Transcription:
Preparing for a Healthy Pregnancy

Melanie Cole (Host): If you're trying to have a baby or just thinking about it, it’s never too early to start getting ready to be pregnant. My guest today is Dr. Chantel Roedner. She’s a physician with WakeMed OBGYN. Dr. Roedner, I'm so glad to have you with us. As someone who’s had two babies and loved being pregnant, what would you tell a woman that she can be doing before she gets pregnant in so far as preconception care checkup. Who should have one and when?

Chantel Roedner, MD (Guest): Of course. So really when a woman comes to me for a preconception visit, we want to identify potential risks to both mom and baby and risks for the pregnancy. So it’s my job to help to educate women about these risks and to identify any potential interventions or management that could help to encourage a healthy pregnancy. So ideally at this visit, I'm going to be assessing a patient based on her age and her medical history and potentially a past pregnancy history, which will help to guide me in my counselling for that woman.

Host: A question many women had, including me, is when should you start taking folic acid supplementation and how much should you be looking for when you're looking at all the prenatal vitamins at the store?

Dr. Roedner: Right. So most prenatal vitamins will have anywhere between 400 and 800 micrograms, which for a person who has no significant family history of spinal defects—particularly spina bifida—or taking medications such as anticonvulsant medications for seizure disorders, those normal risk women should be taking about 400 micrograms. Most prenatal vitamins are going to include this. However, if you have a patient who is at an increased risk for spinal defects then we’re looking at anywhere from one to four micrograms of supplement. We’re usually identifying these women at those preconception or early prenatal visits.

Host: So while we’re talking about preconception measures a woman can take, what vaccinations should a woman planning to get pregnant get? Are there any she should not get if she is pregnant?

Dr. Roedner: So ideally a woman will have been vaccinated against varicella, which is the chicken pox virus, as well as an MMR—which is measles, mumps, and rubella. We will test for these titers to see if a woman has been exposed to it either via vaccination or infection history having had chicken pox as a child to see if she’s immune. These two vaccinations in particular are not recommended in a pregnancy because they are a live attenuated virus. We avoid these vaccinations in pregnancy. So if a patient is not immune to those two particular viruses, we would like for her to receive that prior to conception at least three to six months in advance.

Host: Now comes the pregnancy and it’s such an exciting time doctor. So let’s talk about weight gain. How much weight should a woman gain in her three trimesters?

Dr. Roedner: Right. So ideally, we would want a patient to maintain a healthy lifestyle. So that includes having a healthy BMI, or body mass index. That would also include avoiding things that could potentially be teratogenic to a pregnancy. So avoiding drug use, alcohol, elicit drug use, harmful chemical exposure. It would also be encouraging a woman to maintain a very healthy diet. So that would include taking a prenatal vitamin that’s high in minerals, vitamins, and folic acid.

Host: When a woman is pregnant, not everybody feels great, especially in that first trimester. Do you have some great advice for morning sickness and general nausea?

Dr. Roedner: Right. So nausea and vomiting of pregnancy is one of the most common complaints we get in the early pregnancy, and for good reason. People can be pretty miserable with this. Our recommendations are always to try to stay hydrated, even sipping small amounts of liquid throughout the day. Whether that be water or electrolyte rich fluid, juices, ginger ales. There are many sorts of recommendations as to what people feel like works for them but staying hydrated is very important. Avoiding spicy or high fatty meals, which can trigger the nausea and vomiting. So typically blander and smaller meals are going to sit better on that stomach. There are many people who use ginger tablets or ginger chews. Even antihistamines can help. In particular an over the counter medicine called Unisom in conjunction with a vitamin called B6 can help women in that early first trimester who are suffering from pretty significant nausea and vomiting that’s not controlled with just supportive treatments. This is a safe medication in pregnancy that we prescribe all the time for these patients.

Host: Then doctor, let’s talk about the diet. Women think they're supposed to eat for two. That’s a myth we’ve always heard. How many additional calories should we really be getting and what foods should she be trying to get more of? What foods would you like women to stay away from?

Dr. Roedner: Typically for many patients, that idea of eating for two is not true. You are correct. I try to tell patients that if they are eating a normal, standard diet. So for most women that’s going to be anywhere from 1800 to 2200 calories depending on the type of pregnancy. Because the requirements are different for, for example, a twin pregnancy where you may require more calories. Typically it’s about 200 extra calories a day, which is about a yogurt and an apple. Once I sort of explain that to individuals, they understand that it really is just a normal diet.

Ideally, we are going to have a diet that is very rich in healthy proteins, healthy fats, good amount of vegetables and fruits. Avoiding the use of artificial sweeteners which can be a little bit upsetting to a woman’s stomach is recommended. Also limiting their caffeine use. We really want to limit their caffeine to no more than about 300 milligrams of caffeine a day. Excess caffeine has been linked to having some complications in pregnancy. We also want to avoid certain foods that could be concerning. In particular in the early part of pregnancy, fishes that are very high in mercury. So these are going to be large fishes. Typically your king mackerel, your marlin, and your swordfish. Most clinics are going to provide information for women about safe foods to eat and foods to avoid, but typically those high level mercury fish, foods that are unpasteurized or undercooked we would want individuals to avoid those foods.

Host: What about exercise, doctor? If they were an exerciser before they got pregnant, what can they continue to do once they are pregnant? If they were not an exerciser, is that the time to begin an exercise program?

Dr. Roedner: Many women are afraid to exercise in pregnancy because they’re not sure if they should or if it’s safe. I'm here to say that for most pregnant women that have a normal, uncomplicated pregnancy, it is completely reasonable to continue a healthy lifestyle that involved moderate intensity exercise prior to pregnancy. So that includes aerobic exercise and strength training. The American College of OBGYN actually recommends that women are getting 30 minutes of activity five to seven days before week.

Now if a woman has not been adhering to an exercise regimen and now wants to start in pregnancy, we don’t typically encourage them to do something very high intensity but starting out with walking. Even 20 to 30 minutes at a moderate pace so that they do increase their heart rate and work up a little bit of a sweat is encouraged. They can also work with a trainer who maybe specializes in working with pregnant individuals so that they can start in a low intensity and work on strength training, particularly upper body strength and lower body strength, which would be helpful for a woman in pregnancy. So we do recommend that a woman is getting some sort of activity throughout her entire pregnancy.

Host: What medical conditions can effect a pregnancy? Maybe they had asthma or diabetes or even previous depression. What would you like them to make sure to discuss with their doctor when they have their checkup?

Dr. Roedner: So at that first initial prenatal visit, we are typically identifying certain risk factors that could be problematic for a pregnancy. As you had mentioned, asthma is one of them. Asthma can be exacerbated in a pregnancy and it’s very important that a woman is monitoring her symptoms because it’s important that not only she, but the growing fetus is getting good oxygen flow through the placenta. So if a woman has very persistent or severe asthma, that can actually jeopardize the growth of a growing baby. Asthma, hypertension, and diabetes, of course, all important things that we are monitoring for in a pregnancy.

We’re screening patients at every visit with their vital signs looking for women who may be at risk for high blood pressure. One of the most common medical conditions in pregnancy that could be very detrimental is called pre-eclampsia, which is usually a problem of the placenta and manifests as elevated blood pressure and abnormal blood work in a pregnancy. So we are monitoring women for histories of pre-existing hypertension or a family history of hypertension. Diabetes, in particular, is very common in pregnancy. We are screening women in early pregnancy if they have risk factors such as an increased family history of obesity, diabetes, or a prior pregnancy with gestational diabetes.

We also screen every woman in the third trimester when we know that gestational diabetes can present. We can usually manage most women with healthy diet and exercise throughout their pregnancies to keep these medical conditions in check. If any of these things are exacerbated or worsened in pregnancy, we will be doing our best to monitor these women very closely and monitor the growth of their babies.

Host: As we wrap up, please give us your best advice about a healthy pregnancy and the importance of a preconception checkup. Please tell us about your see you now early pregnancy visit. What kind of services are available?

Dr. Roedner: I think what I would like couples to know is that we are able to help to provide a very educational and helpful service through our facility at WakeMed at the see you now visit. This is an opportunity for couples to sit down and answer questions, have any concerns addressed that they may be experiencing. For instance, if couples are concerned about a significant family history, a genetic history particularly Down syndrome or cardiac defects, we’re able to provide couples counselling regarding our management for those pregnancies. We can get them in touch with high-risk maternal fetal medicine doctors that can help provide testing for a certain condition. Then we can also get them in touch with any other specialists that may be needed for high-risk pregnancy.

I’d like couples to know that prior to conceiving by making sure that they are living a healthy lifestyle, exercising, and avoiding anything that could potentially make pregnancy more challenging. They're providing themselves the best chance of having a healthy baby and having a healthy pregnancy. 

Host: Thank you so much for being in with us today. I’m Melanie Cole with WakeMed Voices, brought to you by WakeMed Health & Hospitals in Raleigh, North Carolina. To learn more about the full range of services provided by WakeMed OBGYN or to schedule an appointment, head on over to our website at wakemed.org/physicians-practices-obstetrics-gynecology for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media. Be sure to check out all the other fascinating podcasts in our library.