What to expect in 1st trimester

First trimester of pregnancy (conception to week 13)

Antenatal care is the medical supervision that every woman should receive during pregnancy. It involves a series of visits to health care professionals for a regular check on you and your baby’s health.

When should you first see the doctor?

You should see a doctor as soon as you know you are pregnant.

What happens at the first visit?

The aim of this visit is to make a care plan for your pregnancy. Your doctor will try to identify any high-risk factors, based on your history, examination, and some routine tests, to determine whether you require any additional care. This will include:

• History
• Physical examination
• Lab tests:
  • Blood grouping and Rh type
  • Complete blood count
  • Fasting/PP blood sugar
  • Hepatitis B, HIV, hepatitis C, VDRL (syphilis)
  • Hb electrophoresis
  • Thyroid function test
  • Rubella IgG
  • Urine routine and microscopic
• Ultrasound around 7 weeks

Screening of chromosomal abnormalities:

Down’s syndrome is the commonest chromosomal abnormality in live-born babies. It is the result of an extra copy of chromosome no. 21 (trisomy 21). The chances of this abnormality increase with age of the mother. The baby may be born with a variety of birth defects and have impaired social and mental development. A combined test is offered for screening of down syndrome between 11 weeks and 13 weeks which includes ultrasound and a blood test (Double marker). This is a screening test. A diagnostic test will be offered to you, after explaining its risks and advantages, in case a combined test is screen positive, you are 35 years or older, or have had previous baby Down’s syndrome.

Supplements during first trimester

Folic acid: Supplementation with folic acid in the first 3 months of pregnancy, when the baby’s organs are forming, reduces the risk of neural tube defects in the baby. You will be prescribed folic acid 5 mg once a day throughout the first trimester.

Vitamin D: Maintaining adequate levels of vitamin D is important during pregnancy and breastfeeding. A daily intake of 400 IU of vit D is recommended. Alternately, 2000 IU can be taken weekly.

Management of common symptoms of pregnancy

• Nausea, vomiting and heartburn
  Also known as morning sickness, but can occur at any time of the day. Presence of absence of this symptom has no correlation with pregnancy outcome. These symptoms usually resolve on its own by 14 to 16 weeks of pregnancy.
  Try diet modification:
  Avoid carbonated drinks, spicy and oily food
  Take small frequent meals
  Eat whatever you feel comfortable eating, instead of forcing yourself to try and eat healthy food.
  Don’t get up from the bed on an empty stomach in the morning, eat something before you leave your bed in the morning.
  If diet modifications do not work, medicines can help to relieve your symptoms, ask your doctor.
• Constipation and Hemorrhoids
  Modification in diet and lifestyle can help to relieve your symptoms.
  Daily exercise and walk.
  High fibre foods such as bran, vegetables and fruits.
  Increase fluid intake.
  Natural fibre supplements like isabgol can be safely taken.
  If symptoms remain troublesome, consult your doctor.
• Frequent urination
  You may have increased frequency of urination during pregnancy. If it is associated with pain or burning, inform your doctor and get urine tested for infection.
  Avoid caffeine containing drinks especially in the evening, as they make you urinate more.
• Vaginal discharge
  Increase in vaginal discharge is usual during pregnancy.
  If it is associated with itching, soreness, offensive smell or pain on passing urine, consult your doctor.
• Backache
  Backache is a common symptom during pregnancy because of relaxation of joints (due to pregnancy hormones) and increased lordosis (increase in spine curvature) with increased weight of baby.
  Maintain a good posture. Back should be fully supported while sitting.
  Regular exercise and massage therapy can help to ease the symptoms.
• Other symptoms
  Fatigue: it is not unusual to feel lethargic and have a low energy level during pregnancy. Take short breaks while working to relax.
  Mood swings: you might have erratic mood changes during pregnancy. The family must understand that these are transient and be supportive.

Lifestyle modifications:

• • Working during pregnancy
    It is generally safe to work during pregnancy, unless advised otherwise by your doctor.
    Avoid sitting for long periods of time, take short breaks and move around. Put your feet up whenever you can.
    Climbing stairs is safe during pregnancy.
  • Exercise during pregnancy
    Unless contraindicated, there is no risk in starting or continuing exercises at a moderate level. The daily schedule should include 30 minutes of cardio-respiratory exercises like walking, swimming or stationary cycling and 30 minutes of musculo-skeletal exercises like stretches or yoga. Those who are used to regular aerobic exercises before pregnancy may continue to do so at a lower physical scale.

Avoid high impact sports and racquet sports that may increase the risk of abdominal trauma or fall.
Hot tub baths and sauna are not advised during pregnancy due to risk of miscarriage.

• Sexual intercourse
  It is not related to any adverse outcome in pregnancy unless advised otherwise by your doctor.
• Alcohol intake
  Drinking alcohol during pregnancy is not safe as it is associated with an increased risk of miscarriage and birth defects.
• Smoking
  Stop/avoid smoking during pregnancy. Both active and passive smoking increases the risk of premature and low birth weight babies.
• llicit drug use
  Intake of drugs like cocaine, marijuana, heroin, nicotine or any other hallucinating agents has potential adverse effects on the baby.
• Travel
  Seat belts must be fastened during road travel. Wear seat belts above and below the bump and not over it.
  Train journeys are safe.
  Long distance air travel increases the risk of developing clots in your legs. Get up and walk frequently, do foot exercises while sitting, and drink good amount of fluids to avoid this problem.
  When travelling by air, take a fitness certificate from your treating doctor. Most airlines allow flying till 32 weeks. Check with the airlines before you book.
• Over the counter drugs
  Avoid self-medication as certain medication may not be safe for your baby. If you are on any pre- pregnancy medication, inform your doctor.

When you are expecting—being a father!

Most first-time dads have their own feelings. If you feel panicky, overwhelmed, or like you are just not ready, you are not alone. You don’t have to feel guilty about having mixed emotions, its completely normal. You can help your partner by:

Supporting a healthy lifestyle during pregnancy.

Accompanying your partner to the doctor’s appointments, where you can ask questions, gather information, hear the baby’s heartbeat.

Understanding that she will have mood swings during pregnancy. It will be more pronounced during the first trimester when pregnancy hormones are in their greatest state of flux.

• Be patient: Pregnancy won’t last forever. This phase will pass and a lot more pleasantly if you are tolerant to her fluctuating moods.
• Don’t take her outbursts personally: they are completely out of her control and because of hormonal changes.
• Help to regulate her moods: low blood sugar can trigger mood swings; offer her healthy snacks when she’s starting to droop. Exercise can release feel good hormones, suggest a walk.