Pregnancy is measured in trimesters from the first day of your last menstrual period (LMP), totaling 40 weeks. The first trimester of pregnancy ends 13 weeks, or about 3 months, after the start of your LMP.

• Normal Changes During Pregnancy
• Prenatal Visits
• First Trimester Checklist
• Other Medical Needs During Pregnancy
• Diet
• Vitamins and Iron Supplements
• Exercise During Pregnancy
• Preventing Colds, Bronchitis and Pneumonia
• We recommend you do not

Normal Changes During Pregnancy

You can expect changes in your physical and emotional states during your pregnancy. You may experience nausea, frequent urination, breast and nipple tenderness, fatigue, bloating and constipation. You can alleviate some of these symptoms by increasing rest periods during the day, eating several small meals (instead of three larger ones), and increasing your intake of fluids and fiber.

The hormonal changes inside your body also may cause mood fluctuations. Fear and ambivalence are as common as excitement and joy during the early months of pregnancy. Talk to your partner about how you are feeling. Ask for help, especially if you are tired. See your physician if you are feeling very depressed or anxious.

It is common to have changes in your feelings about sex and your desire for sex during pregnancy. It is not harmful to have sexual relations while you are pregnant.
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Prenatal Visits

Your first prenatal visit will be between the eighth and tenth week of your pregnancy. You will see an obstetrician, family physician, certified nurse midwife or nurse practitioner trained in obstetrics, who will review your medical history, perform a physical exam and review many pregnancy issues. You may also be scheduled for a class around the sixth week of your pregnancy.

For routine obstetric care, we will see you every four weeks, until 32 weeks. Of course, if you have any pressing concerns before these scheduled visits, do not hesitate to call your chosen obstetrics department.
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First Trimester Checklist

• Have your prenatal screening tests done
  
• Consider breastfeeding your baby. The American Academy of Pediatrics recommends breastfeeding as the preferred method for the first year of life. Since breastfeeding can be challenging for many women at first, we have listed several resources. You may call them now, while you are pregnant, or after your delivery. Some insurance companies do cover lactation consultation visits; if yours does not, you may discuss financial arrangements with the individual consultant.
  
• Register for breastfeeding classes and/or a lactation consultant. Classes fill up fast, and may not be available if you wait until later in your pregnancy.
  
• Register for prenatal classes. Many classes are available. They will provide lots of information and address your concerns about pregnancy, labor, delivery and newborn care. They are a great place to meet and share with other pregnant couples. Sign up early; they fill up fast!

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Other Medical Needs During Pregnancy

Other medical concerns unrelated to pregnancy, such as colds and sore throats, will continue to be managed by your PAMF primary care physician, who will communicate any relevant concerns to your obstetrician.
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Diet

Eating a well-balanced, nutritional diet (4women. gov, accessed October 2007) throughout pregnancy is important. You should select foods that are high in protein, fiber-rich carbohydrates, iron and calcium. You need approximately 200-300 extra calories daily during pregnancy. We recommend substituting nutritionally "dense" foods like dairy products rich in calcium and protein in place of refined sugars and fats. If you cannot tolerate dairy, try tofu, beans, corn tortillas, dark green leafy vegetables and fresh fruits. It is important to drink more fluid when pregnant, including 6-8 glasses of water daily (this does NOT mean caffeine-containing fluids like coffee, tea and sodas).

Eating Fish
Source: EPA

• Fish and seafood are excellent low-fat sources of many nutrients including protein, omega-3 fatty acids and minerals such as calcium and zinc.
  
• Pregnant women, nursing mothers and children should not eat shark, swordfish, king mackerel and tilefish. These long-lived larger fish contain the highest levels of methyl mercury that may harm an unborn baby’s developing nervous system.
  
• Pregnant women should select a variety of other kinds of shell fish and fish that are low in mercury -- five of the most commonly eaten fish that are low in mercury include shrimp, canned light tuna, salmon, pollack and catfish. Smaller ocean fish or farm-raised fish are generally good choices. Pregnant women can safely eat 12 ounces of these cooked fish per week, with a typical serving size being 3 to 6 ounces. However, albacore or chunk "white" tuna has more mercury than canned light tuna. It is recommended that albacore be limited to 6 ounces in a week.
  
• Pregnant women should avoid raw fish to reduce the risk of viral and bacterial illness.
  
• Keep fish and shellfish refrigerated or frozen until ready to use.

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Vitamins and Iron Supplements

Vitamins: We strongly recommend that you take a vitamin containing at least 0.4 mg (400 micrograms) of folic acid (folate) each day. This nutrient is important in fetal neural tube development.

Iron: We also suggest that you take a supplemental iron pill each day containing at least 50 mg of elemental iron. Ferrous fumarate and ferrous gluconate are typically easier on the stomach than ferrous sulfate, but all these iron preparations are adequate. Taking iron supplements with orange juice increases your body's absorption of the iron. Milk will decrease the absorption. If you have severe nausea during the early part of your pregnancy, you may skip the iron and substitute a regular multivitamin for the prenatal vitamin until your stomach settles down.

Calcium: We recommend that you increase your calcium-containing foods during pregnancy. The recommended daily dose is 1500 mg of elemental calcium. You can obtain this most readily through milk products (see below). You may also supplement with calcium tablets (calcium carbonate, e.g. Tums® or calcium citrate, e.g. Calcitrate®).
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Exercise During Pregnancy

Exercising during pregnancy is generally safe. Be careful not to over-exert: keep your heart rate under 140 beats per minute and exercise at an intensity level that allows you to carry on a normal conversation. Drink plenty of fluids before, during and after a workout. Also note that your joints "soften" when pregnant. This and your growing girth increase your chances of falling. If you do not exercise currently, a daily brisk walk (20-30 minutes) is an excellent way to stay in shape.
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Preventing Colds, Bronchitis and Pneumonia

Try to avoid being around those with colds and bronchitis. We recommend that all women receive a flu vaccine if they will be more than 14 weeks pregnant during the typical influenza season (December through March). The vaccine will not prevent most typical colds and bronchitis, but it helps protect against certain viral strains that can cause the flu or severe pneumonia.
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We recommend you do not

• Smoke or be around second-hand smoke.
  
• Eat uncooked fish (e.g. sushi) or undercooked fish, shellfish, eggs or meat.
  
• Change the litter of a cat box. Do use gloves when you garden. Be cautious around sand in parks or playgrounds.
  
• Dye your hair for the first trimester.
  
• Soak in a hot tub or sauna.

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