Some doctors suggest no caffeine be used during pregnancy and others advise limited consumption. There has been no definitive research linking moderate caffeine use (less than five cups of coffee a day) to miscarriage or birth defects.
In general, since most miscarriages occur during the first 12 weeks of pregnancy, it is a good idea to wait until this critical period is over before telling others of your pregnancy. However, it may be difficult to keep such a secret to yourself. So, if you have an ultrasound prior to your 12th week of pregnancy that shows a fetus with a moving heartbeat, your chance of miscarriage is less than 2.5%; therefore, you may be safe in sharing your news.
Acetaminophen (Tylenol) is generally safe to use during pregnancy, although you should consult your doctor first. You can take as much as two extra-strength tablets (500 mg each) every four hours up to four times a day. Maximum consumption per day should be limited to 4,000 mg or less. You can also take acetaminophen to treat other body aches and pains during pregnancy. But, if your headache persists despite maximum doses of acetaminophen, contact your doctor immediately as your headaches may be a sign of something more serious. Aspirin and ibuprofen should not be taken during pregnancy unless you are specifically instructed by your doctor. There are medical or obstetrical conditions that require aspirin or other non-steroidal anti-inflammatory agents during pregnancy, but only under the strict supervision of your doctor.
You should avoid hot tubs and saunas during pregnancy, particularly during your first trimester. The excessive heat may predispose your baby to neural tube defects. However, warm showers and tub baths are safe and are often quite soothing for body aches.
You should have at least three well-balanced meals every day. In general, you should eat foods that are clean and well-cooked. Avoid sashimi and sushi that contains raw fish; undercooked beef, pork, or chicken (including hot dogs); unpasteurized milk or cheeses; undercooked eggs; and improperly washed vegetables and fruits. Foods or beverages containing aspartame (Nutrasweet) are safe in moderation (1 to 2 servings per day) if you do not have a disease called phenylketonuria. Some women have unusual urges to eat chalk, clay, talcum powder, crayons, etc. This condition is known as pica. Discuss these cravings with your doctor and avoid these substances. If you have diabetes or are diagnosed with gestational diabetes during pregnancy, you should follow the American Diabetic Association (ADA) diet, and avoid fruits, juices, and high-carbohydrate snacks, like candy bars, cakes, cookies, and non-diet carbonated sodas.
You should not drink any alcohol during pregnancy, especially during the first trimester. How much alcohol it takes to cause fetal alcohol syndrome is unknown: it might be a glass of wine a day or a glass a week. However, toward the end of pregnancy, with the onset of early labor pains, your doctor may suggest you drink a little wine and take a warm shower (hydrotherapy) to help ease your discomfort.
If you have a cat, particularly an outdoor cat, let your doctor know so you can be tested for toxoplasmosis. You should not change your cat's litter box and should be meticulous about washing your hands after close contact with your cat or with dirt from working in the garden. Toxoplasmosis is transmitted to humans from infected cat feces or poorly cooked meat from a previously infected animal. Further, the infection can be transmitted to an unborn baby and lead to devastating complications, including miscarriage. The treatment for toxoplasmosis is complicated and requires obtaining special permission from the Food and Drug Administration (FDA) for a medication that is not readily available in the U.S. Fortunately, most women are already immune to toxoplasmosis from prior exposures in childhood and therefore cannot be reinfected.
Progesterone production by the ovaries is critical until about the 9th to 10th week of pregnancy. It prepares the endometrium (lining of the uterus) for implantation of the pre-embryo. Soon, the placenta will produce enough progesterone to maintain the pregnancy. Although progesterone is critical to your pregnancy, measuring the levels of this hormone in your body can be difficult. Progesterone is produced in varying amounts throughout the day; therefore, what is measured in the blood may not be an accurate reflection of the amount of progesterone produced by the ovaries. A test that indicates low progesterone levels does not necessarily mean that your overall production of progesterone is low.
However, progesterone levels below 7 ng/ml are associated with miscarriage. These levels are rarely found in women who do not have a history of at least three miscarriages. If you have a history of miscarriages and a low progesterone level, extra progesterone-either as a vaginal suppository, intramuscular injection, or pill-is a reasonable option. There is some controversy about which other women might benefit from supplemental progesterone.
If you are taking progesterone supplements, the best time to do so is about two days after ovulation-when progesterone begins to rise and the lining of the uterus is changing. This is also when the endometrium must be ready for the implantation of the embryo. Few doctors believe that progesterone supplements later in the pregnancy can rescue a failing pregnancy. When a pregnancy is failing, progesterone values may fall. This merely reflects a failing embryo, not problems with progesterone production. If a pregnancy is destined to miscarry because, for instance, the chromosomes are not normal, once the embryo has died, the stimulation of progesterone production by the embryo will also fail. The decline in the progesterone levels, then, is a result of the death of the embryo, not the cause.
Domestic violence affects 17% of all pregnant women. Because of the health effects of domestic violence on women in general, and the detrimental effects of violence in pregnancy (domestic violence doubles the risk of preterm labor and intrauterine infection), your doctor may screen for abusive situations and refer you for counseling if you are at risk.
Domestic violence increases complications of pregnancy. Many women who have been abused do not show up for their prenatal appointments. This is especially true if a woman is bruised or injured at the time of the appointment. It is also common for a woman who is at risk for abuse or who is being abused to bring her partner to her prenatal visits. An abusive partner will rarely leave a woman unaccompanied and typically attempts to take control of the meeting.
If you are in a violent relationship, it is important to report your concerns. If you have been battered before, pregnancy increases the likelihood you will be battered again. Your doctor can give you information about support services and where to go for help.
Despite ongoing abuse, many women are unable or unwilling to leave an abusive partner. The reasons are complex. If you have been abused and choose to stay with your partner for whatever reason, you need an exit plan for you and your children in case you find yourself in a dire situation.
Find out what resources are available in your community. Police stations, shelters, counseling avenues, and legal aid organizations provide help in emergency situations.
Record information about these resources in a safe place, such as a tampon case. Disguise referral numbers as numbers of friends, hair stylists, etc.
Did You Know?
If you need help or want to talk to someone about an abusive situation at home, you can call a 24-hour helpline at 800-333-7233 (333-SAFE) or 800-873-6363 (TDD). These numbers can be reached from anywhere in the U.S.
Pack some needed supplies and leave them at a friend or neighbor's home. Remember to pack clothes for you and your children, toiletries, documents for school enrollment or to obtain public aid (birth certificates and rent receipts), an extra set of car keys, cash or checkbook, and a special toy for each child.
Remember, every day you remain in your home you are at risk. Talk to your providers and plan ahead.