Pregnancy

Overview

What Is It?

A healthy pregnancy starts with taking care of your body and understanding the many changes you will encounter during this special time in your life.

If you've recently found out that you're pregnant, you should learn as much as possible about what it takes to have a healthy pregnancy and how to best care for yourself and your baby during this time of physical and emotional change. Finding a health care professional with whom you're comfortable to care for you throughout your pregnancy is the first step in a healthy pregnancy.

For most women, pregnancy lasts about 40 weeks, or 280 days. This time frame is calculated from the first day of your last menstrual period. After you've missed a menstrual period and confirmed your pregnancy with a home pregnancy test, make an appointment with your health care professional.

Meeting with a health care professional early on (even before you get pregnant if you are planning to conceive) is important for all women, but especially important if you have any medical conditions or family health problems that could put you or your baby at risk.

Certain conditions, such as diabetes or high blood pressure, can affect the health of the fetus if you don't have them under control before you get pregnant or in the early stages of your pregnancy.

The sooner you can plan ahead for pregnancy, the better. For example, you should take 400 micrograms of folic acid (a B vitamin) at least a month before you become pregnant and for the first three months of your pregnancy. If you have already had a child with a neural tube defect, such as spina bifida, a type of birth defect in which the baby's spine doesn't close all the way, you are at a higher risk of having another child with the defect, and therefore, you should take more folic acid, 4 to 5 milligrams, as an extra precaution. Women taking certain antiseizure medicines are also at risk for having a child with spina bifida and may need extra folic acid. Talk to your health care professional about the right amount for you.

You should also be tested to make sure you have antibodies against rubella (German measles) and varicella zoster virus (chicken pox). If you don't have sufficient antibodies against either of these conditions and you're not yet pregnant, you should get vaccinated. Most health care providers and the Centers for Disease Control and Prevention (CDC) recommend that you delay getting pregnant for at least four weeks after receiving the vaccines.

If you're already pregnant and don't have enough antibodies against these conditions, you shouldn't get vaccinated because the vaccines contain weakened forms of the viruses which could, in some cases, trigger an infection, and contracting either during pregnancy could harm your fetus. Instead, avoid contact with anyone exhibiting symptoms of rubella and talk to your health care professional about getting vaccinated after you deliver.

When it comes to chicken pox, if you've been exposed, treatments are available that can prevent or minimize the illness in pregnant women. And remember to ask about getting vaccinated after your baby is born.

Aside from the physical changes you'll face throughout your pregnancy, you will also face many emotional issues and may find yourself on an emotional roller coaster. If it's any consolation, you should know that most pregnant women take a similar ride; it doesn't last forever, however, and there are many things you can do to keep the ride as smooth as possible.

Diagnosis

Once your pregnancy is confirmed, you should make an appointment with your health care professional, usually an obstetrician, nurse-midwife, family practitioner, physician's assistant or nurse practitioner.

This first visit will likely take much longer than other appointments over the next few months. It should include:

• A complete health and family history
• A complete physical examination, including blood pressure, height and weight measurements
• Blood tests to check for your blood group, blood type, Rh factor, anemia, immunity to rubella (German measles), hepatitis B virus and some sexually transmitted diseases (STDs)

Rh factor is a protein that 85 percent of people have on red blood cells. These people are called "Rh-positive." If you belong to the 15 percent of the population that doesn't have the protein, you're known as "Rh negative." Since Rh positive individuals are in the majority, it is likely that your baby's father may be Rh positive, so your baby may also be Rh positive.

If you have Rh-negative blood and your baby's father is Rh-positive, you and your baby may develop health problems. To reduce this risk, your health care provider will offer you injections of Rho (D) immune globulin (RhoGAM) at or around 28 weeks of pregnancy. The drug prevents your body from recognizing Rh positive cells so your body will not attack and destroy your baby's blood cells. After the baby is born, his/her Rh status will be determined and, if the baby is Rh positive, you will be offered RhoGAM again. Receiving RhoGAM while pregnant will not harm you or your baby, even if, after delivery, the baby is found to be Rh negative like you.

Your health care professional may ask whether you've been tested for HIV, the virus that causes AIDS. If you haven't been tested for HIV, he or she will likely suggest you be tested, regardless of whether you are in a high-risk category.

Depending on your ethnic background, your health care professional may also test your hemoglobin (a protein carried in your red blood cells) to look for genetic conditions such as sickle cell disease or thalassemia that could be passed on to your baby or cause you some problems during your pregnancy, such as anemia and urinary tract infections.

During this first visit, your health care professional will also do an internal pelvic exam, likely the only one you'll have until your final weeks of pregnancy. He or she will examine your internal reproductive organs to check for changes in your cervix and the size of your uterus.

A urine test is a routine part of every prenatal visit, so you should drink a lot of water before your visit. These tests provide information about glucose (sugar) and protein levels. A high glucose level may indicate gestational diabetes, a form of diabetes that only occurs during pregnancy, while a high protein level could signal potential kidney problems or urinary infection.

This first visit also may include a Pap smear to detect changes in your cervix that could be an early sign of cancer. Other tests may be recommended depending on your age and other risk factors. These include routine screenings for genetic disorders such as cystic fibrosis and more specialized genetic tests, if your medical history suggests them.

Prenatal visits after this one will be relatively brief, and most likely include the following:

• Urine sample to check for glucose (sugar) and protein
• Blood pressure measurement to gauge whether your levels are normal
• Weigh-in to make sure you are gaining enough weight and let you know if you're gaining too much
• Checking the baby's heartbeat
• Checking the size of your uterus and the position of your baby by feeling your stomach
• Providing information and education about what you can expect over the next month and any signs of problems you should look for.

This might all sound a little scary, but don't worry—most women in the United States have healthy pregnancies that lead to healthy babies.

Still, throughout your pregnancy your health care professional will recommend a handful of standard tests to check the health of your baby. These include:

• Ultrasound. Also known as a sonogram, this test uses short pulses of high-frequency, low-intensity sound waves to create images of the baby inside your uterus. Unlike X-rays, there is no radiation exposure to you or the baby. This test can be performed in a health care professional's office or in an outpatient diagnostic center.
  
  Ultrasound has been used safely in obstetrics for decades. When performed early in the pregnancy, it can provide an accurate gestational age and due date for your baby and is sometimes more reliable than calculating your due date mathematically from your last period. Many expectant moms like to get an ultrasound hoping to learn the child's sex, but health care professionals are much more focused on looking for possible birth defects. If they suspect any problems with your baby, you may need other tests.
  
  Most women experiencing a healthy pregnancy receive one to two ultrasounds. The first is usually between 11 weeks through 13 weeks 6 days and checks the thickness in the baby's neck to determine a risk for Down's syndrome. The second is usually around 18 to 20 weeks when the anatomy and organs of the baby can be assessed.
  
  To perform the test, a technician rubs a thin layer of lubricating jelly on your belly and passes a hand-held instrument called a transducer over that part of your body.
  
  Additionally, you may need a transvaginal ultrasound early in your first trimester to confirm your pregnancy or to determine how healthy the pregnancy is if you're experiencing any bleeding, signs of preterm labor or other risks that require a careful examination of your cervix. This type of ultrasound is similar to the kind of internal exam you get during a Pap smear, only instead of a speculum inserted into your vagina, the ultrasound wand is inserted.
  
  Regardless of which type of ultrasound you have, during the test itself the technician occasionally stops to take ultrasound images, which record the size of certain body parts and other developmental features of the baby. Also, an ultrasound can usually determine if you're carrying more than one baby.
  
  Multiple births (twins, triplets or more) have become much more common in the United States over the past 20 years, according to the National Center for Health Statistics. The dramatic rise, especially in triplets or higher births, is associated with two related trends: advances in and greater access to assisted reproductive therapies like in vitro fertilization and more women having children at an older age (women in their thirties are more likely to have multiple births than younger women, even without the use of fertility therapies). The rate of triplet and higher births seems to be leveling off. Reasons include refinements in assisted reproductive techniques that lower the risk of multiple births.
• Amniocentesis. This screening enables your health care professional to examine fetal cells in the amniotic fluid for any chromosomal abnormalities. If you are 35 or older when you're due to have your baby, your health care professional will likely discuss the risks of chromosomal abnormalities based on your age and recommend this test.
  
  That's because women over 35 have a higher risk of having a baby with Down's syndrome. An amniocentesis is also recommended if you've already had a child with certain birth defects, or if you have a family or personal history that puts you at risk for certain inherited diseases. You might choose to have this test if you had abnormal blood tests that suggest there might be a problem.
  
  Amniocentesis can diagnose numerous conditions, but only if the lab evaluating the amniotic fluid knows which tests to conduct. These tests are very expensive, so talk with your health care professional about which ones are necessary based on your history and risk factors. It can take anywhere from a few days to a few weeks to get the results.
  
  During an amniocentesis, the doctor inserts a needle through your abdomen into the amniotic sac and removes a small amount of amniotic fluid. The doctor uses ultrasound to guide the needle and avoid inserting it into the placenta.
  
  An amniocentesis has a complication rate of less than 1 percent, but there is a small risk of miscarriage associated with this procedure. The test can be performed on an outpatient basis in a health care professional's office or in a hospital. When it's performed for genetic studies, amniocentesis is usually done between 15 and 17 weeks.
• Chorionic villus sampling (CVS). During this test, a sample of chorionic villi, a portion of the placenta, is removed and analyzed. It is usually offered to look for certain kinds of birth defects.
  
  There are two types of CVS tests:
  • Transcervical. This is the most common method. The doctor uses ultrasound to guide a thin catheter through your cervix to the placenta, suctioning the chronic villi cells into the catheter.
  • Transabdominal. The doctor uses ultrasound to guide a long, thin needle through your abdomen to the placenta, using a needle to draw a tissue sample. This is similar to the amniocentesis.
  CVS carries a higher risk of miscarriage than amniocentesis, but some women prefer this test because it can be performed earlier than amniocentesis.
• First trimester screening (FTS). This test, which can be done as a single combined screening or a step-by-step process, involves an ultrasound scan between 10 weeks 3 days and 13 weeks 6 days of pregnancy, as well as blood testing. The ultrasound measures the "nuchal translucency," or thickness of skin on the back of the baby's neck. This measurement, in conjunction with levels of certain proteins found during the blood test, can help predict the risk of chromosomal abnormalities in the baby.
  
  First trimester screening allows women to get more information about the health of their babies without having to undergo the more invasive tests described earlier.
• Second trimester screening. This test detects four to five substances in your blood that come from the baby that could be a sign of a birth defect. All pregnant women are offered this test between weeks 15 and 20 of pregnancy. The results may indicate the need for further tests such as amniocentesis.
  
  One of the more common substances tested is alpha-fetoprotein (AFP). High levels may be a sign of a neural tube defect (such as spina bifida), in which the brain or spinal cord doesn't develop normally. Low levels could be a sign of Down's syndrome, a chromosomal defect that results in various developmental disabilities and physical problems.
  
  Don't panic if the results of either test aren't ideal, however. The tests are purely a screening tool used to identify women who are at an increased risk for having a baby with one of these conditions; other tests can provide more certain information.
  
  Other genetic screening tests identify individuals who "carry" genes for certain genetic conditions and who may pass those genes onto their children. These include Tay-Sachs and sickle cell disease, both of which are more common in certain ethnic groups. If you belong to one of these groups, your health care team may recommend you talk with a genetic counselor or have additional genetic screenings.
• Fetal heart rate monitoring. This test enables health care professionals to monitor your baby's heart rate and check his or her well-being before delivery. This test is generally performed during the last 10 to 12 weeks of your pregnancy. It may be performed earlier if a problem arises during the pregnancy, such as high blood pressure in you, or if you don't feel the baby moving.
  
  There are two types of fetal monitoring—non-stress and contraction stress. During both, a device is strapped to your abdomen and the results recorded on a tracing.
  • Non-stress test (NST). During this test, you sit quietly while the monitor records any movement of the baby and records the baby's heart rate. If the heart rate goes up when the fetus moves, the test is normal. If the heart rate doesn't increase, the baby may be "sleeping." Sometimes, the technician may want you to "wake up" your baby, by rubbing your abdomen or making a loud noise above your abdomen with a special device.
  • Contraction stress test (CST). This test is not used very often, especially since reliable, less invasive methods are available to assess fetal well-being. When used, uterine contractions are produced either by medications or other methods. When your uterus contracts, the baby is momentarily deprived of its usual blood supply and oxygen. Most babies have no problem with this, but some aren't healthy enough to handle the stress, and they develop an abnormal heart rate pattern.
    
    If the baby's heart rate slows down rather than speeds up after a contraction, the baby may be in jeopardy, and you may need to have a cesarean section to get the baby out quickly. The stress test is considered more accurate than the non-stress test, but it's not 100 percent accurate and often involves use of intravenous synthetic oxytocin to stimulate contractions. Your health care professional might want to repeat it to ensure accuracy. Most women describe this test as mildly uncomfortable, but not painful.
• Biophysical profile. If the baby doesn't react during a non-stress test, your health care professional may order a biophysical profile. This test uses a combination of a non-stress test and a detailed ultrasound to evaluate the baby's movement, body tone and breathing efforts, as well as amniotic fluid volume.
• Amniotic fluid index (AFI). This test is often performed weekly toward the end of pregnancy in women with high blood pressure, diabetes or other medical problems. It estimates the amount of amniotic fluid in the fetal sac to make sure there isn't too much (a condition called polyhydramnios) or too little (a condition called oligohydramnios). Both conditions may cause problems for mom and baby and can be a sign of other problems. If your health care provider suspects an abnormal fluid level, he or she may perform an AFI.
• Blood sugar screening. The American College of Obstetricians and Gynecologists (ACOG) strongly suggest all pregnant women be screened for gestational diabetes, a form of diabetes that occurs during pregnancy.
  
  Generally, the screenings occur between the 24th and 28th weeks of pregnancy, which coincides with the end of your second trimester or the beginning of your third trimester. Screening is so important because intervention can make a big difference in the health outcome of both a mother with gestational diabetes and her baby.
  
  Women considered to be at high risk for developing gestational diabetes should be screened during the first trimester, as well as later.
  
  You are at greater risk for developing gestational diabetes if you are obese (body mass index greater than 30); have a family history of diabetes; have previously given birth to a very large infant; or have had a stillbirth or a child with certain birth defects. One study showed a strong relationship between a mother's birth weight and her risk of getting gestational diabetes during her first pregnancy—women with low or high birth weights had an increased risk.
  
  You also have a greater risk of developing the condition if you're over 25, Hispanic, African American, Native American, South or East Asian, Pacific Islander or indigenous Australian.
• Glucose loading test (GLT). Also called a glucose challenge test, this is a simple blood test. You drink a super-sweet glucose liquid and one hour later your blood sugar level is measured to see how your body handles the sugar. You shouldn't eat or drink anything (except sips of water) during the one-hour waiting period. If you're scheduled for this test, ask your health care professional if you have to fast beforehand or make any other special preparations.
  
  Most health care professionals consider a woman to be at risk for gestational diabetes when her blood sugar level is between 130 mg/dL or higher. Some health care providers use a cutoff of 140 mg/dL or higher.
  
  Not all women with a positive screening have diabetes. Further testing is required with a three-hour glucose tolerance test (GTT) as described below.
• Three-hour glucose tolerance test (GTT). This test usually occurs first thing in the morning in your health care professional's office or a laboratory. For 10 to 14 hours before the test, you should not eat or drink anything except water.
  
  The day of the test, a technician draws your blood to measure your fasting blood sugar level. Then you drink some more of the super-sweet glucose drink. Some women feel nauseated when they drink this, but nausea should subside quickly. Then blood is drawn every hour for three hours after the glucose drink. If two or more of your blood sugar levels are higher than a certain threshold, you have gestational diabetes.

Gestational Diabetes

Gestational diabetes is a form of diabetes that occurs because of pregnancy-induced changes in the way your body processes sugar (glucose) from food, leading to high blood sugar levels. According to the American Diabetes Association, up to 9.2 percent of all pregnant women in the United States are diagnosed with the condition. Gestational diabetes doesn't cause birth defects because women with the condition don't experience abnormal blood sugar levels during the first trimester. Most birth defects related to diabetes occur during the first trimester. However, if your blood sugar remains high, the baby may grow too large to pass easily through your birth canal.

The main concern with gestational diabetes is that the baby may develop fetal macrosomia, a condition in which the baby grows larger than usual for its gestational age. A baby is considered macrosomic if its estimated weight is greater than 4,500 grams, or 9 pounds, 9 ounces. This condition occurs because the baby is getting large amounts of glucose from the mother, which triggers the baby's pancreas to produce more insulin. Extra insulin causes the glucose to be changed into fat resulting in a larger baby.

In some cases, the baby becomes too large to be delivered through the mother's vagina, requiring a cesarean delivery.

Gestational diabetes also increases the risk of hypoglycemia, or low blood sugar, in the baby right after delivery. This medical problem typically occurs if the mother's blood sugar levels have been consistently high, leading to high blood levels of insulin in the baby. After it's born, the baby continues to have a high insulin level but no longer has the high levels of glucose from the mother. So the newborn's blood sugar levels drop sharply and suddenly. Your baby's blood sugar levels will be checked in the newborn nursery, and if they're too low, the baby may receive oral or intravenous glucose.

Babies whose mothers have gestational diabetes or whose mothers had insulin-dependent diabetes before they became pregnant are also at higher risk for respiratory distress syndrome (RDS) after birth, a condition that makes it hard for the baby to breathe without assistance.

Additionally, children whose mothers had gestational diabetes are at higher risk for getting diabetes as they get older and are more likely to be obese as children or adults, which can lead to other health problems.

Like other forms of diabetes, this condition can be managed once it is diagnosed. The goal is to keep your blood sugar levels within normal ranges (less than 95 mg/dL when fasting, less than 130 to 140 mg/dL one hour after eating).

You can usually do this by following a specific diet high in complex carbohydrates (such as whole-grain cereals) and low in simple sugars, such as found in cakes and candies. Ask to meet with a nutritionist to develop the right diet for you.

You may also need to monitor your blood glucose yourself. Self-blood glucose monitoring allows you to track your glucose levels at home without extra trips to your health care professional. You may need to test your blood several times a day, usually first thing in the morning before eating and one to two hours after each meal.

You do this with a device that pricks your finger for a drop of blood. You put the blood on a test strip, insert it into a small machine and the results appear on the monitor.

If you can't control your blood sugar levels through diet alone, an oral medicine for diabetes such as glyburide or metformin or you may need insulin, a hormone you take via a shot that helps return your blood glucose levels to normal.

There's no cut-off point that automatically triggers the need for insulin. Many health care professionals recommend insulin treatment when blood sugar levels exceed 95 mg/dL first thing in the morning (the fasting sugar) or if post-meal level exceeds 140 mg/dL on two separate tests. Others are stricter—recommending it if fasting levels are higher than 90 mg/dL or if post-eating levels exceed 120 mg/dL.

Although gestational diabetes almost always disappears after you deliver your baby, having had it increases your risk for developing diabetes later. A very small percentage of women continue to have diabetes after delivery, so your blood sugar will be assessed two to six weeks after the birth to make sure your diabetes is gone.

Preeclampsia

Another fairly common but potentially serious complication of pregnancy is preeclampsia, which occurs in up to 9.2 percent of pregnancies. It is characterized by high blood pressure and/or excess protein in the urine. Other symptoms include headaches, changes in your vision and upper right abdominal pain.

Preeclampsia, previously referred to as toxemia, usually occurs during the second half of pregnancy after 20 weeks gestation, although it may occur earlier and can continue in the postpartum period.

Rapid and excessive swelling in hands and face were at one time considered possible symptoms of preeclampsia but are no longer regarded as symptoms. Many women experience some swelling during pregnancy. If your rings or shoes start feeling too tight, don't panic. Talk to your health care provider about measures to relieve the discomforts.

Preeclampsia is more likely to develop during your first pregnancy and if other women in your family developed it during their pregnancies. It's also more common in women pregnant with more than one baby, those in their teens and over 40 and those with high blood pressure or kidney disease.

Preeclampsia is dangerous for your baby because it can interfere with your placenta's blood supply. The placenta is the source of nutrition and oxygen for your baby. Any problems with the blood supply can affect the amount of nutrients and oxygen the baby receives and could lead to a low birth weight or other problems. Additionally, a small number of women go on to develop eclampsia, which includes dangerous seizures.

Unlike gestational diabetes, there really isn't one test that can diagnose preeclampsia. That's why it's so important that your blood pressure and urine be checked during each prenatal visit. Blood pressure readings significantly higher from one visit to the next could be an early sign of preeclampsia, as can high levels of protein in your urine.

Other warning signs that could indicate preeclampsia include:

• Severe headache that doesn't improve with acetaminophen (Tylenol)
• Abdominal pain in the upper right area just below your rib cage
• Double vision or blurred vision or persistent spots before eyes
• Sudden blindness (rare)
• Nausea or vomiting, other than what occurs in early pregnancy

We don't know what causes preeclampsia, but there are several theories, including:

• Not enough blood getting to the uterus
• Hormonal imbalances that affect the size of blood vessels
• Damage or injury to blood vessel linings
• Too little calcium
• Undiagnosed high blood pressure of other condition such as diabetes, lupus, sickle cell disease, hyperthyroidism or kidney disease
• Immune system deficiency
• Too little or too much protein in the diet
• Poor diet (not enough fruits and vegetables)
• High levels of body fat
• Too little magnesium and vitamin B6

There is some evidence that vitamin D deficiency may increase risk of preeclampsia. A 2010 study published in the American Journal of Obstetrics and Gynecology found that vitamin D levels were generally lower in women with early severe preeclampsia compared with those of healthy pregnant women.

A more recent 2014 study published in the journal Epidemiology found women with vitamin D deficiency in the first 26 weeks of pregnancy were at increased risk for preeclampsia.

Talk to your health care professional about vitamin D and how to boost your intake with food and/or supplementation.

Most women with preeclampsia give birth to healthy babies because the condition is usually identified early enough in pregnancy for your health care professional to intervene.

The single most important thing you should do is rest and reduce the stress in your life. Also ask your health care professional about any dietary changes that may help you stay healthy. Your health care professional may also want to see you more often to monitor your blood pressure and weight gain. Additionally, you may need a non-stress test, biophysical testing and fetal movement counts to keep an eye on how your baby is doing in light of your high blood pressure.

If you are on or near your due date and have been diagnosed with preeclampsia, discuss the risks and benefits of delivering early with your health care professional as a way to end the associated fetal and maternal risk of this condition.

Anemia

Anemia is a fairly common pregnancy condition that occurs when you have low levels of hemoglobin in your blood. Hemoglobin carries oxygen to your body tissues through red blood cells. Pregnant women often become anemic as a result of normal changes in their bodies. Fortunately, in most cases, it's not harmful to either mother or baby.

The most common cause of anemia is iron deficiency because your body uses iron to make hemoglobin. Other common anemias are related to folic acid deficiency, blood loss and genetic illnesses such as sickle cell disease.

Anemia during pregnancy is diagnosed by assessing the percentage of red blood cells/hemoglobin carriers to your total blood volume. Other laboratory tests may be conducted to identify your particular type of anemia. Screening for the condition is usually done early in the pregnancy, then again between the 24th and 28th weeks.

Signs and symptoms of anemia include:

• Tiredness, weakness or fainting
• Paleness and occasional breathlessness
• Headaches and nausea
• An inflamed or sore tongue
• Palpitations or an abnormal awareness of your heartbeat

Poor nutrition increases your risk of developing anemia, especially if you have multiple vitamin deficiencies. Smoking also increases your risk because it reduces your body's ability to absorb important nutrients. Conversely, smokers may not show the usual laboratory signs of anemia, because nicotine replaces hemoglobin , the oxygen carrying part in the red blood cells. Yet these women's bodies are starved for oxygen, which stimulates the body to produce extra red blood cells, hurting the baby's nutrition. Excess alcohol consumption also increases your risk for anemia because it is associated with poor nutrition. Other conditions and medications may place you at risk for anemia. Your health care provider will discuss these with you if needed.

If you are anemic, your health care professional may prescribe iron and folic acid supplements and recommend dietary changes, and urge you to increase rest.

Treatment

Now more than ever is the time to follow guidelines for a balanced, nutritious diet. Early in pregnancy, your baby's central nervous system and organs are forming; later in pregnancy, the baby is growing longer and heavier. Your body needs increased nutrients and protein to keep your baby healthy during pregnancy.

As a basic guideline, nutrition experts who specialize in prenatal care recommend you plan your meals and snacks to include foods from the following:

• Bread, cereal, rice and pasta, particularly whole grains
• Fruit and vegetables
• Low-fat milk, yogurt and cheese
• Meat, poultry, fish, dry beans, eggs and nuts
  
  A note about fish: Some fish contains high levels of mercury that can harm your baby's developing nervous system if eaten regularly. However, a report released by the Institute of Medicine (IOM) showed that the heart benefits of seafood outweigh the risks. The report showed that omega-3 fatty acids found in fish promote healthy vision and brain development in infants whose mothers consume seafood while they are pregnant or nursing. These healthy fats also appear to lower the risk of delivering a preterm or low-birth-weight baby.
  
  So does this mean you should eat fish or not? The answer is you should eat fish, but you should make sure it's the right kind. Guidelines issued jointly in 2004 by the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) noted that pregnant women can safely eat up to 12 ounces (about two servings) a week of a variety of cooked fish and shellfish with lower levels of mercury, such as clams, oysters, catfish, crab, haddock and trout. If you choose tuna, stay away from albacore, or white tuna, which contains higher levels of mercury than regular canned tuna. The FDA and EPA also recommend that women of childbearing age, pregnant women and breastfeeding women not eat shark, swordfish, king mackerel or tilefish, which have high levels of mercury.
• Fats, oils and sweets. Foods in this category lack nutrients and provide mostly calories. They should be consumed in small amounts.

Weight Gain and Pregnancy

There is no magic number for how much weight you should gain during pregnancy. Every woman is different when it comes to height, weight, physical activity and metabolism. A healthy pattern of weight gain is about three to six pounds during the first three months of pregnancy and about a pound a week for the remainder of your pregnancy, but your health care professional will tell you the appropriate amount for you.

General guidelines from the IOM recommend that women who were underweight before getting pregnant gain 28 to 40 pounds during pregnancy; normal weight women gain 25 to 35 pounds; overweight women gain 15 to 25 pounds; and obese woman gain 11 to 20 pounds.

Women who are pregnant with twins are given special guidelines from the IOM. Those in the normal BMI category should aim to gain 37 to 54 pounds; overweight women, 31 to 50 pounds; and obese women, 25 to 42 pounds.

High weight gain during pregnancy is associated with a greater risk for cesarean section and higher than normal birth weight and moderately associated with weight retention later in life. On the flip side, low pregnancy weight gain can lead to infants with lower than normal birth weights.

But gaining the appropriate amount of weight during pregnancy is easier said than done, as most women know. That's especially true if you suddenly have to reduce your normal physical activity because of your pregnancy. To compensate, limit snack foods high in calories and low in nutritional value, such as cookies, doughnuts, chips, soft drinks and cakes. Choose fresh fruits, vegetables and skim milk instead.

Also, if you're obese during pregnancy you have a greater risk of having a stillborn, premature or overly large baby, or a baby with neural tube defects. Your baby also has a higher risk of being obese in childhood. Thus, the American College of Obstetricians and Gynecologists (ACOG) recommends that obese women planning to conceive get a preconception consultation, weight-loss counseling and continuing nutritional counseling and exercise programs after delivery.

Morning Sickness

If you're concerned you're not gaining enough weight or if your appetite is decreased from morning sickness, discuss your concerns with your health care professional. You may want to see a nutritionist to make sure you get enough calories.

The good news is that the majority of women who suffer from morning sickness will no longer have this problem after the third month of pregnancy. Your health care professional can provide information on strategies to decrease nausea and vomiting and, if these strategies don't work, can offer medications for your morning sickness. Here are some suggestions to help minimize this problem:

• Eat saltine crackers or dry bread just before you go to bed at night and when you first wake in the morning.
• Eat smaller, more frequent meals so your stomach never gets completely empty.
• Avoid greasy or fatty food.
• Drink fluids between rather than during your meals.
• Get enough rest and take breaks when your energy level is low.
• Avoid highly seasoned foods, cream and strongly flavored vegetables such as onions.
• Take a total of 1 to 1.5 grams of powdered ginger in divided doses throughout the day (after clearing it with your health care professional).
• Take 25 mg three times a day of vitamin B6 alone or with the antihistamine doxylamine (after clearing it with your health care professional).

If you have severe "morning sickness" that continues all day, every day, or lasts beyond the first three months of pregnancy, discuss it with your health care professional. You could have a condition called hyperemesis gravidarum that affects up to 2 percent of pregnant women, causing extreme nausea and vomiting.

Gastrointestinal problems

Heartburn. You may experience heartburn or indigestion during your pregnancy. These problems typically show up later in the pregnancy and are caused when stomach acid backs up into your esophagus, causing a burning sensation in your throat and chest.

This occurs because during pregnancy hormonal changes slow digestion and relax the muscles that normally keep the stomach acids where they belong. Plus, pressure from the baby tends to push on the stomach, causing acid reflux. Here are a few things you can do to minimize discomfort from these feelings:

• Avoid large meals and eat more frequent, smaller meals.
• Avoid large spicy meals and fried or fatty foods.
• Avoid exercising or going to bed within two hours after eating.
• Ask your health care professional about antacids that might provide relief.
• Raise the head of your bed a couple of inches by putting risers under the bed's legs at the headboard.

Constipation. You may also experience some constipation during your pregnancy. This occurs partly because your baby puts pressure on your bowel, and partly because of hormonal changes that slow the passage of food through your digestive system.

To minimize constipation, eat foods that are high in fiber, exercise and drink lots of nonalcoholic and non-caffeinated fluids.

Hemorrhoids. Sometimes your constipation may be accompanied by hemorrhoids, enlarged veins near your anus. You may get hemorrhoids during pregnancy even if you don't have any problems with constipation. They occur, in large part, because the growing baby puts pressure on these veins, causing them to swell.

Try not to strain during bowel movements, because that could make your hemorrhoids worse, leading to itching, soreness or even bleeding. If you have hemorrhoids, increase your fluid and fiber consumption and check with your health care professional before taking any medication.

Varicose Veins

Varicose veins are veins in your calves, thighs and vagina that become swollen and painful during pregnancy. They get worse if you have to stand for long periods.

The best remedy is to wear support stockings. Lying on your side or sitting with your legs elevated can also help. If you must stand for a long time, move around as much as possible and lift your heels or toes to increase circulation to your legs.

Sleeplessness

In the early months of your pregnancy, you may find you're more tired than normal, taking naps and sleeping longer. In later months, you may begin to experience some sleep problems, including problems falling and staying asleep as the growing baby makes lying down uncomfortable.

Some of these problems may get worse as you get closer to your delivery time, and you may find you get your sleep in shorter stretches.

To help with pregnancy-related insomnia:

• Take warm baths before bed.
• Learn relaxation exercises.
• Lie on one side with a pillow between your legs or use a body pillow that helps you stay in this position.

Emotions

In addition to the physical changes of pregnancy, you may also feel as if you're on an emotional roller coaster. During the first three months of pregnancy, you're still adjusting to the idea of being pregnant and the prospect of becoming a mother (if it's your first time) or adding another child to your family.

The middle part of your pregnancy may be more relaxing and calmer as you ease into the routine of pregnancy and begin bonding with the baby.

During the last phase of your pregnancy, however, you may find yourself feeling more anxious, fearing any complications during labor and delivery. Many women experience nightmares or other disturbing dreams about their pregnancy, labor and birth. Dreams are a way of expressing our anxieties.

Discussing your feelings with your partner and health care professional could help allay some of your anxieties and make you feel more positive about the whole experience.

Sexuality

Don't be surprised to find your feelings about sex with your partner change during pregnancy. Some women report feeling increased sexual desire, during their pregnancies, because of hormonal surges. At other times, you may feel a decreased desire for sex.

Additionally, physical changes may interfere with your desire for sex, including nausea, physical discomfort, fear of harming the baby and feeling less desirable because of your weight gain and appearance changes.

In the absence of conditions such as vaginal bleeding and ruptured membranes, sexual activity is safe during pregnancy. Don't worry about hurting the baby during sex; that won't happen because of the cushion provided by the fluid in the amniotic sac. Try different positions that don't put pressure on your abdomen. And if you're concerned that sexual activity might interfere with or cause a pregnancy complication, discuss the matter with your health care professional.

Your partner also may have a different sexual response to you during pregnancy. Some women report their partner draws closer to them during pregnancy, while others say their partners go through their own psychological changes and withdraw from the relationship. If your relationship becomes strained, your health care professional can refer you for counseling or other mental health services.

The following discussion addresses treatment options for more serious medical considerations during pregnancy that haven't already been discussed in the Diagnosis section.

HIV transmission. HIV is the virus that causes AIDS. About 25 percent of babies born to untreated HIV-positive women become infected with the virus. But if infected women take antiviral drugs during their pregnancy, this number can be reduced to close to zero.

If you're pregnant and don't know if you have HIV, you should get screened. If you are HIV-positive, your health care professional can start you on drug treatment to reduce the risk of transmitting the virus to your baby.

Miscarriage. Also known as a spontaneous abortion, a miscarriage is defined as the loss of your pregnancy before 20 weeks' gestation. It occurs in up to 30 percent of all pregnancies.

Miscarriage usually happens in the first trimester—that is, during the first 12 weeks of pregnancy. After four months, it's much less likely to occur. However, the risk of miscarriage increases with age.

If you have a miscarriage, it's important to know that it doesn't necessarily mean you won't be able to carry a baby to full term in the future.

Early warning signs of a miscarriage include:

• Vaginal spotting of blood
• Pain in the lower back
• Cramps in the lower abdomen
• Heavy bleeding with clots

Most women who have bleeding or cramps during early pregnancy are not miscarrying, and the pregnancy usually progresses normally.

The loss of your baby through a miscarriage is emotionally traumatic. You should discuss your feelings with your partner and others; your health care professional can recommend a bereavement counselor if you want to consider this option for helping you overcome your grief and loss.

Prevention

Throughout pregnancy, you should avoid certain substances to keep your baby as healthy as possible, before and after birth. They include:

• Alcohol, drugs and tobacco. There is no known safe level of alcohol that you can consume during your pregnancy. Heavy alcohol consumption can cause severe defects in the brain and body development of your baby, known as fetal alcohol syndrome (FAS). Even moderate drinking is associated with delayed growth of the baby and causing spontaneous abortion or low birth-weight babies. The Surgeon General warns pregnant women to avoid alcohol completely.
  
  Babies of mothers who use some illegal drugs, such as heroin, are born addicted to these drugs. Other drugs that flow through the mother's bloodstream pass through the placenta into the baby's bloodstream, affecting the baby as well.
  
  If you smoke, ask your health care professional for help quitting. Tobacco deprives your baby of oxygen during pregnancy and causes low birth weight and increased respiratory and ear infections in infants and young children.
• Prescription or over-the-counter medication. You may need to stop taking some medications during your pregnancy or stop them for a while early in pregnancy and then take them again later in pregnancy. Your health care professional will discuss your options with you.
• Caffeine. It is generally recommended that you avoid caffeine or limit your intake during pregnancy and breastfeeding. If you do consume caffeinated drinks (such as coffee, tea and soda), limit them to one to two cups or no more than 200 milligrams a day (the amount in one 12-ounce cup of coffee) or try decaffeinated beverages. If you are a heavy caffeine user, remember that you may have withdrawal headaches if you abruptly stop using caffeine. Discuss with your health care provider how you can most comfortably and safely decrease your caffeine intake.

Infections

Certain infections during pregnancy may be passed along to the baby during pregnancy or birth, increasing your baby's risk of birth defects. These infections include:

• Toxoplasmosis, an infection caused by a parasite in cat feces and raw meat. If you have cats, assign someone else the duty of cleaning the litter box and wear gloves if you garden in places where cats may frequent. Be sure to wash your hands and all surfaces thoroughly after working with raw meat, and avoid eating raw meats.
• Group B streptococcus (GBS). This is a type of bacterium that can cause bladder infections and womb infections in pregnant women, and sepsis, meningitis and pneumonia in newborns.
  
  According to the Centers for Disease Control and Prevention (CDC), about 25 percent of pregnant women carry GBS in the rectum or vagina, but most don't have any symptoms. These women are considered "carriers." The danger occurs if the baby comes in contact with GBS before or during birth.
  
  The CDC recommends screening all pregnant women between 35 and 37 weeks gestation for the bacterium. If you have the bacteria, you will likely receive intravenous antibiotics (e.g., penicillin or ampicillin) during labor, which studies find can prevent most GBS disease in newborns.
• Sexually transmitted diseases (STDs). Pregnant or not, be sure to use a condom if you have sex with a partner who could have an STD so you can reduce your risk of HIV/AIDS, syphilis, gonorrhea, hepatitis B, herpes and other STDs.
  
  If you are diagnosed with an STD, make sure you take your medication as prescribed. Depending on the STD, your partner may also need to be treated. Post treatment, your provider may want to retest you to be sure that the infection is gone. Some infections, such as HIV/AIDS and herpes, can't be cured, but their effects on your baby can be minimized or eliminated with treatment.

Workplace Hazards

Avoid on-the-job hazards that could be harmful to you or your baby, including exposure to chemicals, gas, dust, fumes or radiation. Discuss all workplace concerns with your health care professional. Employers that use potentially dangerous chemicals should have material safety information/data sheets (MSDS) to help you understand risks during pregnancy. The Occupational Safety and Health Administration (OSHA) (www.osha.gov) is the federal agency that provides information and regulates this area.

Exercise

If you've been exercising regularly before your pregnancy, chances are your health care professional will encourage you to keep exercising with some slight changes as your pregnancy progresses.

If you haven't been exercising and want to start, your pregnancy is a good time. Just be sure and discuss this matter with your health care professional first. And remember to start slow and steady.

Exercise is important during pregnancy. It strengthens your muscles, eases some discomforts of pregnancy and can help you prepare for delivery.

Yoga can be particularly beneficial, helping with breathing and relaxing, both of which come in handy during labor, childbirth and parenting. Some precautions for yoga while pregnant:

• Avoid poses on your back after the first trimester.
• Avoid poses that stretch the stomach muscles.
• Take care not to lose your balance; keep your heels to the wall or hold onto a chair.
• Bend forward from your hips, not your back.
• Do twisting poses more from your shoulders and back to avoid pressure on your stomach.

When exercising, don't get overheated or extremely tired; drink a lot of water at regular intervals; and slow down your overall workout.

Childbirth Education

Childbirth education and support can help ensure a joyful birth and transition to a new family. Prenatal classes, usually offered at a local hospital approximately three months before baby's due date, help prepare you and your partner for labor and delivery using proven relaxation, massage and breathing techniques.

The classes also provide discussion on important issues such as pain relief, cesarean birth and breastfeeding. Plus, you usually get a tour of the labor, delivery and postpartum areas.

Most childbirth classes follow a similar format: You and your partner join other expectant couples for the course, which may meet one night a week for several weeks, over an intensive weekend or as a private class taught in your home. There are several, popular childbirth education programs available; some of the most popular include the following:

• The Lamaze method. Popularized in the early 1950s by French obstetrician Dr. Ferdinand Lamaze, it emphasizes pain management through relaxation and breathing exercises.
• The Bradley method. Developed by Dr. Robert Bradley in the late 1940s, it emphasizes a natural approach to childbirth, with few or no drugs and little medical help during labor and delivery. The method stresses good diet and exercise during pregnancy and teaches deep relaxation techniques to manage pain. It also educates a woman's partner so he or she can be an effective coach.
• HypnoBirthing. HypnoBirthing, also called the Mongan Method, promotes using deep relaxation, self-hypnosis and visualization to create a calm, serene, comfortable birth. HypnoBirthing works both for women who want a natural childbirth and those who require medical intervention during labor.

When looking for a childbirth class, you may want to look for an instructor who has been certified by the International Childbirth Education Association (ICEA), an organization that educates and trains childbirth instructors. The ICEA does not promote any particular childbirth technique, so you should look for an instructor who teaches the method you would like to use.

Here are some features to look for when choosing your class:

• Instruction that supports birth as normal, natural and healthy and empowers women to make informed choices
• Class content that covers a broad range of topics, including positioning for labor and birth; techniques to ease pain; labor support; communications skills; postpartum care; and information about medical procedures, breastfeeding and healthy lifestyles
• At least 12 hours of instruction that includes practice for positioning and relaxation and class discussion
• Small classes with a maximum of 12 couples
• Qualified instructors; look for certification from a nationally recognized program

Facts to Know

1. Most pregnancies last about 40 weeks or 280 days, beginning from the first day of your last menstrual period.
2. According to the American Diabetes Association, up to 9.2 percent of pregnant women develop gestational diabetes. This condition can be identified early in pregnancy and managed to prevent complications. The American College of Obstetricians and Gynecologists (ACOG) recommends screening for gestational diabetes between pregnancy weeks 24 and 28.
3. Preeclampsia (also known as toxemia), a condition that may occur during the second half of pregnancy, causes high blood pressure, swelling that doesn't subside and higher-than-normal amounts of protein in the urine.
4. Anemia during pregnancy occurs when you have a low level of hemoglobin, a protein that carries oxygen to your body tissues via red blood cells. Anemia can be caused by iron deficiency, folic acid deficiency, blood loss and hereditary diseases such as sickle cell disease.
5. General guidelines from the IOM recommend that women who were underweight before getting pregnant gain 28 to 40 pounds during pregnancy; normal weight women gain 25 to 35 pounds; overweight women gain 15 to 25 pounds; and obese woman gain between 11 and 20 pounds.
6. Miscarriage occurs in 8 percent to 30 percent of known pregnancies, usually during the first 12 weeks of pregnancy.
7. If you are HIV-positive, you can reduce your chances of transmitting the infection to your baby by undergoing drug treatment while pregnant.
8. The rate of births delivered via cesarean section is increasing in this country. In 2013 (the most recent data available), about 33 percent were delivered via cesarean section.
9. Although episiotomy (an incision made between the vagina and the rectum—called the perineum—to facilitate the birth) used to be routine during deliveries, some studies have found that women who receive episiotomies do not have significantly improved labor, delivery and recovery compared with women who do not have one. Research has also shown that the adverse consequences of the procedure, including a larger tear, dysfunction of the anal sphincter and painful sex, are underestimated. As a result, ACOG now recommends limited use of episiotomies.

Questions to Ask

Review the following Questions to Ask about pregnancy so you're prepared to discuss this important health issue with your health care professional.

1. What do you recommend as a healthy weight gain for my pregnancy? How much is too much, and how much is too little?
2. What kind of exercise, and how much, is safe for me during pregnancy?
3. Am I at risk for any specific complications during pregnancy or labor and delivery?
4. What are your recommendations about alcohol, tobacco and caffeine? Is a small amount safe, or do I need to stay away from them completely during my pregnancy?
5. What over-the-counter medications can I take if I'm sick? Which ones should I stay away from completely during my pregnancy?
6. What kind of medications can I take if I have indigestion or heartburn?
7. What are the tests that you are recommending, and when should they be done? Will my insurance cover the costs?
8. Are there any foods that I should avoid during my pregnancy, such as sushi? Are there any activities that I should stay away from? Do I have to stay away from cats? What about hot tubs?
9. Is there any danger to the baby if I engage in sexual activity during pregnancy?
10. At what point in my pregnancy would you advise me to stop flying?

Key Q&A

Lifestyle Tips

1. A little caffeine OK during pregnancy
   Drinking one cup of coffee daily or limiting your caffeine intake to 200 mg per day does not appear to increase a pregnant woman's chances of miscarriage. Remember that caffeine is also found in chocolate, colas and certain medications and that some brands of coffee contain more caffeine than others.
2. Preventing incontinence naturally
   Pregnancy can weaken pelvic muscles, which in turn can lead to urinary incontinence. Exercising the pelvic floor muscles for five minutes a day can help you maintain or regain bladder control. These exercises, known as Kegel exercises, involve the same muscles you use to stop the urine stream while urinating. To make sure you know how to contract your pelvic floor muscles correctly, try to stop the flow of urine while you're going to the bathroom. If you can do this, you've found the right muscles.
   
   To do Kegel exercises, empty your bladder and sit or lie down. Contract your pelvic floor muscles for three seconds, then relax for three seconds. Repeat 10 times. Once you've perfected the three-second contractions, try doing the exercise for four seconds at a time and then resting for four seconds, repeating 10 times. Gradually work up to keeping your pelvic floor muscles contracted for 10 seconds at a time, relaxing for 10 seconds in between. Aim to complete a set of 10 exercises, three times a day.
3. Exercise during pregnancy
   If your pregnancy is normal and you have no serious medical problems, exercising gently is probably safe. But check with your health care provider first—especially if you did not exercise before you became pregnant. Exercising can make you feel better and help you avoid excessive weight gain. If your care provider approves, you can start exercising at a level that does not cause pain, shortness of breath or excessive fatigue. Then slowly increase your activity but not to the point where you feel uncomfortable, short of breath or very tired.
4. Visit your prenatal care provider regularly throughout pregnancy
   You should see your health care provider as soon as possible after getting a positive pregnancy test. After that, you will likely visit him or her every four weeks until 28 weeks, every two weeks from 28 to 36 weeks, and then weekly until you're ready to deliver. Don't take any medication unless it is prescribed or recommended by a health care professional who knows you are pregnant. Take prenatal vitamins that contain iron and folic acid to protect you against anemia and to reduce the risk of birth defects. Contact your care provider if you develop any abnormal symptoms, including severe pain, blurred vision, vaginal sores or vaginal bleeding.
5. Fight back against morning sickness
   If you're feeling queasy during your pregnancy, you're certainly not alone—nausea with or without vomiting occurs in up to 90 percent of all pregnant women. The good news is that morning sickness is associated with lower risks of miscarriages and stillbirths. But that doesn't mean you have to suffer. To get some relief, try to avoid nausea triggers, such as stuffy rooms; odors like perfume, food, chemicals or smoke; heat; humidity; and noise. Also try to eat as soon as you start to feel hungry and consume foods that are high in carbohydrates and low in fat. Try to drink fluids between meals, and stick to drinks that are cold, clear, carbonated or sour (lemonade and ginger ale are good examples). You may also try acupressure wrist bands—they put pressure on the P6 pressure point on the wrist, which is known in traditional Chinese medicine to ease nausea. And ginger and vitamin B6 supplements may help; be sure to discuss them with your health care professional first, however. If all else fails—or if you have a severe case of nausea and vomiting—you may be able to take a prescription medication to help ease your discomfort.

Organizations and Support

For information and support on Pregnancy, please see the recommended organizations, books and Spanish-language resources listed below.

Adoption.org
Website: https://www.adopting.org/

Adoption Resources
Website: https://www.adoptionresources.org/
Hotline: 1-800-533-4320
Email: info@adoptionresources.org

American College of Nurse-Midwives (ACNM)
Website: https://www.midwife.org
Address: 8403 Colesville Rd., Suite 1550
Silver Spring, MD 20910
Phone: 240-485-1800

American College of Obstetricians and Gynecologists (ACOG)
Website: https://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org

Association of Maternal and Child Health Programs
Website: https://www.amchp.org
Address: 2030 M Street, NW, Suite 350
Washington, DC 20036
Phone: 202-775-0436

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
Website: https://www.awhonn.org
Address: 2000 L Street, NW, Suite 740
Washington, DC 20036
Hotline: 1-800-673-8499
Phone: 202-261-2400
Email: customerservice@awhonn.org

CordBloodGuide.com
Website: https://www.cordbloodguide.com

DONA International
Website: https://www.dona.org
Address: P.O. Box 626
Jasper, IN 47547
Hotline: 1-888-788-DONA (1-888-788-3662)
Email: info@dona.org

Fertility Awareness Center
Website: https://www.fertaware.com/
Address: P.O. Box 1190
New York, NY 10009
Phone: 212-475-4490
Email: admin@fertaware.com

FASD United -Fetal Alcohol Spectrum Disorders
Website: https://fasdunited.org/

First Candle
Website: https://www.firstcandle.org
Address: 1314 Bedford Avenue, Suite 210
Baltimore, MD 21208
Hotline: 1-800-221-7437
Phone: 410-653-8226
Email: info@firstcandle.org

HRSA Maternal and Child Health Bureau
Website: https://mchb.hrsa.gov
Address: Parklawn Building Room 18-05
5600 Fishers Lane
Rockville, MD 20857
Phone: 301-443-2170
Email: ctibbs@hrsa.gov

iChooseAdoption.org
Website: https://www.ichooseadoption.org
Email: info@iChooseAdoption.org

International Cesarean Awareness Network
Website: https://www.ican-online.org
Address: 1304 Kingsdale Ave.
Redondo Beach, CA 90278
Phone: 310-542-6400
Email: info@ican-online.org

La Leche League International (LLLI)
Website: https://www.llli.org
Address: P.O. Box 4079
Schaumburg, IL 60168
Hotline: 1-800-LALECHE (1-800-525-3243)
Phone: 847-519-7730

Lamaze International
Website: https://www.lamaze.org
Address: 2025 M Street, Suite 800
Washington, DC 20036
Hotline: 1-800-368-4404
Phone: 202-367-1128

March of Dimes
Website: https://www.marchofdimes.com
Address: 1275 Mamaroneck Ave.
White Plains, NY 10605
Phone: 914-997-4488

National Abortion Federation
Website: https://www.prochoice.org
Address: 1660 L Street, NW, Suite 450
Washington, DC 20036
Hotline: 1-800-772-9100
Phone: 202-667-5881
Email: naf@prochoice.org

National Family Planning and Reproductive Health Association (NFPRHA)
Website: https://www.nationalfamilyplanning.org/
Address: 1627 K Street, NW, 12th Floor
Washington, DC 20006
Phone: 202-293-3114
Email: info@nfprha.org

National Institute of Child Health and Human Development
Website: https://www.nichd.nih.gov
Address: National Institutes of Health
P.O. Box 3006
Rockville, MD 20847
Hotline: 1-800-370-2943
Email: nichdinformationresourcecenter@mail.nih.gov

Maternal and Child Health Bureau
Website: https://mchb.hrsa.gov/
Address: Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
Hotline: 1-888-ASK-HRSA (1-888-275-4772)
Phone: TTY/TTD: 1-877-4TY-HRSA (1-877-489-4772)
Email: ask@hrsa.gov

Planned Parenthood Federation of America
Website: https://www.plannedparenthood.org
Address: 434 West 33rd Street
New York, NY 10001
Hotline: 1-800-230-PLAN (1-800-230-7526)
Phone: 212-541-7800

Postpartum Support International
Website: https://www.postpartum.net
Address: P.O. Box 60931
Santa Barbara, CA 93160
Hotline: 1-800-944-4PPD (1-800-944-4773)
Phone: 805-967-7636
Email: psioffice@postpartum.net

Waterbirth International
Website: https://www.waterbirth.org
Address: P.O. Box 1400
Wilsonville, OR 97070
Hotline: 1-800-641-2229
Phone: 503-673-0026

Books

The Disabled Woman's Guide to Pregnancy and Birth
by Judith Rogers

Dr. Ruth's Pregnancy Guide for Couples
by Amos Grunebaum M.D.

Everything Pregnancy Book: What Every Woman Needs to Know Month-By-Month to Ensure a Worry-Free Pregnancy
by Paula Ford-Martin , Elisabeth A. Aron, and Maryann Bucknum Brinley

Exercising Through Your Pregnancy
by James F. Clapp

Getting Pregnant Naturally: Healthy Choices to Boost Your Chances of Conceiving Without Fertility Drugs
by Winifred Conkling

The Good Housekeeping Illustrated Book of Pregnancy and Baby Care, Revised & Updated
by From the Editors of Good Housekeeping

A Guy's Guide to Pregnancy: Preparing for Parenthood Together
by Frank Mungeam and John Gray

The High-Risk Pregnancy Sourcebook
by Denise M. Chism

Holistic Pregnancy and Childbirth: Natural Ways to Have a Healthy, Joyful Experience
by James Marti

Just Take It Out! The Ethics & Economics of Cesarean Section and Hysterectomy
by D. Campbell Walters

Mama Sana, Bebe Sano (Healthy Mother, Healthy Baby)
by Aliza A. Lifshitz

Mayo Clinic Guide to a Healthy Pregnancy
by Mayo Clinic

Mommy's Little Breastfeeding Book: 101 Tips Your Baby Wants You to Know About Breastfeeding
by Michele Leigh Carnesecca, Jeanette Bennett, and Carol Shelley Xanthos

The New Essential Guide to Lesbian Conception, Pregnancy, and Birth
by Stephanie Brill and Preston Sacks

Pregnancy and Parenting after Thirty-Five: Mid Life, New Life
by Michele C. Moore, M.D. and Caroline M. de Costa, M.D.

Yoga for Pregnancy: Ninety-Two Safe, Gentle Stretches Appropriate for Pregnant Women & New Mothers
by Sandra Jordan

Spanish-language resources

National Institute of Diabetes and Digestive and Kidney Diseases
Website: https://www.niddk.nih.gov/health-information/informacion-de-la-salud/control-de-peso/consejos-futura-mama
Address: Weight-control Information Network
1 WIN Way
Bethesda, MD 20892
Hotline: 1-877-946-4627
Email: win@info.niddk.nih.gov

Medline Plus: Pregnancy
Website: https://www.nlm.nih.gov/medlineplus/spanish/pregnancy.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov