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Ebony Carter, MD, MPH (Guest): Hello. My name is Dr. Ebony Boyce Carter. I’m a maternal fetal medicine physician at Children’s Hospital and I am a Mom Doc.

Melanie Cole (Host): Heh, this is MomDocs a podcast from St. Louis children’s Hospital and today, we’re talking about having a healthy, wonderful pregnancy. Dr. Carter, I loved being pregnant. Not everybody does. But tell us your best advice as we start this segment about why it’s so important to get appropriate prenatal care when you are even thinking about getting pregnant and then throughout your pregnancy.

Dr. Carter: Well I love your question because it starts with then you’re thinking about getting pregnant and that’s actually the most important time to seek care. Because there are certain conditions that you could enter in pregnancy that we can actually address before a woman gets pregnant and improve outcomes.

So, for example, there is a measles outbreak happening currently and so it would be a good idea before getting pregnant to make sure that all vaccinations are up to date, that women are immune to things like measles and rubella and chicken pox because if not, we can do those vaccines before pregnancy. You can’t get live vaccines when you are pregnant. So, in order to optimize all conditions beforehand, it’s really important to come and see an obstetrician before getting pregnant.

And during prenatal care; our goal is to identify any risks that could potentially compromise a pregnancy and decrease it to the extent possible. And that’s really the purpose of prenatal care is to make sure that we are taking really good care of mom and baby and making sure that we get a good pregnancy outcome.

Host: Well really, it is so important. So, then let’s talk about some of the basic things a woman can do to have a healthy pregnancy. Dr. Carter, let’s start with prenatal vitamins because back in the day, and women didn’t know, and now we know how important folic acid and other prenatal vitamins are. Speak about what we should be taking.

Dr. Carter: So, if you go to any drugstore, anything labelled prenatal vitamins should have the recommended amount of folic acid in it. There are some women who should be taking a prenatal vitamin that has additional folic acid in it. You can discuss that with your medical provider. But one thing I like to emphasize about prenatal vitamins is starting to take it when you find out you’re pregnant is a bit late. So, any reproductive age woman I think should be taking prenatal vitamins because most pregnancies are actually unintended. But you want to be taking prenatal vitamins before pregnancy because the main purpose of folic acid is to prevent open neural tube defects like spina bifida where the spine doesn’t close appropriately and that actually occurs so early in the baby developing that most women don’t even know they’re pregnant when that happens. So, basically, if you are even thinking pregnancy is a remote possibility; prenatal vitamins should be taken.

Host: And what about eating? So, this could include Dr. Carter, before we get pregnant and then during pregnancy. We’ve heard that myth eating for two, but as I’m only four foot ten, so I was not about to go for that because I would have been as wide as I was tall. But it’s not really true that we are eating for two, is it? How many calories should we be eating? How much weight should we put on?

Dr. Carter: So, a healthy normal weight woman – actually no one really needs to be eating additional calories in the first trimester. In the second and third trimesters about 400 calories more than your baseline if you are a normal weight is recommended. In terms of weight gain; it depends on where you start the pregnancy. So, if you are normal weight then you can gain more in pregnancy than if you started off obese. And I would say that should be an individual conversation that every woman can have with her physician. But we do have guidelines based on what the starting weight is.

One other thing I will say, when women are thinking about conceiving is going into pregnancy with obesity also confers additional risk factors. So, to the extent possible, trying to normalize weight before pregnancy also is a great way to improve pregnancy outcomes.

Host: And what about foods that you would like us to try and include more of in our diet and what foods do you not want us to be eating and please include liquids too, caffeine, alcohol and of those things.

Dr. Carter: So, a healthy balanced diet in pregnancy is ideal. Omega 3 fatty acids, there have been data in recent years showing that those tend to be good for the baby’s brain development and so taking a prenatal vitamin that has omega 3 fatty acids included in it is an excellent idea. And you can also get those in fish. We do have some guidelines for some types of fish that you want to have in very low levels in pregnancy because they can have additional mercury levels that we don’t want. So, you can talk to your obstetric provider about that.

And then healthy fruits, vegetables I’d say, and this is a general guideline for not being pregnant as well, trying to stay away from like the sugary beverages, trying to limit caffeine. In terms of alcohol, we do not know a safe threshold for alcohol in pregnancy at all so it’s best to just avoid it all together. And I love what you said about eating for two; it’s not true. Because all of that weight needs to come off after having the baby, so it’s actually all of that weight that we gain in pregnancy; it’s really important to get it off after having the baby for one’s future health.

Host: And now, on to exercise. As someone who used to teach pregnancy and exercise, Doctor, tell us what is an acceptable amount. If you were someone who never exercised before; is when you’re pregnant the time to start? Do you keep up with what you were doing? Tell us about recommendations for exercise during pregnancy.

Dr. Carter: So, if you were active prior to pregnancy, I’d say it’s totally acceptable to continue that same level of exercise during pregnancy. Your body is wonderfully made and will tell you what you can and can’t do and so I always say to patients if you’re exercising and you start to feel like you are cramping or uncomfortable, it’s your body’s natural way of saying this is too much, you need to back off. So, I’d say listen to your body. In addition to that, drink a lot of water as you are exercising. If a woman didn’t exercise beforehand; I’d say the benefits are still wonderful and so even something like a moderate walk that a woman takes on the majority of the days of the week for thirty minutes or so would be wonderful in pregnancy. There’s also some data that that might potentially decrease the risk of getting gestational diabetes if you have exercise in pregnancy.

Host: So, sticking with exercise for just a minute Dr. Carter, what about weight training, or water exercise. But as far as weight training, can we do abdominals? Do we have to lie on one side. I mean there’s so many things and do you have some red flags because you know, Braxton Hicks and things, women get scared of and then they think they are in labor. Are there any red flags you’d like us to know about that if we are exercising and going through a weight training program, cramping; what would you like us to keep an eye on?

Dr. Carter: So, cramping would be something that would make me slow down and that’s why I say to have water so, anytime you are dehydrated that can increase the risk that the uterus gets a little bit irritable and begins to cramp. With weight training, I would say moderate weight training would be reasonable in pregnancy. Again, listen to your body.

And in terms of positioning; once the baby begins to get larger and you are laying flat on your back, it can lay on one of the major blood vessels in the middle of your body and so, as you get further along in pregnancy; you don’t want to lay flat on your back and so you would make modifications so that you are at any point leaning on your side. And this means, I mean you could just take a little towel and wedge it on one side so that you’re just slightly off center and not laying on your back. And that would be acceptable.

Host: That’s really great advice. Tell us a little bit about a high risk pregnancy. What is that?

Dr. Carter: So, a high risk pregnancy is a huge category and it’s anything that increases risk that needs to be modified. So, I am a maternal fetal medicine physician so I specialize in high risk pregnancies and those could be a woman who is dealing with high blood pressure that’s difficult to control, or she could have diabetes before she enters pregnancy, or maybe an autoimmune disease like lupus, a new cancer diagnosis that she’s trying to manage during pregnancy and figuring out what cancer fighting medications are safe in pregnancy. So, any of those additional factors for mom or for baby. If the baby has a condition like a heart defect or something is wrong with the kidneys or a genetic disorder like Down’s Syndrome. Those would all be things that a high risk physician like myself would help with.

Host: Then tell us about what services are available at the Women and Infant Center both for normal and high risk pregnancies.

Dr. Carter: So, at the Women and Infant Center, we have a wonderful compliment of physicians both general obstetricians and gynecologists who take care of pregnancies. We have nurse practitioners and we also have maternal fetal medicine physicians or high risk doctors. And we are very lucky to have Dr. Michael Bebbington who is a fetal surgeon who is also in our group to care for women. Along with the physicians and the nurse practitioners we have wonderful genetic counselors who are available to help families both with general counseling and families who have a baby with issues or have a family history and need some additional information. We have wonderful sonographers who do nothing but scan babies all day. So, we very rarely miss things here because we have a highly specialized service. We also have a robust transport service so physicians from all over our region call us and we – as long as the patient is stable, will go by ambulance, helicopter, or plane with an obstetric nurse to go out and get patients and bring them back here so that mom and baby are getting the best care possible.

We have a brand new beautiful Parkview Tower where our labor and delivery and our antepartum service takes care of pregnant women who aren’t well enough to go home, but not need to have the baby yet, where they stay with us for a while. And activities. So, I think my favorite part when I’m on service is on Thursday afternoons, we always have an arts or crafts activity that happens on that antepartum service.

So, I feel really blessed and fortunate to work among an amazing team at the Women and Infant Center and I think so highly of it that I had all of my babies here as well.

Host: That’s so cool. Is it different being an obstetrician and such a specialized obstetrician and also a mom?

Dr. Carter: Yes. Because I feel like I know too much. So, I always try to act like a completely normal patient when I am on the ward. But I just had a baby a few months ago in our new Parkview Tower Labor and Delivery and I already knew it, but the experience of being a mom and a patient; it’s a very special place and I felt so well-cared for and I know that we take really good care of our patients.

Host: That’s wonderful. Congratulations to you Dr. Carter. As we wrap up, best advice for women thinking about getting pregnant or women that are pregnant. What would you like them to know about really having a healthy pregnancy, enjoying every second of it because it goes by so quickly and really what you can do for them at the Women and Infant Center.

Dr. Carter: Sure. My best advice for women considering pregnancy is to visit your obstetrician prior to getting pregnant, a few months before getting pregnant so that if there are any issues that need to be resolved before getting pregnant; that you can work with your physician to work on those.

For women who are pregnant, it is to enjoy every minute of the pregnancy and rather than relying on Dr. Google, one of us is here 24/7. That’s another great service. Our labor and delivery always has at least two obstetricians and a full compliment of anesthesiologists. So, when in doubt, give us a call. I would say never be at home worried about whether something is wrong. We are here to answer questions all of the time.

And for those women who have just had their baby and are going out to be moms for the first time; I will share some advice that my mom shared with me when I had my first child and didn’t know what a cry meant or didn’t know what to do and her advice was, you’re not going to harm her by loving her. So, it’s the hardest and yet most wonderful job in the world. So, enjoy motherhood.

Host: Thank you so much Dr. Carter. What a great segment. So much great information. Thank you again for joining us. If you found this podcast informative; please share on your social media and be sure to check out all the other helpful podcasts in the library. Head on over to our website at www.stlouischildrens.org to get connected with one of our providers. I’m Melanie Cole.