First Trimester (0 to 14 weeks)

Early Pregnancy Loss

The loss of a pregnancy during the first 13 weeks of the pregnancy (the first trimester) is called early pregnancy loss, miscarriage, or spontaneous abortion.

Early pregnancy loss is common. It happens in about 10% of pregnancies. About half of the cases of early loss are caused by a random event in which the embryo receives an abnormal number of chromosomes. This can originate for an abnormal egg or sperm; if there is the wrong number, development will not occur normally, sometimes resulting in the loss of the pregnancy. The likelihood of early pregnancy loss increases as a woman gets older and can occur in up to one third of pregnancies in women older than 40 years old.

Some women worry that they have done something to cause their pregnancy loss. Working, exercise, having sex, or having used birth control pills before getting pregnant do not cause early pregnancy loss. Morning sickness does not cause early pregnancy loss. Some women who have had an early pregnancy loss believe that it was caused by a recent fall, blow or even fright. In most cases, this is simply not true.

Smoking, alcohol, and caffeine also have been studied as causes of early loss. Some research suggests that smoking increases the risk, while other research suggests that it does not. Alcohol use in the first trimester may slightly increase the risk of early pregnancy loss, but the research is not clear. It is best to avoid smoking and drinking alcohol during pregnancy. Consuming 200mg or less of caffeine a day (the amount in two cups of coffee) does not increase the risk of pregnancy loss.

Bleeding and cramping are the most common symptoms of early pregnancy loss. A small amount of bleeding and cramping in early pregnancy is relatively common. Bleeding often stops on its own, and pregnancy continues normally. Bleeding and cramping also can be a sign of other pregnancy problems. It would be best to contact your OB/GYN if you begin to have bleeding and cramping.

We are here for you every step of the way. If medical issues arise during regular business hours, call your doctor’s office. After hours, call our 24/7 OB Hotline at 713-442-BABY (2229).

Prenatal Genetic Testing

Prenatal genetic testing gives parents information about whether their baby has certain genetic disorders. Genetic disorders are caused by changes in a person's genes or chromosomes, the basic map of the human body.

There are two main types of prenatal genetic tests:

• Prenatal screening tests: these tell you the chances that your baby has a genetic problem.
• Prenatal diagnostic tests: these tell you whether your baby actually has a certain disorder.

Screening tests include carrier screens and prenatal genetic screens.

• Carrier screening is done on parents using a blood sample or mouth swab. These tests are used to find out whether a person carries a gene for certain inherited disorders. They can be done before or during a pregnancy. For example, screening for sickle cell disease, cystic fibrosis or Tay-Sachs disease.
• Prenatal genetic screening done on the pregnant mother by a blood sample or by ultrasound of the baby. These can screen for genetic defects and birth deformities. Birth deformities may exist as a syndrome with a genetic link or on its own.

First trimester screening includes a test of the pregnant woman's blood and an ultrasound. Both are done together between 10-13 weeks in the pregnancy.

• A blood sample measures the level of two substances.
• The ultrasound exam, called the nuchal translucency screening, measures the thickness of a space at the back of the baby's neck. An abnormal measurement means there is an increased risk that the baby has Down syndrome or another type of chromosomal problem.

Second trimester screening includes a test of the mother's blood and an ultrasound. These are done between 15-22 weeks of the pregnancy.

• The "quad" or "tetra" blood test measures the levels of 4 different substances in the blood and calculates a risk of Down syndrome, trisomy 18, and neural tube defects.
• An ultrasound exam done between 18-22 weeks checks for major physical defects in the brain, spine, facial features, abdomen, heart and limbs.

Combined first and second trimester screening, also called sequential or integrated screening, is an option for screening for genetic problems. This test will combine the Nuchal translucency testing of the first trimester with the Quad/Tetra screens of the second to give a composite risk. It is a more accurate results to assess risk.

Cell-free DNA testing can be done by finding the small amount of DNA that is released from the placenta into a pregnant woman's bloodstream. This cell-free DNA can be screened for Down syndrome, trisomy 18, trisomy 13 and the sex chromosomes. It can be done from 10 weeks on in the pregnancy. This will work best in women who already have an increased risk of having a baby with a chromosome disorder. For women with a low risk of having a baby with a chromosome disorder, the first trimester nuchal translucency, tetra or combined screening are the recommended testing.

Talk with your doctor about which testing is best for you and your pregnancy.

Considerations about Prenatal Genetic Testing at Kelsey Seybold Clinic

It is your choice whether to have prenatal testing. Your personal beliefs and values are important factors in the decision about prenatal testing. It can be helpful to think about how you would use the results of prenatal screening test in your pregnancy care. Remember that a positive screening test tells you only that are at higher risk of having a baby with Down syndrome or another genetic problem. A diagnostic test should be done if you want to know a more certain result. Some parents want to know beforehand that their baby will be born with a genetic disorder. This knowledge gives parents time to learn about the disorder and plan for the medical care that the child may need. Some parents may decide to end the pregnancy in certain situations. Other parents do not want to know this information before the child is born. In this case, you may decide not to have follow up diagnostic testing if a screening test result is positive. Or you may decide not to have any testing at all. There is no right nor wrong answer.

Most of the time, the results of a screening test are negative (normal). A negative result does not rule out the possibility that the fetus has a genetic disorder. It only tells you that the fetus does not have the particular disorder that was tested for. If a test is positive, your doctor will explain the results and provide guidance about your choices, options, and recommended next steps that is best for you and your family.

Reducing Risk of Birth Defects

A birth defect is a condition that is present at birth. Some birth defects can be seen right after the baby is born, such as a clubfoot or extra fingers or toes. Special test may be needed to find others, such as heart defects or hearing loss. Some may not be identified until later in life.

Birth defect can be caused by genes that can be passed from parents to children. Others result from a problem with chromosomes. A small number of birth defects are caused by exposure during pregnancy to certain medications, infections and chemicals. For many defects, the cause is not known.

Most birth defects cannot be prevented because their cause is not known. However, you may be able to decrease your risk by taking certain steps:

• See your doctor BEFORE getting pregnant
• Know your risk factors
• Take a daily multivitamin for women before and a prenatal vitamin during the pregnancy
• Maintain a healthy weight
• Use medication wisely
• Take care of medical conditions before pregnancy
• Do not use alcohol, marijuana, illegal drugs or prescription drugs for non-medical reasons
• Prevent, screen and use vaccines to prevent infections that could affect a developing baby
• Limit your exposure to mercury by not eating shark, swordfish, king mackerel, or tilefish. You do not have to avoid all fish during pregnancy; the ones mentioned are considered to have higher levels of mercury that can affect the development of your baby.
• Avoid exposure to lead. Lead can be found in old paint, construction materials, Alternative medications, and items from foreign countries, such as jewelry and pottery.
• Avoid taking high levels of vitamin A. Doses that are less than 10, 000 international Units/ day are considered safe.

The following risk factors for birth defects should be understood and with the help of your doctor, discussed and managed:

• Increased maternal age (being older than 37-38 years old)
• A family history of birth defects
• A previous child with a birth defect
• Medication use early in pregnancy (don't stop medication appropriately prescribed before talking with your doctor)
• Medical conditions like diabetes and obesity
• Use of recreational and addicted drugs or alcohol

Morning Sickness: Pregnancy Nausea & Vomiting

Nausea and vomiting during pregnancy, especially in early pregnancy, are very common. Though it is called "morning sickness," it can occur at any time of the day. Usually, this is not harmful to the baby, but it can have a serious effect on your life, including your ability to work or do your normal daily activities.

It usually starts before 9 weeks of pregnancy and will typically subside by the 14th week. Occasionally, it can last for months and in a few, the entire pregnancy. The following conditions may increase the risk of severe nausea and vomiting (Hyperemesis Gravidarum):

• Being pregnant with more than one baby (twins or triplets)
• Previous pregnancy with severe nausea and vomiting
• A family history of severe nausea or vomiting
• A history of migraines or motion sickness
• Being pregnant with a baby girl

Other conditions can cause nausea and vomiting but not be specifically from the pregnancy, for example, ulcers, food allergies, thyroid dysfunction, and gallbladder disease.

Diet and lifestyle changes may help you feel better. We recommend:

• Use a prenatal vitamin
• Try eating dry toast or crackers in the morning before you get out of bed to avoid moving around on an empty stomach
• Drink fluids often
• Avoid smells that bother you
• Eat small frequent meals instead of three large meals
• Try more bland foods
• Try ginger ale (made with real ginger), ginger tea, candies or capsules

If the nausea and vomiting becomes too much of a problem, then you doctor may prescribe medication for you and occasionally if that is unsuccessful a brief hospitalization may be needed to provide extra fluids and medication intravenously that can help.

Travel During Pregnancy

Travel during pregnancy is safe. As long as you and your baby are healthy, you can travel safely until you are 34-36 weeks. The best time to travel is the middle of your pregnancy (between week 14-28).

Paying attention to the way you feel is the best guide for your activities. Travel is not recommended if you have certain conditions and complications such as:

• Preeclampsia (high blood pressure problems unique to later pregnancy)
• Premature rupture of membranes (leaking water)
• Preterm labor
• Multiple pregnancies (twins/ triplets)

It is not recommended to travel to areas where mosquito carried infections and illness occur, especially area where the Zika virus or malaria are common.

There are a few things you can do to make sure your trip is safe:

• Schedule a visit with your doctor just before you leave.
• Know your due date and consider having a paper copy of your chart to have with you.
• Bring any over the counter medications that you may need.
• Check that your vaccinations are up to date.
• Choose the fast way to reach your destination.
• Choose travel options that allow for travel to change even if this means purchasing travel insurance. This flexibility will help if problems arise before or during your trip.

If traveling by car, make each day's drive as short as possible. Wear a seat belt always. Plan frequent stops. If traveling by plane, some airlines restrict travel at different times in pregnancy or require a note from your doctor for travel. You will want to check with your airline when planning your trip. Consider an aisle seat to allow movement during the flight and avoid gas producing or carbonated drinks before your fly. Always wear a seat belt.

If traveling by ship, make sure that a doctor or nurse is on board the ship. Also make sure that your scheduled stops are places with modern medical facilities.

If traveling outside of the United States, check with your insurance company to see if you are covered internationally. Traveling to developing countries comes with the risk of consuming contaminated food or water.

Go to the hospital or call emergency medical services right away if you have any of the following:

• Vaginal bleeding
• Pelvic or abdominal pain or contractions
• Rupture of the membranes (“water breaks”)
• Signs and symptoms of preeclampsia (headaches that won't go away, spots or flashes before your eyes or changes to eye sight, with swelling of your hands or face)
• Severe vomiting or diarrhea
• Signs of a blood clot (pain or swelling of extremities that does not improve with rest)