Answers to Prenatal Health and Nutrition Questions Video Transcripts
Multivitamins and Pregnancy Video Transcript
When a woman’s pregnant, everyone should be on multivitamins. In fact we have a special formulation just for pregnant women. Vitamins in pregnancy is a medical success story of the last 30 years. About 15 years ago a small study came out that showed that people who took a small, inexpensive multivitamin before pregnancy, during conception and during pregnancy had a reduced risk of birth defects. Doctors kind of laughed at the idea. “How could this little cheap multivitamin reduce birth defects!” So they did a large study with a large number of women and it should the exact same thing. So, now we want to make sure everybody is on multivitamins. The secret ingredient in multivitamins is folic acid. Folic acid is in all multivitamins but there’s extra in prenatal vitamins. That’s what helps reduce birth defects. Other ingredients in prenatal multivitamins include iron. Babies in the womb need a lot of extra iron; they steal iron from the mother’s blood supply so she needs extra iron. Unfortunately that can cause constipation which can be a problem so we want people to be on a high fiber diet and drink a lot of water to prevent that. Calcium is another added mineral you need during pregnancy. There’s a new nutritional supplement out called DHA. It is related to the omega 3 fatty acids also known in the general category of anti-oxidants. It’s an ingredient they put in multivitamins but you can also take it separately if you want to. Initial studies show it may help with baby’s brain development. At the moment this costs a little bit more. The basic prenatal multivitamins don’t have this in it but you can add it. The more expensive ones have it. We are waiting for more studies to come out to show us if this is really true. We don’t think it does any harm at this time, it might be helpful. But at the moment about half our patients go on them and about half do not. It depends on their personal feelings. Over the next few years women can talk to their health care provider and they should have more information about this new development.
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Do’s and Don’t of pregnancy Video Transcript
In pregnancy we have a lot of do’s and don’ts and some maybe’s. We have some things we absolutely don’t want you to do during pregnancy and some things you can do in moderation and some things are fine but people have misconceptions. Patients will come in almost in tears because someone has given them advice. It may have been right for that particular person’s pregnancy but wrong for my patient’s pregnancy. Sometimes the advice is a little bit weird but sometimes it’s good advice. I tell them when you have questions, write them down on paper and take them to your doctor and ask your doctor. Use your doctor to the best of your ability. Smoking is an absolute no-no in pregnancy. A lot of my patients don’t get pregnant ‘til they’ve quit smoking which is very difficult to do. We would like people to not smoke during pregnancy. Smoking is a poison. It goes through mom’s lung and her blood supply and technically goes through the baby. You only get one chance in life to make this particular baby and you want to make this the best baby possible. Cigarette smoking can have some adverse consequences. Some people it doesn’t do anything to their baby. Some people it can be very dangerous and it’s just that we don’t know. Sometimes we don’t know until your baby’s full grown. We advise people to abstain, to quit. We have ways to help you. There are programs to help you It is difficult. It’s not easy and I feel sorry for some people. If you cannot quit, we try to have you slow down or reduce as much as possible.
Another thing to not do in pregnancy is alcohol consumption. Twenty years ago we told people it’s okay to have a little alcohol in moderation during pregnancy. Forty years ago they used to use alcohol to prevent premature labor. Now we have some new studies out that show even small amounts can be harmful to babies. It’s total abstention during pregnancy. No alcohol at all, not even a common drink.
Others questions we’re commonly asked during pregnancy is about exercise. What can I do and what can I not do while pregnant. When my patients become pregnant I usually suggest to them to refrain from diving off the high board, parachuting and boxing. Seriously we’re trying to get people to refrain from ballistic-type activities, anything that might be dangerous. Horse riding we usually tell them to slow down. These are things you are not able to control and you might fall down and take a blow to your abdomen. A lot of exercise during pregnancy is just fine. The American College of OB/GYNs recommends that pregnant patients get about 30 minutes of aerobic exercise everyday. Sometimes that hard to get at work but sometimes you can get it just running around. The exercise during pregnancy will not guarantee you will have a perfect baby but it does help. It will make you feel better to get you up moving around and it will help prevent certain diseases. You’ll have decreased risk of gestational diabetes and a disease called phlebitis (blood clot in the legs). It all round gives people a sense of well being. It is not always required but it is encouraged. Certain exercises are more beneficial . . . walking, swimming is very good. Running and jogging are okay during pregnancy but in general you don’t want to take up a new exercise you weren’t used to doing before you were pregnant. If you’re a marathon running and you get pregnant, that’s fine; we’ll get you through it. But, don’t take up marathon running if you’ve never done it before you were pregnant.
There are certain medical or obstetrical conditions in which we would not want you doing exercise such as placenta previa where your placenta is down low. If you have a short cervix or are at risk of premature labor or you’re having bleeding in pregnancy, we really want you to decrease your activities if you have these conditions.
We get asked often about airplane travel. Can I fly on an airplane when I’m pregnant? The answer is yes. If you are 36 weeks or earlier in your pregnancy, air travel is usually okay. If you have questions, talk to your health care provider or talk to the airlines. Some airlines have different regulations. Most of them will not want you flying if you are past 36 weeks pregnant. They just don’t want you going into labor on their airplane. It costs them a lot of money to land somewhere else and makes them very unhappy. When you are flying drink plenty of water and stay hydrated.
Also, there is a disease called phlebitis. It’s rare but very serious illness and you can prevent it – when they remove the seat belt sign get up and walk up and down the aisles and stretch your legs a lot. Empty your bladder a lot to prevent bladder infections.
All these combined can help you have a little bit better pregnancy and put your mind at ease. But if you ever have any questions ask your health care provider.
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Weight Gain and Pregnancy Video Transcript
The things you work hardest for are the things you appreciate the most. The same goes for diet and pregnancy. All our patients come in and notice that we weigh them every visit. There are medical reasons for this. They get very concerned about their weight gain in pregnancy. In general weight gain in pregnancy is important but really what’s more important is what you eat. Your daily diet, what you take in, is much more important than your weight gain even though we do follow it. As a general rule, we’d like to see a weight gain of 25 to 30 pounds during the whole pregnancy. The majority of your weight gain is in the second half of pregnancy. Many people have nausea and vomiting during early pregnancy which resolves. But about 15 to 16 weeks into pregnancy, the nausea goes away and is replaced by this massive hunger and thirst. Sometimes it’s almost uncontrollable. A lot of water is needed during pregnancy to make a healthy baby. Also you need some extra calories; not double the amount, just a little bit more. Some people who are average weight gain about 25 to 30 pounds during pregnancy. If you’re underweight before pregnancy, you might gain a bit more . . . 25 to 40 pounds. People who are overweight before pregnancy might gain very little weight . . maybe 5 to 30 pounds and that’s very normal. It’s about your intake. You want a diet full of fruits and vegetables and non deep-fried food. You want to watch your calories. If you overeat during pregnancy you have a very high chance of having a very large baby or gaining extra weight which is hard to lose after delivery or even having a disease called gestational diabetes which is controllable but you decrease your risk by eating right in the first place.
Basically during pregnancy it’s water. Water all the time. At home, at work, in your car, everywhere you go drink water. It’s very important. Soda pop should be rare, like dessert. Just every once in a while if you have a craving that’ okay. Fruit juices and sweet drinks you can have but just one glass a day or less. That sounds drastic. Everyone thinks fruit juice has vitamins in it that are good for your baby. Yes, it has vitamins but it also has a lot of tag-along calories and this can really add up during a pregnancy. So you want to drink water for thirst and fruit juice for enjoyment now and then. The same thing goes for milk. All milk has the same amount of calcium and vitamin D. However you want stick with one percent or skim milk and drink it with meals not for thirst. A lot of our patients ask about chocolate milk. That’s really like ice cream. It’s a sweet treat you can have every once in a while. Be careful about fatty foods. Seafood is interesting problem right now. Twenty years ago we would say eat all the seafood you can. It’s brain food for the baby and very healthy. But now they are worried about mercury in seafood and want to limit your servings of seafood to two or three servings per week. If you really like fish, try to eat the fish that are not bottom feeders.
In general, it’s about what you put into it. Eating during pregnancy is very important. Also, if you tend to gain a little bit too much weight during pregnancy, breastfeeding is a wonderful idea. It is so important for your baby. It helps decrease your baby’s risk of illness after birth. It’s a lot of fun and a wonderful bonding experience. And if you breast feed, the weight falls off you. It’s one of the easiest ways in the world to lose weight after the baby. You’re only pregnant a few times in life and it’s something you don’t want to miss out on.
In general in diet during pregnancy, you want to do your best. Nobody’s perfect but follow a couple of simple rules. If you have questions, ask your health care provider.
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Medications During Pregnancy Video Transcript
I’ve been practicing obstetrics for more than 30 years. Medicines in pregnancy is one of the most important topics that has changed in that time. Medicines in pregnancy fall into four categories. Number one is safe medicines you can use any time during pregnancy. Number two are medicines we sometimes use but may have side effects and that’s a medicine about which you have a very deep discussion with your health care provider. The third category are medicines we absolutely never use. We call them X. They should never be used in pregnancy under any circumstances. The fourth category are medicines we just don’t know. These are usually new medications that have come out that we have not studied thoroughly and the jury will have to wait on those. But those we do observational studies. We don’t do active studies and give them to pregnant women to see what happens but we do retroactive studies and see if we discover problems for people who accidently took these during pregnancy.
This first category, the safe category, commonly include a lot of cold preparations, Benedryl, Tylenol are quite common. These are safe in pregnancy. We consider these like air and water. Very low chance of causing problems. The third category which is medicines we do not use. There are some antibiotics we do not use during pregnancy – Cypro, tetracycline or doxycycline medicines are things that can cause harm to babies. Other medicines that we would or would not use, if you have any problem with medicines, when you go to visit your doctor, write down your medicines. Your doctor on your first obstetrical visit will sit down and go over each of your medicines in great depth and talk about them. We have a new concept in the last two years across America called the pre-conception visit or early pregnancy visit with your obstetrician. This is a visit where as soon as you find out you’re pregnant, we zip you into the doctor’s office and sit down and have a long discussion and find out what medicines you are on or your medical conditions and things we would want to change immediately. Typical things are some anti-hypertension, people who have chronic blood pressure problems that are on medicine. There are many medications we use when you’re not pregnant that we cannot use in pregnancy. These medicines can be very harmful to the baby but we would switch you over to an anti-hypertensive that is safe.
People with diabetes. There are certain medications we use when we titrate your diabetes and have your blood sugar run as carefully as possible in consultation with your other doctors. These are all questions you bring in. It’s usually a short visit. It’s not an official first obstetrical visit but it’s just a quick checklist to see if there’s anything we should be doing right now to make a better baby later on.
The middle category; there are a lot of medicines we use in pregnancy that could have side effects but we don’t really have a choice. Typically these are anti-seizure medications – dilantin, phetabarbotol are quite common. These are medicines we have to use so what we do is find out which medicine is the safest for both you and the baby and sit down and talk in great depth about it with you. There’s another category of medicines. A lot of patients come in with brand new brand name medicines and we just don’t know. So we take that medicine and research it and find out is this the best medicine for you and your baby or is there something else we can switch you to. This is a changing environment. What we said about one medicine 15 years ago we find out that maybe we have better medicines or something safer. So this is changing. Every year this is a new topic to investigate with your doctor. Working with your health care provider our goal is to make you the very baby we can this pregnancy.
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