The Doctor Is In

An OB-GYN answers the questions that you forgot to ask.

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Especially for a first-timer, early pregnancy can be disorienting, and even the most thorough and caring doctor is bound to overlook some of your concerns. To help, we’ve come up with answers to some of the questions newly pregnant women ask most. Our expert is Raymond I. Poliakin, M.D., professor emeritus of obstetrics and gynecology at the University of California, Los Angeles, and the author of What You Didn’t Think to Ask Your Obstetrician (Contemporary Books, 1994).

Am I at high risk for having a baby with birth defects? Women who are 35 or older have a higher chance of carrying babies with congenital defects, including Down syndrome and other chromo- somal abnormalities. Prenatal tests for these conditions include alpha-fetoprotein testing, amniocentesis and chorionic villus sampling. Certain ethnic groups are at increased risk for having children with such genetic disorders as sickle cell anemia and Tay-Sachs disease. Genetic counseling and testing can help you determine your individual risk.

Am I at high risk for having pregnancy complications? You may be a candidate for certain complications if you’ve experienced miscarriages in the past, are clinically obese or suffer from an eating disorder. In addition, women ages 35 and older are more likely to have uterine fibroids, lupus, diabetes, hypertension and other medical conditions that can increase their risk for complications during pregnancy.

Why am I so tired? Fatigue is often worse in the first trimester but may persist throughout your pregnancy, Poliakin says. Causes include increased progesterone levels and difficulty sleeping through the night because of heartburn, leg cramps or other discomforts. But fatigue can also be a sign of anemia, so ask your doctor to check your iron level.

Why do I have a urine test at each office visit? Your urine is tested for the presence of sugar, protein and nitrites. About one-sixth of pregnant women have sugar in their urine; this may mean nothing but in some instances can indicate diabetes. A significant amount of protein found in your urine can signal pregnancy-induced high blood pressure or a kidney problem, says Poliakin. The nitrite test, he explains, screens for urinary tract infections.

Why am I asked if I have ever been pregnant before or had an abortion? If you have previously given birth, your doctor will want to find out how that pregnancy unfolded. For example, Poliakin says, if you delivered very early or very late, you have a good chance of doing so again. If you have had multiple miscarriages, your doctor may want to order certain blood tests early in your pregnancy. And an abortion may have left you with scar tissue that can cause placenta previa, a condition in which the placenta covers the inside of the cervix; this can lead to delivery complications.

When I hear the heartbeat, does that mean my baby is OK? “It means the baby’s alive; it doesn’t tell you anything more than that,” says Poliakin. Most of the time the baby is fine, but to be certain, you need to undergo other tests. At the minimum, all pregnant women, regardless of age, should have an ultrasound to measure fetal development and help detect abnormalities.

What supplements should I take? All pregnant women should take prenatal vitamins, preferably in prescription form, Poliakin says. Getting 1,000 milligrams of calcium and 600 micrograms of folate per day is especially important. If you don’t get enough of these nutrients from food sources (this is especially likely with folate), you will need a supplement.

What are these cramps that I feel? You may experience round-ligament syndrome, or pains that extend down to the groin and result from the stretching of ligaments as the uterus grows. Braxton Hicks contractions begin late in pregnancy; they are mild cramps that last from two seconds to two minutes and can occur up to 100 times a day. They’re caused by the expansion of the uterus and are harmless. But if you have stronger contractions that last at least 45 seconds and occur fewer than 10 minutes apart, call your doctor.

Do I need to change my diet or try to gain weight? Instead of focusing on weight gain, aim to eat a variety of foods that contain adequate protein, iron, calcium, vitamins and minerals. (See our nutrition quiz on page 54 for more information.) Typical weight gain in the first trimester can range from zero to 10 pounds, but don’t be overly concerned if you gain a bit more. Pregnant women require 100 additional calories per day in the first trimester and 300 extra calories daily in trimesters two and three.

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