Episode 111: Pregnancy FAQ

Episode 111: Pregnancy FAQ  Dr. Urso answers commonly asked questions during pregnancy.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Written by Carmen Urso, MD. Edited by Hector Arreaza, MD.Pregnancy is one of the most exciting moments of a woman’s life, but at the same time, it could be a little scary because whatever the mother does may affect the baby. This is why it is so important to make sure about general recommendations during pregnancy. The information I present here is evidence-based. 1. Should I take prenatal vitamins?The goal of prenatal supplements is to provide the vitamins and minerals needed to promote normal fetal development. Some studies have shown that in high-income countries where the food is vitamin-fortified, and typically people are well-nourished, vitamin supplementation has not proved to improve maternal and neonatal outcomes. However, a Cochrane review of randomized trials in low- and middle-income countries with vitamin and mineral diet deficiency found that supplementation reduces the risk of low birth weight and small for gestational age. Because you don’t always know the nutritional status of a patient, it is advised to use a standard prenatal vitamin. What are the most important vitamins in the prenatal period? The 2 most important elements are folic acid and iron, which can be found in regular prenatal vitamins. The American College of Obstetrics and Gynecology (ACOG) recommends multivitamins with: -Folic acid: 400mcg to 800mcg daily to reduce the risk of neural tube defects. It is recommended to start before pregnancy until the end of the first trimester (12 weeks). Patients with a history of fetal neural tubal defect should take 4000 mcg (4mg) daily. The USPSTF recommends (Grade A, 2017) to supplement with folic acid for all women of childbearing before pregnancy. Supplementation should start at least one month before pregnancy, according to CDC. -Iron: 30 mg/day to prevent maternal anemia. The formulation should contain 15-30 mg/dl. Most prenatal contain about 30 mg, which is considered a “low” dose, and 65 mg of elemental iron is equivalent to 325 mg of ferrous sulfate, which is a common supplement given to patients in our clinics. So, patients could take one tablet of 325 mg of ferrous sulfate daily and have enough for their pregnancy, or take it every other day if they are intolerant to iron]-Vitamin D: Vitamin D deficiency is associated with preterm birth and preeclampsia. 200-600 international units are recommended. ACOG does not recommend screening for vitamin D deficiency before or during pregnancy. The USPSTF concluded there is insufficient evidence to recommend for or against Vitamin D deficiency screening in asymptomatic adults. This is a Grade I recommendation.-Calcium: Supplements should contain 1000 mg/dL. Most multivitamins have 200-300mg; the rest of the daily calcium should come from dietary sources. Foods rich in calcium include dairy products such as milk, yogurt, cheese, soybeans, seeds, beans, lentils, and dark-green leafy vegetables like kale, spinach, and collard greens. Another source of vitamin D is sun exposure. We do not recommend sun exposure as a source of vitamin D, but there are benefits to sun exposure for other reasons, for example, mood.2. Should I be eating for 2 while I am pregnant?It is a misconception. Pregnant women do not have to eat for 2. Caloric intake will depend on the number of fetuses (single or multiple), the trimester, and the pre-pregnancy weight. During the first trimester, no extra daily calories are needed. In the second trimester, a pregnant person will need 340 extra calories/day, and in the third, 450 extra calories/day for a total of 2200 to 2900 kcal/day. The weight gain will be based on pre-pregnancy BMI (body mass index). For example, a patient who is overweight (BMI 20-29) should gain 15-25 lbs. in the whole pregnancy, but a patient with obesity (BMI above 30) should gain 11-20 lbs. only. These are the recommendations by the National Academy of Medicine.Interestingly, if you are underweight before pregnancy, you can gain 30-40 pounds.National Academy of Medicine Recommendations for Weight Gain in Pregnancy:Pre-pregnancy BMI Category (kg/m2)                  Recommended Weight Gain (lbs.) Underweight (less than 18.5)                                                       28–40 Normal weight (18.5-24.9)                                                              25-30Overweight (25.0-29.9)                                                                    15-25Obese (30 or greater)                                                                         11-203. Can I drink alcohol?There is not a safe level of alcohol during pregnancy. Alcohol can cause life-long birth defects. Even little amounts can cause problems to the baby, such as coordination, behavior, attention, and learning disability. Heavy drinking can cause fetal alcohol syndrome, characterized by developmental delay, short stature, abnormal facial features, small head size, vision impairments, and hearing difficulty. It is recommended to avoid alcohol at all costs during pregnancy. 4. Can I drink coffee? Caffeine increases catecholamine levels in the maternal blood, and it crosses the placenta. Caffeine was thought to increase the risk of spontaneous miscarriage, but recent studies showed that moderate caffeine intake was not related to miscarriage or preterm birth. ACOG states that low to moderate intake, less than 200mg (6 oz per day), does not appear to be associated with adverse effects. The amount of caffeine varies in different foods. For example, 8 oz of brewed coffee has approximately 137mg of caffeine. Also, we must remember that caffeine is in other drinks like soda and tea.Content of caffeine in different drinks: -Instant Coffee 76mg -Tea, Brewed 48mg; Instant 26-36mg-Caffeinated soft drink (12 oz) 37mg-Hot cocoa (12oz) 8-12mg-Chocolate milk (8oz) 5-8mg-Dark chocolate (1.45 oz) 30mg -Milk chocolate (1.55oz) 11mg -Semi-sweet chocolate (1/4 cup) 26-28mg -Chocolate syrup (tbsp) 3 mg-Coffee ice cream or frozen yogurt 2mg 5. Can I eat fish?Fish is an excellent source of omega 3, which is associated with improved neurodevelopment in children, decreased risk of preterm birth, and reduced allergy and atopic disease. Fish also contains mercury which can cause fetal neurologic damage. All fish contain mercury, but some have more than others. This is why it is so important to know what fish has more mercury content.ACOG recommends 2 to 3 servings per week. Pregnant women can have fish high in omega 3 and low in mercury. Some examples of fish that are high in omega 3 and low in mercury are anchovies, Atlantic herring, Atlantic mackerel, mussels, oysters, farmed and wild salmon, sardines, snapper, and trout. Seafood that is low in mercury and low in omega 3 includes shrimp, pollock, tilapia, cod, and catfish. Fish high in mercury include king mackerel, marlin, orange roughy, shark, swordfish, tilefish, and tuna bigeye. 6. Can I eat sushi?Raw fish can carry bacteria or parasites. Therefore, it is recommended not to have raw fish, but you can have cooked options like tempura sushi. For example, all ingredients are cooked in the California roll except the cucumber and avocado.7. Can I exercise?Yes. If you do not have any complications (healthy pregnancy), it is recommended that you have moderate-intensity aerobic exercise for 30 minutes, 5-7 days a week. Moderate exercise means you can carry on a normal conversation during exercise. For example, brisk walking, gardening, and dancing. The benefits of exercising during pregnancy go beyond maintaining a good weight. Exercise also decreases muscle discomfort (back pain, pelvic pain), makes the pelvic floor strong, and decreases the risk of urinary incontinence. Avoid exercises with a higher risk of injuries, such as skiing, horseback riding, scuba diving, hot yoga o hot Pilates (for the risk of overheating), and skydiving. 8. Hot tubs and swimmingHot tubs are not recommended during pregnancy, especially in the first trimester, because higher body temperature has been associated with neural tube defects and miscarriage. Swimming does not appear to have any teratogenic effect because pools are typically cooler than body temperature. 9. Can I dye my hair? There is limited data on the safety of cosmetics. Because it is a topical product, systemic absorption is supposed to be low unless the skin is compromised. However, it is recommended to avoid ammonia-based products. Plant-based hair dyes are probably safe. Also, using these products in a well-ventilated area is recommended to avoid allergies. 10.  Is it safe to have sex during pregnancy?Sex is safe if you do not have any complications such as placenta previa, vaginal bleeding, cervical incompetence, preterm labor, risk of preterm labor, or leaking of amniotic fluid. Sex does not increase the risk of complications during pregnancy, but like in the general population, there is a risk of sexually transmitted diseases during pregnancy. During pregnancy, the vaginal circulation is increased, and the cervix is more sensitive, so may have scant vaginal bleeding during intercourse but if the bleeding is heavy, patients should be evaluated.Conclusion: Now we conclude our episode number 111 “Pregnancy FAQ.” Dr. Urso explained that pregnancy is one of the most exciting moments in a woman’s life. Special care is needed to make sure both mother and baby are healthy and safe during this special time. Appropriate vitamin supplementation, a nutritious diet, adequate exercise, and avoiding alcohol are key elements of prenatal care. We were reminded that sex is generally safe in uncomplicated pregnancies. This week we thank Hector Arreaza, Carmen Urso, Gagan Kooner, and Arianna Lundquist. Audio by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Fox, N.S. “Do and Don’ts in pregnancy, truths and myths”. Obstetrics & Gynecology, vol 131, issue 4, 2018, pp.713–21. DOI:10.1097/AOG.0000000000002517. https://journals.lww.com/greenjournal/Fulltext/2018/04000/Dos_and_Don_ts_in_Pregnancy__Truths_and_Myths.16.aspx. Accessed 7 July. 2022.Advice about eating fish. For those who might become or are pregnant or breastfeeding and children ages 1- 11 years. https://www.fda.gov/food/consumers/advice-about-eating-fish. Accessed 1 August 2022.Garner C.D. Nutrition in pregnancy: Dietary requirements and supplements. Up to Date, last updated April 14, 2022. https://www.uptodate.com/contents/nutrition-in-pregnancy-dietary-requirements-and-supplements. Accessed 4 August 2022.Lockwood, C.J. Prenatal care: Patient education, health promotion, and safety of commonly used drugs. Up to Date, last updated August 16, 2022.https://www.uptodate.com/contents/prenatal-care-patient-education-health-promotion-and-safety-of-commonly-used-drugs. Accessed 1 August 2022.Goetzl, L.M. Folic acid supplementation in pregnancy. Up to Date, Last Updated Jun 16, 2022. https://www.uptodate.com/contents/folic-acid-supplementation-in-pregnancy. Accessed 2 August 2022.Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017 Apr 13;4(4):CD004905. doi: 10.1002/14651858.CD004905.pub5. Update in: Cochrane Database Syst Rev. 2019 Mar 14;3:CD004905. PMID: 28407219; PMCID: PMC6478115. https://pubmed.ncbi.nlm.nih.gov/28407219/. Accessed 2 August 2022.“Moderate Caffeine Consumption During Pregnancy”, The American College of Obstetrics and Gynecologists (ACOG). Committee Opinion, Number 462, August 2010. (Reaffirmed 2020). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2010/08/moderate-caffeine-consumption-during-pregnancy. Accessed 1 August 2022.Royalty-free music used for this episode: Good Vibes Alt Mix by Videvo, downloaded on May 06, 2022 from https://www.videvo.net/royalty-free-music-track/good-vibes-alt-mix/1017292/ Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week!