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Pregnancy: Health Information

Pregnancy is an exciting time for a woman, but it can also be overwhelming. To ensure the best possible outcome for you and your baby, it’s important to eat right, exercise and get plenty of rest. You should also talk to your doctor about the potential effects of any medications you might use in the course of your pregnancy.

Are You Pregnant?

Before a pregnancy is confirmed, an expectant mother is likely to experience a number of symptoms that could indicate that a baby is on the way. These include:

• Nausea and vomiting (morning sickness)
• Breast tenderness
• Headaches
• Cravings
• Spotting or slight bleeding
• Fatigue
• Mood swings
• Frequent urination
• Missed period

You can confirm your pregnancy via a home test. These tests are available in any drug store, and are very convenient.

Seeing Your Doctor

Regular check-ups with your doctor are vital to ensuring both your health and the health of your baby. Most women have their initial appointment between the 6^th and 8^th weeks of pregnancy. The first visit will likely include:

• A complete physical
• A pelvic and rectal exam
• A complete blood cell count
• A urine sample
• A pap test
• Blood typing and screening

Your doctor may also want to conduct other tests, such as those that screen for HIV or other sexually transmitted diseases, as well tests to see if you’ve been exposed to chickenpox, mumps or measles.

If everything is normal, you will probably see your doctor once a month up until your 28^th week. From that point, visits will be scheduled every two weeks until the 36^th week. From the 36^th week on, you’ll see the doctor once per week.

Stages of Pregnancy

A normal pregnancy lasts about 40 weeks, and is measured in trimesters from the first day of your last menstrual period.

• First Trimester: A developing baby will form all of its vital organs during the first 12 weeks of pregnancy. At this stage, it is important that expectant mothers maintain a healthy diet, including adding an adequate amount of folic acid in order to help prevent neural tube defects. Avoid smoking and alcohol, as these behaviors have been linked to many serious pregnancy complications and birth defects. And discuss any medications you take with your doctor, to ensure they won’t put your baby at unnecessary risk.
• Second Trimester: During the second trimester, usually around the 16^th week, your doctor can determine the sex of the fetus. Bones, muscle tissue and skin have formed by then. You’re likely to start feeling movement around the 20^th week. During the second trimester, you’ll undergo an ultrasound to verify your delivery date, and to make sure your baby is doing well. You might also undergo amniocentesis to screen for potential birth defects. Your doctor will also want to test you for gestational diabetes between the 24^th and 28^th week.
• Third Trimester: A baby’s eyes can open and close by the 32^nd week, and the bones are almost fully formed. At your weekly appointments, your doctor will check your urine for protein, measure your fundal height, check your blood pressure, and listen to your baby’s heart rate. Your doctor will also determine the baby’s position and check your cervix in order to monitor how your body is preparing for childbirth.

Using Medications in Pregnancy

Since 1979, the U.S. Food & Drug Administration (FDA) has used pregnancy categories to help doctors determine what prescription medications are appropriate for use during pregnancy. These categories included:

• Category A: Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
• Category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
• Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
• Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
• Category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Recently, the FDA determined that the current pregnancy categories lacked clarity and failed to provide meaningful information.  By 2020, labels for prescription drugs will include more narrative descriptions to communicate the risks and benefits of using a particular medication during pregnancy. Other label changes include:

• Information on labor and delivery will be added to the “Pregnancy” section
• The “Nursing Mothers” section will be renamed “Lactation”
• A new section will be added called “Females and Males of Reproductive Potential.”

It’s important to discuss your medications with your doctor if you are expecting, or if you plan to become pregnant in the near future. Some drugs may pose a risk to your baby, including:

• SSRI Antidepressants: Studies suggest that women who take SSRI antidepressants in early pregnancy may be more likely to have a baby with birth defects. Most of these drugs, including Zoloft and Prozac, are included in Pregnancy Category C. However, Paxil has been placed in Pregnancy Category D.
• Zofran: Though it has never been approved to treat morning sickness experienced by expectant mothers, Zofran is often prescribed off-label for this purpose. Some recent studies suggest that pre-natal exposure to Zofran in the first semester may be associated with an increased risk of birth defects. The FDA currently classifies Zofran as a Pregnancy Category C drug.