Warning signs of pregnancy complications

If one or more of these symptoms occur call your physician immediately, or call the labor and delivery department of your hospital:

1. Uterine contractions that feel like your womb is tightening (baby balling up)
2. Menstrual-like cramps that may come and go or are constant
3. Abdominal cramps with or without diarrhea
4. Low back aches that come and go or are constant
5. Pelvic pressure which feels like the baby is pushing down on your vagina
6. Change in vaginal discharge or a discharge that becomes mucousy, watery or slightly bloody
7. Vaginal discharge that has a "fishy" or foul odor
8. Vaginal irritation or itching that is severe
9. Urinary changes: increased urgency or feeling of need to urinate; decreased amount of urine; concentrated urine with strong or foul odor; pain or burning with urination
10. Excessive swelling of feet, legs, hands (rings are tight) or face (especially around eyes)
11. Frequent or severe headaches, dizziness, or confusion (inability to think clearly)
12. Visual changes: blurring or seeing spots before the eyes
13. Steady back or abdominal pain or nausea after the end of the first trimester
14. Decrease in fetal movement after 20 to 24 weeks into gestation period

Listening to your body

Treatment of minor discomforts^1,2

Moms-to-be sometimes have minor discomforts associated with their pregnancies. Here are some strategies for managing those discomforts:

Strategies for managing nausea and vomiting:

• Eat crackers, melba toast or dry cereal on awakening (before getting out of bed) and at other times when nauseated.
• Eat frequent small meals.
• Drink fluids such as flat, sugar-sweetened soft drinks and clear juices (between meals, not with) and avoid excessive fluids at time if nauseated - make up for lost fluids later.
• Avoid caffeinated tea and coffee (always avoid caffeine).
• Avoid food odors that make you feel ill.
• Limit intake of high-fat foods.
• Avoid skipping meals. Extreme hunger can cause nausea.

Strategies for managing heartburn:

• Eat small, low-fat meals and eat slowly.
• Snack on crackers, toast or fruit as needed.
• Drink fluids between meals, not with them.
• Avoid spicy foods.
• Eat slowly and chew thoroughly.
• Avoid lying down 1 to 2 hours after eating, especially before going to bed. Avoid bending over immediately after eating. Sleeping with head elevated may relieve symptoms.
• Wear loose-fitting clothing.

Strategies for managing constipation:

• Drink six to eight glasses of fluid daily; warm or hot fluids are helpful upon awakening.
• Eat high-fiber cereals, whole grains, fruit, vegetables and legumes.
• Engage in physical activities, such as walking.
• Do not take laxatives unless recommended by your provider.
• Stop what you are doing and immediately get to a toilet at the first urge to defecate.

Strategies for managing frequent urination:

• Limit fluid intake two hours before bedtime. Do not cut down on daily fluid intake; redistribute it. Call your physician if experiencing pain or burning when going to the bathroom.

Strategies for managing nasal stuffiness:

• Try using a humidifier.
• Use normal saline nose drops.

Strategies for managing vaginal discharge:

• Wear pads.
• Refer to physician if discharge becomes yellow, has a foul odor or causes burning or itching. Urinary Tract Infections [UTI] can cause preterm labor.
• Do not douche.

Strategies for managing fatigue and stress:

• Prioritize your commitments.
• Eliminate non-essential "duties."
• Get help from your spouse, or another family member.
• Relax your housekeeping standards.
• Plan ahead for errands and group them if you can. If possible, rest with feet up at lunch and/or breaktime.
• Reduce the noise in your environment.
• If certain activities make you tense or frustrated, try to change or avoid these events.
• Know your physical and intellectual rhythms and take advantage of them (e.g. if you are a morning person, do your difficult jobs then).
• Avoid rushing by planning a little extra time for everything.
• Don't over-schedule yourself. Be realistic.
• Learn to say no. Be assertive.
• Avoid or reduce entertainment that causes you to feel tense.
• Try not to make too many changes at once, if possible. Even changes for the better cause stress. For example, don't start new job, move to a new house and start school all in the same year.
• Exercise regularly within your physician-established guidelines.
• Eliminate caffeine and nicotine.
• Eat a well-balanced diet.
• Get adequate sleep.
• You may want to try meditation, deep breathing, visualization or a similar technique.
• Make time for fun - whatever you enjoy.
• Develop a support network.
• If you feel like crying, do.

1. Institute of Medicine, Nutrition During Pregnancy and Lactation: An Implementation Guide, National Academy Press, 1992.
2. Bobak & Jensen - Maternity & Gynecological Care, Mosby, 1993.
3. Fact Sheet. Community Counseling and Resource Centre, 1993.

Uterine palpation procedure (Braxton-Hicks)

You may experience irregular, non-painful uterine contractions. These contractions, also known as Braxton-Hicks contractions, are a normal occurrence. They begin during the first trimester and increase in frequency, duration and intensity as pregnancy progresses. The contractility of uterine muscle increases in pregnancy. Near term, strong Braxton-Hicks contractions are often difficult to distinguish from the contractions of true labor. The acceptable number of contractions in a one-hour time frame is determined by your physician. Be sure to discuss Braxton-Hicks contractions during a physician visit.

• Keep a clock or watch with easily readable numbers and a second hand available at bedside.
• Uterine contraction is a gradual tightening of the uterine muscle which lasts at least 35 seconds from beginning to end.
• When they occur, you need to monitor the uterine palpation through the following steps:
  
  1. Empty your bladder.
  2. Lie on your left side or in a comfortable position.
  3. Place the heel of both hands just above your hipbone on both left and right sides. Allow the palm of your hand and fingers to lie over the uterine abdominal area. Be aware of any tightening of the uterus.
  4. Time this tightening from the beginning, through the crescendo (when uterus is very hard) and the decreased tightening. When the uterus is no longer tight the contraction is completed.
  5. Count the number of times this occurs in one hour.
  6. If there are greater than the allowable number of contractions drink two (2) 12 oz. glasses of water, empty your bladder, lie on left side only and begin to palpate again for one hour.
  7. If contractions remain above threshold which has been established by your doctor after second hour of palpation, call your obstetrician immediately.

Your palpation program should be done as instructed by your obstetrician.

Gestational Diabetes

What is gestational diabetes?

Gestational diabetes is a special kind of diabetes that only happens during pregnancy and disappears following delivery. Changes that occur in your body while you are pregnant causes you to have too much blood sugar. Any woman might develop gestational diabetes during pregnancy. Some of the factors associated with women who have an increased risk are obesity, a family history of diabetes, having given birth previously to a very large infant, a stillbirth, or a child with a birth defect, or having too much amniotic fluid (polyhydramnios). Also, women who are older than 25 are at greater risk than younger individuals. Although a history of sugar in the urine is often included in the list of risk factors, this is not a reliable indicator of who will develop diabetes during pregnancy. Some pregnant women with perfectly normal blood sugar levels will occasionally have sugar detected in their urine.

The complications of gestational diabetes are manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made. If you have or develop gestational diabetes during your pregnancy, be sure to follow your doctor's directions for the special care you will need to manage it. Learn more. Your Nationwide Better Health nurse health coach is also available to discuss with you any questions you may have about gestational diabetes.

1. Understanding Gestational Diabetes; National Institute of Child Health & Human Development, National Institutes of Health.

Prevention of vaginitis and urinary tract infections

Practicing simple hygiene measures will help prevent vaginitis and urinary tract infections.

Vaginitis

• Wear cotton underwear and pantyhose with cotton crotch.
• Avoid wearing underwear to bed.
• Avoid tight fitting or restrictive clothing: for example, jeans, panty hose.
• Avoid vaginal sprays and deodorants.
• Avoid tampons/napkins that contain deodorants.
• Avoid douching, unless recommended by your health care professional.

Urinary tract infections

• Wipe from front to back following a bowel movement.
• Use soft, absorbent toilet tissue, preferably white and unscented. (Harsh, scented or printed paper may cause irritation).
• Maintain adequate fluid intake.
• To prevent stasis of urine, do not delay urination.
• Urinate before going to bed.
• Urinate before and after intercourse.

Nutrition

Adequate weight gain during pregnancy is vital. The desired amount of weight gain varies with the individual. Your obstetrician's recommendations will be based on your body mass index, (i.e. the appropriateness of weight for height prior to pregnancy). Not only must weight gain be adequate, it must be continuous throughout the pregnancy.

A woman with poor nutrition has a higher risk of giving birth to an infant who is small for gestational age. Poor weight can also predispose to pre-term birth.

There are many factors that conspire to make meeting nutritional needs during pregnancy difficult. Lack of time to eat properly, having to eat meals away from home and the desire to remain slender - or at least to avoid weight gain. Below are some strategies to accommodate your new nutritional needs. In addition, it is essential to take prenatal vitamins and iron as prescribed by your doctor.

Suggested strategies to improve your nutrition during pregnancy

When you have to eat some meals away from home:

• If packing a lunch, make a sandwich with two servings of bread and meat or eggs (avoid processed lunchmeats). Peanut butter and a piece of fruit and skim or low fat milk will help meet daily nutritional requirements.
• Cottage cheese, cheese or yogurt can be substituted for milk. A small amount of flavoring such as chocolate syrup may make skim milk more palatable.
• When eating out, the same principles apply. If eating in a fast food establishment, choose one with a salad bar. Make up the missed fruit requirement later in the day or at breakfast.

For a busy lifestyle:

• Make sandwiches for the week and freeze them. Have containers out and ready to pack the night before.
• Get breakfast utensils out before going to bed. Plan ahead - even if it's only deciding what to have for dinner as you leave for work. Once you make that decision, it's less likely that you will snack mindlessly.

Worried about losing your figure or weight gain

• Your developing baby has various nutritional requirements that can only be met by you properly eating during your pregnancy. Pregnancy is not the time to start a diet, however; following the nutritional guidelines also gives you a head start on healthy eating after delivery.

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Click to enlarge

Iron Supplements
If prescribed, it is important to be aware of interactions with certain foods. Bran, tea, coffee, milk, spinach, swiss cheese and egg yolk decrease iron absorption. Do not take them at the same time as an iron supplement. Vitamin C and hemeiron (in meats) increase iron supplement absorption. Iron is best absorbed when stomach is empty. Take between meals, with beverage other than coffee, tea or milk. If iron is causing abdominal upset, take at bedtime. Prenatal vitamins are commonly prescribed - some brands contain iron, others do not.

Folic Acid
Research has shown that women who take folic acid supplements at the time of conception are less likely to give birth to infants with neural tube deficits, e.g. spina bifida, anencephaly. In 1992, the U.S. Public Health Service recommended that preconception care include 400 micrograms of folate daily. Pregnant women are advised to take the same amount. Dietary intake of folate is not difficult. Eating 5 servings of vegetables or fruit daily should suffice. Learn more about folic acid.

Caffeine
Present in tea, coffee, some soft drinks and chocolate. It is best to limit caffeine intake during pregnancy, as some research indicates that caffeine intake of more than 300 mg. per day (approximately two 6-ounce cups of coffee) might cause low birth weight.

Sugar Substitutes
Saccharin should be avoided, as it crosses the placental barrier. In-utero exposure may predispose to later development of cancer. Aspartame, (NutraSweet, Equal) has not been found to have any adverse effects on normal mother or fetus. Pregnant women who carry the metabolic disorder gene phenylketonuria (PKU) should avoid sugar substitutes.

Alcohol
Currently, it is not known if there is a safe level of alcohol intake pre-conceptionally or during pregnancy. While fetal alcohol syndrome is well documented in infants born to mothers who are chronic alcohol abusers, less is known about the effects of alcohol on infants born to women who drink occasionally. Consequently, pregnant women should be counseled to avoid alcohol. Learn more about the risks of drinking during pregnancy.

Hydration
Water is essential for the exchange of nutrients and wastes across cell membranes. It is the major component of essential body fluid and maintaining body temperature. In general, pregnant women should drink eight 8-ounce glasses of water, milk or juice during each 24-hour period.

One practical way to meet your fluid requirements is to carry a special container marked at 8- ounce to make it easier to keep track of your intake. Dehydration acts as a uterine irritant that is a risk factor for preterm labor.

Exercise Tips For Pregnant Women
The following is general information regarding exercise and pregnancy. You must always check with your health care provider before starting or continuing an exercise program to ensure that the exercise is safe and appropriate for your particular situation:

• Consider decreasing weight-bearing exercises such as jogging or running, and concentrate on non-weight-bearing activities such as swimming, cycling, or stretching. If you are a runner, starting in your seventh month, you may wish to walk instead.
• Activities requiring precise balance and coordination may be dangerous. Avoid activities that require holding your breath and bearing down (Valsalva's maneuver). Jerky, bouncy motions also should be avoided.
• Exercise regularly - at least three times a week - as long as you are healthy. This will improve muscle tone and increase or maintain your stamina. Sporadic exercises may put undue strain on your muscles.
• Limit activity to shorter intervals. Exercise for 10 to 15 minutes, rest for 2 to 3 minutes, then exercise for another 10 to 15 minutes.
• Decrease your exercise level as your pregnancy progresses. The normal alterations of advancing pregnancy, such as decreased cardiac reserve and increased respiratory effort, may produce physiologic stress if you exercise strenuously for a long time.

Because strenuous exercise during the last few weeks of pregnancy increases the risk of low birth weight, still-birth, and infant death, reduce exercise sharply 4 weeks before your due date.

• You should be able to talk or carry on a conversation easily while exercising. If you cannot, you need to slow down.
• Avoid becoming overheated for extended periods. It is best not to exercise for more than 35 minutes, especially in hot, humid weather. As your body temperature rises, the heat is transmitted to your fetus. Prolonged or repeated fetal temperature elevation may result in birth defects - especially during the first 3 months.
• Learn more about exercise and pregnancy.

Smoking Risks
Although it is well known that smoking has adverse health effects on the general population, smoking has specific effects on fetal growth and development.

The risk factors include

• Low birth weight
• Pre-term labor
• Premature rupture of the membranes
• Complications associated with the placenta

If you smoke
Analysis of data from 30 years of research on maternal smoking found that it is responsible for 3 percent to 8 percent of all prenatal deaths. Between 20 percent and 40 percent of sudden infant deaths are attributed to smoking. Smoking is also known to cause spontaneous abortions. ⁵

There is also a relationship between smoking and cleft palate. The California Birth Defects Monitoring Program concludes that women who smoke one pack of cigarettes per day had twice the risk of having a baby with a cleft palate compared to nonsmoking women. ⁶

Here are some ideas to help you quit.

Even if you don't smoke in pregnancy
Continued exposure to second-hand smoke carries the same risk. Here's some additional information about second-hand smoke and how to avoid it:

• Centers for Disease Control and Prevention
• EPA

5. Journal of Family Practice, 40:385-394 April 1995
6. Medical Interface, June 1996, p45