Pregnancy Handbook

Your pregnancy is made up of three trimesters, each one lasting roughly three months. Your body will go through many different changes during your pregnancy as your baby grows and develops. Read on to learn more about what happens to you and your baby during each of the three trimesters.

Your baby grows exponentially during the first trimester, beginning as a small clump of cells and growing into a fully formed fetus with body structure and internal organs and systems in a relatively short period of time. A crucial time of development, birth defects and miscarriage are more likely to occur now than in later trimesters.

Your body will undergo many changes as well, and many early pregnancy symptoms may begin to show up early in your pregnancy, maybe before you even know you’re pregnant. These can include nausea (“morning sickness”), fatigue and breast tenderness. You may experience some or none of these symptoms; every woman and every pregnancy is different.

The second trimester is a time of rapid growth for babies, and by the end of the second trimester (around week 26), your baby can weigh 2-3 pounds. Baby will develop defined fingers and toes and may start to hear sounds. The sex of the baby will also become apparent during the second trimester, and you may begin to feel the first fluttering movements sometime after 16 weeks.

Many women find the second trimester to be a golden period of pregnancy as the symptoms of the first trimester begin to recede. However, you may start to experience new symptoms – such as heartburn, constipation and back pain – as your baby continues to grow. Many women don’t gain much weight during the first trimester, but during the second trimester you can expect to start gaining 1 to 2 pounds a week.

Your baby’s internal systems continue to mature during the third trimester, and the baby will rapidly increase in size and weight. The baby will begin to stretch and kick, practice breathing, and will be able to detect light. After about 31 weeks, most of the baby’s development is complete; he now begins to rapidly gain weight, going from around 2 pounds at 27 weeks to between 6.5 to 10 pounds by 40 weeks.

Your baby’s increase in size may cause some discomfort as you grow bigger too. Symptoms may include shortness of breath, hemorrhoids, trouble sleeping, urinary incontinence, pelvic pain, and swelling in the feet and legs. You may also have more trouble moving around with your expanding belly. These symptoms may get worse the closer you get to your due date – but they should all go away after your little one’s arrival.

Once you learn you are pregnant, it is important to call and schedule your first prenatal appointment. This will generally take place between 11 and 13 weeks in a low-risk pregnancy.

Your provider will want to see you once a month for the first several months of your pregnancy, increasing to every two weeks, then every week as your due date approaches. If you are high risk, your appointments may be more frequent.

At each appointment, you will have your vitals taken, such as weight and blood pressure. Your provider will go over information about your pregnancy and you will be able to bring up any questions or concerns. Different tests may be conducted depending on where you are in your pregnancy. You will also be able to hear your baby’s heartbeat on the fetal Doppler.

GRMC also offers a gestational diabetes class focused on complications for the mother, such as preeclampsia and eclampsia, as well as the baby. Examples of focuses include hypoglycemia, hyperinsulinemia, pre-term and respiratory distress, as well as jaundice.

Class topics include:

• What is gestational diabetes and the risk factors for gestational diabetes
• Treatment of gestational diabetes: medications healthy eating, physical activity, monitoring your blood sugar levels
• How to reduce the risk of complication to mother and baby

For more information or to sign up, contact Ann Camacho, 830.484.4237 or acamacho@grmedcenter.com.

Download Gestational Diabetes Form

Blood panel: Blood work will test for:

• Blood type and Rh factor
• Complete blood count
• Sexually transmitted diseases
• Hepatitis B
• Rubella antibodies
• Genetic screenings (optional)
• Other tests as ordered by your provider

Urine culture: You will be asked for a urine sample at your first appointment to test for infections that could affect your pregnancy.

Pap test: Your provider may perform a Pap test at your first appointment to test for cervical abnormalities.

Ultrasound: An ultrasound may also be done at your first appointment. You will be able to see your baby for the first time and may be able to hear the heartbeat, and your provider will be able to determine how far along you are in your pregnancy.

Starting in the early stages of your pregnancy, you have the option to screen and test for certain birth defects in your baby, such as:

• Down syndrome (trisomy 21)
• Trisomy 13
• Trisomy 18
• Neural tube defects

Decisions about genetic screening, prenatal testing and other options are very personal ones. Any additional questions can be directed to your provider, care team, genetic counselor or maternal fetal medicine team.

The first trimester screen: 11 – 13 weeks. This is a simple blood sample obtained by a finger stick combined with an ultrasound to estimate the risk of Down syndrome, trisomy 18, and trisomy 13.

Quad or Tetra screen: 15 – 20 weeks. The second trimester screen (Quad or Tetra screen) uses a blood draw to estimate the risk of Down syndrome and trisomy 18. This test is usually offered to women who have not had a first trimester screen.

MSAFP: 15 – 20 weeks. Maternal Serum Alpha Fetoprotein is a blood draw to screen for open neural tube defects such as spina bifida and other rarer conditions.

Noninvasive prenatal screening (NIPS): After 10 weeks. NIPS is a blood test that screens for chromosomal disorders such as Down syndrome, Trisomy 18, Trisomy 21 and sex chromosome abnormalities. This test can also determine the sex of your baby. This screen is recommended for mothers at increased risk for having a baby with birth defects, such as those of advanced maternal age, have history of chromosomal abnormalities, or previous abnormal screening results.

For patients identified for increased risk of having a child with birth defects, diagnostic tests are also available. These tests provide definitive information about birth defects as opposed to other screenings, which only identify the risk factors. However, diagnostic testing does carry a small risk of miscarriage. You should discuss the risks and benefits with your care provider. Some of the most common diagnostic tests include:

Amniocentesis: 15 – 20 weeks. In this procedure, a small amount of amniotic fluid is taken from the sac surrounding the baby and tested for conditions such as chromosomal abnormalities or neural tube defects.

Chorionic villus sampling (CVS): 10 – 12.5 weeks. In chorionic villus sampling (CVS), a small sample of cells is taken from the placenta and tested for conditions such as chromosomal abnormalities and cystic fibrosis.

Anatomy ultrasound: 19 – 21 weeks. The anatomy ultrasound provides a detailed look at your baby’s anatomy, taking measurements of all of his body parts and internal organs. This scan will help determine if your baby is growing and developing normally, and you can usually find out the sex of your baby at this time if you choose to do so.

1-hour glucose tolerance test: 24 – 28 weeks (or sooner if you have a history of gestational diabetes or other risk factors). This test is used to screen for gestational diabetes. During the glucose tolerance test, you will drink a sugary drink containing 50 grams of glucose. After one hour you will have your blood drawn.

If your results are:

• Under 135 mg/dL: You do not have gestational diabetes
• 135 – 199 mg/dL: Further testing is needed; your provider will order a three-hour test
• 200 mg/dL or greater: Diagnosed with gestational diabetes without further testing

3-hour glucose tolerance test: Unlike the one-hour, the three-hour glucose tolerance test is a fasting test, so you should not eat or drink anything for at least eight hours before your test. First thing in the morning, before you eat breakfast is an ideal time for the test.

When you arrive at the lab, you will have blood drawn for your fasting blood glucose test. You will then drink a glucose drink containing 100 grams of glucose. You have your blood drawn again at the 1-, 2- and 3-hour marks. If two or more of your numbers are out of the normal range, you are diagnosed with gestational diabetes. You will need to monitor and control your blood glucose levels during the remainder of your pregnancy, through diet and exercise and/or medication.

Group B strep test: 35 – 36 weeks. Group B streptococcus (GBS) is a common type of bacteria that can live in the body, and may affect three out of every 10 women. It is generally harmless to adults; however, it can be dangerous to your baby if passed to him or her during delivery. During this test, your provider will do a vaginal and rectal swab to test for GBS. If you are GBS positive, you will be administered IV antibiotics during labor in order to prevent infecting your baby with GBS.

Non-stress test: Your provider may order a non-stress test to measure the baby’s heart rate in response to fetal movement. A non-stress test may be performed if you are overdue, have been feeling the baby move less than usual, or have other complications or conditions that make you high-risk. During the test, two belts will be placed on your abdomen – one that measures the baby’s heart rate and one to measure contractions. Your provider will watch to see if the baby’s heart rate increases when he is active. The test should take about 20 minutes and is completely safe for both you and your baby.

Tdap: 27 – 36 weeks. The Tdap vaccine provides protection against tetanus, diphtheria, and pertussis. It is recommended that pregnant women receive this shot in the third trimester of every pregnancy. This ensures your own protection from these diseases and allows you to pass protection on to your baby in utero.

It is also highly recommended that your partner receives a Tdap vaccine, as well as any other family members who will be in frequent contact with your baby after he or she is born.

COVID-19 Vaccine: The CDC now recommends that all women who are pregnant or considering pregnancy get vaccinated for COVID-19. CDC recommendations align with those from professional medical organizations serving people who are pregnant, including the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal Fetal Medicine and the American Society for Reproductive Medicine (ASRM).

Flu shot: It is recommended that all pregnant women receive a flu vaccination before flu season. Contracting the flu while pregnant can be dangerous to both you and your baby. Since your baby cannot receive a flu vaccine for the first six months of his or her life, it is also recommended that anyone who will be in close contact with the baby receives a flu shot (including partners, other children, and close family members).

Rh immune globulin injection: After week 28. If you have an Rh negative blood type (as determined during your 1st trimester blood panel) you may need an Rh immune globulin injection after week 28 to prevent Rh compatibility issues with future pregnancies.

A diet rich in healthy foods like fruits, vegetables, proteins (meat, eggs, nuts) and whole grains will help ensure that your baby is getting the nutrition he needs to grow and develop. Healthy eating should be part of your plan from the start since many of your baby's major organs are formed during the first few weeks of pregnancy.

Eating a balanced diet can help prevent a number of serious complications with your pregnancy and delivery, including: anemia, infections, premature birth, abnormal birth weight, and poor healing after delivery.

You may have heard the saying "eating for two" while pregnant. Though this is important to remember from the standpoint of "what I eat, my baby eats", this saying doesn't mean that you should eat twice as much food. On average, pregnant women should be eating an extra 300 calories a day to help support their growing baby. To provide the best nutrition for you and your baby, you should choose foods that are high in protein, calcium, iron and folic acid, and avoid added fats and sugar.

On average, the total amount of weight gain during pregnancy will fall in the following ranges:

While most of the vitamins and minerals you need should come from the food you eat, a good prenatal vitamin is also recommended to supplement your diet. Your prenatal vitamin should contain vital nutrients such as folate, iron, calcium, magnesium, choline, selenium, zinc, and vitamins A, C, B6, B12 and D.

Folate, or folic acid, is critical in the formation of DNA and cell division and supports rapid growth of the placenta and fetus. It is also helps prevent neural tube disorders such as spinal bifida. The CDC recommends pregnant women take a minimum of 400 micrograms of folate daily. Most prenatals contain folate, but it can also be found in foods such as lentils, beans, chickpeas, okra and spinach.

Calcium helps your baby develop strong bones and teeth and is important for your own bone health as well. It is recommended that pregnant women get 1,000 mg of calcium daily. Foods rich in calcium include dairy (e.g., milk, yogurt and cheese), as well as greens such as spinach and kale.

Iron is essential for transporting oxygen in both baby and mom and decreases the risk of anemia in pregnancy. Foods rich in iron include meat, beans (including soy, kidney and white beans), spinach and lentils.

Magnesium is necessary to build body tissues in babies and may reduce the risk of preterm labor. It also may help reduce leg cramps and help with insomnia in moms. Sources of magnesium include buckwheat and wheat flours, grains such as bulgur and barley, oat bran, spinach and squash.

Selenium can help reduce the risk of preeclampsia, or dangerously high blood pressure during pregnancy and aids in healthy fetal development. It is recommended that pregnant women get 60 mcg of selenium a day. Selenium can be found in food such as barley, crab, salmon, turkey and wheat flour.

Omega-3 Fatty Acid DHA is essential for baby’s brain and eye development. It can also combat postpartum depression in moms and has been shown to reduce the risk of preterm labor. DHA can be found in many types of fish, as well as flaxseed, hempseed, walnuts and soybeans. DHA can be taken in the form of a fish oil supplement or vegan DHA supplement.

Choline plays an important role in baby’s brain development, including the development of memory. Eggs are rich sources of choline, as is veal, beef and soybeans.

Food sources for vitamins:

• Vitamin A: Carrots, pumpkin, spinach and other greens
• Vitamin C: Bell peppers, papaya, citrus juice and fruit, strawberries, Brussels sprouts
• Vitamin D: Salmon and other fish, milk, eggs
• Vitamin K: Kale, spinach, and other greens, brussels sprouts, broccoli
• B6: Chickpeas, chestnuts, turkey, pork
• B12: Trout, salmon, ground beef, milk, yogurt, cheese

Alcohol: There is no safe amount of alcohol during pregnancy. Alcohol use during pregnancy has been linked to miscarriage, preterm birth, low birthweight and can cause other problems for your developing baby. Pregnant women are advised to abstain from alcohol throughout their pregnancy.

Caffeine: Small amounts of caffeine, totaling 300 milligrams or less per day, is safe in pregnancy. This is the amount in one to two cups of coffee. Be aware of caffeine intake from other sources as well, such as soda and chocolate.

Fish: Fish can be a healthy source of protein and omega 3 fatty acids during pregnancy. It is best to choose varieties of fish that are low in mercury, such as salmon, sardines, cod and tilapia. Fish to avoid or limit due to their mercury content include tuna, swordfish, mackerel and shark.

Deli meat: Deli meat such as turkey can potentially carry the foodborne bacteria, listeria. Although outbreaks are rare, listeria can be very dangerous for your unborn baby. It is best to either avoid deli meat altogether during pregnancy, or else heat to steaming before consuming to kill any bacteria.

Soft cheeses: Unpasteurized soft cheeses such as brie, feta and queso fresco can contain listeria bacteria and should therefore be avoided. Most soft cheeses sold commercially in the U.S. are pasteurized and are safe to eat, but always check the label first.

Unpasteurized milk and juice: These products should be avoided as they may contain dangerous bacteria.

Undercooked/raw meat and fish: Undercooked meat and fish can carry bacteria such as listeria, E. coli and salmonella, which can be very harmful to you and your baby. It is best to make sure the meat and fish you eat is fully cooked to limit the risk.

Include foods with adequate amounts of folate, iron, calcium, and other important vitamins and minerals. Also consider taking a prenatal vitamin to help ensure you are getting the required nutrients if diet alone is not enough.

About 30 minutes a day, as long as your provider agrees it is safe to do so. Activities that are safe during pregnancy include walking, swimming, low impact aerobics and prenatal yoga. Avoid activities that could risk a fall or injury to your abdomen.

Travel by air is considered safe for women while they are pregnant, and most airlines allow pregnant women to travel into their eighth month. Please talk to your provider about the safety of travelling overseas while pregnant, as there may be certain risks or considerations depending on where in the world you are going.

Smoking during pregnancy has been associated with miscarriage, placental abruption, preterm birth, low birth weight and stillbirth. Women are urged to quit smoking or cut back drastically when pregnant.

Or at least wear gloves and thoroughly wash your hands after handling cat litter. Cat feces can contain bacteria that may cause toxoplasmosis infection, which can be very harmful to your baby, causing serious birth defects or even death. The bacteria may also be present in garden soil, so it is best to wear gloves and thoroughly wash your hands after gardening.

A commitment to teaching is part of our mission and ensures that our patients and their families are well-informed about their health and health care options. That’s why we offer a complete series of childbirth education programs and services designed to help you prepare for – and achieve – a memorable birthing experience.

Breastfeeding classes are a great way to learn and prepare to breastfeed your newborn. These classes gives first time moms, as well as current moms, an opportunity to ask questions and voice concerns regarding breastfeeding. Expectant mothers, new mommies and any other members of the support team are encouraged to attend since support is important with breastfeeding success. GRMC’s lactation consultant offers breastfeeding classes in both English and Spanish. See below for available class dates. All classes will be held in person unless otherwise notified. Please note the times for the English and Spanish breastfeeding classes.

Each breastfeeding class we will discuss:

• Breastfeeding basics: benefits, making breast milk (transitions, production cycle, etc.), and special situations
• Latching on/positioning (what effective and ineffective latch looks like) and feeding in the first weeks
• Feedings: when, hunger signs, feeding guidelines, tummy size, and feeding a sleepy baby
• How much is enough, satiety signs, and when to call your doctor
• Breast care (engorgement, nipple care, etc.)
• Breastfeeding lifestyle: taking care of yourself, proper time to introduce bottles and pacifiers if applicable, returning to work, expressing milk, milk storage guidelines, and where to find support

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GRMC is a great hospital for childbirth. In order to prepare for labor and birth, this class provides you with a forum to ask questions and learn about key issues surrounding your baby’s birth. This class is held virtually via ZOOM from 8am to 2:30pm.

Some information you will learn from our birthing class includes:

• Healthy pregnancy developments
• Making pregnancy, labor, and delivery more comfortable
• Breathing and relaxation techniques
• Signs you are in labor
• Pain coping techniques
• Expectations for labor and delivery
• The labor partner/ coaching role

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