Second Trimester (15-28 Weeks)

Which foods should I eat?

The best diet for you and your baby will include fresh fruits, vegetables, and whole grains, some low-fat dairy products, and a few sources of protein, such as meat, fish, eggs, or dried peas or beans. If you don't eat dairy foods, you will need calcium from other sources.

If you're a vegetarian, speak to a dietitian (food expert) about your food choices. Vegetarian diets can sometimes be missing nutrients that are important for a growing baby.

Should I prepare food differently?

Maybe. You need to be extra careful about avoiding germs in your food. Getting an infection while you are pregnant can cause serious problems. Here's what you should do to avoid contaminated food:

• Wash your hands well with soap and water before you handle food. Make sure to fully cook fish, chicken, beef, eggs, and other meats.
• Rinse fresh fruits and vegetables under lots of running water before you eat them.
• When you are done preparing food, wash your hands and anything that touched raw meat or deli meats with hot soapy water. This includes countertops, cutting boards, and knives and spoons.

To reduce the risk of unsafe food, you should also avoid foods that can easily carry germs, including:

• Raw sprouts (alfalfa, clover, radish, and mung bean), milk, cheese, or juice that has not been pasteurized.M

Which foods should I avoid?

You should avoid certain types of fish and all forms of alcohol. You should also limit the amount of caffeine in your diet, and check with your doctor before taking herbal products.

• Fish - See Weekly Servings of Fish and Shellfish guidelines.
• Alcohol - You should avoid alcohol completely. Even small amounts of alcohol could harm a baby.
• Caffeine - Limit the amount of caffeine in your diet to one to two cups of coffee each day. Be aware that tea and cola also have caffeine, although not as much as coffee.
• Herbal products - Check with your doctor or nurse before using herbal products. Some herbal teas might not be safe.

What are prenatal vitamins?

Prenatal vitamins are vitamin supplements that you take the month before and through pregnancy. These vitamins, which also contain minerals (iron, calcium), help ensure your baby has all the building blocks he or she needs to form healthy organs. Prenatal vitamins help lower the risk of birth defects and other problems.

What should I look for in prenatal vitamins?

Choose a multivitamin that's labeled "prenatal" and that has at least 400 micrograms of folic acid. Folic acid is especially important in preventing certain birth defects. Show your doctor or nurse the vitamins you plan to take to make sure the doses are right for you and your baby. Too much of some vitamins can be harmful.

How much is too much in pregnancy weight gain?

As pregnancy progresses, an expanding waistline and increasing weight gain may be a source of anxiety for some moms-to-be. Although weight gain is a natural side effect, some may wonder how much is healthy as they transition through each trimester?

Recommendations for pregnancy weight gain may depend on your pre-pregnancy weight. This, and for many other reasons, is why women are encouraged to seek counseling from an obstetrician in advance of becoming pregnant.

While addressing these issues in advance isn't always possible, it's important to note that the obstetrician will monitor the expectant mother's weight over the course of her pregnancy and will work with her to help manage expectations, as well as help treat any health issues (including weight-related ones) that may come up.

For single-birth pregnancies, the following list of target weight ranges is based on pre-pregnancy BMI (body mass index):

• With a BMI less than 18.5, recommended weight gain is 25 - 40 pounds.
• With a BMI of 18.5 - 24.9, recommended weight gain is 25 - 35 pounds.
• With a BMI of 25 - 29.9, recommended weight gain is 15 - 25 pounds.
• With a BMI greater than 30, recommended weight gain is 11 - 20 pounds.

Evidence tells us that weight gain above the target weight criteria is associated with larger babies, increased risk of C-sections, pregnancy-related hypertension, and gestational diabetes.

Weight gain in pregnancy may fluctuate from month to month. Some gain weight early in the first trimester, while others gain more in the third trimester. Often, weight gain can be managed by engaging in healthy eating habits and incorporating 30 minutes of exercise a day. During pregnancy, your obstetrician may be able to counsel on diet and exercise programs to help keep you and your baby healthy.

Everyone has different experiences during pregnancy, so it is important to hold judgment about weight gain until trends can be observed over a longer period of time. Most of all, show your body a little grace as you grow your little bundle of joy - the best is yet to come.

The United States Department of Agriculture has made it easier to plan meals during pregnancy by creating a website that can help you make healthy food choices at each meal time: MyPlate.gov

Food choices can be tailored to your trimester of pregnancy. The amounts of food are determined by your height, pre-pregnancy weight, due date, and how much exercise you get during the week.

There are 5 food groups:

• Grains: breads, pasta, oatmeal, cereal, and tortillas are all grains
• Fruits: fresh, canned, frozen, or dried. Juices that are 100% fruit juice also count
• Vegetables: vegetables can be raw, cooked, frozen, canned, dried, or 100% vegetable juices.
• Protein foods: meats, poultry, seafood, beans, peas, eggs, soy, nuts, and seeds.
• Dairy: milk and products made for milk, like cheese, yogurt, or ice cream.

Choose MyPlate

MyPlate.gov provides practical information to individuals, health professionals, nutrition educators, and the food industry to help consumers build healthier diets with resources and tools for dietary assessment, nutrition education, and other user-friendly nutrition information.

Although not a food group, oils and fats do provide important nutrients. During pregnancy, the fats that you eat provide energy and help build many fetal organs and the placenta. Most of the fats and oil in your diet should come for plant sources.

Vitamins and minerals to take when you're pregnant

Vitamins and minerals play an important role in all bodily functions. During pregnancy, you need more folic acid and iron than a woman who isn't pregnant.

Kelsey-Seybold recommends that you take a prenatal vitamin supplement daily during and after pregnancy. This and a well-rounded diet will supply the needed vitamins and minerals needed for a healthy pregnancy.

• Folic acid, also known as folate, is a B vitamin that's important for pregnant women. It is often found in a prenatal vitamin. Before and during pregnancy, a mother needs 400 mcg daily. This will help prevent major birth defects of the brain and spinal cord.
• Iron is used by the body to make substances in red blood cells that carry oxygen to your organs and tissues. During pregnancy, you need extra iron - about double the amount when not pregnant. Daily recommendations are 27 mg of elemental iron daily. This also may be in the prenatal vitamin, but you will have to check and add this if it's not.
• Calcium is used to build your baby's bones and teeth: 1,000 mg of calcium daily is recommended.
• Vitamin D works with calcium to help build bones and teeth in the developing baby: 600 IU are recommended daily.
• Omega 3 fatty acids are a type of fat found naturally in many kinds of fish. They may be important factors in your baby's brain development both during pregnancy and after delivery. Look for a prenatal vitamin that contains DHA (the active ingredient of Omega 3). About 200-500 mg daily will help.

If you're taking supplements, minerals, or vitamins before or during pregnancy, discuss this with your doctor.

Obesity and Pregnancy

Body mass index, or BMI, is based on a simple math formula (weight divided by height squared) to determine whether an individual is at a healthy weight. A BMI over 25 is considered overweight. BMI over 30 is considered obese. You and your doctor will determine your BMI during your first visit.

Obesity during pregnancy puts you at risk for several health problems:

• Gestational diabetes (diabetes first diagnosed during pregnancy)
• Preeclampsia (high blood pressure disorder)
• Sleep apnea (a sleep disorder that causes a person to stop breathing periodically during sleep)

Obesity increases the risks of the following problems during pregnancy:

• Miscarriage
• Birth defects of the heart and developing spinal cord
• Difficulty obtaining accurate results from ultrasounds and fetal monitoring
• Fetal macrosomia- an abnormal extra growth pattern of the baby
• Preterm birth
• Stillbirth
• Cesarean delivery (C-section) or complications in childbirth

Losing weight BEFORE you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5 to 7% of your current weight, or about 10 to 20 pounds) can improve your overall health and pave the way for a healthier pregnancy.

Rh Factor

The Rh factor is an inherited protein that can be found on the surface of red blood cells. If your blood cells have this protein, you are Rh positive. If your blood cells don't have this protein, you are Rh negative.

During pregnancy, problems can occur if you are Rh negative and your baby is Rh positive (Rh incompatibility). If the blood of an Rh-positive baby gets into the bloodstream of an Rh-negative mother, her body will understand it's not her blood and will fight it by making anti-Rh antibodies. These antibodies can cross the placenta and try to destroy the fetus's blood. This reaction can lead to serious health problems and even death in a fetus or newborn.

Baby's Blood Mixing with Mother's Blood During Pregnancy

During pregnancy, a woman and her baby usually do not share blood, but sometimes a small amount of blood from the baby can mix with the mother's blood. This can happen during labor and delivery. It can also occur with any of the following:

• Amniocentesis or Chorionic Villus Sampling-CVS (used to diagnose genetic problems)
• Bleeding during pregnancy
• Attempts before labor to manually turn a baby in the wrong position
• Trauma to the abdomen during pregnancy
• Miscarriage, ectopic pregnancy, or induced terminations.

A simple blood test can determine your blood type, Rh status, and antibody status. If negative, your doctor will recommend an antibody, RhoGAM. This will help prevent your body from developing antibody against your baby's blood type.

The typical circumstances in which Rhogam is given are the following:

• Routinely at 28 weeks of the pregnancy
• Within 72 hours after the birth of a Rh-positive baby
• A recent ectopic pregnancy, miscarriage, or termination
• Following an invasive procedure (amniocentesis, CVS, fetal blood sampling, or fetal surgery)
• Bleeding during pregnancy
• Trauma to the pregnancy (a fall, blow, or car accident)
• Attempts to manually reposition a baby in the wrong position for delivery

Talk with your doctor if you have any questions about your blood type and how this will affect your pregnancy.

Gestational Diabetes

Diabetes mellitus is a condition in which too much sugar stays in the blood instead of being used for energy. Health problems can occur when blood sugar is too high. Some women develop diabetes for the first time during pregnancy. This condition is called gestational diabetes and requires special care during and after pregnancy.

The body produces a hormone called insulin that keeps blood sugar levels in the normal range. During pregnancy, higher levels of pregnancy hormones can interfere with insulin. Usually, the body can make more insulin to keep the sugar levels normal. But in some women, the body can't make enough insulin and their blood sugar levels go up, causing complications for mother and baby.

Typically, gestational diabetes will go away after childbirth, but leave you at risk for diabetes later in life. Although gestational diabetes can occur in women without risk factors, it's more likely to occur in women who are/have a history of:

• Overweight or obese
• Physically inactive
• African American, Asian American, Hispanic, Native American or Pacific Island background
• Gestational diabetes in a previous pregnancy
• Previous high birth weight (greater than 9 pounds) baby
• High blood pressure
• Heart disease
• Polycystic ovarian syndrome (PCOS)

When a woman has gestational diabetes, her body passes more sugar to her baby than it needs. With too much sugar her baby can gain too much weight. These large babies can lead to complications for the mother and baby, including:

• Labor difficulties
• Cesarean deliveries
• Heavy bleeding after delivery
• Severe tears of the birth canal
• High blood pressure and preeclampsia
• Babies with jaundice, breathing problems, and trauma in the birthing process are at increased risk of stillbirth

ALL pregnant women should be screened for gestational diabetes.

Mothers with gestational diabetes will need to modify their diets and more frequent prenatal visits. Blood sugar will need to be monitored carefully and daily. Fetal growth and well-being will be monitored. Medication or insulin may be needed. Also, the severity of the condition must be taken into consideration for the timing and method of delivery. Most women with gestational diabetes can complete a full-term pregnancy, though a cesarean section is more likely.

Blood sugar should be checked in the months following delivery. If the blood sugar is normal, mothers will need to be tested for diabetes at one to three years.

Flu Vaccine and Pregnancy

Influenza (the flu) comes on suddenly with headaches, fever, fatigue, muscle aches, coughing, and sore throat. It can lead to complications such as pneumonia. Some complications can be life threatening. Certain people have an increased risk of developing flu complications:

• Adults over 65 years old
• Children younger than 5 years
• People who have illnesses or conditions like asthma, heart disease, or cancer
• Pregnant women

Normal changes in the immune system that occur during pregnancy may increase your risk of flu complications such as preterm labor and delivery, hospitalization, and pneumonia. Some of these complications can be life threatening.

The Centers for Disease Control and Prevention (CDC) and Kelsey-Seybold Clinic recommend that everyone 6 months of age and older, including pregnant women and women breastfeeding, get the flu vaccine annually.

The flu shot contains a form of the flu virus that is inactivated. It can't cause disease. The shot can be given to pregnant women at any time during pregnancy. The vaccine triggers your immune system to make antibodies against the flu virus. Antibodies circulate in the bloodstream. It takes two weeks for the body to build up protective antibodies after you get the flu shot.

The flu shot protects both you and your baby as you transfer antibodies that fight infection to your baby. These will help your baby until he or she can get the vaccine at 6 months.

If you think you have the flu call your doctor at 713-481-5347 during normal business hours or 713-442-BABY (713-442-2229) after hours – don't wait!