Cheryl Martin (Host): You're pregnant. Congratulations. Now what? You probably have questions about your first pregnancy. Well, Dr. Julia Malis is here with answers to some key pregnancy questions. She's an OBGYN with Southern Pines Women's Health Center. This is First Health and Wellness podcast from First Health of the Carolinas, connecting you to the people and medical services that make your life healthier.

I'm Cheryl Martin. Dr. Malis, so glad you're here to answer some key questions.

Julia Malis, MD, FACOG: Hello, thank you for having me.

Host: So first, tell us what to expect in a typical prenatal visit schedule, beginning with that first appointment.

Julia Malis, MD, FACOG: Well, we typically see you first, around seven to eight weeks of pregnancy to confirm the pregnancy with an ultrasound and to give you correct dating based on that ultrasound. We do some blood work at that first visit, counsel you about the pregnancy, what to expect at all the visits. Do a physical exam and then following that visit, which is a little bit longer due to the ultrasound and the blood work and the exam, then visits are usually on an every four week schedule, until about 28 weeks.

So we see you at 12, 16, 20, 24 then 28 weeks. And then we see you a little bit more frequently after that, every two weeks until about 36 weeks. And then we see you every week from 36 weeks on to 40 weeks.

Cheryl Martin (Host): Now, what should you expect during the three trimesters?

Julia Malis, MD, FACOG: So, you know first trimester is from 0 to 14 weeks. That is when you're going to feel your worst, the nausea, the food aversions, all of that, but we can definitely help you get through all of those symptoms. Weight gain should not be significant in the first trimester, usually only zero to five pounds.

That's when, you're not really going to be feeling baby move yet. So it's a little bit more nerve wracking, but again, we see you to confirm everything and to kind of give you reassurance during that time. And then second trimester is when you'll start to feel the baby move. You'll start to kind of be in that sort of like a honeymoon period around 20 weeks when the nausea kind of subsides, you feel like you can eat more normally, for most people, and that's when you're gonna kind of see your highest increase in weight in that second trimester.

Third trimester is you're waking kind of plateaus again, and, you know, you're just having those more weekly visits, making sure everything's okay, blood pressure especially in that last month of pregnancy or so until you have the baby.

Host: Now, speaking of weight, how much should you expect to gain?

Julia Malis, MD, FACOG: So it depends on your starting weight or your pre-pregnancy weight. So we really base weight gain guidelines based on your pre-pregnancy weight. So for most people who have a normal BMI, meaning BMI from 18.5 to 24.9, you want to plan on gaining about 25 to 35 pounds during the pregnancy.

So that's really, if you're starting at a normal BMI, you can expect that weight gain. Now, if you are overweight, which is BMI 25 to 29.9, then we want you to gain a little bit less weight, meaning about 15 to 25 pounds. And then if you're in the obese range, for BMI, meaning your BMI is over 30, we only want you to gain about 11 to 20 pounds during the pregnancy.

Host: I'm sure this is on the minds of a lot of pregnant women. What about the challenge of getting the weight off?

Julia Malis, MD, FACOG: After you deliver?

Host: Yes.

Julia Malis, MD, FACOG: So that is something that varies for everyone. You'll hear people say like, oh, you know, you should lose the weight by the six month mark or some arbitrary benchmark like that, but it really differs from person to person. And I try to tell my patients and give them reassurance that it really is different for everyone.

And it can take up to a year and even over a year for women to really go back to their pre-pregnancy weight. So that can be a real challenge. But just giving patients a realistic expectation that it might take longer than six months, for your body to really recover fully. And breastfeeding can help, but even if you're not breastfeeding, you know, there are ways to implement different things, diet, exercise to kind of help things along.

Host: So, are there foods you should avoid during pregnancy? Or foods you should be consuming more of?

Julia Malis, MD, FACOG: In terms of avoiding foods, I give a little speech to all my newly pregnant patients. So I usually tell them to avoid anything unpasteurized. So, no unpasteurized milk, cheeses, even some juices can be unpasteurized. So it's really important to just check the labeling. Most things from the grocery store are pasteurized, so it's usually not an issue, but it's always good to check the label for that.

No cold meat from the deli counter. The thing that we are avoiding here is a bacteria called Listeria. So if you heat up the meat, if you heat up the deli meat, you know, put it in a pan, make sure it's piping hot. If you're getting a Subway sandwich, put it through the toaster, make sure it's heated, then it is okay to eat, but no cold meat from the deli counter.

All meat needs to be well cooked. All fish needs to be well cooked. I would avoid fish high in mercury such as swordfish, tilefish, king mackerel, even some tuna can be high in mercury. So I limit tuna from a can to about once a week.

Host: Any foods you should consume more of?

Julia Malis, MD, FACOG: So it's important to take a prenatal vitamin every day. That's going to give you your daily, recommended amounts of all your vitamins. Making sure that your prenatal vitamin has 400 micrograms of folic acid in it. You want to kind of meet your daily allowances for calcium, iron, vitamin D, omega 3 fatty acids, choline. Iron, you want to think about, consuming about 27 milligrams a day.

Beans, lentils, beef, turkey, and even some fruits, like oranges, grapefruits, strawberries, broccoli. It's really just about having a balanced diet, lots of fruits and vegetables, lots of lean meats, are gonna really give you all the vitamins, that you need. Fish is safe, two to three servings of fish per week.

You wanna limit the tuna to once per week, but other fishes are totally safe to do more than once a week, like salmon, for example. Just make sure it's well cooked. Hydration is key in pregnancy, it's about 8 to 12 cups of water per day, 64 to 96 ounces. Some people need even more than that, so it's really, really easy to get dehydrated in pregnancy, so water consumption is really, really important.

Host: Doctor, any activities you should avoid while pregnant?

Julia Malis, MD, FACOG: So, exercise is definitely encouraged and it's important to keep doing the activities that you're used to doing and that you feel good doing. But you want to avoid things like contact sports with a high risk of being hit in the abdomen, like hockey, soccer, basketball, you know, those can all be high contact sports, activities that have a high risk of falling, like downhill skiing, surfing, mountain biking, gymnastics, horseback riding, that kind of stuff.

Anything that's going to increase your core body temperature, like hot yoga or hot Pilates, those aren't necessarily safe in pregnancy either. Scuba diving for obvious reasons, is not great during pregnancy and avoiding things like hot tubs, saunas, anything, again, that can increase that core body temperature. 

Host: Now I'm sure that certain women may need to see a specialist while pregnant. Give examples of when that may be the case.

Julia Malis, MD, FACOG: If you are, what we call advanced maternal age, which is over the age of 35; we have everyone over the age of 35 see our maternal fetal medicine specialists for their anatomy scan, which is the 20 week ultrasound. If you're starting BMI is over 35, especially if you're starting BMI is over 40; we also have you see our maternal fetal medicine specialists for that 20 week ultrasound. If you have chronic medical conditions such as high blood pressure, Type 2 diabetes, other medical issues, autoimmune diseases, things like that, that need to be closely monitored during pregnancy; we will co-manage your pregnancy with our maternal fetal medicine specialist, which we work hand in hand with.

Host: Talk in more detail about the process of getting a specialist, how that works.

Julia Malis, MD, FACOG: So it's very simple. We place a referral to our maternal fetal medicine specialist, through UNC and we work very closely with her office, and we get the patients in pretty quickly for whatever visit, consult, they need.

Host: So really, First Health helps patients receive the specialized care.

Julia Malis, MD, FACOG: Yes, of course.

Host: Anything else you'd like to add that may be on the minds of those experiencing their first pregnancy?

Julia Malis, MD, FACOG: Bring all of your questions, write all of your questions down. All of us will be happy to go through everything with you at each of your prenatal visits. And, that's what we're here for, to help you through the process.

Host: Dr. Julia Malis, thanks for answering some of those key questions for pregnant moms. Very helpful information. Thank you.

Julia Malis, MD, FACOG: Thank you.

Host: To learn more about pregnancy care at First Health and Southern Pines Women's Health Center, visit firsthealth.org/women. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics of interest to you.

This is First Health and Wellness Podcast brought to you by First Health of the Carolinas. Thanks for listening.