Congratulations, you are pregnant!
Below are some of the important issues and concerns that should be considered in early pregnancy.
A healthy but moderated exercise regime bears no significant risk to you or your pregnancy provided there are no medical or obstetric reasons that preclude such activity. The Royal Australian College of Obstetricians and Gynaecologists Guideline [PDF Download] endorses and details general advice about what would be considered a healthy exercise regimen to help regulate your metabolism and encourage a healthy weight during pregnancy.
Diet and food preparation
There are foods that are encouraged and discouraged in pregnancy, but the general advice is to ensure your diet is well balanced, healthy, is safely stored and prepared and does not include potentially dangerous foods.
Fresh foods (mainly fruit and vegetables) should be handled with washed hands, kept separate from meats when prepared and stored in the fridge, and washed well before consumption.
Use gloves when gardening and handling kitty litter and cat faeces. This is to avoid contamination of foods and food-borne infections.
Food types that should be avoided in pregnancy include unpasteurized dairy products such as soft cheeses, smoked salmon, cold meats, pates and fresh ciders. Undercooked meat should also be avoided, while meat that has been cooked through well is safe to eat. Likewise food that has been refrigerated should be re-heated till piping hot before consumption. Foods that have not undergone a heating or pasteurizing process may harbor potentially dangerous microorganisms that can cause infections that affect your unborn child.
Foods very rich in Vitamin A, such as liver, should be avoided during pregnancy due to concerns about Vitamin A teratogenicity, especially in the first trimester.
Seafoods such as clams, oysters, muscles, abalone, other sea-living crustaceans, and shark, swordfish, king mackereal, marlin, orange roughy and big eye tuna (other tuna’s are ok) may be high in heavy metals, such as mercury and can affect your child’s neurological development. Most other fish may be consumed but no more one to two servings per week for the same reasons.
When to book in to see the GP
Once you have found out that you are pregnant it is important to book an early appointment with your GP. Your GP will usually recommend early pregnancy blood tests that confirm the pregnancy hormone level in your blood (bHCG), and will recommend an early pregnancy ultrasound to date and locate your pregnancy. This is to ensure that your pregnancy is viable with a heartbeat and is safe and sound inside your uterus.
1-2% of pregnancies are ectopic, meaning they fall outside the womb and pose a significant risk to the mother. This risk increases for women who have had a previous ectopic pregnancy, pelvic infections in the past (most commonly sexually transmitted infections that have infected the fallopian tubes), endometriosis, previous pelvic surgery, cystic fibrosis sufferers, pregnancies conceived by IVF and smokers.
Accurately dating the gestational age of your pregnancy with an early pregnancy ultrasound allows for a true assessment of your babies growth and wellbeing throughout pregnancy. In turn it enables you and your doctor to help make good decisions about the safe planning and timing of delivery and can help to reduce unnecessary intervention. An optimal gestation to date your pregnancy with a specialist pelvic ultrasound is between 8-12 weeks of pregnancy.
The “expected due date” (EDD) of delivery is the date at which you would be 40 weeks pregnant. This has traditionally been thought of as the median gestational age at which babies will deliver spontaneously. The EDD is used as a yardstick to calculate the gestational age of your pregnancy. It is important to note that the EDD may not necessarily be the optimal time for your baby to be delivered. In fact the optimal time for your baby to deliver may be earlier, may be later or when the “baby decides” depending on your specific circumstances.
Special tests in early pregnancy
When you visit your GP in early pregnancy, they will order a host of blood tests to check on your health and fitness for your pregnancy. This will include a check on your immune status for important infections, type of blood group, liver kidney and blood health and fasting blood sugar levels.
Your GP will check to make sure your urine contains no infection. Infections in your urine can cause early pregnancy loss and can cause your baby to be born prematurely. If infection in your urine is found your doctor will treat it with antibiotics. Sometimes it is recommended to check that the infection has been cleared.
Screening for Down’s syndrome and other chromosomal disorders
There are two common tests that your doctor will offer if you wish to screen your pregnancy for common chromosomal disorders including Down’s syndrome.
1. The “First Trimester Screen” includes blood tests, best done at 10 weeks, and an early ultrasound at 12-13 weeks. These results are combined to calculate a risk of your baby being affected with some of the most common chromosomal disorders including Down’s syndrome. It is not a diagnostic test, so a “high risk” result means the pregnancy needs further assessment. Apart from screening for chromosomal disorders, the purpose of this ultrasound is to get an early look at your babies basic anatomy, investigate the placenta(s) of twins/multiple pregnancies, and date the pregnancy, should this have not been done previously.
Non-Invasive Prenatal Testing (NIPT) is another screening test for common chromosomal disorders such as Down’s syndrome. Some pathology laboratories also offer specific tests for chromosome aneuploidies and other genetic mutations. They all can detect whether your baby is a male or female, but you have the option as to whether or not this information is disclosed. NIPT is a much more accurate screening test than the first trimester screen. It involves a maternal blood test after 10 weeks of pregnancy. A very small fraction, less than 5%, of tests will fail. Unfortunately at this time NIPT is not Medicare subsidized and the patient bears the cost of this test. The cost however is continuing to decrease as the technology becomes less expensive.
Like the first trimester screening test, NIPT is not a diagnostic test, so if it comes back as high risk, the pregnancy will need further diagnostic testing. At this point it is best to discuss what this means for your pregnancy and where to from here with your doctor.
Bleeding in early pregnancy
Reassuringly most bleeding in early pregnancy will resolve and your pregnancy will continue on to be normal. However bleeding should never be ignored and must be investigated as soon as possible. If your doctor is accessible they will request an urgent ultrasound to ensure your pregnancy is safe and sound within your uterus. If there are delays you should attend a hospital emergency centre to investigate.