The Unofficial Guide to Having a Baby

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By Ann Douglas John R. Sussman

John Wiley & Sons

ISBN: 0-7645-4148-X

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Chapter One

GET THE SCOOP ON ... What's going on with your body * What's going on with your head * Thinking pregnant-even before you are * How pregnancies are dated * Pregnancy symptoms * How you and your partner may feel about being pregnant * Home pregnancy test tips

The First Month: Great Expectations

The first month of pregnancy is a month like no other. While you're likely to have baby-making on the brain, you'll spend most of this month playing the role of the Lady in Waiting: waiting for ovulation to occur and then waiting to do a home pregnancy test. Even if your gut instinct is telling you that this was your lucky month, you won't know for certain whether or not you've managed to hit the reproductive jackpot until the end of the month, so you're pretty much destined to spend the entire month in pregnancy purgatory!

In this chapter, we tell you what to expect on a week-by-week basis during each of the first four weeks of pregnancy. You'll get the inside scoop on what's going on with your body, what's going on with your head, and - after conception has occurred - what's going on with your baby.

Each week-by-week section also includes answers to the most-asked questions for each week of pregnancy - our so-called "Hot List." This month, we'll be tackling everything from how pregnancies are dated to pregnancy testing do's and don'ts to earlypregnancy symptoms.

We'll be sticking with this format in Chapters 6 through 13, too, so that you can quickly zero in on the real need-to-know information for each of the remaining months and weeks of pregnancy. (Pregnancy can be stressful enough without your pregnancy book driving you crazy, too.)

Week 1

The first week is all about putting in time, waiting for your period to end and the baby-making season to begin.

If this is your first month of trying, you may be eagerly loading up on ovulation predictor kits and rereading the armloads of "how to get pregnant books" that you loaded up on at the library. (Come on, 'fess up. You didn't leave any books for anyone else to check out, now did you?)

If you're a veteran of the trying-to-conceive scene, you may be feeling a little less enthused - or possibly even downright discouraged by now. (The trying-to-conceive roller-coaster ride can get pretty tiresome pretty quickly.)

What's going on with your body

Because pregnancy is dated based on the first day of the woman's last menstrual period, the first day of your pregnancy is actually the first day of your last period. So this month starts out with your menstrual cycle.

Assuming you manage to conceive this month, your uterus will begin to undergo a rather remarkable metamorphosis that will see it increasing in capacity by up to 1,000 times over the course of your pregnancy. Its weight will increase dramatically at the same time: while your prepregnant uterus weighs approximately 2.5 ounces (70 grams), by the time you're ready to give birth, your uterus will be a much heftier 2 1/2 pounds (1,100 grams).

What's going on with your head

Assuming your pregnancy is planned, you're probably already thinking like a pregnant woman and considering the effects of your actions on the long-term health and well-being of your baby-to-be. You've probably got a million-and-one questions on the "is this safe?" theme, in fact - questions we'll attempt to answer both in this chapter and in the remainder of this book.

The Hot List: This week's must-ask pregnancy questions

Here are the answers to some of the more pressing questions that are likely to be running through your head this week.

Should I give up my morning coffee now that I'm trying to conceive?

While the medical profession has done a fair bit of flip-flopping about the caffeine issue over the years, most experts today agree that excessive quantities of caffeine can be harmful to the developing baby. Some recent studies have linked caffeine to decreased fertility, an increased risk of miscarriage (in women who consume more than five cups per day), stillbirth, premature labor, lower birthweight, and Sudden Infant Death Syndrome (SIDS).

Where things get tricky, of course, is in trying to get the experts to agree on what constitutes a "safe" amount of caffeine consumption during pregnancy - whether that means cutting out caffeine entirely or keeping your caffeine consumption in the moderate range (something in the neighborhood of 100 milligrams of caffeine per day), in which case you'd still be okay having your morning coffee. (A single, 5-ounce cup of coffee, mind you - not an entire pot!)

Of course, you may want to limit your consumption of caffeine during pregnancy for some entirely different reasons:

* Caffeine tends to act as a diuretic, drawing both fluid and calcium from the body.

* Caffeine can interfere with the absorption of iron.

* Caffeine can heighten mood swings.

* Caffeine can heighten the breast tenderness that many women experience during early pregnancy.

* Caffeine can cause insomnia - something that tends to be a problem for pregnant women anyway.

Caffeine is found in more foods than you may realize. If you want to cut back your consumption of caffeine, it's important to know which foods to avoid or to limit (see Table 5.1). Note: The amount of caffeine found in a typical serving of food can vary considerably, which is why we have chosen to provide a range for each of the foods and beverages listed in Table 5.1.

It's also important to remember that caffeine can be found in certain over-the-counter drug products, too, including certain brands of headache tablets, cold remedies, and wakeup pills. (Of course, you'll want to steer clear of all but the most essential medications while you're trying to conceive in order to avoid exposing your baby to anything potentially harmful.)

Is it okay to have the occasional serving of alcohol while I'm trying to get pregnant?

While candlelight and champagne may help set the stage for romance, this is one time in your life when you'll want to stick with the nonalcoholic bubbly. The reason is simple: alcohol can be extremely damaging to the developing baby. According to the March of Dimes, more than 40,000 babies are born with some degree of alcohol-related damage each year.

Babies born to mothers who drink heavily during pregnancy are often born with Fetal Alcohol Syndrome (FAS)-the leading known cause of preventable mental retardation. Approximately 30 percent to 40 percent of babies born to women who consume more than two drinks per day during the first trimester will suffer from fetal alcohol syndrome at birth. Babies with FAS are abnormally small at birth and don't catch up with other babies the same age after birth. They are also born with facial malformations, central nervous system dysfunction, and varying degrees of major organ system malfunction - a pretty rough start in life for any baby - and things don't get better as they grow older. Studies have shown that adolescents and adults with FAS experience psychological and behavioral problems that make it difficult for them to hold down a job and live on their own.

A related syndrome - Fetal Alcohol Effect (FAE) or Fetal Alcohol Spectrum Disorder (FASD) - is a milder version of FAS. Approximately 10 times as many babies are born with FAE as with FAS.

But, wait: there's more bad news. Consuming alcohol during pregnancy also increases the risk that a woman will experience a miscarriage or give birth to a low-birthweight baby or a baby with learning disabilities, behavioral problems, and/or a lower IQ.

Because alcohol can have such a devastating effect on the developing baby, we recommend that you avoid alcohol entirely while you are trying to conceive and during the entire time that you are pregnant. Drinking at any stage of pregnancy can affect your baby's brain. It's simply not worth gambling with your baby's health. Besides, if you do manage to hit the reproductive jackpot this month, you'll spend the next nine months worrying about the potentially harmful effects of that single glass of champagne on your baby-to-be.

And, of course, smoking and the use of recreational drugs are definitely to be avoided during pregnancy, too. See Chapter 2 for more on why you may want to kick these two particular lifestyle habits before you continue with your baby-making plans.

Do I need to avoid taking headache tablets and other over-the-counter medications while I'm trying to conceive? What about my prescription medications?

Nearly 2,500 years ago, the Greek physician Hippocrates warned that for the safety of the developing baby, drugs should be administered to pregnant women only from the fourth to the seventh month. Three millennia later, we're continuing to heed his warnings about the dangers of using medications during pregnancy - although we now realize that the period of greatest risk is during the earliest weeks of pregnancy.

The period of greatest vulnerability for the developing baby is approximately 4 to 10 weeks from the first day of your last menstrual period - the period during which the baby's major organs are being formed. Exposure to a harmful substance during this period can result in either birth defects or miscarriages.

If the fetus is exposed to a harmful substance prior to this - that is, during the first two weeks after conception - either it will be unaffected by the exposure or the cells will die and the pregnancy will not continue.

A drug taken during the second and third trimesters may alter the growth and physiological and biochemical functioning of the developing baby.

Depending on the fetal age, drug potency, and dosage taken, a medication may

* be toxic to the developing baby;

* cause a variety of birth defects;

* interfere with placental functioning, thereby affecting the flow of oxygen and nutrients from the mother to the baby;

* alter the mother's biochemistry, something that indirectly affects the baby as well.

There are three basic categories of drugs you need to be concerned about during pregnancy: lifestyle drugs, over-the-counter products, and prescription medications. We talked about the harmful effects of lifestyle drugs in Chapters 2 and 3, so we won't repeat that discussion again, but we're going to devote the next few pages to talking about the care you need to exercise when using over-the-counter products and prescription medications during pregnancy.

Over-the-counter products

The fact that a particular drug is available over-the-counter (or that it's sitting in your own medicine cabinet) is no guarantee that it's safe during pregnancy. As Table 5.2 shows, even a seemingly harmless product such as aspirin poses particular risks during pregnancy. You'll note that each of the drugs in this table has been assigned a particular risk factor using a rating system designed by the FDA to classify drugs for use during pregnancy.

As helpful as these ratings can be to caregivers and pregnant women, they tend to oversimplify the highly complex issues involved. That's why it's so important for caregivers to review the sources of information available to them when recommending or prescribing medications. They should consult such reliable sources such as Drugs in Pregnancy and Lactation, make use of teratogen/pregnancy risk-lines (a.k.a. hotlines), tap into the Physician's Desk Reference or PDR (the so-called "bible" of FDA-approved information about prescription and nonprescription drugs that also includes a compendium of the package inserts that manufacturers are required to package with their products), and so on.

Decisions about the use of medications during pregnancy must take many factors into account, including the specific individual circumstances that necessitate the use of a medication, the dose and method of administration, the timing and duration of exposure in the pregnancy, and the simultaneous use of other drugs. All factors being equal, it is generally best to use drugs that have been available longer and therefore have more of a track record in pregnancy. No pregnant woman wants to be a guinea pig, if she can avoid it.

Prescription drugs

Over-the-counter drugs aren't the only drugs that can be harmful to the developing baby. Some of the most harmful drugs are those used to treat such serious medical conditions as epilepsy, heart disease, and cancer.

If you take prescription drugs regularly, it's important to find out whether it's safe to continue taking these medications during your pregnancy. In some cases, your doctor will advise you to stop taking the drug because the risks to the fetus are greater than the benefits the drug provides. In other situations, she may advise you to continue taking the drug because the developing baby is more likely to be harmed by the condition the drug is treating (for example, epileptic seizures) than the medication itself.

Although there is still a great deal we don't know about the effects of drug use during pregnancy, the Food and Drug Administration (FDA) rates drugs on the basis of their safety during pregnancy. Prescription drugs are assigned to one of the previous five categories, based on their relative safety during pregnancy, as previously discussed earlier in this chapter.

As you can see from Table 5.3, only a handful of prescription drugs are considered absolutely safe to take during pregnancy.

Before we wrap up this discussion, we want to say a quick word about antidepressants.

There's been a lot of misinformation in the media in recent years about the supposedly harmful effects of antidepressants on the developing baby. We want to counter some of that misinformation by presenting the facts. A study conducted at the University of California in Los Angeles concluded that there is no increased risk of birth defects or neonatal complications associated with the use of three selective serotonin reuptake inhibitors (SSRIs) - specifically, fluoxetine, paroxetine, and sertraline - during pregnancy. So that's one worry you can scratch off your list if your doctor has prescribed antidepressant medications for you.

Which herbal products are safe to use during pregnancy?

As you've no doubt gathered by now, there's no easy answer to this question. Because herbal products are treated as dietary supplements rather than as drugs by the Food and Drug Administration, herbal product manufacturers don't have to jump through the same product approval hoops as their pharmaceutical industry counterparts. Consequently, there isn't as much data available about the safety and effectiveness of herbal products.

Continues...

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Excerpted from The Unofficial Guide to Having a Baby by Ann Douglas John R. Sussman Excerpted by permission.
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