming. However, many women experience spotting or bleeding especially during the first trimester but then go on to have perfectly healthy babies.

It is considered spotting when there are a few drops of blood occasionally found in your underwear. It is considered bleeding when there is a heavier flow of fluid and you need a pad to keep your clothes from becoming soaked.

Implementation of the embryo may cause a few days of bleeding and will not cause harm to your baby. Cervical polyps (harmless growths on the cervix) can also bleed during pregnancy due to higher estrogen levels. However, bleeding may be a sign of pregnancy complications.

It is recommended that you contact your care provider whether you are spotting or bleeding. He or she may want to examine you to determine the cause and may recommend more time resting and off your feet or decreasing physical activity.

Medical Costs and Budget Prep

One thing you have undoubtedly heard about having a baby is that it is costly. From prenatal care to birth and delivery, the average cost of having a baby is around $8,000 in the United States, but the number can vary greatly in other countries.

Health insurance plays a huge role in the costs of medical care for your unborn baby. If you don’t have it, expect to pay for everything throughout the process. If you do, you will need to do some research regarding what is covered and what is not.

Here are a few questions to ask your insurance company about maternal care:

  • What type of coverage do I have and what are the maternity benefits?
  • What percentage of my costs are covered? What is the deductible?
  • Is there a cap to my coverage?
  • How do I submit claims?
  • How are Cesarean deliveries covered?
  • How are high-risk pregnancies covered?
  • Is my choice in hospital accommodations limited?
  • What tests, medications and pain management options are covered?
  • What process should I follow before delivery? After delivery to have my baby covered?
  • How long can I stay in the hospital?
  • What conditions are not covered?

Every “service” provided to you and your baby during prenatal care and delivery is recorded and billed to you or your insurance company. This includes everything from an epidural and hospital room to extra doctors needed for a Cesarean delivery and the pediatrician who examines your baby after he or she is born. The insurance company will review what is covered and what is not.

When it comes to costs, the best plan is to be prepared ahead of time. Talk to your insurance company or employer to understand your options and ask any questions you may have.

You are literally growing a human—there is no better excuse (or time!) to pamper yourself. The list of ways to enjoy your pregnancy is endless. Let’s discuss some.

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