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Most women in their early pregnancy experience some mild to moderate nausea and vomiting.  In addition, after you miss your period you may also notice fatigue, breast tenderness, some mild cramping, frequent urination and sensitivity to odors.  One of the common and more embarrassing symptom of early pregnancy is gas.  If you feel bloated and have gas, try to limit foods such as broccoli and beans.

Each pregnancy is different just as each patient is different.  Some women may experience these symptoms to the extreme, whereas others may not have any symptoms at all.  Each woman may also notice that she may feel different symptoms with each of her pregnancies.

"Eating for two" is not necessary.  Enjoy your meals and remember to take your prenatal vitamins.  You only need about 300-500 additional calories per day during your pregnancy.  Eating a well balanced diet is important.  Recommended daily servings include 6-11 servings of breads and grains, two to four servings of fruit, four or more servings of vegetables, four servings of dairy products, and three servings of protein sources (meat, poultry, fish, eggs or nuts). Use fats and sweets sparingly.

Beginning with your second trimester it is also important to increase your calcium intake; if you are not able to drink milk this would be the time to add calcium supplements (about 1000-1500 mg/day) to your diet.  You should consume about 4 servings of calcium per day during your pregnacy.

Folic acid is very important for a healthy pregnacy and you should consume at least 0.8 to 1 mg of folic acid per day.  Certain high risk pregnancies may need additional folic acid.  You should begin folic acid supplementation about 2-3 months before getting pregnanct and continue until after delivery.  Adequate folic acid levels may help reduce the risk of certain birth defects such as neural tube defects.

Omega-3 fatty acid is important for a healthy pregnany.  New data suggests that not only is it important for a healthy adult for preventing heart disease, it is also important for your baby's brain development and eye development.  Some data also suggests that it may also prevent certain complications of pregnancy including premature labor and pre-eclampsia.  It is important to continue while breast feeding so that your new born can get this essetial fatty acid from your breast milk.

Iron is important for proper oxygen supply to your tissue.  While pregnant you should eat iron fortified foods and foods high in iron.  USRDA recommendation is to consume at least 27 mg per day of iron while pregnant and about 15 mg per day while breast feeding.  Eating foods rich in iron will decrease your fatigue during pregnancy.

In addition, you should aim to eat at least one serving of vitamin C, reduce cholesterol intake to 300 mg per day and reduce fat intake to less than 30% of fat calories (for the average person that is less than 65 gms per day.)  And don't forget to remain hydrated.  Drink plenty of water - at least 8-10 glasses per day.

It is well known that alcohol, tobacco products and drugs should be avoided during pregnancy.   There are however, some other food items that you should be careful with while pregnant.

*Caffeine should be limited to 300 mg per day.  Usually that translates into about 2 cups of coffee per day.  Remember that chocolate has caffeine as well and a bar of chocolate has about the same amount of caffeine as 1/4 cup of coffee.

*Artificial sweetener saccharin should be avoided in pregnancy as this can cross the placenta and accumulate in the fetal tissue.  Other sweeteners such as aspartame (Equal or NutraSweet), acesulfame-K (Sunett), and sucralose (Splenda) are considered safe in moderation.

*Fish that contain mercury should be limited during pregnancy.  Certain fish that swim in polluted waters accumulate high levels of mercury and can result in mercury poisoning in the fetus.  These fish include shark, swordfish, king mackerel, or tilefish (also called white snapper).  Tuna steak is also high in mercury and should be limited to 6 ounces per week.  On the other hand, canned tuna is low in mercury and may be consumed up to 12 ounces per week.  Shellfish, shrimp and smaller fish such as snapper, catfish and salmon are lower in mercury and may be consumed up to 12 ounces per week.  Uncooked fish like sushi, oysters and clams should be avoided as this may carry bacteria that could be harmful for the pregnancy.

*Avoid unpasteurized cheeses and deli meats as both may carry a Listeria which is a bacterium involved in causing miscarriage and serious fetal infections.  This organism is killed by high temperatures, therefore, deli meats heated in the microwave until steaming should be ok.  Also avoid processed foods like hot dogs as they may contain chemicals that may not be safe for human consumption.  Some of the more common unpasteurized cheeses include Brie, Camembert, blue-veined, and Mexican-style cheese.

It is important for you health and your baby's health to maintain an active and healthy lifestyle.   As long as you are experiencing an uncomplicated pregnancy you should continue to exercise.  You can continue most of the exercise regimens that you were involved in prior to pregnancy.  I usually do not recommend beginning a brand new training regimen during pregnancy.

Walking, biking, running, treadmill and using the elliptical are great aerobic workouts for pregnant women.  Your target heart-rate should not exceed 140 beats per minute.  In addition, you should not exercise to exhaustion and should be able to have a comfortable conversation while exercising.  You can continue to lift weights to moderation, however, after about 12 weeks you should not lie down on your back to exercise.  You should also avoid doing crunches, or other abs exercises after 12 weeks.

If you were not physically active prior to pregnancy you can still remain active.  I would recommend 20-30 minutes of brisk walking about 5-6 days per week.

If you experience vaginal bleeding during of after exercise, or are considered a high risk pregnancy, you should not exercise until discussing it with me.

It is safe to remain sexually active during pregnancy.  Some women experience heightened sexual arousal and experience during pregnancy, while others may loose interest in sexual activities during pregnancy.  Having vaginal or oral sex should not harm your baby as the baby is well protected by the amniotic fluid around him. 

You will notice that as your baby grows you may not be comfortable in certain positions.  You should not remain on your back for extended periods of time as this may lead to nausea or  dizziness.  These symptoms are due to your enlarging uterus pushing on the blood vessels in your body.  You can use a water based lubricant if necessary.  During an orgasm you may notice some mild contractions, however, these should not be strong enough to put you in labor. 

If you experience persistent contractions, your water breaks, or you have vaginal bleeding after intercourse you should proceed to the labor and delivery unit and have Dr. Imtiaz paged.  If you are considered a high risk pregnancy, have a history of miscarriages, premature labor, abnormal placenta, or certain other high risk conditions you should not engage in intercourse.

For patients who are experiencing a completely normal pregnancy traveling is considered safe until late in the third trimester.  I generally recommend staying close to home after 36 weeks - you should be able to get to the hospital within 20-30 minutes in case you go into labor.  Traveling after 24-25 weeks out of the country is also not recommended unless absolutely necessary. 

Flying is perfectly safe during pregnancy, however, it increases your risk of blood clots.  If you are flying or taking a long road trip during pregnancy you should wear support hose that prevent blood clots and stretch your legs at least eveyr 2 hours. 

If your cat lives only indoors, does not go outside at all, and only eats processed cat food your cat should be safe.  Outdoor cats can carry Toxoplasmosis which is a parasite that can be dangerous for your baby's health.  Toxoplasmosis can be passed from cat feces to humans and can cause infections of the fetus.  If your cat goes outdoors at all have someone else change the litter box during your pregnany.  Alternatively you can wear gloves and wash thouroughly after changing your cat's litter box.

Toxo can also be transmitted by eating raw or under cooked meats so make sure that your food is properly cooked while you are pregnant.  Always use gloves while gardening or handling soil.   Thoroughly wash and peel your fruits and vegetables while pregnant.

If you have an outdoor cat you should be checked for toxo prior to becoming pregnant.  In general women who are infected with toxo about 9 months prior to conception will develop immunity against this parasite and will not pass this on to their fetus. 

If you need to discuss a routine matter, please call us during office hours or e-mail us.  If you experience an emergency situation such as vaginal bleeding (more than spotting), fever (temp more than 101 F), severe pain (that does not improve with tylenol), etc. please call the main office number or proceed to the hospital and the answering service will call the either Dr. Imtiaz or the doctor on call.

If you are in your third trimester and have contractions that last 3-5 minutes for at least an hour, your water breaks (a big gush of fluid from the vagina), you have bleeding that is more than just a few spots or you have decreased fetal movements please do not wait by the phone.  You should proceed to labor and delivery and have the doctor paged.

If you are after 36 weeks and you pass your mucous plug or have bloody show (blood tinged mucous discharge) or your contractions are sporadic you do not need to inform the doctor.  As long as your baby has normal movement it is ok to wait at home.

As always you should always use your best judgement.  If you think you have an emergent need to speak to the on-call doctor, please feel free to call the main number and have the answering service page us.

As you may have noticed your baby moves often and moves a lot.  After 28 weeks your baby should have regular movement.  The patterns of movement will change during different phases of pregnancy. 

Dr. Imtiaz recommends that you check for fetal movements at least once per day.  Best time to check for movements is after dinner while lying on your left side.  When you check for fetal movements you should not be watching TV, reading a book, talking, or be otherwise pre-occupied.  An average baby moves at least 10 -12 times per hour.  If you are lying down after a meal and have not experienced at least 10 movements in one hour you should proceed to labor and delivery. 

No medication, including over-the-counter medications should be considered completely safe during pregnancy.  All medications may have certain risks, however, below is a list of medications that is considered generally safe.  Remember to limit the use of medications unless you absolutely need it or it is recommended by Dr. Imtiaz and minimize the number of days/doses taken.  If your symptoms are not relieved with the medications suggested below please call and make an appointment to be seen.  If your temp is more than 101 or your symptoms are severe you need to go immediately to the ER.

• Headache - Tylenol, Extra Strength Tylenol, Acetaminophen.  If your headache is not relieved by these medications you need to call Dr. Imtiaz.
• Cold/Fever - Tylenol or Extra Strength Tylenol, Sudafed, Tylenol Sinus.  Call for temp more than 101.0.  Remember to drink lots of water.
• Cough - Robitussin DM, cough drops.
• Constipation - Metamucil, Surfak, Colace, Fibercon.  Increase dietary fiber and water intake.
• Diarrhea - Kaopectate, Imodium AD.
• Heartburn - Maalox, Mylanta, Tums, Pepcid.
• Hemorrhoids - Tucks pads, Anusol, Preparation H.
• Gas - Mylicon, Mylanta.
• Nausea - Vitamin B6, 200 mg three times a day, giner, unisom.
• Sore Throat - Cepacol lozenges, gargle with salt water, chloroseptic throat spray, Tylenol.
• Itchy skin - Calamine lotion, topical steroids with hydrocortisone, Neosporin, benzoyl peroxide.