How much weight should I gain during pregnancy?
This is a common question and fairly recently underwent a revision in the recommendations. Prior to 2009, the focus on mother’s weight gain was for concerns regarding the baby. Low weight gain was thought to increase the risk of the baby being too small. More recent data demonstrates the risk to the baby from low weight gain was greatly exaggerated. What we did see was that the excessive weight gains recommended in the past, increased the risk of postpartum weight retention in the mother which led to obesity. In fact, having kids is one of the leading causes of obesity in women. New guidelines came out in 2009, weighing the risks and benefits of weight gain for both the mother and baby. They are as follows
Here are the guidelines for pregnancy weight gain, based on a woman's BMI (body mass index) before becoming pregnant with one baby:
- Underweight: Gain 28-40 pounds
- Normal weight: Gain 25-35 pounds
- Overweight: Gain 15-25 pounds
- Obese: Gain 11-20 pounds
And here are the guidelines for weight gain during pregnancy with twins, based on the mother's prepregnancy BMI:
- Normal weight: Gain 37-54 pounds
- Overweight: Gain 31-50 pounds
- Obese: Gain 25-42 pounds
- Underweight: No weight gain guidelines are available because of insufficient data.
Is ultrasound safe in pregnancy?
Yes!!! It is very safe!!. Ultrasound is high frequency sound waves, sort of like sonar or a fish finder, that generates an image based on how the sound waves are reflected back to the transducer. It has been studied extensively and does not result in any damage to the baby’s developing organs. However, it is a medical procedure and is only used when necessary. Concerns for a baby’s well-being may result in the need for many ultrasounds. It is the medical condition of the baby that puts the baby at risk of complications and not the ultrasound that is following this condition.
What is the need for a transvaginal cervical length?
Preterm birth is the leading cause of babies dying or having mental retardation, cerebral palsy, or other life long health problems. Despite many advances in medical care, the preterm delivery rate in the United States has remained fairly stable at 11-12%. This equates to approximately 500,000 babies a year that are born too early. One of the biggest risk factors for having a baby early is if you had a prior preterm birth. However, only 10% of babies born early are born to mom’s with a prior history of a preterm birth. In fact, the vast majority of babies born early are born to mom’s without any risk factors. Recent studies have shown that if a patient has a short cervix on a 20 week ultrasound (less than 2 cm in length), her risk of having her baby early increases dramatically. Also, recent studies have shown women with a short cervix on ultrasound who receive nightly vaginal progesterone can reduce the risk of having her baby early by 40%!!! So now that we have an effective treatment option/intervention to offer those patients with a short cervix, there is a growing recommendation to offer transvaginal ultrasound cervical screening to all patients.
Is it necessary that I am screened for diabetes?
Yes!! Gestational diabetes (also known as diabetes of pregnancy) is a very common complication and may affect upwards of 15-20% of all pregnancies. Though there are many risk factors that may increase the risk (being overweight, twins, prior history of gestational diabetes, family history of diabetes, having a large baby before…), many patients without risk factors will still have gestational diabetes. Therefore, we do screen all patients at least once during the pregnancy.
What happens if I do have gestational diabetes?
If you do screen positive for diabetes, we will then referral you to our diabetes education department and nutritional services to discuss the goals of treatment, how to check your blood sugars 4 times a day, and outline a diet for you. This is not a diet to limit calories but to alter how you eat (3 smaller meals with 3 snacks, less simple carbohydrates…). Diet is the mainstay of therapy and will generally control blood sugars over 80% of the time. For those who fail diet, we will then move on to medication.
What is considered a “high blood sugar” and is it dangerous to the baby?
The current recommendations are for daily fasting (no eating for 8 hours) blood sugars should be less than 95. We also recommend taking blood sugars 1 hour after each meal (60 minutes from your first bite) and these should be less than 140. If blood sugars are consistently higher than these numbers, it places the baby at risk for many complications but while inside and outside. The baby can become too big to fit through the birth canal which will increase your risk of a cesarean section. Or the baby may also suffer trauma from a vaginal delivery if the shoulders are big which is more common in babies born to diabetic mothers. After birth, the baby is at risk for having low blood sugars for a couple of days, more likely to be jaundice, and research is showing these babies have a higher incidence of childhood obesity and developing diabetes themselves!!!
What will happen if diet doesn’t work?
Diet seems to be effective in over 80% of the cases. However, that means that nearly a quarter of patients will require medication. The recommendations for medication use in pregnancy have recently changed. Starting about 10 years ago, oral medications were being used to treat the majority of patients with gestational diabetes. These included glyburide or metformin. However, it is clear that oral medications are not as effective as insulin. Babies born to mothers on these medications are often bigger, the cesarean section rate may be higher, and these babies have more issues with their blood sugars after birth. Also, these medications cross the placenta and the long term effects of these on the baby are unknown. Therefore, patients who fail diet are started on insulin. Even though this sounds bad (who wouldn’t rather take a pill than do shots), the vast majority of patients find insulin to be no big deal and some even prefer it because their blood sugar control is better and they have less stress about potentially harming their baby.
What are things I should look for as I approach my due date?
Being aware of your baby’s movement is very important. We usually say that the baby should move at least 10 times in a 2 hour period at least once a day. If the baby doesn’t, then you should call. Also concerns for preterm labor would be regular contractions that don’t improve/resolve after emptying your bladder, resting on your side, and drinking fluids. If you have done all of these things and still have more than 4 contractions in an hour for 2 consecutive hours, then you should call. Vaginal bleeding or leaking of vaginal fluid, whether you are contracting or not, should be relayed to your provider. Finally, some patients will develop a high blood pressure condition in pregnancy called gestational hypertension or preeclampsia. What you might notice would be a headache that is unusual for you, especially if it is not improved with acetaminophen. Also if you have unusual visual changes (blurry vision, haziness, stars/sparkles…) or unusual pain in your right upper abdomen could be a sign you blood pressure is elevated and you should call your provider.
Can I be induced and have my baby before my due date?
Well, that depends. It is clear that the earlier babies are delivered, the more potential there is for some newborn complications. Even babies who are only born 2 or 3 weeks before the due date have more problems with regulating their temperature, don’t feed as well, more likely to be jaundice and may even have some breathing problems. Therefore, the Joint Commission on Hospital Accreditation, the March of Dimes, and some other consumer groups came up with the 39 week initiative. What this says is elective deliveries cannot be performed prior to 39 weeks. However, there is a list of conditions where it is felt that due to either a condition in the mother or baby, prolonging the pregnancy is dangerous and therefore, delivery prior to 39 weeks is warranted and not elective. These are pretty strict and can be reviewed with you in more detail if you desire.