Health Concerns: Recommendations for Pregnancy
*Note: No medications are considered 100% safe during pregnancy. Even if no medications are taken during pregnancy, there is a 1·2% congenital anomaly rate. Using nothing is better, but, when the patient herself decides that her symptoms are severe enough, based on years of experience, the following are the safest recommendations we know:
Headaches
Use Regular·Strength Tylenol and increase fluids. You may also use Benadryl (at night) and Claritin (daytime) for headaches associated with allergies. Headaches during pregnancy are common, but if blurred vision or spots before eyes accompany headache or if unrelieved by Tylenol, call for further advice.
Cough
Use Regular-Strength Robitussin, Chloraseptic spray, nasal saline drops, or any throat lozenges. If needed, increase fluid intake, stop smoking (if a smoker) and use a vaporizer. If cough is accompanied by a fever, discolored phlegm, shortness of breath, or chest pain call for further advice.
Sinus congestion and cold symptoms
Use Sudafed, Benadryl, Mucinex, or Tylenol; increase fluid intake; take throat lozenges if needed; stop smoking (if a smoker); and use a vaporizer. Also Chloraseptic Spray and nasal saline drops are very safe to use in pregnancy. Sinus congestion during pregnancy may be common, but if sinus congestion is accompanied by a fever (greater than 100.4) or discolored drainage, please call for further advice.
Eye drops
Visine, if needed.
Nasal sprays
Vicks or Ocean Spray.
Constipation
First try increasing fluids to 6-8 glasses per day, increasing fiber and bran in your diet, and increasing your exercise. If these efforts are unsuccessful, try Metamucil or Konsyl and/or stool softeners, such as Colace. Develop regular bowel habits. If you have gone for over three days without a bowel movement, you may use Milk of Magnesia. We do not recommend laxatives such as Ex-Lax, or use of enemas.
Hemorrhoids
Use Tucks Medicated Pads, Anusol suppository, Preparation H, sitz baths and measures to prevent constipation. If you experience rectal bleeding or significant pain, call for further advice.
Diarrhea
Metamucil, Kaopectate, and lots of clear liquids.
Heartburn
Use antacids (Maalox. Mylanta, Turns or Rolaids; not baking soda or Alka Seltzer) after meals and eat small, frequent high-protein meals of bland quality. Eat slowly, and do not lie down immediately after eating. If persists, you may use over-the-counter Pepcid twice daily.
Nausea and Vomiting
Keep crackers or dry toast at bedside to eat before getting up, have juice with breakfast, eat small frequent high protein meals of bland quality, and drink fluids between meals instead of with them. Take Vitamin B6 tablets 25mg twice daily and take Mylanta or Maalox. Use Unisom (Doxylamine) at night. If nauseous only, consider purchasing a "Sea Band" (a non-drug acupressure method for controlling nausea). If vomiting is persistent for more than 24 hours, call for further advice.
Leg cramps
Leg massage, heating pad, avoid pointing the toes, and walking "heel first", avoid lying on your back. If severe. call for advice.
Varicose Veins
Avoid standing for long periods of time, elevate your legs at frequent intervals during the day and do leg exercises. Wearing support hose may help. We can prescribe specific support hose for you based on specific needs.
Breast Tenderness
Wear a good support cotton bra. Later in pregnancy, you may need 1-2 size larger cup. Anytime from the 5th month on you may produce colostrum (yellowish fluid) which is the beginning of breast milk. Avoid plastic shields, instead, tuck a cotton handkerchief or gauze into each bra cup.
Faintness
When standing for long periods of time, move around frequently to stimulate your circulation. Take frequent rest periods, eat healthful foods in small amounts throughout the day, and drink plenty of fluids. Avoid getting overheated.
Call if dizzy spells with fainting persists.
Tiredness
Fatigue during pregnancy may be normal. Daily exercise and an adequate night's rest is important. Iron supplements may be recommended if anemic. Shortness of breath toward the end of your pregnancy, due to pressure of the growing uterus, may cause fatigue and is helped by lying on your side or propped up on pillows.
Backache
Maintain good posture, squat instead of bending over, rise from lying down by rolling on your side and pushing yourself up with your hands, exercise daily, wear comfortable low heeled shoes, and sleep on a flat, firm mattress. Wearing a maternity girdle may help. If the pain persists, we may refer you to a recommended and pregnancy-certified Physical Therapist.
Skin Changes/Stretch Marks
A brown discoloration over your face and nipples, as well as a line from your naval to the pubic bone is normal. Avoid sunburn which could deepen the skin discoloration. The spots will disappear after your baby is born. Stretch marks may be minimized if your skin is kept soft and supple with lotion, cream or cocoa butter. They may fade after delivery, but probably won't disappear.
Increased Salivation or "Metal Taste"
This is normal. Use throat lozenges.
Urinary symptoms
A feeling to urinate frequently is normal, especially at the beginning of pregnancy and toward the end. Call for an appointment, however, if painful urination, bloody urine or fever occurs.
Vaginal Infections
A yellowish clear mucous discharge may be normal during pregnancy. If burning, itching, pain, swelling or foul odor occurs, call for appointment. You may use a non-deodorant pad. If you know you have a yeast infection, use Monistat or GyneLotrimin externally only in the 1st trimester, and both internally or externally after the 1st trimester.
Tampons/Douching
Do not use during pregnancy due to the potential for infection and damage to your developing baby if fluid or air gets up inside your cervix.
Swelling
Wear loose, non-constrictive clothing. Elevate your legs at frequent intervals during the day, bed rest for 2 hours daily on side, eat a diet rich in protein, drink plenty of fluids, avoid salty foods and don't add salt to foods. Report marked or rapidly worsening hand or face swelling immediately.
Cramping
Most cramping in early to mid pregnancy is due to pressure from the enlarging uterus and stretching ligaments. Exercise, a heating pad, Tylenol, and relaxation techniques may help. Call for advice or appointment if vaginal bleeding occurs.
Contractions. Later in pregnancy, as early as your 5th month, uterine tightening ("Braxton Hicks" contractions) or false labor can occur. Relieve false labor with walking, rest, Tylenol, heating pad, liquids,warm baths and relaxation techniques. After 26 weeks and before 36 weeks if you think you are having more than 4 contractions an hour on a consistent basis, call for advice and/or appointment. After 36 weeks, call for an appointment to be checked if you have increasingly strong contractions every 5 minutes for two hours, and they are not relieved with conservative measures.
Nosebleeds
Adequate intake of Vitamin C, cold compresses to your nose, lie down, tilt head back, pinch nose, humidifier in home, thin coating of Vaseline to each nostril at bed time.
Bleeding Gums
Later in pregnancy, gum inflammation may occur. Increase Vitamin C intake and continue gentle brushing.
Dental preparations
Routine dental care is fine, but you should be shielded for x-rays and no nitrous oxide (gas).
Palpitations
May be normal later in pregnancy, but call if palpitations are persistent or associated with chest pain, fainting, or fatigue.
Hair perming or coloring
There is a tendency to lose hair during pregnancy, and hair becomes slightly more brittle. A permanent or coloring may cause hair to break or may not "take", but will not harm baby.
Antibiotics
You may use Penicillin, Cephalosporin or Erythromycin, if ordered by a dentist or a physician and you have no allergies to the medication.
Sex During Pregnancy
Sex will not harm the baby. The baby is floating in amniotic fluid which protects the baby and absorbs shock. If bleeding or contractions happen with sex, please call and inform your physician. Desire may be lessened in the first trimester, which is normal.
Travel
Toward the end of your pregnancy stay close to home so that we can be available for delivery. Otherwise, for a normal healthy pregnancy, travel by air or car is fine, but we do not recommend air travel after 35 weeks. Use a shoulder strap and a seatbelt fastened loosely under your protruding abdomen, with the belt more on your thighs than on your abdomen. Eat and drink sensibly en route. Elevate your feet if possible. Avoid sitting still for prolonged periods of time. Take frequent stops, if traveling by car, or walk around inside the plane at Intervals. Get up and ambulate every 1 1/2 hours.
Hot tubs/Saunas
Animal experimentation suggests that extreme body temperatures can damage developing babies. Since no studies on humans are available, we suggest you avoid hot tubs and saunas. Baths are fine, but the water temperature should not be over 100°.
Exercise
Whatever exercise you were used to before you were pregnant is okay during pregnancy unless contractions, bleeding or other symptoms occur. Prenatal exercises to promote good posture, good body mechanics and strengthening for labor are highly recommended, but if you have never exercised before, begin with low intensity activities and advance slowly. Your heart rate should not exceed 140 beats/minute and strenuous activities should not exceed 15 minutes duration (should be able to talk while exercising). Avoid exercise in hot, humid weather or during an illness when you have a fever. Avoid jumping, jarring motions or rapid changes in direction. Exercise that involves lying down (flat on your back) and pulling up should not be done after the 4th month. Always include a 5-minute warm up and cool down. Please avoid road bikes and treadmills as accidents are more common and can potential harm your baby.
Swimming
Will not harm the baby and is safe throughout pregnancy.
Alcohol in any amount is NOT recommended. Also, cigarette smoking, marijuana, cocaine and other "street" drugs
such as any "downers" or "uppers" should be avoided during pregnancy to prevent potential harmful effects to the growing baby and mother. Please let us know if you have a problem stopping alcohol or drugs.
Cats
Have someone else change your eat's litter box to avoid exposure to cat feces.
Household Products
Avoid products like oven cleaners that have label warnings about toxicity, but most day-to-day products probably won't harm your baby. Most latex paints are safe, but you should use any products that have strong fumes in a well-ventilated area. (Smells may bring on nausea). Don't climb to paint hard-to-reach areas. Wear gloves.
Diet
Limit caffeine to 1 serving per day and Nutrasweet to 2 servings per day, or avoid all together. Daily eat 3 - 4 servings of milk or dairy products, 4 servings of fruit and vegetables, 4 servings of whole grain or enriched bread, 3 - 4 servings of meat, poultry, eggs, nuts or beans. Drink 6-8 glasses of water daily. Normal weight gain is ten pounds in the first 20 weeks, and one pound per week during the rest of pregnancy. Women who are overweight should gain less and those who are underweight or carrying twins should gain more. Do not try to go on a diet to lose weight. Eat sensibly and avoid cravings. A low birth weight baby can have problems during labor and the first few months. Vitamins may be prescribed to help supplement your diet (not in place of your diet). Avoid eating raw meats to prevent contracting Toxoplasmosis, a disease that can be harmful to your baby. Also avoid eating raw oysters and sushi. Servings of some fish, such as tuna should be limited to 2 servings/week due to concerns of mercury levels. Avoid larger fish like shark, mackerel, tile fish, and swordfish as they may contain higher mercury levels. (see Food Do's and Don'ts for more detailed information)
*Note: No medications are considered 100% safe during pregnancy. Even if no medications are taken during pregnancy, there is a 1·2% congenital anomaly rate. Using nothing is better, but, when the patient herself decides that her symptoms are severe enough, based on years of experience, the following are the safest recommendations we know:
Headaches
Use Regular·Strength Tylenol and increase fluids. You may also use Benadryl (at night) and Claritin (daytime) for headaches associated with allergies. Headaches during pregnancy are common, but if blurred vision or spots before eyes accompany headache or if unrelieved by Tylenol, call for further advice.
Cough
Use Regular-Strength Robitussin, Chloraseptic spray, nasal saline drops, or any throat lozenges. If needed, increase fluid intake, stop smoking (if a smoker) and use a vaporizer. If cough is accompanied by a fever, discolored phlegm, shortness of breath, or chest pain call for further advice.
Sinus congestion and cold symptoms
Use Sudafed, Benadryl, Mucinex, or Tylenol; increase fluid intake; take throat lozenges if needed; stop smoking (if a smoker); and use a vaporizer. Also Chloraseptic Spray and nasal saline drops are very safe to use in pregnancy. Sinus congestion during pregnancy may be common, but if sinus congestion is accompanied by a fever (greater than 100.4) or discolored drainage, please call for further advice.
Eye drops
Visine, if needed.
Nasal sprays
Vicks or Ocean Spray.
Constipation
First try increasing fluids to 6-8 glasses per day, increasing fiber and bran in your diet, and increasing your exercise. If these efforts are unsuccessful, try Metamucil or Konsyl and/or stool softeners, such as Colace. Develop regular bowel habits. If you have gone for over three days without a bowel movement, you may use Milk of Magnesia. We do not recommend laxatives such as Ex-Lax, or use of enemas.
Hemorrhoids
Use Tucks Medicated Pads, Anusol suppository, Preparation H, sitz baths and measures to prevent constipation. If you experience rectal bleeding or significant pain, call for further advice.
Diarrhea
Metamucil, Kaopectate, and lots of clear liquids.
Heartburn
Use antacids (Maalox. Mylanta, Turns or Rolaids; not baking soda or Alka Seltzer) after meals and eat small, frequent high-protein meals of bland quality. Eat slowly, and do not lie down immediately after eating. If persists, you may use over-the-counter Pepcid twice daily.
Nausea and Vomiting
Keep crackers or dry toast at bedside to eat before getting up, have juice with breakfast, eat small frequent high protein meals of bland quality, and drink fluids between meals instead of with them. Take Vitamin B6 tablets 25mg twice daily and take Mylanta or Maalox. Use Unisom (Doxylamine) at night. If nauseous only, consider purchasing a "Sea Band" (a non-drug acupressure method for controlling nausea). If vomiting is persistent for more than 24 hours, call for further advice.
Leg cramps
Leg massage, heating pad, avoid pointing the toes, and walking "heel first", avoid lying on your back. If severe. call for advice.
Varicose Veins
Avoid standing for long periods of time, elevate your legs at frequent intervals during the day and do leg exercises. Wearing support hose may help. We can prescribe specific support hose for you based on specific needs.
Breast Tenderness
Wear a good support cotton bra. Later in pregnancy, you may need 1-2 size larger cup. Anytime from the 5th month on you may produce colostrum (yellowish fluid) which is the beginning of breast milk. Avoid plastic shields, instead, tuck a cotton handkerchief or gauze into each bra cup.
Faintness
When standing for long periods of time, move around frequently to stimulate your circulation. Take frequent rest periods, eat healthful foods in small amounts throughout the day, and drink plenty of fluids. Avoid getting overheated.
Call if dizzy spells with fainting persists.
Tiredness
Fatigue during pregnancy may be normal. Daily exercise and an adequate night's rest is important. Iron supplements may be recommended if anemic. Shortness of breath toward the end of your pregnancy, due to pressure of the growing uterus, may cause fatigue and is helped by lying on your side or propped up on pillows.
Backache
Maintain good posture, squat instead of bending over, rise from lying down by rolling on your side and pushing yourself up with your hands, exercise daily, wear comfortable low heeled shoes, and sleep on a flat, firm mattress. Wearing a maternity girdle may help. If the pain persists, we may refer you to a recommended and pregnancy-certified Physical Therapist.
Skin Changes/Stretch Marks
A brown discoloration over your face and nipples, as well as a line from your naval to the pubic bone is normal. Avoid sunburn which could deepen the skin discoloration. The spots will disappear after your baby is born. Stretch marks may be minimized if your skin is kept soft and supple with lotion, cream or cocoa butter. They may fade after delivery, but probably won't disappear.
Increased Salivation or "Metal Taste"
This is normal. Use throat lozenges.
Urinary symptoms
A feeling to urinate frequently is normal, especially at the beginning of pregnancy and toward the end. Call for an appointment, however, if painful urination, bloody urine or fever occurs.
Vaginal Infections
A yellowish clear mucous discharge may be normal during pregnancy. If burning, itching, pain, swelling or foul odor occurs, call for appointment. You may use a non-deodorant pad. If you know you have a yeast infection, use Monistat or GyneLotrimin externally only in the 1st trimester, and both internally or externally after the 1st trimester.
Tampons/Douching
Do not use during pregnancy due to the potential for infection and damage to your developing baby if fluid or air gets up inside your cervix.
Swelling
Wear loose, non-constrictive clothing. Elevate your legs at frequent intervals during the day, bed rest for 2 hours daily on side, eat a diet rich in protein, drink plenty of fluids, avoid salty foods and don't add salt to foods. Report marked or rapidly worsening hand or face swelling immediately.
Cramping
Most cramping in early to mid pregnancy is due to pressure from the enlarging uterus and stretching ligaments. Exercise, a heating pad, Tylenol, and relaxation techniques may help. Call for advice or appointment if vaginal bleeding occurs.
Contractions. Later in pregnancy, as early as your 5th month, uterine tightening ("Braxton Hicks" contractions) or false labor can occur. Relieve false labor with walking, rest, Tylenol, heating pad, liquids,warm baths and relaxation techniques. After 26 weeks and before 36 weeks if you think you are having more than 4 contractions an hour on a consistent basis, call for advice and/or appointment. After 36 weeks, call for an appointment to be checked if you have increasingly strong contractions every 5 minutes for two hours, and they are not relieved with conservative measures.
Nosebleeds
Adequate intake of Vitamin C, cold compresses to your nose, lie down, tilt head back, pinch nose, humidifier in home, thin coating of Vaseline to each nostril at bed time.
Bleeding Gums
Later in pregnancy, gum inflammation may occur. Increase Vitamin C intake and continue gentle brushing.
Dental preparations
Routine dental care is fine, but you should be shielded for x-rays and no nitrous oxide (gas).
Palpitations
May be normal later in pregnancy, but call if palpitations are persistent or associated with chest pain, fainting, or fatigue.
Hair perming or coloring
There is a tendency to lose hair during pregnancy, and hair becomes slightly more brittle. A permanent or coloring may cause hair to break or may not "take", but will not harm baby.
Antibiotics
You may use Penicillin, Cephalosporin or Erythromycin, if ordered by a dentist or a physician and you have no allergies to the medication.
Sex During Pregnancy
Sex will not harm the baby. The baby is floating in amniotic fluid which protects the baby and absorbs shock. If bleeding or contractions happen with sex, please call and inform your physician. Desire may be lessened in the first trimester, which is normal.
Travel
Toward the end of your pregnancy stay close to home so that we can be available for delivery. Otherwise, for a normal healthy pregnancy, travel by air or car is fine, but we do not recommend air travel after 35 weeks. Use a shoulder strap and a seatbelt fastened loosely under your protruding abdomen, with the belt more on your thighs than on your abdomen. Eat and drink sensibly en route. Elevate your feet if possible. Avoid sitting still for prolonged periods of time. Take frequent stops, if traveling by car, or walk around inside the plane at Intervals. Get up and ambulate every 1 1/2 hours.
Hot tubs/Saunas
Animal experimentation suggests that extreme body temperatures can damage developing babies. Since no studies on humans are available, we suggest you avoid hot tubs and saunas. Baths are fine, but the water temperature should not be over 100°.
Exercise
Whatever exercise you were used to before you were pregnant is okay during pregnancy unless contractions, bleeding or other symptoms occur. Prenatal exercises to promote good posture, good body mechanics and strengthening for labor are highly recommended, but if you have never exercised before, begin with low intensity activities and advance slowly. Your heart rate should not exceed 140 beats/minute and strenuous activities should not exceed 15 minutes duration (should be able to talk while exercising). Avoid exercise in hot, humid weather or during an illness when you have a fever. Avoid jumping, jarring motions or rapid changes in direction. Exercise that involves lying down (flat on your back) and pulling up should not be done after the 4th month. Always include a 5-minute warm up and cool down. Please avoid road bikes and treadmills as accidents are more common and can potential harm your baby.
Swimming
Will not harm the baby and is safe throughout pregnancy.
Alcohol in any amount is NOT recommended. Also, cigarette smoking, marijuana, cocaine and other "street" drugs
such as any "downers" or "uppers" should be avoided during pregnancy to prevent potential harmful effects to the growing baby and mother. Please let us know if you have a problem stopping alcohol or drugs.
Cats
Have someone else change your eat's litter box to avoid exposure to cat feces.
Household Products
Avoid products like oven cleaners that have label warnings about toxicity, but most day-to-day products probably won't harm your baby. Most latex paints are safe, but you should use any products that have strong fumes in a well-ventilated area. (Smells may bring on nausea). Don't climb to paint hard-to-reach areas. Wear gloves.
Diet
Limit caffeine to 1 serving per day and Nutrasweet to 2 servings per day, or avoid all together. Daily eat 3 - 4 servings of milk or dairy products, 4 servings of fruit and vegetables, 4 servings of whole grain or enriched bread, 3 - 4 servings of meat, poultry, eggs, nuts or beans. Drink 6-8 glasses of water daily. Normal weight gain is ten pounds in the first 20 weeks, and one pound per week during the rest of pregnancy. Women who are overweight should gain less and those who are underweight or carrying twins should gain more. Do not try to go on a diet to lose weight. Eat sensibly and avoid cravings. A low birth weight baby can have problems during labor and the first few months. Vitamins may be prescribed to help supplement your diet (not in place of your diet). Avoid eating raw meats to prevent contracting Toxoplasmosis, a disease that can be harmful to your baby. Also avoid eating raw oysters and sushi. Servings of some fish, such as tuna should be limited to 2 servings/week due to concerns of mercury levels. Avoid larger fish like shark, mackerel, tile fish, and swordfish as they may contain higher mercury levels. (see Food Do's and Don'ts for more detailed information)