Strategies for a Healthy Pregnancy, Women's Health PDR Family Guide

t's one of the most exciting times in any couple's life: the planning, the preparation, and—finally—the reality of having a baby. Yet it's a worry­filled time too. You want to be certain you've done everything right, that you've given the little one every possible break along the way. In this chapter, you'll find the basic measures you need to take to make your pregnancy as trouble­free as possible, and your baby as healthy as can be.

Preparing for Pregnancy

Your body is the baby's home for its first 9 months. Ideally, you want to do everything possible to make that home as healthy as possible. Proper care of your body during pregnancy is crucial, but there are limits to what you can do once the baby is on the way. If you are planning a pregnancy, the best thing you can do is prepare your body before you conceive. That's why most doctors recommend that you see a doctor (preferably the obstetrician/gynecologist, or ob/gyn, you will see during your pregnancy) for what is known as a preconception checkup.

This visit enables your doctor to uncover any potential health problems before you get pregnant. These problems can then be prevented or treated. At the very least, you and your doctor will be aware of them so you can manage your pregnancy appropriately. It also gives you time to change your lifestyle to maximize your health before pregnancy, improve your chances of conceiving, and remove any potential dangers to the baby.

A preconception checkup is somewhat similar to the first visit after you know you are pregnant. If you see a doctor before you conceive, then your first prenatal visit will be more routine.

Here are some of the topics that may be discussed and tests that may be performed at a preconception visit. To be ready for the doctor's questions, you may need to obtain some information from your partner before seeing the doctor or ask your partner to go with you.

Topics You Should Discuss

Family history of genetic diseases and multiple births can be an important factor in your pregnancy and in the health of your baby. Since multiples run in the family, it will help your doctor to know whether you are more likely than the average woman to have them. If you or your partner know of a family history of a genetic disease, your doctor may want to test you both to see if either of you carries the genes for that disease. A blood test is sufficient in most cases. For example, Jews of central and eastern European ancestry are more likely to be carriers for Tay­Sachs disease; if both parents are carriers, chances are one in four that the child will have this fatal disease. Tay­Sachs' results can be difficult to interpret when the test is performed on a pregnant woman, so this test needs to be performed before pregnancy occurs. (If you're already pregnant, the father can still be tested. If he's negative, there's no danger the baby will inherit the disease.)

Your menstrual periods. The doctor will ask you about the pattern of your menstrual periods to check for any abnormalities that should be treated before you become pregnant or that might affect your ability to conceive. Keeping a diary of your periods can be helpful at this point.

Exposure to poisons at work or at home should be avoided before conception and during pregnancy. Radiation found in x­rays, known as ionizing radiation, also can harm a developing baby. If you are exposed to x­rays at work, you should ask for monthly readings of the amount of radiation before attempting to conceive. A pregnant woman should not be exposed to more than 0.5 rad total dose for the entire pregnancy, or 0.05 rad in any 1 month. It's best to avoid x­rays for medical purposes if possible. If you get a chest x­ray, for instance, it exposes your baby to about 0.008 rad. However, according to an April 1993 publication of the American College of Obstetricians and Gynecologists, radiation from video display terminals, color televisions, and microwave ovens is not dangerous during pregnancy. This is called non­ionizing radiation. Other health hazards at work include lead poisoning and, if you're a healthcare worker, chemotherapeutic agents.

General health. Your doctor needs to know about any serious disease or chronic illness you may have. Diabetes, high blood pressure, heart disease, the connective tissue disease called systemic lupus erythematosus, and epilepsy and other seizure disorders can all affect pregnancy. Women with diabetes, for example, may need to change their medications before conceiving.

You and your partner may be asked about any history of sexually transmitted diseases because some STDs can make conception difficult, harm a developing baby, or affect management of pregnancy. For example, pelvic inflammatory disease brought on by a sexually transmitted infection can damage reproductive organs.

Medications. Even some over­the­counter drugs can affect a developing baby, so you should tell your doctor about every medicine you are taking. Some drugs can impair your ability to conceive; others could damage a fetus in the first few weeks before you know you are pregnant. If you take any medication regularly, you may need to stop taking it before trying to conceive, and you might need time to change your medication regimen.

High doses of vitamin and mineral supplements can also harm a fetus. If you are taking megadoses of supplements, tell your doctor about them so he or she can determine whether you need to stop them before attempting to conceive.

Birth control. If you've ever used an IUD, conception may be more difficult and your chances of a miscarriage are somewhat higher. If you have been using birth control pills, it will take from a few weeks to 3 months for your body to return to its normal hormonal cycles so that you can become pregnant. Conceiving immediately after stopping the pill, does not however, increase your chances of miscarriage or birth defects.

Prior pregnancies. Any problems with previous pregnancies can affect future pregnancies. Tell your doctor about any complications you experienced such as miscarriages, induced abortion, or premature or multiple births.

Examinations and Tests

A pelvic exam and a Pap smear will help identify any problem with the pelvic region and birth canal before pregnancy. If your doctor finds a condition requiring treatment, he or she may recommend further tests. Therapy will be much easier before you get pregnant.

Your weight. When you conceive, your pre­pregnancy weight, along with your weight gain during pregnancy, have an important bearing on your baby's health and will be monitored carefully. It's important to do everything possible to reach your ideal weight before becoming pregnant.

IN THE BEGINNING

Well before you learn you're pregnant, amazing developments are already underway. Leaving the fallopian tube behind, the fertilized egg finds a resting place in the rich tissue of the endometrial lining, implants itself, and begins growing the placenta that will nourish the developing baby in the months ahead. Already, your intake of alcohol, tobacco, and drugs is a cause for concern. If you're even trying to conceive, it's time to cut out these potentially damaging substances. Remember, too, that certain prescription medications can be as just as damaging as an illegal drug. For more information see the table on Drug Risks in Pregnancy near the end of the book.

Blood and urine tests. Your doctor will do a blood test for anemia, or insufficient iron in the blood. Because women lose blood through their periods every month, many begin pregnancy without enough iron. You can start to remedy this problem with an iron supplement or dietary changes if it is uncovered before conception. Another blood test determines the Rh factor. If you are Rh negative and your partner is Rh positive, there is potential for problems for the baby, particularly if this is not your first pregnancy. If your doctor knows both partners' Rh status, any difficulty usually can be prevented by administering a drug called Rho(D) Immuno Globulin (Human) (Rhogam), if necessary, at certain points before or after delivery. Urine will be analyzed for signs of kidney disease or diabetes.

Possible infection. You will be tested for hepatitis B, syphilis, and gonorrhea because these diseases can cause serious harm to the developing baby. Gonorrhea and syphilis can be cured prior to pregnancy. If you have hepatitis B the doctor will be prepared to give the baby hepatitis B immune globulin and the hepatitis B vaccine. Because the virus that causes AIDS can be passed to the baby, if you are at risk for AIDS, an HIV test will also be done at this visit.

Vaccinations. Your doctor will ask you if you have an immunity to German measles (rubella). Fifteen percent of women of childbearing age are not immune to German measles and if you become infected with it in the first 8 weeks of pregnancy, there is a high chance that your baby will be born deaf, blind, or with other serious problems. You cannot get the rubella vaccination while you are pregnant because the vaccine contains a weakened form of the virus. If you are not sure if you have the immunity, your doctor can do a blood test to confirm it. In addition, you should also update your tetanus and diphtheria boosters as needed and get a polio vaccine if you did not receive one as a child.

Getting Yourself in Shape

The nine months of pregnancy put a lot of stress on the body, but there are a number of things you can do before you conceive to make your pregnancy easier and healthier.

Weight

If you are under or overweight, try to get as close as possible to your optimal weight before conception. Underweight mothers are more likely to give birth to underweight and premature babies, even when they gain weight normally during pregnancy. In addition, underweight women may not be able to gain enough during pregnancy to offset their low preconception weight. Women who are overweight before conceiving are more likely to develop diabetes during pregnancy and, due to increased weight of their babies, more likely to need Cesarean section. Weight loss is not advisable for any woman during pregnancy, so act before conceiving!

Exercise

If you do not have a regular exercise program, this is the time to start one, preferably one that you can maintain while you are pregnant. Carrying and nourishing a baby is hard work, and a fit woman is likely to feel better and be less fatigued during pregnancy than one who has avoided exercise most of her life. Some evidence suggests that women who are physically fit tolerate pregnancy and delivery better.

It's best to start an exercise program 1 year before becoming pregnant, but at the very least you should begin at least 3 months before conception to give your body a chance to adjust to the additional physical activity before facing the added challenge of carrying a child.

If you haven't exercised before, start slowly. Within 3 to 4 weeks, you should be able to perform aerobic (fitness) exercise for 30 minutes. If you have any medical problems, consult your physician before starting the program. Likewise, see a doctor if you experience any symptoms during exercise.

Resistance exercises, in which you lift weights so that your muscles are working against something, are also important and should be done 2 or 3 times a week on alternate days. Strengthening your muscles will help you recover more quickly from labor and delivery and give you more strength to carry the baby after birth. Because back pain can be a problem during pregnancy, exercises to strengthen the back can be helpful, too.

Alcohol, Tobacco, Caffeine, and Illegal Drugs

Alcoholic beverages have been proven to harm the developing baby. In particular, because the first 2 months after conception are so critical for healthy development, and because it is not known whether there is a “safe” level of alcohol consumption for a fetus, women should stop drinking before attempting to conceive. No form of alcohol is safer than any other; beer and wine are just as bad for the baby as hard liquor. Some studies suggest that women who drink before pregnancy tend to have smaller babies. Persistent and significant drinking during pregnancy can cause fetal alcohol syndrome, as a result of which infants may be born with brain, heart, and nervous system problems, distinctive facial abnormalities, and mental retardation.

Smoking increases your chances of a miscarrying during the first trimester. Mothers who smoke are also more likely to go into premature labor; have a premature rupture of membranes; experience third­trimester bleeding; have slower fetal growth, and deliver underweight babies. Prospective fathers who smoke should also quit. Studies indicate that a mother exposed to “passive smoking” during pregnancy is more likely to give birth to an underweight baby. You can't count on quitting smoking overnight, so it's best to start trying to withdraw from cigarettes well before attempting to conceive. Additionally, some evidence suggests that smoking impairs a woman's fertility. One study showed that 10.7 percent of smokers (women who smoked more than 20 cigarettes per day), compared with 5.4 percent of nonsmokers, failed to have a successful pregnancy within 5 years of stopping contraception. Smoking also affects sperm and may impair male fertility, too.

Caffeine. Many obstetricians recommend that pregnant women limit themselves to the equivalent of one cup of coffee daily. If you consume more than that—especially if you drink a lot of caffeine—withdrawal may take time, so start weaning yourself before you try to conceive. Some evidence suggests that in women who take in 400 milligrams of caffeine daily, the equivalent of four cups of coffee, the baby grows more slowly. Caffeine may also increase the risk of late first or second trimester miscarriage. Most studies find no association between caffeine consumption and low birth weight or birth defects but moderation is still best.

A few researchers have suggested that high caffeine consumption may also affect fertility. One study found that women who consumed more than 300 milligrams of caffeine daily (the equivalent of three cups of coffee) had a 27 percent lower chance of conceiving each cycle compared to women who consumed no caffeine. Women who consumed some caffeine but less than 300 milligrams daily were 10 percent less likely to conceive.

Illegal drugs are bad for your health, whether or not you are pregnant and they can only harm a baby. If you use them, it's imperative to stop before trying to conceive.

Folic acid

Women who have had a baby with a neural tube defect are at higher risk of having another baby with similar defects. Examples of neural tube defects are spina bifida, in which the spinal cord does not close completely, and anencephalopathy, in which part of the baby's brain and skull do not develop completely.

Most authorities recommend that anyone trying to conceive—and especially someone who's already had a baby with a neural tube defect—take 0.4 milligrams of folic acid daily starting 1 month before she plans to become pregnant and continuing at least for the first 3 months of pregnancy. In fact, the US Centers for Disease Control and Prevention now recommend that all women of child­bearing age consume 0.4 milligram of folic acid daily through diet or supplements. Your doctor can recommend a multivitamin that contains the right amount.

Prenatal care

Proper care of your body is crucial to a healthy pregnancy and baby. It's important to see your doctor as soon as you think you might be pregnant. Missing a period, or being a week or two late, is one possible sign of pregnancy, though it's not conclusive. Other indicators include nausea and vomiting, dizziness, and fatigue. A home pregnancy test is also an excellent indicator, but you should still see your doctor for confirmation.

Prenatal care enables your doctor to identify signs of any problems early. Your first visit to the doctor to confirm pregnancy will be similar to the preconception checkup. If you have had one of these checkups, then only a few tests will be repeated when your pregnancy is confirmed. Thereafter, if you are between 18 and 35 with no known medical problems you will probably see your doctor once a month until week 28 of pregnancy, every 2 or 3 weeks until week 36, then every week until the baby is born. The age of the baby is dated from the first day of your last menstrual period.

Visits after the first one are brief and involve measuring the fetal heart rate, the size of the baby, fetal activity, your blood pressure, your weight, and the length of your abdomen (to measure uterus size—another way of measuring the baby). The doctor will also ask for a urine specimen to check for protein and sugar. At times during the pregnancy, urine will also be checked for signs of infection. The doctor will also ask you if you are experiencing any symptoms.

Other tests that may be performed at some point during pregnancy include blood tests, glucose tolerance tests to check for gestational diabetes, and ultrasound. Some women will have an amniocentesis or chorionic villus sampling to detect abnormalities in the baby. These tests are discussed further in the next chapter. A pelvic exam is part of the initial visit and generally is not repeated until the 36th week of pregnancy, or later, unless there is a complication.

Nutrition During Pregnancy

What you eat and how much weight you gain while pregnant has a major impact on your baby's health. This is one time when even the most body­conscious woman can feel that it's all right to gain weight!

How Much Weight to Gain

How much you should gain varies with your weight before pregnancy. Underweight women should gain 28 to 40 pounds, normal weight women should gain 25 to 35 pounds, and overweight women should gain 15 to 25 pounds (if very overweight, even less.) If you are of normal weight you should gain about 2 to 4 pounds in the first trimester and three­quarters to 1 pound per week thereafter. Underweight women should gain about one and a quarter pounds per week in the second and third trimester and overweight women should gain a half to three­quarters of a pound each week during that time.

Don't worry too much about retaining your pregnancy weight; most women lose about two­thirds of it by the time they leave the hospital, and much of the rest is lost within 6 months. The reason for this becomes apparent when you see that in most women, only about a quarter of the weight is fat. The average amount of weight retained 6 months after delivery is 3 pounds.

Food and Drink

Pregnant women should consume 2,500 calories per day, 300 more than women who are not pregnant. Almost any diet with sufficient calories supplies enough of all the minerals you need except iron. Recommended Daily Allowances of vitamins and minerals during pregnancy and a daily menu for pregnant women can be found in the boxes nearby.

You will need to eat about 27 percent more protein than what's recommended for women who are not pregnant—a total of 60 grams a day. Meat, fish, poultry, eggs, milk, and other dairy products are excellent sources. Milk and dairy products have the added advantage of providing calcium.

Drink at least eight 8­ounce glasses of water or other fluids a day. Coffee and tea don't count as they cause you to lose fluid but if you do drink them, make sure they're decaffeinated. Avoid diet soda, and other artificially sweetened foods and drinks, as aspartame may harm your baby.

Vitamins and Minerals

You will need more iron, calcium, folic acid, and zinc. With the exception of iron, these substances can generally be obtained through diet. When you do use salt, make sure it is iodized to ensure that you get enough iodine. Don't take supplements without consulting your doctor. Too much vitamin A, B ₆, C, D, E, or K, or too much zinc, iron, or selenium, can be harmful during pregnancy.

Women whose diets are deficient in some nutrients or who have other special needs may have to take supplements. However, even the recommended amounts of certain prenatal vitamin and mineral supplements can lead to total ingestion of far more of certain substances than is required, so it's important to ask your doctor what you should take. Many physicians recommend that women take supplemental iron in their second and third trimesters, and the amount that most healthy women need is contained in many prenatal vitamins. Ask your doctor if he or she thinks you need a supplement. Take iron at bedtime or between meals with water or citrus juice—never with milk, because calcium makes it harder for the body to absorb iron.

What's Safe During Pregnancy?

You may feel that your regular lifestyle has become severely restricted due to your pregnancy, and it may be difficult to give up certain habits. It is important to remember, however, that you are doing what is necessary to ensure your health and the health of your baby.

Exercise

Most women can continue their exercise routine after becoming pregnant. But don't start or intensify an aerobic exercise regimen while pregnant. The American College of Obstetricians and Gynecologists recommends brisk walking, swimming, and stationary cycling as the safest exercises during this period. Tennis and jogging in moderation are acceptable if you start before becoming pregnant. If you were not getting enough exercise before conceiving, stick to brisk walking. You should discuss your exercise program with your doctor, both at the start and as you progress through your pregnancy.

The American College of Obstetricians and Gynecologists recently revised its recommendation regarding exercise in pregnant women to remove limits on intensity and heart rate. However, the guidelines say that there is no need to exercise strenuously because mild to moderate exertion can maintain cardiovascular fitness. One definition of moderate exercise is a 30-minute aerobic workout, twice or three times weekly at 50 percent to 85 percent of maximum capacity. The College recommends letting your own body be your guide; do not exercise to the point of exhaustion.

Less oxygen is available for aerobic activity during pregnancy, so even well­conditioned pregnant women may not be able to continue their prepregnancy regimens at the same level. Aerobic exercise does raise body temperature, and high body temperatures early in pregnancy can increase the risk of certain birth defects. The ideal way to monitor this is to check your rectal temperature after completing your typical exercise regimen. Since this is not a realistic option at the gym, most doctors recommend checking your pulse instead, with a goal of keeping it below 140. If you do get overheated (a temperature exceeding 101 degrees Fahrenheit), try to keep cooler by drinking more water, wearing lighter clothing, or exercising for a shorter time. Do not use hot tubs or saunas while pregnant.

After the third month of pregnancy, do not exercise while lying on your back, since this can reduce your heart rate, lower your blood pressure, cause dizziness, and reduce blood flow to the baby.

Even women who got no exercise before pregnancy can benefit from a mild weight training program to strengthen their back, leg, and other muscles needed to carry the baby. You should build up gradually to avoid injury. Always check with your doctor before starting such a regimen.

Strengthening the muscles in the pelvic region can help support the uterus, ease delivery, and speed the return of normal muscle tone after delivery. You can locate the pelvic muscles by spreading your legs apart while urinating, then stopping and starting the flow of urine several times. Once you have found these muscles, you can exercise them anywhere. Contract them hard for 5 seconds, then gently release them. Ideally, this should be done 20 to 30 times a day. These movements are known as Kegel exercises.

Avoid contact sports or other activities during which you risk colliding with someone or falling on your abdomen, since your baby could be injured. Examples include downhill skiing and horseback riding. If you have had complications in previous pregnancies, your doctor may advise you to avoid exercising altogether.

Work

Healthy women with uncomplicated pregnancies whose jobs pose no more risk than that of other everyday activities can stay at work right up to labor, and resume working several weeks after giving birth. Any job that requires severe physical strain should be avoided, however. As pregnancy progresses, strenuous work will become more tiring. On the other hand, activity such as heavy housework or child care is actually associated with a less than average rate of miscarriage.

As with exercise, it's important to rest during the day as you become tired. Women who have had complications during other pregnancies should minimize physical work. It's also wise to avoid working with toxic substances that could harm the baby, just as you would avoid them while trying to conceive.

Travel

Travel is acceptable except within a month or so of your due date. The main risk is not in the journey itself but in the chance that a complication may develop or labor may begin while you are far from medical services. If you must be away late in pregnancy or for a prolonged period, ask your doctor to recommend a local physician you can contact in an emergency. If you are traveling abroad, be sure to take whatever dietary precautions are needed at your destination.

When traveling by car, fasten the seat belt with the lap portion under your abdomen and across the upper thighs. Stop the car, get out and walk every hour and a half or so to prevent swelling and reduce discomfort. You should also do this on a plane or train. As with any drugs, do not take motion sickness medications without consulting your doctor.

Sexual intercourse

Some physicians suggest that you refrain from intercourse during the last 4 weeks of pregnancy. Aside from this possible restriction, intercourse is safe unless you are at risk for miscarriage or early labor. Women experiencing vaginal bleeding are at risk for miscarriage and should avoid intercourse.

Some data show that 1 woman in 4 is less interested in sex during the first trimester of pregnancy. Some women also lose interest during the last trimester.

Light bleeding may occur after intercourse, possibly due to minor injury to the cervix, which is engorged with blood during pregnancy. If this is the reason, you and your partner may merely need to avoid deep penetration. Still, you should call your doctor to be sure there is no problem.

Abdominal cramps after intercourse are common, but if they continue and worsen over an hour, notify your doctor. It could mean contractions are starting. Some pregnant women may leak fluid from their breasts during sexual activity but this does not present a medical problem.

Avoiding Infection

Raw meat and cat litter both can contain an organism called Toxoplasma that can cause miscarriage, stillbirth, or an infection in the baby or mother. Wash your hands immediately after handling raw meat and make sure the meat is well cooked, also avoid cleaning litter boxes or gardening in soil frequented by cats.

Poisons

It's best to avoid contact with hazardous materials such as harsh cleaning solutions, paint fumes, paint removers, etc. Some other materials you might not think of are garden fertilizers, herbicides, and pesticides; arts and crafts glues, solvents, and photographic chemicals; and chemical hair dyes. If you absolutely must use these types of products, wear gloves and make sure you have adequate ventilation (both of which are a good idea anyway). Lead is also highly toxic. The two most common ways you can be exposed to lead are through inhaling particles of flaking lead­based paint and drinking lead­tainted water. You can have your drinking water tested if you think it might contain dangerous levels of lead or you can simply drink bottled water. Your doctor can do a blood test to detect lead levels in your system.

Other Concerns

Douching can cause complications that can kill the developing baby.

Tub baths in the last trimester of pregnancy should be avoided, as your balance may be off and you may be more likely to slip and fall.

Dress in whatever is comfortable. Avoid constricting garters and tummy­control pantyhose because they can interfere with blood flow. Many women find maternity pantyhose to be very supportive, particularly towards the end of the pregnancy. Shoes with heels are fine if you are comfortable and can balance yourself although many women feel better in low heels or flats. You probably will need new bras since breasts increase by about two cup sizes during pregnancy. You may also need larger shoes, as your feet may swell in the last 2 months.

Sleep on your side instead of your back after the third month. The weight of the enlarged uterus can constrict some of your major blood vessels if you lie flat on your back.

Treating Common Problems

Most women encounter some of the problems and discomforts discussed here. Generally, they are not serious, but if you have any questions, or your symptoms seem out of the ordinary, contact your doctor.

Digestive

Nausea and vomiting are very common in early pregnancy. Eat several small meals throughout the day, rather than three larger ones, and drink plenty of liquids. Avoid any foods that cause nausea. Although it's called morning sickness and usually passes after the first trimester, many women experience nausea and vomiting throughout the day and, sometimes, throughout their pregnancy.

WHY ALL THE PROBLEMS?

It's easy to see. As the baby grows, it exerts increasing pressure on virtually all your internal organs. Upward pressure on the stomach can lead to heartburn; downward pressure on the bladder can keep you heading for the bathroom. Hemorrhoids develop as the uterus presses on the rectum. And all the extra bulk up front means backaches for many women nearing term.

Constipation is also a common problem. Getting enough fiber from bran, fruits, and raw vegetables is important. Proper diet, along with enough fluids, engaging in reasonable amounts of daily exercise, and, sometimes, using mild laxatives such as prune juice or milk of magnesia should prevent constipation if you did not have this problem before you were pregnant.

Heartburn is a third common digestive problem. It occurs as the uterus pushes on the stomach, forcing acid up into the esophagus. Again, eating smaller, more frequent meals rather than three larger meals can help. Avoid bending over or lying flat. Antacids may relieve discomfort.

Cravings are not harmful as long as you eat the substances in moderation and also consume healthy foods. Rarely, some pregnant women crave, and eat, items such as laundry starch, clay, dirt, or chopped ice. See your doctor if you have any really unusual cravings. Some may indicate that you are not getting enough iron, and a supplement may be in order.

Fatigue and Headache

Most women complain of being tired early in pregnancy. This feeling usually goes away by the fourth month and is considered to be normal. Fatigue can also be due to anemia, or insufficient iron in the blood. A simple blood test can reveal anemia and your doctor may recommend an iron supplement. Don't start taking supplements on your own. Too much iron can be dangerous.

Headaches are also common in early pregnancy and usually go away by the fourth or fifth month. It's safe to take Tylenol for headache relief. Headaches in later pregnancy can be a sign of serious complications, such as high blood pressure, and should be reported to your doctor immediately.

Vaginal and Urinary Symptoms

Increased vaginal discharge. Many women develop thicker, more plentiful, more odorous discharge for no apparent reason. The discharge can, however, be caused by infection—yeast infections are more common during pregnancy. Any infection needs to be treated so if you think you have one, don't wait until your next scheduled appointment to call your doctor.

Frequent urination is a problem for many women as their large uterus presses on the bladder and their hormone balances are altered. Some women lose urine when they move or cough. The pelvic exercises described earlier in this chapter may help.

Urinary tract infections are more common during pregnancy. Most doctors will test your urine at each visit but call your doctor immediately if you experience burning during urination. Untreated urinary infections can trigger premature labor. Your doctor will know which antibiotics are safe to take during pregnancy.

Other Physical Discomforts

Breast swelling is common and, for many women, uncomfortable. There really is no solution except to wear a very supportive bra, 24 hours a day, if necessary.

Hemorrhoids occur as the uterus presses on the veins of the rectum. They sometimes develop for the first time during pregnancy but are more likely to occur if you've been troubled by them earlier. Pain­relieving creams, warm soaks, and drugs that soften stool can help. As always, check with your doctor before using any over­the­counter medication while you are pregnant.

Backache develops late in pregnancy in many women, especially those with poor posture. A fitted maternity girdle can alleviate backache due to your new shape. Rest, supportive shoes, and massage also help. Exercises that strengthen the back muscles can make you less vulnerable to back problems.

Varicose veins often can develop in the legs, external genitals, or abdominal wall, especially when there is a family history of this complication. Wearing elastic support stockings and raising your legs when possible can help prevent and alleviate varicose veins.

Fluid retention is a common occurrence in late pregnancy, and is rarely serious. If you see swelling in your hands and face, however, it can be a sign of a serious complication called preeclampsia (pregnancy­induced high blood pressure) and should be reported to the doctor immediately. Preeclampsia should be treated to ensure that blood flow (and thus oxygen and nourishment) to the baby remains unrestricted, and to prevent an even more serious condition called eclampsia (pregnancy-related convulsions) that can be fatal to both mother and baby.

Leg cramps can be caused by a deficiency of calcium in a form that your body can use, or by getting too much phosphorus. Your doctor may tell you to drink less milk, and stop taking supplements containing calcium phosphate. Instead, the doctor may prescribe calcium carbonate or calcium lactate tablets. Leg massage, flexing the feet, and applying heat can relieve the pain. Avoid pointing your toes when you stretch your legs in the morning since this can cause cramps. Also, lead with the heel when you walk.

If Complications Get Serious

This chapter dealt with the kind of pregnancy we all hope for—full of little discomforts, but basically trouble­free. However, if you've had problems in previous pregnancies, are under 18 or over 35, have a medical condition, or believe that you are at risk for a difficult pregnancy for other reasons, you'll probably also want to read chapter 25, “Potential Complications You Should Keep in Mind” later in this section.