Exposures
Painting
Painting is OK as long as 1) it’s with Latex or non-VOCs (volatile organic compounds) paint AND 2) it’s done in a well ventilated space.
Hair dye
OK after the first trimester or 14 weeks
Parvovirus (Fifths disease or hand slap)
Call with exposure. We’ll ask you to come in for labs.
Chicken pox exposure
If you’ve had it, you’re now carrying antibodies against it and there’s no problems for you or your baby.
If you’ve NOT had chicken pox… have we checked your immunity against it? If yes and you’re immune – it’s like you’ve had it and there’s no problem. If you’re not immune, you have to show signs of chicken pox for there to be any potential risk to baby. If you have chicken pox, call us immediately. DO NOT come to the office WITHOUT calling first. We will want to take precautions to decrease exposure to our other patients.
Shingles in the pregnant patient
There is no risk of birth defects if you have shingles during pregnancy. There is a small risk of transmitting it to your baby IF you deliver within the first 3-5 days of shingles appearing. After that, you’ve created enough antibodies to protect the baby. You do shed virus and are contagious to people who haven’t had chicken pox. Limit your exposure to others until the scabs heal over.
Shingles exposure
If you’ve had chicken pox, no concern like above.
If you’ve NOT had chicken pox and are exposed to shingles, wash your hands very well. It is possible to contract chicken pox from someone with shingles but it’s relatively hard to do so. If you start developing an itchy, bumpy, red rash, call as above.
Hand/foot/mouth disease (coxsackie virus)
This is a normal childhood virus that spontaneously resolves in 2-3 days. Very likely you’ve been exposed in the past and you’re protected. There is limited data on risk. Wash hands carefully if you’re exposed.
CMV
If you’re exposed and with symptoms like mono, we will bring you in for testing.
Travel & Exercise
Travel during Pregnancy
Car Travel
- Car safety doesn’t change for pregnant women.
- You should use the shoulder and lap belt.
- Keep your seat at least 10 inches back from dashboard.
- Airbags should be kept on for pregnant women.
- You should stop during car travel every 1-2 hours to walk around to prevent blood clots.
Air Travel
- In the absence of pregnancy or medical complications, the airlines will allow travel within 30 days prior to your due date. If you plan to travel by air after 34 weeks, please consult with your doctor. Please check with the airlines for their specific rules or requirements including possible need for documentation of your due date.
- Patients at significant risk for preterm labor or placental problems should avoid air travel.
- You should continuously wear your seatbelt while seated since air turbulence cannot be predicted; seatbelts should be worn low on your hip bones.
- Consider support stockings and periodic movement of your lower extremities to help minimize risk of blood clots.
- Metal detectors do not harm you or your baby.
- Always take a copy of your prenatal records if you are traveling far from home.
Exercise during Pregnancy
- Exercise should be performed most, if not all, days of the week for 30 minutes unless otherwise instructed by your OB provider.
- Swimming is an excellent, preferred form of activity.
- There are several activities that pose increased risks in pregnancy and should be avoided; scuba diving, activities that put one at risk for falls (skiing, horseback riding) or risk of belly trauma (soccer, basketball, riding roller coasters, kayaking or river rafting).
- Activities that may result in excessive joint stress should be done with caution (jogging). Exertion lying flat on your back should be avoided.
- Exercising above an altitude of 6,000 feet has not been determined to be safe in pregnancy.
- The lower end of your target heart rate range is preferred in pregnant individuals (60-70 % of maximum heart rate). You can use perceived exertion as well. You should be able to carry on a normal conversation with moderate exercise intensity.
Immunizations
Immunizations during Pregnancy
NO
- HPV vaccine is not recommended during pregnancy
- MMR (Measles/Mumps/Rubella) is a live vaccine and should not be given during pregnancy and one should avoid pregnancy for 28 days after receiving the vaccine. Your children should not be vaccinated during your pregnancy either.
- Varicella vaccine should not be given during pregnancy and one should avoid pregnancy for 28 days.
- Zoster vaccine should not be given during pregnancy.
- If you have a personal history of chickenpox and come in contact with chicken pox, shingles or herpes zoster; you should be protected.
YES
- Flu (influenza) vaccine is strongly recommended during pregnancy.
- Hepatitis B pre-exposure and post-exposure treatment is indicated for pregnant women at risk of infection.
- Hepatitis A pre-exposure and post-exposure treatment is indicated for pregnant women at risk of infection.
- Pneumococcus vaccine indications are not altered by pregnancy.
- Rabies vaccine indications for prophylaxis are not altered by pregnancy
- TB (tuberculosis) testing indications are not altered by pregnancy
- TDap (tetanus, diptheria, pertussis) is recommended with each pregnancy even if you have been vaccinated before. The CDC recommends all persons who will be in close contact with your newborn are also vaccinated.
First Trimester Bleeding & Cramping
First Trimester Bleeding
- 25% of normal pregnancies will experience first trimester bleeding, usually no more than a menstrual period flow
- Bleeding is very common 1-2 days after intercourse (sex does not cause miscarriage)
- Miscarriage is very uncommon after fetal heart tones are established
- Call AWMC immediately if bleeding accompanied by severe cramping/pain, fever (T>100.4) or chills, or if it lasts >24hrs. Please call during office hrs if otherwise.
First Trimester Cramping
- Early in pregnancy, uterine cramping can indicate normal changes of pregnancy initiated by hormonal changes; later in pregnancy, it can indicate a growing uterus. Cramping that is different from previous pregnancies, worsening cramping, or cramping associated with any vaginal bleeding may be a sign of tubal pregnancy or miscarriage.
- Other physical effects that are normal during pregnancy, and not necessarily signs of disease, include nausea, vomiting, increase in abdominal girth, changes in bowel habits, increased urinary frequency, palpitations or more rapid heartbeat, upheaving of the chest (particularly with breathing), heart murmurs, swelling of the ankles, and shortness of breath.
Medications & Diet
Dietary Considerations in Pregnancy
Iron — Experts recommend an increase in iron consumption by about 15 mg/day (to about 30 mg/day), an amount readily met by most prenatal vitamin formulations. Women who are anemic may need additional iron in pregnancy as prescribed by their doctor.
Calcium —The recommended daily allowance for elemental calcium is 1000 mg per day in pregnant and lactating women.
Folic acid — Folic acid requirements are higher in pregnancy. The recommendation is for all fertile women to take at least 400 micrograms of folic acid per day, increasing to 600 micrograms per day in pregnancy to meet the growth needs of the fetus and placenta.
Vegetarian diet — Vegetarian diets, particularly those that exclude all animal products, may not provide adequate amounts of certain proteins, iron, vitamin B-12, or complex lipids for normal embryonic development. These deficiencies can usually be resolved with minor dietary alterations; consultation with a registered dietitian is advisable
Alcohol– There is no safe amount of alcohol consumption in pregnancy. High doses of alcohol over time may lead to a preventable form of mental retardation called fetal alcohol syndrome.
Fish — Methylmercury exposure, primarily through ingestion of contaminated fish, can cause severe central nervous system damage. It is recommended that pregnant or nursing women
- Avoid eating any shark, swordfish, king mackerel, or tilefish because they may contain high levels of mercury.
- Do eat up to 12 ounces (two average meals) a week of a variety of fish and shellfish that are lower in mercury. Commonly eaten fish that are low in mercury include shrimp, canned light tuna, salmon, and catfish. Levels of methylmercury in other species are available at the EPA website at www.epa.gov/ost/fish. Check local advisories about the safety of fish caught in local lakes and rivers.
Caffeine —the available evidence suggests consumption of very large amounts of caffeine modestly increases the risk of miscarriage. However, caffeine consumption to one or two cups, or less than 300 mg, per day appears to carry no additional risks.
Artificial Sweeteners — There is no evidence that use of Nutrasweet, Splenda, Sweet ‘N Low, Sunnet, and Stevia by pregnant or breastfeeding women is harmful to their baby.
Herbal Supplements — There are no randomized trials evaluating the efficacy and safety of traditional herbal preparations in pregnancy. We recommend avoiding use of herbal medicines in pregnancy.
Avoidance of food borne illnesses — To reduce the risk of food borne illness, it is important that pregnant women:
- Consume only meats, fish, and poultry that are fully cooked
- Avoid unpasteurized dairy products
- Thoroughly rinse fresh fruits and vegetables under running water before eating
- Hands, food preparation surfaces, cutting boards, and utensils that come in contact with raw meat, poultry, or fish should be washed well with hot, soapy water
- Deli meats are generally thought to be safe if in date and refrigerated well.
Sample 2 hour OR 3 hour GTT Diet
If you are scheduled for a 2 hour OR 3 hour glucose tolerance test, please follow the sample diet below:
You will need to follow the sample diet for 72 hours prior to having your labs drawn.
Breakfast:
Pancakes with eggs OR Biscuit with eggs and cheese OR Egg sandwich
Lunch:
Pasta with grilled chicken OR Rice with salmon or another type of fish OR Grilled chicken sandwich with sweet potato fries
Dinner:
Steak and baked potato OR Pork tenderloin with mashed potatoes OR Shrimp with rice
DO NOT eat anything after 9:00pm the night before your lab draw. You may continue to drink water up until 12:00am (midnight). After midnight, no food or drink (including gum or mints). Please come to the office at your scheduled time and inform the front desk staff you are here for your 2 hour OR 3 hour glucose tolerance test.
Medical Therapy
Medications — Medications that reduce NVP have been proven to be effective in some women and are safe to take during pregnancy.
Over-the-counter:
Vitamin B6 and Doxylamine — Vitamin B6 and Doxylamine together three to four times per day has been shown to be safe and effective in reducing nausea and vomiting in pregnancy. Doxylamine is found in the over-the counter medication Unisom Sleep tablets. Suggested dosing is ½ Unisom tablet and 25 mg Vitamin B6 three to four times per day. For patients that have only nausea without vomiting, vitamin B6 alone may alleviate symptoms.
Ginger — Powdered ginger may help to relieve symptoms of NVP in some women. However, further clinical studies are needed to confirm that this treatment is both safe and effective.
Antihistamines and other anti-nausea medications — Antihistamines and other over-the- counter anti-nausea medications such as Dramamine and Emetrol are safe and effective treatments for pregnancy-related nausea and vomiting.
Antacids — Pregnant women often develop gastroesophageal reflux (heartburn), which can worsen nausea and vomiting. An antacid treatment may be recommended in this case. This is particularly useful for nausea in later pregnancy.
Medications for Common Ailments during Pregnancy:
Headache – Tylenol (regular or extra strength).
Sinus Problems/Head Colds – Sudafed, Tylenol Cold, Tylenol Sinus, Dimetapp, Dimetapp, Drixoral, Mucinex, Saline Nose Spray
Cough – Robitussin (Plain or DM)
Sore Throat – Chloraseptic Spray or sore throat lozenges/cough drops. (Report fever over 101 degrees.)
Nausea/Vomiting – Emetrol (if not diabetic), Dramamine (makes you sleepy), Meclizine
Indigestion/Heartburn – Antacids (chewable tablets or liquids), Papaya Enzyme Tabs, Tagamet, Pepcid AC, Prevacid, Prilosec
Constipation – Senekot or Perdiem (vegetable supplement), Colace, Citrical/Metamucil (fiber supplements). Do not use a stimulant laxative.
Diarrhea – Immodium AD, Kaopectate, Lomotil. Eat yogurt with live cultures like Dannon or Breyers.
Hemorrhoids – Witch Hazel, Tucks pads, Anusol, Americain, or Nupercain Ointment.
Insomnia – Benadryl, Tylenol PM
Rash – Benadryl cream or gel, topical hydrocortisone cream
Seasonal Allergies – Benadryl orally, Zyrtec, Allegra, Claritin after the first trimester
Dental Information
All dental work can be done during pregnancy. Elective procedures should be scheduled after the first 12 weeks. X-rays can be done (with shielding) at any time. The following medications are safe in pregnancy and can be prescribed/given by your dentist if needed:
- Local anesthetic
- Antibiotics (Penicillin, Ampicillin, Cephalosporins)
- Tylenol with Codeine
- Medications that are best to be avoided, except in extreme circumstances, are:
- Valium
- Nitrous Oxide
Tobacco Use
When you smoke cigarettes during pregnancy, you risk not only your own health, but that of your baby. Nicotine, tar, and carbon monoxide are some of the 1,500 chemicals that are inhaled with each puff.
Pregnant women who smoke are at increased risk for the following complications:
1. Ectopic Pregnancy
2. Miscarriage
3. Premature Delivery
4. Placental abruption/Premature separation of the placenta
5. Still birth
6. SIDS (Sudden Infant Death Syndrome)
Once the harmful effects of smoking are understood, many patients are able to make the extra effort to stop smoking, at least during the pregnancy. If you would like help in quitting, please let us know. Since it is important, we will probably discuss your smoking status several times during the pregnancy.
Nausea & Vomiting
Nausea and vomiting occur commonly during pregnancy and between 50 and 90 percent of women have some degree of nausea, with or without vomiting. Symptoms and severity may vary between patients but usually develops by 5-6 weeks of pregnancy. Nausea and vomiting of pregnancy (NVP) usually peaks at 9 weeks and gradually gets better by 12 to 14 weeks of pregnancy. Rarely, the nausea may persist until delivery.
Mild to Moderate Nausea and Vomiting of Pregnancy
Although the term for mild pregnancy-related nausea and vomiting is “morning sickness,” the symptoms may occur at any time of day and in most cases (80 percent), persist throughout the day. Many women, especially those with mild to moderate nausea and/or vomiting, do not need to see a healthcare provider for treatment of their symptoms. Below are some suggestions for management of your symptoms.
Non-medical therapy
Dietary changes — Women with NVP should eat before or as soon as they feel hungry in order to avoid an empty stomach, which may aggravate nausea. Women are advised to eat snacks frequently and have small meals that are high in carbohydrates and low in fat. Eliminating spicy foods and eating salty or high protein snacks/meals appears to help some women. Fluids are better tolerated if cold, clear, and carbonated or sour (ginger ale, lemonade) and if taken in small amounts between meals. Aromatic therapies involving lemon (lemonade), mint (tea), or orange have also been described as useful.
Avoidance of triggers — One of the most important treatments for NVP is to avoid odors, tastes, and other activities that trigger nausea. Examples of some triggers include: stuffy rooms, odors, heat, humidity, noise, and visual or physical motion. Brushing teeth after eating, quickly changing position, and not getting enough rest may also aggravate symptoms. If prenatal vitamins worsen symptoms, taking them at bedtime may be helpful. If symptoms persist, it is reasonable to stop the vitamins temporarily because iron can irritate the stomach.
Acupuncture and acupressure — P6 acupuncture or acupressure wristbands do not require a prescription and have become a popular treatment for NVP. Clinical trials have not shown these wristbands to be more effective than sham (fake, look-alike) wristbands, although some women find them helpful. P6 acupuncture or acupressure have no known harmful side effects.
Other Concerns
Fetal Kick Counts
Fetal kick counts should not be performed until your baby is at least 28 weeks gestation. This is for when you notice a period of time has elapsed without feeling your baby move. Put your hands on your belly and lay on your left side. If he/she kicks 10 times in the first 5 minutes, you’re done and there is no need to worry. However, it’s ok if it takes up to 2 hours for 10 movements to take place. Be reassured. If there are less movements in that amount of time, call the office.
Role of Primary Care Providers
To reduce the exposure risk in our office, AWMC encourages our pregnant patients to contact their primary care providers during office hours for suspected upper respiratory infections, coughs/colds, and any ongoing conditions for which they already receive treatment. We also encourage patients to review the provided materials for over-the-counter medications deemed safe for use during pregnancy and lactation. These steps are critical to help reduce exposure to other patients in our office and to avoid missing opportunities to maintain appropriate primary care during pregnancy.
Round Ligament Pain
This is a common pain syndrome that really intensifies around the mid second trimester, or around 20 weeks gestation. Some women will experience more pain in subsequent pregnancies due to lack of rectus muscle support and the ability of the large uterus to move around and shift. This creates a “pulling” sensation of the ligaments that support the uterus. This is not dangerous, but can be very uncomfortable.
Warning signs that your pain is not round ligament pain are as follows:
- Rhythmic pain that comes and goes in a regular pattern
- Blood in the urine or blood from the vagina
- Inability to tolerated foods or fluid accompanied by lower abdominal pain
- Fever of 101 or above
If the above symptoms are present, then you need to contact your doctor. Otherwise, ligament pain is harmless and can be relieved by rest, hydration, Tylenol or a heating pad.
Mission Hospital Registration
Around 26-28 weeks gestation (just after your Glucose screening), it will be time to register for your anticipated delivery at Mission Hospital. This will allow us to facilitate your admission in a timely fashion. Please go to the following link and enter your information.
