If you are pregnant during flu season, you should have a flu shot as soon as it’s available. We also recommend that you stay up-to-date with any needed COVID booster shots and you can receive this vaccine during pregnancy if needed. Seasonal flu and COVID infections are a leading cause of maternal death and pregnancy complications and these vaccines are highly effective and safe. If you are between 32-36 weeks’ gestation during the months of September to January, you should also receive the RSV vaccine to protect your newborn against RSV infection in those peak months after birth. We also recommend the Tdap vaccine during pregnancy to protect you and your newborn against whooping cough (pertussis). We recommend this between 27-36 weeks’ gestation to optimize the production and transmission of antibodies across the placenta to protect your newborn. If you happen to receive this shot earlier in pregnancy for some reason (maybe you stepped on a nail), you don’t need to repeat it later.
Do I need any vaccinations before pregnancy?
The most important vaccine that you should get prior to pregnancy is the MMR (measles, mumps, rubella) vaccine. Many people received this vaccine during their childhood; however, immunity can wane over time. Your doctor can order a blood test called a titer that looks at your immunity to those diseases and will decide based on your antibody levels whether you should get the vaccine again. Historically, congenital rubella syndrome was a devastating disease that affected newborns whose mothers developed rubella in the first trimester. Thankfully, because of the vaccine, this condition is now rare with fewer than 1,000 cases a year but even those are preventable.
Is it normal that I’m cramping?
Almost all women have some cramping or other pains during pregnancy, particularly in the first trimester. This cramping is almost never anything to be worried about, particularly if you’re not bleeding. In the first trimester, the uterus grows rapidly and most of the cramping that a woman experiences is simply growing pains. As the uterus gets bigger, it becomes top-heavy and has a tendency to pull and tug from one side to the other. This will stretch ligaments, particularly the round ligaments of the uterus, and cause either cramping or sharp pains in the groin. None of these symptoms put the baby at risk.
Sometimes cramping is not related to your uterus at all. Many women become constipated during pregnancy and the cramping they experience is actually related to their bowels slowing down. Sometimes cramping is related to the bladder and might be a sign of bladder infection, but almost always there will be other symptoms like burning when you pee.
In the second and third trimesters, cramping is often what is called Braxton-Hicks contractions. We will talk about these contractions and compare them to real labor contractions later when we answer the question, “How can I tell if I’m in labor?”.
Do I need to take anything besides my prenatal vitamin?
In most cases, the answer is no.
There is a whole industry that markets supplements and other products to pregnant women. Even among prenatal vitamins, for most women the only ingredient that is actually required is folate, and folate is only necessary until the baby’s neural tube is closed, which happens early in the first trimester. The truth is, prenatal vitamins are best taken beginning at least two to three months before pregnancy and provide little to no benefit past the first half of the first trimester. In fact, if you are beyond six weeks and prenatal vitamins are making you nauseous or constipated, there’s no reason for you to keep taking them.
Aside from the folate in a prenatal vitamin, the other ingredients often found in these vitamins are not science-based. Don’t get caught up in buying the most expensive prenatal vitamin because the company says it will make your child smarter or reduce the risks of pregnancy; this simply is not true.
In some cases, due to restrictive diets or preexisting anemia or other risk factors, your doctor might ask you to take an additional supplement or medication, most commonly iron.
What happens at my prenatal visits?
Click here for full explanation of what should happen at your prenatal visits.
I don’t understand my due date? When is the baby due?
How your due date is calculated is often confusing and different from what you expect. Pregnancy is 40 weeks or 280 days long, starting from the first day of the last menstrual period. This means that at the time of conception, a woman is already two weeks pregnant. This assumes that her menstrual cycles are 28 days apart.
There are plenty of pregnancy due date apps and calculators that will tell you your estimated due date (EDD) based upon the first day of your last menstrual period (LMP). There’s even one on the front page of wonderfulpregnancy-com.preview-domain.com. Calculating your EDD from your LMP assumes a few things:
- That you remember the first day of your last menstrual period correctly;
- That you weren’t on birth control or something that would alter your cycles at the time of conception;
- That you have regular, 28-day cycles.
If your cycles are shorter or longer, your due date must be adjusted. If you don’t remember when your period was or you were on birth control at the time, you will probably have to be dated by an ultrasound. The earlier the ultrasound is performed, the more accurate it is for estimating your due date. Your doctor or midwife will help you figure out an exact due date at your first or second visit.
Many times, women don’t remember the exact day of their last menstrual period, or they may not have menstrual cycles that are exactly 28 days long, or they might have been on birth control at the time of conception. Sometimes women ovulate a little bit later than usual, or the bleeding they thought was their last menstrual period was actually related to the pregnancy (e.g., implantation bleeding). All of these factors mean that dating based on the last menstrual period is wrong about 40% of the time. Your doctor or midwife will determine your due date based on your last menstrual period and compare that to a due date determined by the earliest ultrasound, and in some cases, your due date will need to change based on the ultrasound.
As we said, the earliest ultrasound that you have is the best one to determine your due date. Sometimes, patients are confused because subsequent ultrasounds will show measurements that have a slightly different due date and they will wonder if their due date should be changed again based on these later ultrasounds. The answer is no. The later ultrasounds reflect a pregnancy that is just a little bigger or smaller than the average for that gestational age or vary just because of the margin of error of the scan.
Make sure you clarify at one of your first prenatal visits what your final estimated due date is; then, don’t get too fixed on that day. Only 2% of women deliver on their due date. Maybe we should’ve called it a due month!
How much weight should I gain?
Normal weight women (BMI of 18.5-24.9) should gain about 25-35 pounds during their pregnancies. Underweight women (BMI < 18.5) may need to gain more and overweight women less. For obese women (BMI > 30), dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by their 20th week; this is healthy and okay.
We check your weight at every visit, but please don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much weight. Excess weight gain increases the risks of several pregnancy complications, including the risks of preeclampsia, diabetes, fetal macrosomia (a big baby), and Cesarean delivery.
Many overweight women can gain no weight for the entire pregnancy or even lose some weight if they’re actively dieting. This is not a bad thing. Maternal weight gain, if it is excessive, is associated with a larger fetal size; but that doesn’t mean that gaining too little weight during pregnancy will not make your baby too small if you are overweight at the start of the pregnancy. The goal is to have a healthy baby and a healthy mom. Talk with your doctor or midwife about what your weight journey should look like throughout pregnancy based on your pre-pregnancy weight.
Can I drink caffeine?
Yes, you can.
As with most things in life, moderation is the key. Scientific studies have not demonstrated any problems with caffeine consumption during pregnancy until a woman consumes over 700 mg per day. That’s a lot of caffeine! To be safe, and to make sure that a woman never approaches that amount of caffeine consumption, we recommend that women limit themselves to 350 mg of caffeine per day.
Click here to find out how much caffeine is in your favorite beverage.
Why am I so tired?
Pregnant women are often excessively tired in the first and third trimesters, but probably for different reasons. In the first trimester, your body undergoes rapid physiological changes accompanied by high levels of hormones that conspire to exhaust you. Couple this with food aversion or nausea and vomiting, and the result for many women is complete exhaustion.
This tends to get better by the second trimester and then in the third trimester, particularly the last few weeks of pregnancy, exhaustion returns as you sleep less at night and carry around 30+ extra pounds during the day. If you have another small baby or two at home already, then the effect is even worse.
To help with symptoms in the first trimester, you can work on minimizing the effects of nausea and vomiting of pregnancy by eating several small meals or snacks throughout the day and adding vitamin B6 twice a day if you haven’t already. Naps sometimes feel like a good idea, but they often have the opposite effect than what you desire. Napping can interfere with your ability to get good rest at night and this can create a vicious cycle. Going for a walk or getting some exercise is probably a better idea and will improve your nighttime sleep.
Some women in the first trimester are excessively tired because they have cut caffeine completely out of their diets. Remember, you are still allowed to have up to 350 mg of caffeine per day; so don’t feel too bad about having that cup of coffee in the morning or maybe after lunch.
Many pregnant women need to work on maximizing their sleep hygiene. Make sure you have a dark room, maybe with a noisemaker, like a fan or something else that makes background noise, to minimize interruptions. Try to use your bedroom for sleep only; don’t make a habit of watching TV from your bed or staring at your phone. Women in the third trimester often find every little uncomfortable spring in their mattresses with their rounder bellies and hips. Try adding an extra layer of egg crate or a foam topper to your mattress and make sure you have a long pillow that you can hug with your legs. A hot shower about an hour before you go to sleep can also make a huge difference.
Also, be sure to empty your bladder right before you go to sleep and if you find that you are waking up to pee several times a night, you might need to restrict water intake for two to three hours before going to sleep.
In rare cases, excess fatigue might indicate another problem like a thyroid abnormality or anemia; if you feel like you are more tired than the average pregnant woman, be sure to talk to your doctor.
If you are occasionally tired or having a difficult time getting to sleep, tossing and turning, etc. an antihistamine like Unisom SleepTabs or Benadryl can be a safe option for moms to help with sleep. We recommend trying healthy sleeping habits before resorting to medications. Finally, if you are snoring a lot, you might have sleep apnea. A sleep study and treatment for this can be life-changing! Don’t hesitate to talk to your doctor about a sleep study while you’re pregnant.
What can’t I eat?
Good question. The truth is, you can eat just about anything you want. Click here for a full explanation. The short answer is to not eat:
- Big fish with high levels of mercury (shark, swordfish, king mackerel, and tilefish)
- Unpasteurized milk and soft cheeses
- Raw or undercooked meats
- Cold cuts (lunch meat, salami, etc.)
Finally, make sure you wash your fruits and vegetables well before eating them. The absolute risk of the anything that happening from eating any of these foods is incredibly low. So you shouldn’t worry too much; but pregnancy isn’t the time to explore strange and new foods from uncertain sources.