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Initial pregnancy visit

At Novant Health Providence Obstetrics and Gynecology (OB/GYN), we look forward to helping guide you on your journey to motherhood. After your pregnancy confirmation visit, your initial pregnancy visit should occur at approximately 10-12 weeks.

This visit with your physician typically involves an evaluation to make sure that you and the baby are healthy, an examination (including screening tests such as Pap smears, if necessary), and often laboratory studies.

Nutrition and folic acid

Good nutrition during pregnancy does not vary greatly from good nutrition for a non-pregnant woman. There are some key differences:

About 300 extra calories are needed per day to support a healthy pregnancy. The calories should come from a good balanced diet limiting the sweets and fats. Don’t worry if you cannot do this in the first trimester—the pregnancy will remain healthy even if you lose weight in the first trimester. Most women catch up in the second trimester. Increased fluid intake is also recommended to maintain hydration. Be sure to drink 8 to 16 eight-ounce glasses daily.

During pregnancy, consumption of folic acid (400 mcg daily minimum) is important to help prevent neural tube defects. Folic acid is found in green leafy vegetables, berries and fortified breakfast cereal. We recommend a prenatal supplement to make sure adequate amounts are consumed. Folic acid is the most beneficial in the 30 days after conception so starting a prenatal vitamin prior to conception is recommended.

Please discuss any supplement use with your physician prior to using it in pregnancy.

See the Pregnancy Confirmation Visit information for guidelines on weight gain and foods to avoid during pregnancy. Visit http://www.choosemyplate.gov/ for pregnancy nutrition information and menu planning.

Laboratory testing

At one of your visits during the first trimester, we will obtain some routine laboratory work. We will obtain a urine culture, a pap smear (if you are due for one), and testing for gonorrhea and chlamydia (required by NC law). We will also draw routine prenatal blood tests which include your blood type, a blood count, testing for sickle cell disease, testing for syphilis, hepatitis B, HIV and immunity to rubella.

Genetic screening and testing

Some birth defects and malformations can be diagnosed during pregnancy. It is your choice whether to proceed with the testing. Screening tests are available to estimate the risk of trisomy 21 (Down Syndrome), trisomy 18, and neural tube defects such as spina bifida.

The screening test that we recommend is called sequential screening. This combines an ultrasound and blood work performed between 10 and 13 weeks of pregnancy with a second blood test obtained between 16 and 21 weeks. If this test is negative, it gives us good reassurance that these conditions are most likely not present. That, along with a normal ultrasound performed at 18-21 weeks, gives us the best information about the baby.

If the test is positive, it does not mean that the pregnancy is affected, but further testing may be recommended. Some patients also choose to proceed directly to diagnostic tests (amniocentesis or chorionic villus sampling)—this is available to all patients but is usually a better option for older moms, moms with a history of an affected infant or families with an increased risk of Down syndrome. Your physician will discuss these options with you early in pregnancy.

Advanced maternal age

Advanced maternal age (AMA) has traditionally been described as women who will be aged 35 or older at the time of delivery. The age of 35 was chosen because at this age the risk of genetic problems (such as Down Syndrome) begins to increase as compared to younger women. Several options are available to evaluate your individual risk of genetic abnormalities.

Testing falls into two basic categories—screening (noninvasive) and diagnostic (invasive). Screening tests, while less invasive, do not offer a specific diagnosis. They tell you the “odds” or likelihood that your pregnancy could be complicated by a genetic disorder. For instance, based on your age, your risk may be 1/100, but the screening test can help individualize that more and tell you that for this pregnancy, your risk is decreased to 1/1000 or increased to 1/50.

Screening tests usually consist of blood work for the mom and an ultrasound. Diagnostic tests are designed to tell you if your baby has a genetic problem. Testing is done on fetal cells obtained by chorionic villus sampling (CVS) (10-13 weeks) or amniocentesis (15-20 weeks). As such, they are more invasive and carry a higher potential for complications. These tests are typically performed by maternal-fetal medicine specialists trained in high-risk pregnancies. Have an open discussion with your obstetrician to decide which, if any, testing best fits your needs.

Second trimester

During the second trimester, most women feel pretty healthy. The fatigue and nausea usually resolve by the 15th to 20th week of pregnancy and your appetite is back to normal. All pregnancies are screened by ultrasound at 18-20 weeks. The gender can usually be determined at this visit for parents who desire this information. We will continue to see you every 2-4 weeks during this time, unless complications warrant more frequent visits.

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