Month Two
Processing
WEEK NINE
• Baby is .9 inches and .07 ounces.
• Brain waves can be detected by an electroencephalogram (EEG).
• The skeleton is formed.
• Fingers and toes are fully defined.
WEEK TEN
• Baby is 1.2 inches and .14 ounces.
• Almost all organs are completely formed, and kidneys begin to function.
• The fetus can move and respond to touch when prodded through your abdomen.
• Arm joints are functioning.
• Hair and fingernails are growing.
• Baby is already practicing swallowing.
WEEK ELEVEN
• Baby is 1.6 inches and .25 ounces.
• The head and body are proportional (for now).
• Fingers and toes are no longer webbed.
• Baby is 2.1 inches and .49 ounces.
• Reflexes are continuing to develop.
• Fingers and toes are wiggling.
East-West Fetal Development
This month of the baby’s development correlates to the Chinese Gallbladder system, which carries with it the emotional themes of change, processing, and decision making. You may have noticed yourself having different reactions to change than you’re used to, or more than usual moodiness. Don’t fret. You’re working overtime, and expressing a full range of whatever emotions may be present for you is an important part of ultimately more smoothly processing these physical and emotional changes. You’re not harming your baby by being in an unpredictable mood.
Just as you are working overtime, your actual gallbladder is clocking a lot of time as well. It may have difficulty processing greasy, fatty foods. You might find yourself beginning to veer toward a vegetarian diet, no matter how much of a carnivore you used to be. Just get protein where you can (remember quinoa is a protein too!). The upcoming chapters will be chock-full of recipes with vegetarian slants to help you get adequate pregnancy nutrition without disrespecting your aversions.
It may be hard to see the forest for the trees right now (especially because visual changes can occur during this month), but while you’re surviving these rigors, some pivotal decisions need to be made about how to proceed with genetic testing and how to manage a general life balance that’s conducive to the rest and support you need to finish your first trimester.
Now that you’ve had a little time to adjust to being pregnant, it might be time to adjust some of your patterns and shift into new routines that make room for all that is required of you and your body right now. This may include relaxing into the back-and-forth flux while incorporating new ways of thinking, eating, or even feeling.
Ultrasounds
Although regular checkups are recommended during pregnancy, that doesn’t necessarily mean regular ultrasounds at each checkup. Ultrasounds can provide important information and even allow you to begin to bond to baby. It can be exciting to gather this first bit of evidence, and, it’s important to evaluate the benefits and risks of this keepsake scan.
Ultrasounds have been used in obstetrics for a few decades without major evidence of harm. We often hear mixed input about the potential harm ultrasounds may be doing, and an absence of evidence of harm is not the same thing as evidence of absence of harm. In this case though, there really only is a smattering of research around a high frequency of ultrasounds potentially contributing to low birth weight (and it is worth noting that many factors may contribute to low birth weight). Also, it can be hard to isolate one cause of low birth weight, and more importantly, babies can rapidly recover from this. Oddly, the only other consistent finding with ultrasounds in utero is that boys exposed to frequent ultrasounds are more likely to be left-handed (obviously not a medical problem).
You may have also heard the myth that when a baby hears an ultrasound, it sounds as loud as a subway train. In truth, the pulsing from ultrasounds would probably translate, to baby, as a pitch and rhythm that’s similar to tapping the highest notes on a piano. Ultrasounds do produce heat and pressure changes in there. Your baby is kind of like a deep-sea diver, and the negative pressure of ultrasounds can produce gas bubbles equivalent to a diver’s decompression. In very, very rare instances, this can lead to tissue damage at the site of the bubble. These impacts are most relevant to a developing embryo (preimplantation) and in later stages of pregnancy when the baby has more mineralization in her bones, which can absorb more of the radiation exposure.
For this reason, you may want to consider not having an ultrasound too early, and minimize the late pregnancy ultrasounds unless a known medical condition warrants it. Even though it’s exciting to see your baby splashing around, now that you know that his intriguing movement during the ultrasound might be a response to the invasion of his quiet space, perhaps it will temper your temptation to see what your child is doing at every given moment. However, to introduce one of many conflicting stands, as the nature of pregnancy is to work in the gray areas, sometimes assuaging your own worry is actually worth some minor intervention, and having said all of this, I’d like to reiterate that the current risk of ultrasounds is incredibly low, and technology is constantly being improved and refined. So, don’t be dissuaded from getting any necessary diagnostics.
Intrauterine Growth Restriction (IUGR)
When the baby isn’t growing as expected it can be a very scary feeling, and the truth is, it can represent significant and life-threatening problems for the baby. Carefully monitoring the baby and assessing factors such as her blood flow supply and overall well-being will be the cornerstone of differentiating temporary growth changes that aren’t exactly on the curve versus true IUGR.
Nausea and Vomiting
Colloquially known as “morning sickness” despite being an omnipresent daily event for many expecting women, nausea (which sometimes, but not always, includes vomiting) affects 90 percent of pregnant women at some point in their pregnancy, and its impact is often sorely underappreciated in regard to the misery and disruption of daily life. “Morning sickness” is a complete misnomer; it can strike at any time. It’s crucial to remember that you’re not sick—you’re pregnant and healthy; you just have nausea and vomiting.
On that note, perhaps the experience of nausea and vomiting is more adaptive than it is pathological. The earliest descriptions of vomiting during pregnancy date from about 2,000 BCE, which gives us a clue as to the origins of this curious effect of pregnancy. As with many anthropological explanations, a biological rationale exists. Nausea, vomiting, and the heightened sense of smell that are often present in the early stages of pregnancy have all been postulated to be protective mechanisms to prevent women from consuming substances that could be harmful to the fetus.
For example, many newly pregnant women feel repulsed by the thought of eating animal products. There is a logical reason for this: meat and dairy, traditionally, often contained pathogens and parasites that could harm the developing fetus. Of course, in our modern world, this is unlikely, but remember that your body is reacting based on its genetic legacy. A few hundred years ago—before the advent of refrigerators and modern food sanitation techniques—animal products stored at room temperature could be dangerous for pregnant women to consume. Even though food poisoning might blend right in with nausea and vomiting, let’s not add insult to injury.
An aversion to animal-based food products is, of course, only one potential scenario, and many women experience quite the opposite effect. Morning sickness, cravings, and aversions are seemingly random and unique to each pregnant woman, but it can be comforting to know that they are happening for a very good reason—albeit one that may be a relic of our anthropological development.
Indeed, symptoms of nausea and vomiting often seem to peak when babies are most susceptible to harmful changes from chemical disruption (weeks six to eighteen). A pregnant woman’s immune response is weakened during pregnancy in order to prevent her body from rejecting its own offspring. A fetus contains half of another genetic body’s immune system, so the carrying mother’s body can see it as a foreign organism. This immune susceptibility is also why pregnant women (and their babies) are at greater risk for food-borne pathogens such as toxoplasmosis.
As pregnancy progresses, you’ll probably notice that your food aversions decrease, paralleling the strengthening of your and your child’s immunity. Another explanation for random food aversions may be that your body is acting on behalf of potential allergies in your fetus. Yet, another theory is that nausea corresponds to rising levels of the pregnancy hormone human chorionic gonadotropin (hCG).
The silver lining in the stomach lining: except for an unlucky 10 percent of women whose symptoms last right up to birth, is that most women do spontaneously improve and don’t have any long-term consequences to their pregnancy as a result of morning sickness. Many of my patients have reported to me that they woke up one day (usually on the cusp of the second trimester) and their morning sickness was magically and permanently gone. This will probably happen for you too.
In the meantime, mild to medium cases of nausea can generally be managed by eating enough protein and staying hydrated. Of course, while both of these things can help stave off nausea to whatever extent is available, often the last thing one wants during this time is protein, which leads to what I call the “beige diet” (more on that below). For now, your mantra should simply be “this too shall pass,” and your M.O. to eat what you want and can stomach—as long as it includes a prenatal vitamin that contains folic acid, which can adequately support an important aspect of baby’s development during this time of monotonous food intake.
Severe Nausea and Vomiting
Up to 2 percent of pregnant women experience persistent and intense nausea and vomiting, known in medical circles as hyperemesis gravidarum. Some women at this stage might even be so disconsolate that they feel a desire to terminate their pregnancy. That’s how unmanageable so-called “morning sickness” can be.
Signs of severity include nausea and vomiting that continue beyond the first trimester or simply feel unmanageable to you. If severe, the situation demands intervention. You could lose a significant amount of electrolytes, which will threaten you and baby’s nutritional needs. This could call for intravenous fluids for electrolyte replacement, vitamin B1 supplementation, potential use of conventional antinausea medication (antiemetics), and psychological support to develop strategies for dealing with the discomfort and learning to navigate it—because let’s face it, inability to comfortably function in your daily life is bound to make any woman feel unstable.
It’s important to involve the right interventions of skilled clinicians for management, encouragement, and support.
Diet for Morning Sickness
In Chinese medicine, we advocate a balanced diet—which includes good quality meat—for most pregnant women. But many women, at this point, involuntarily convert to what I call the “beige diet,” with a focus on crackers, bread, rice, etc. You might normally have a varied diet with a love of vegetables and balanced nutrition, but don’t be surprised if your body starts to reject the things you once thought were delicious once you are pregnant. Since food is such a comfort for us, and we all have our attachments to foods that we believe make us feel better, this can add another confounding layer. Take comfort in knowing that many cravings are related to actual nutritional needs; harken back to chocolate cravings during PMS (chocolate contributes magnesium, which is great for relaxing cramping), and carbohydrates (the “beige foods”) trigger the release of insulin, which promotes the absorption of amino acids, such as tryptophan (also contained in eggs, salmon, nuts, and seeds), which gives you a serotonin boost and makes you feel good, which goes a long way in pregnancy. These foods become relevant again toward the end of pregnancy when they may help prepare for birth on the backdrop of very little room in your stomach.
Many women express concern during this time that they are not giving their baby the nutrients it needs. If you’re trying your best to get the foundations from the “eat like you’re taking a prenatal vitamin” section of this book, you’re in good shape. Like a picky toddler who sometimes refuses the wholesome food choices given to him, you will survive, and you will, in fact, be fine—and so will your baby—as long as you get some of the basic building blocks down the hatch. As your appetite restores itself, typically in the second trimester, you will make up for all of this “bad eating.”
However, note that during this early stage of pregnancy, eating protein and staying really hydrated can, for many women, stave off nausea and vomiting to some degree. Even though small, protein-based meals—if you can manage them—will often quell a certain degree of nausea, the difficult irony during this time is that, once nausea sets in, the last thing most women crave is protein, and sometimes even things as innocuous as water seem repulsive. So, again, the first trimester is a good time to practice letting go. There’s really nothing for you to do but sink into the changes happening to your body, rest as much as you can get away with, and nourish yourself as best you can.
For those of you not able to stomach the thought of eating meat, here’s a consolation bit of research for you: morning sickness has never been observed in societies with a primary dietary staple of only plants (mainly, corn). Let’s not go crazy about corn though. Besides being hard to digest, if it’s spoiled, it can produce microorganisms that are harmful to fetuses. Think of the corn factor more as a metaphor for the permission to eat bland veggies and grains. So, if any of the things that are supposedly “good for you” sound absolutely intolerable in your given state of queasiness, rest assured that you will have time to play catch-up with nutrition in your next trimester. In the meantime, I’ve included in this chapter a recipe for porridge that can be a medium for toppings that can impart some good and palatable nutrition right now.
Lethargy and Sluggishness
We’ve talked about sluggishness in your body, but this myopic view doesn’t account for the whole you feeling lethargic. From the start, I’d like to remind you that you are actually growing a whole person, and this takes a huge amount of your resources. It can be challenging to remember this, since your pregnancy may still seem like an abstract concept, but let me assure you, it’s happening, and it’s requiring almost all of you.
This is an important time to begin to adjust your relationship to what you’re able to do—which does not mean you’re in any way incompetent. The most active, busy women find themselves yearning to be sedentary during this time. You will inevitably have energy shifts throughout your pregnancy, allowing you more of a semblance of the you that you knew yourself to be. But the first trimester is a time to slow down, at least a bit, and let your body do what it needs to do. There’s no cure (because it’s not an ailment; it’s just a healthy albeit uncomfortable process), not even sleep. You can push through, but you can also choose to revel to some degree in this inevitable part of your pregnancy by finding ways to indulge in this new pace in any way you can. I promise the world, and all that you may be doing in the world, will go on. This is a pause, but not a permanent stop. This particular quality of fatigue will most likely begin to lift in the second trimester.
Slowing down brings up a lot for most people. Most of us define ourselves in some manner by what we do or how we do things. This is a wonderful time to connect with the inherent value inside yourself that is not just attached to what you do.
Ptyalism (Drooling)
Unique disorders are associated with pregnancy. One of these is ptyalism, less delicately known as drooling. During the first trimester, when the whole digestive tract is in upheaval, this can be an uncouth side effect.
One possible culprit of ptyalism is the sympathetic nervous system, which is responsible for our fight-or-flight reaction to stress. Unfortunately, there’s no running away from this symptom, which some women experience as an embarrassing but really rather harmless side effect of pregnancy. In addition to your nerves being shot, nausea and heartburn can stimulate the salivary glands to produce excess saliva in an attempt to protect the throat and mouth from the irritation of acid reflux and vomiting. If you’ve been forced to resort to carrying around a spittoon, at least the acid in your stomach may have neutralized.
Ingredients
1 cup mixture of grains such as buckwheat, barley, farro, quinoa, millet and amaranth
3 cups water
¼ teaspoon salt
¾ cup dried berries (blueberries, cherries, etc.)
2 cinnamon sticks
1 vanilla bean (or ¼ teaspoon real vanilla extract)
Directions
Rinse the grains in hot water. Bring water and salt to a boil. Add grains and the rest of the ingredients to the water, turn down to low heat, and cook covered for fifteen minutes. Stir occasionally. When the water is gone, cover and turn off the heat. The porridge should be just about ready in another ten minutes. Remove the cinnamon sticks and vanilla bean, and mix in almond milk or coconut milk. (You can reuse the spices the next morning if you rinse them in cold water and let them dry.)
Nutritious topping ideas: Chia, flax, or pumpkin seeds; shredded coconut; walnuts; a tablespoon of blackstrap molasses; seasonal fruit.
As you may recall from month one, the Chinese Liver system is analogous to the nervous system. So, nourishing yourself with activities such as walking, yoga, or anything that helps keep stress coursing through your body may diminish the production of salvia. Chewing gum sometimes helps as well, and the only other advice I can give you for drooling is to optimize your digestion and do your best to manage other symptoms such as nausea and reflux to whatever extent possible.
NOTE: Antacids such as Tums and Mylanta, famotidine (Pepcid), and andranitidine (Zantac) are generally thought to be safe to use during pregnancy, but always consult with your doctor before using any medication and bear in mind these are palliative, not curative remedies. Over time they can actually alter your stomach acid and worsen the problem, which is why many of the recipes in this book are aimed at strengthening your digestion.
Keeping an Eye on Pregnancy
You may feel like you’re flying blind right now, and another in the slew of unexpected symptoms can be changes in your vision. All of the same changes that are essential for supporting the baby can also contribute to a spectrum of not-so-favorable changes for you—especially on the visual spectrum.
Fluid retention during pregnancy can actually change the thickness and shape of your cornea, contributing to a little distortion in your vision. In Chinese medicine, we say that the Liver opens to the eyes, and you may recall that the first trimester kicks off the Liver’s action, which weaves into this month as well, since the Liver is a kindred pairing to the Gallbladder.
The Chinese Liver system also supplies blood flow to the uterus (read: blood flow rerouted from everywhere else). In Chinese medicine, this idea of blood flow also encompasses other fluids, such as the ones that lubricate your eyes, and one of the primary visual problems that can occur right now (which typically self-resolves after pregnancy) is the development of dry eyes and blurry vision.
As a matter of fact, in Chinese medicine we call dry eyes “Liver blood deficiency.” Breast milk is also related to this fluid level. So, boosting up and nourishing now can help you way down the line as well.
To nourish this “blood” level, foods from the iron-rich category in month one can boost you up and help you see straight. You can also use “artificial tears” to lubricate your eyes. Just make sure to check with your doctor to make sure the active ingredients are safe for you.
Other ocular (eye) issue that can happen during pregnancy can be thought of in three categories:
1. Visual changes that occur for the first time during pregnancy, such as increased pigmentation around the eye.
2. Existing issues that are further exacerbated or changed by pregnancy—such as diabetes, which can lead to diabetic retinopathy during pregnancy.
3. Visual changes that can be clues about other conditions, such as preeclampsia (this condition can damage the small blood vessels that supply the retinas of the eyes, causing a particular strain of visual changes such as temporary loss of vision, persistent light sensitivity, auras, or the appearance of flashing lights).
4. Eclampsia, Sheehan syndrome, or Grave’s disease.
One positive effect that pregnancy can have on the eyes: if you suffer from an immune-related condition that affects the eyes, pregnancy can be a period of reprieve, since it’s generally a time of relative immune suppression.
Check in with your provider about any visual changes but don’t count on getting your prescription changed or of course plan any eye surgeries during pregnancy. Wait a few months after birth, because most of these issues will self-resolve. In the meantime, wearing sunglasses and minimizing screen time can bring some relief to overstrained eyes. You can also drink plenty of carrot, spinach, and kale juice—a great blend of lutein-rich foods that contribute health and vitality to your eyes.
Nervousness about Genetic Testing
Genetic testing is a very personal choice for you and your partner. In addition to considerations such as age, ethnic background, and health history, all of which influence potential genetic concerns for your baby, these decisions are also intertwined with your emotions and your personal values. Being faced with genetic testing can be one of your first steps in developing an emotional lexicon around parenting. It’s great prep for what you will have to deal with from here on out: never getting a right or wrong answer from “experts,” but instead having to always arrive at the answer that’s right for your family, through weighing the options. It’s also great preparation for the stress that you will come to know as a normal part of parenting.
Science has made it possible for us to find out a lot about a baby long before it is born. However, it’s important to remember that science isn’t perfect and there is still a lot we do not know. And needing to know the answers at a time when it is not always possible to get them is a direct recipe for suffering. This is why, in this chapter, we will start to emphasize the option of not only relying on scientific information but also touching in on your own truths as you make decisions about your pregnancy and which tests to conduct.
On the very slim chance that genetic testing causes you to encounter a potential abnormality in your baby, the type of decision making you will be faced with will be complex and emotional. So, I recommend seeking out a therapist who specializes in these issues to help you navigate the gray areas, and remember that you’re always in charge of what’s right for you.
There are many layers to both the testing and the decision making process. In an attempt to help you weigh the benefits and risks, here are some of the statistics and reasons for the typical interventions that you have to choose from for your screenings, and also some help interpreting the statistics. A genetic counselor can also be a great resource to help you weed through all of the statistics and variables.
There are typical times associated with screening different aspects of your pregnancy, as follows:
First Trimester Tests
In the first trimester, most people are anxious to get some markers for how their pregnancy is going. It is often tempting to satiate our anxieties with information, but nothing in this process of genetic testing is black and white—except, of course, the ultrasound photograph. However, outside of our own relationship to reassurance, since there are few other things to go on, screening can be a very comforting process, and if you have a partner, it can be a way for both of you to have a tangible glimpse of the growing baby and potentially connect more closely to what’s happening inside your body.
We’ve all heard the adage that women become mothers the moment they find out they’re pregnant, and that men or partners become parents when they’re holding their baby. I have noticed in my own practice with countless couples that many partners experience a more relatable connection to the pregnancy when they see the first ultrasound. “There’s a baby in there!” At which point, you look at them as if to say, that’s what I’ve been telling you for weeks. So, this test can be a relatively tangible way for each of you to begin to gain a relationship and trust in the health of your developing baby. Remember, each test is one piece of the pie, and a comprehensive set of information over time is what will best inform you. So, if there is an initially unfavorable result in one area, hang in there while you gather more evidence (and of course always retest negative results as lab errors can occur as well).
The least invasive, first set of tests is an integrated screening combining an ultrasound and blood tests. When used together, the tests (below) can help to both confirm a healthy pregnancy and begin to identify potential risks of certain birth defects such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13).
HUMAN CHORIONIC GONADOTROPIN HORMONE (HCG)
hCG is not only an indicator of pregnancy, but also a hormone produced by the placenta. An unexpected number can simply suggest a miscalculated due date, but a high level can also indicate the possibility of multiples or, in rare cases, a molar pregnancy. A very low level may indicate the threat of a miscarriage, or an ectopic pregnancy.
OTHER BLOOD TESTS
One standard blood test measures substances found in all pregnant women during early pregnancy. Abnormal levels are associated with an increased risk in chromosomal abnormalities.
• Pregnancy-associated plasma protein screening (PAPP-A)
There are also specialized blood tests, which have higher detection rates and lower false-positive rates than other first trimester screenings.
• MaterniT21, Harmony, Verifi, and Panorama all measure fetal chromosomal abnormalities and can also detect the sex of the baby as early as ten weeks in.
NUCHAL TRANSLUCENCY (NT)
This is a topical ultrasound that looks at the back of your baby’s neck to rule out any skin thickness and increased fluid accumulation. If the nuchal translucency is in the 95th percentile or measures more than 3.5 mm, it is considered an increased risk factor for chromosomal abnormalities, congenital heart malformations, Noonan syndrome, and, ultimately, pregnancy loss.
Keep in mind that very occasionally there can be “false positive” results, indicating a problem when the fetus is actually healthy, and there can also be “false negative” results, indicating no abnormality when the fetus actually does have a health problem. If the outcome of the tests won’t affect your decision about keeping your pregnancy, then there may be less reason to have further tests such as chorionic villus sampling or amniocentesis. Although, knowing about any potential risk, even if it doesn’t change your decision to have the baby, may help you with additional preparations. However, if any of the above results are abnormal, and that might influence your decision about your pregnancy, then some of your complex decision making about the next levels of screening may commence. In addition to using our guided exercise for coming up with your own insights, you may also want to seek out genetic counseling and any other support that helps you to further inform your choices.
Second Trimester Tests
From weeks fifteen to twenty-two, you can have several optional blood tests (most accurate when done between weeks sixteen to eighteen), called the “multiple marker screening,” which continues to provide information about potential genetic conditions or birth defects such as Down syndrome, trisomy 18, and neural tube defects.
All of the following tests together are called the quadruple screening.
ALPHA-FETOPROTEIN SCREENING (AFP)
Alpha-fetoprotein (AFP) is a protein produced by the baby’s liver and present in the amniotic fluid. It crosses the placental barrier and is present in the mother’s blood, which is why it is also called maternal serum alpha-fetoprotein (MSAFP). Increased levels of AFP can be a first indicator of some of the following. I can’t emphasize enough—if you get an unfavorable result back, further screening is necessary before leaping to any conclusions:
• Down syndrome and other chromosomal abnormalities
• A miscalculated due date or multiples
• Defect in the baby’s intestines or other nearby organs
• Potential miscarriage
• Open neural tube defects (ONTD) and spinal defects such as spina bifida
• Tetralogy of Fallot (heart defect)
• Turner syndrome (genetic defect)
• Absence of part of the brain and skull (anencephaly)
ESTRIOL
This is a hormone produced by the placenta and your baby’s liver. Significantly lower than normal levels of estriol may indicate an increased risk of Down syndrome.
INHIBIN-A
This is a hormone produced by the placenta. Low levels of AFP and estriol, along with high levels of hCG and inhibin-A, may be due to issues such as:
• Down syndrome (trisomy 21)
• Edwards syndrome (trisomy 18)
If this last test is omitted, then it’s called a triple screening. The results of the triple/quadruple screening are usually given as a probability of risk. Generally, the test is considered positive if the risk is one in 300 or less. Multiple marker screening is not diagnostic. It is only a screening test to assist you in determining if you might want additional, more definitive testing and is integrated with your cumulative tests for a more comprehensive assessment.
Keep in mind that a positive test (meaning negative results) simply means that some of the levels that were measured were outside the normal range. Again, this is not definitive and can happen for many reasons, including:
• A miscalculation of how long you’ve been pregnant
• The presence of multiples
• Hormone changes in your blood from in vitro fertilization (IVF)
• The presence of other medical conditions, such as diabetes
MaterniT21 (and related tests in this category), amniocentesis, and chorionic villus sampling can help further diagnose genetic disorders such as cystic fibrosis, Down syndrome, muscular dystrophy, sickle cell anemia, Tay-Sachs disease, neural tube defects, hemophilia A, and thalassemia.
CHORIONIC VILLUS SAMPLING (CVS) AND AMNIOCENTESIS
Chorionic villus sampling (CVS) extracts a sample of placental tissue, which contains the same genetic material as the baby and can be tested for chromosomal abnormalities and genetic disorders. It is either done with a catheter through the vagina and into the cervix to reach the uterus, or similarly to an amniocentesis, by needle insertion through the abdomen into the uterus. This procedure is usually done between weeks ten and twelve because earlier testing has been linked to some reports of causing limb abnormalities in the baby.
Sometimes a CVS sample doesn’t yield enough tissue to examine in the laboratory, so the results can be inconclusive and may warrant an amniocentesis as well. Additionally, if you have an active vaginal infection such as herpes or gonorrhea, it is prohibitive for having a CVS. In comparison to amniocentesis, CVS does not provide information on neural tube defects such as spina bifida. The second trimester blood tests listed above will continue to screen for neural tube defects.
If you opt for an amniocentesis, it is usually performed between weeks fifteen and twenty. This involves a needle biopsy through your abdomen into the amniotic sac to gather a sample of the amniotic fluid, which contains cells that have been shed by the baby and alpha-fetoprotein (a protein made by the baby). Through this method, more reliable genetic detection of chromosomal disorders and open neural tube defects (ONTDs) such as spina bifida can be obtained.
If you are carrying multiples, you can expect multiple samples to be needed from each placenta or amniotic sac, but this isn’t always possible due to positioning of the babies, location of the placenta, amount of amniotic fluid, or your own anatomy.
The main risks (albeit small) that CVS and amniocentesis carry are increased risks for pregnancy loss and possible risks for birth defects. On average, pregnancy loss after a CVS is 1.1 percent (about one out of every 100 women) and amniocentesis 0.4 percent (about one out of every 1,400 women). The risks are low, but they do exist. After all of the above procedures, strenuous activities should be avoided for at least twenty-four hours. Typically, you’ll get your results back in about ten days.
Waiting for results can be an anxiety-inducing process, but it can also be an opportunity to cultivate your relationship to the decisions you face independent of being influenced by the results at this stage. This is a great time to utilize the genetic testing writing exercise found earlier in this chapter and any other tools that you find helpful for arriving at a clear choice, or at least an avenue toward peace of mind for yourself.
FETAL BLOOD SAMPLING (FBS)
FBS is the collection of blood directly from the umbilical cord, which is tested for signs that your immune system is attacking the baby’s red blood cells (which is only possible, by the way, if you are Rh-sensitized and your baby is Rh-positive). A slight risk of this procedure is that it can lead to worsening of the Rh-sensitization problems, since the baby’s blood may mix with the mother’s blood during the blood sampling, and you may need to take medications to help prevent preterm labor (tocolytic medicines) for this procedure.
Gestational Diabetes
Normal metabolic changes occur throughout pregnancy, mostly to help optimize the transfer of nutrients to the baby. One of them is a decrease in insulin sensitivity, which requires an increase in insulin production to counteract this change and keep glucose (blood sugar) balanced for mom and baby. When this balance doesn’t occur and glucose is too high, the result can be gestational diabetes mellitus (GDM). GDM is the most common medical complication of pregnancy.
Some of the hormones involved in this process include estrogen, progesterone, cortisol, and prolactin, which increase and promote pancreatic changes and insulin release, resulting in higher fasting glucose, or higher blood sugar levels. Each of these hormones has a peak time that it affects the glucose balance. For instance, cortisol peaks in its effect at twenty-six weeks of gestation, and progesterone has strong anti-insulin properties that peak at thirty-two weeks. The timing of these hormonal changes is relevant in scheduling your testing for GDM.
Diagnosing and treating GDM is important for preventing any adverse outcomes, such as:
• Polyhydramnios (excessive accumulation of amniotic fluid)
• Macrosomia (abnormally large growth of the baby)
• Early delivery
• Increased risk of cesarean section, because the particular growth pattern that occurs from glucose imbalances can create a larger shoulder girth compared to head circumference in babies and contribute to an increase in the risk of shoulder dystocia during birth
As a side note, studies have shown that there is a correlation between rates of shoulder dystocia and birth weight. If the estimated weight of your baby is over 9.9 pounds, it may play an important role in the decision-making process for route of delivery. But just remember that ultrasounds have a range of error of about 10 to 15 percent in estimating fetal weight at term.
So, although GDM can set you and your baby up for postpartum blood-sugar issues, continued monitoring throughout your pregnancy and after birth (including a glucose-tolerance test six weeks after birth and a fasting glucose test annually) it usually results in very manageable and recoverable outcomes. Also, rest assured that GDM can be a normal course of development even with the healthiest of habits, so if you do test positive for it, it’s not necessarily something you’re doing or not doing.
Typical screening for GDM is performed with a 50 gram oral glucose load given between twenty-four and twenty-eight weeks. Basically, this is an artificially colored, very sweet drink that you have to manage to get down in about five minutes, followed by a blood draw an hour later to measure glucose levels in your blood. If your glucose is too high (over 140 mg/dl), you’ll get further screening: a three-hour, 100-gram oral glucose tolerance test (OGTT). Women with high-risk factors, such as a prior personal or family history of diabetes or chronic steroid use, may benefit from earlier testing at around twenty weeks.
It is possible to get a false reading on your glucose test. So, if you have a high glucose level at one of your checkups, it’s always a good idea to retest. Any of the factors below might contribute to a false reading:
• If you recently ate a larger meal than usual (especially carbohydrates such as bread, pasta, or rice) and haven’t moved around much since eating
• If you ate within two hours of the test
• A contaminated urine sample
• If you already take insulin and missed a dose of your medication
As with many things, GDM can usually be successfully managed with a nutrition plan that emphasizes foods that are low on the glycemic index (GI). Carbohydrates are broken down at different rates. The glycemic index is a tool to understand and interpret how carbohydrates affect blood glucose levels (BGLs). For instance, foods that are high on the GI are broken down quickly and cause rapid rises in BGLs. Foods on the medium spectrum cause a moderate rise in BGLs, and foods low on the GI are just that—broken down slowly so that they create a small rise in BGLs, which is what you want for preventing or managing GDM. Additionally, consuming ten grams a day of fiber has been associated with a 26 percent reduction in the risk of GDM.
Eating well is key, since caloric restriction (a typical strategy for glycemic control) in pregnancy can increase ketone levels, which occur from the breakdown of fat instead of glucose, and can have negative effects on the baby. Other nutrients that are associated with preventing GDM include selenium, vitamin D, zinc, and myoinositol. The best sources for food-based myoinositol are beans, cantaloupe, citrus fruits (except lemons), grains, and nuts. For more variety, other foods that are particularly low on the glycemic index and good for managing blood sugar are:
asparagus
avocados
bamboo shoots
beef
blueberries
celery
cabbage
chicken
daikon radishes
grapefruit
limes
shitake mushrooms
pears
plums
pumpkin
winter squash
radishes
snow peas
spinach
string beans
sweet potatoes
rice
millet
mung beans
toasted pumpkin seeds
turnips
BALANCED MORNING PORRIDGE
Here’s a Chinese porridge, or jook, that you can use as a base recipe to stabilize your blood sugar each morning, then add in whatever else appeals to you (preferably drawing on the list of foods low on the GI index). Jook, a bland and beige Chinese porridge, is a palatable way to get some digestible nutrients without aggravating an overstimulated stomach. It’s very easy to make, for times when even standing up in the kitchen sounds challenging.
Ingredients
½ cup rice
½ cup quinoa (a grain that is also a complete protein)
8 cups water (you can also boost the nutrients by using the Boosted-Up Chicken Stock recipe on page 46 if you have some on hand and if it sounds yummy)
Three ¼-inch slices of fresh ginger root
Directions
Combine all ingredients in a large pot. Bring to a boil and let simmer for several hours or until the grains are well cooked. Use the back of a ladle or an immersion blender to mash the porridge into a soothing mush. Top with a poached egg (see next recipe).
Fresh, pasture-raised eggs are the most nutrient-dense choice. If you can’t find them, at least go for organic for maximum nutrition. A teaspoon of apple cider vinegar helps hold them together while you poach. In addition to topping your Balanced Morning Porridge, poached eggs can be eaten over steamed vegetables, with salads, with sprouted grain toast, or in soups.
Ingredients
Fresh pasture-raised or organic eggs
1 to 2 teaspoons apple cider vinegar
Pinch of sea salt
Equipment
Shallow saucepan with cover
Slotted spoon
Directions
Fill the saucepan with water and bring it to a boil. Then, lower the heat until the water is no longer boiling. Add vinegar to the water. Working with the eggs one by one, crack each egg into a small cup, then place the cup near the surface of the hot water and gently drop the egg into the water. With a spoon, nudge the egg whites closer to their yolks. This will continue to help the egg whites hold together. Turn off the heat. Cover. Let sit for four minutes, until the egg whites are cooked. Lift eggs out of pan with a slotted spoon.
Eating a balanced, protein-based breakfast paves the way for stable blood sugar throughout the day. Another pivotal strategy for managing GDM is to continue to eat protein-based meals, balanced with complex carbohydrate accompaniments that are low on the GI, and to get thirty minutes of physical activity every day, which helps to lower blood-glucose levels because your muscles are utilizing some of your circulating glucose.
If you’re feeling deprived while trying to manage your blood sugar, these cookies are a great, wholesome treat that still works in your favor.
Ingredients
1 cup quinoa
1 ½ cups water
½ banana
1 heaping tablespoon roasted almond butter
8 Medjool dates
¼ cup sunflower seeds
¼ cup pumpkin seeds
¼ cup shredded coconut
3 sprinkles of cinnamon
1 heaping tablespoon extra virgin coconut oil
Directions
Rinse quinoa, then combine with water in a medium pot. Bring to a boil, and then simmer for about twelve minutes. Preheat the oven to 350 degrees Fahrenheit. Transfer the quinoa to a large mixing bowl. Mix in coconut oil. Add chopped banana, almond butter, and dates, and mix. Add sunflower seeds, pumpkin seeds, and shredded coconut, and mix thoroughly. Sprinkle cinnamon into the dough and mix everything together. Grease a baking sheet with coconut oil.
Use a large spoon to pick up a heaping tablespoon of the dough and form it into a ball with your hands. Place the ball onto the greased cookie sheet and press the middle of the ball down gently to form a circle a bit more than a half inch thick. Repeat with the rest of the dough. Bake for fifty minutes. Remove cookies and allow to cool for fifteen minutes on baking sheet. You can store the cookies in an airtight container.
Four grams per day of myoinositol plus 400 micrograms per day of folic acid taken for eight weeks has also been associated with significantly decreasing glucose levels. Low vitamin D levels have also been implicated. So check that too in case you need to add that into your supplement regime.
If attentive eating and exercise don’t manage your GDM, sometimes insulin is indicated for treatment.
No Cons to Probiotics
From conception to long-term health, there is an ongoing interplay between genetics and environmental factors. During pregnancy, many of baby’s immune functions are drawn from the mother’s diet. Exchange of bacteria from the mother to the baby during pregnancy, birth, and breastfeeding influences baby’s own intestinal flora, and a healthy start in this area may enhance baby’s overall immunity and health later on. As a matter of fact, our highly hygienic conditions in the Western world, although they help prevent many diseases, can simultaneously be responsible for inhibiting proper maturation of the immune system and predispose a child to allergies and other immune susceptibilities.
Another pro for incorporating probiotics is that they may also interfere with the inflammatory cascade that can sometimes lead to preterm labor and delivery. Since there’s no downside to utilizing probiotics throughout your pregnancy, I suggest either supplementing with a daily probiotic and/or regularly incorporating the following probiotic foods into your routine:
• Kefir (high in antioxidants, Bifidus bacteria, and Lactobacillus)
• Kimchi (a spicy and sour fermented cabbage with beneficial bacteria, high in beta-carotene, calcium, iron, and vitamins A, C, B1, and B2)
A mainstay for easy probiotic consumption is miso soup. Miso is made from fermented rye, beans, rice, or barley. Simply adding it to hot water makes a quick, probiotic-rich soup full of Lactobacillus and bifidus bacteria.
Just scoop a heaping tablespoon of miso paste into some hot water (make sure it’s cooled a little from the boiling point to preserve all the good effects of miso). For added nutrients, you can use your Boosted-Up Chicken Stock from month one as a base. As additions, you can stir in some sautéed or soaked (from dried) shitake mushrooms (these give you an extra immune boost) and sprinkle in some dried seaweed, such as dulse flakes.
Have a side of the following pickles for an extra probiotic boost with a refreshing crunch!
QUICK GINGER CARROT PICKLES
Ingredients
10 carrots, cleaned but unpeeled
4 inches of ginger, sliced lengthwise
2 tablespoons sea salt
3 cups of room-temperature water
Directions
Cut the carrots into quarters and put them in a quart-sized mason jar. Intersperse with slices of ginger in between the carrots. Dissolve salt into room-temperature water, and pour it over carrot and ginger pieces, filling up the jar so carrots and ginger are submerged. Try to leave about an inch of room between the surface of the liquid and the top of the jar. Cover with a fine mesh cloth and secure with a rubber band. Let sit at room temperature for one to two weeks, then use as a probiotic-rich side snack to accompany any of your other meals.
• Microalgae (ocean-based plants such as spirulina, chlorella, and blue-green algae, which are high in both Lactobacillus and Bifidus)
• Miso soup
• Pickles
• Sauerkraut
• Yogurt (with probiotics such as Lactobacillus or Acidophilus)
Travel and X-Rays
While traveling during pregnancy is relatively safe, there are potential risks. The official medical statement from the American Congress of Obstetricians and Gynecologists is that in the absence of obstetric or medical complications, pregnant women can observe the same precautions for air travel as the general population and can fly safely. But the fine print notes that in frequent flyers, the risks to the fetus from exposure to radiation may be higher. Since medical science does not have all the answers, especially as far as risks to the fetus are concerned, it’s advisable to be informed about the possibilities in order to make the best decision for you and your growing family.
The obscure but notable risks of traveling while pregnant may include preterm birth or unforeseen emergencies such as bleeding complications. And of course, if you have specific medical conditions such as respiratory or cardiac diseases that might be exacerbated by the oxygen changes on a plane, or if you have a known risk for preterm labor, air travel should unequivocally be avoided. And if you’re traveling to an area that requires specific vaccinations or medications, risks and benefits should be carefully weighed.
During pregnancy you also have an increased tendency toward blood clotting, and if you’re continuing on any hormone therapy from assisted reproductive interventions, you may be at higher risk as well—beyond the already tenfold increase in the risk of venous thromboembolism (also called deep venous thrombosis)—when a blood clot breaks loose and travels through the blood. Cabin pressure and immobility while flying can be major contributors to this possibility. So, ladies, if you must fly, wear your support hose and walk around as much as possible.
If you have a choice in the matter, it’s best to plan any necessary air travel for your second trimester. Risks of preterm birth are potentially minimized after twenty weeks, and after thirty-six weeks most airlines won’t let you on a plane anyway, nor is it medically advisable to fly.
The real, research-based lowdown is that potential background radiation from cosmic rays—which, in truth, pass through you all the time, but are a little more intensive while flying—doesn’t outweigh the normal statistics for things that would happen anyway. The main, grounded research is that you just shouldn’t travel for a cumulative total of more than 150 hours while pregnant, as this would exceed the recommendation for fetal exposure to radiation. Airlines, for instance, monitor their employees as if they work at a nuclear facility.
The way I figure it, knowing that there is exposure at all, and knowing how these type of guidelines often change over time as more information and understanding emerges, I think it warrants serious evaluation as to whether to fly at all during this important time (most importantly during the first trimester). Perhaps planning a babymoon via road trip will suit you fine.
If you are going to fly, consider these pregnancy-safe foods and supplements to counteract in-flight radiation exposure:
Foods
• Olive Oil: Cold-pressed olive oil (extra virgin olive oil is better for you) helps protect the cell membranes from radiation.
• Chlorophyll-rich foods: This substance is found in alfalfa sprouts, celery, leafy greens, parsley, spirulina and chlorella (two micro-algae products), and wheatgrass. It helps the liver detoxify.
• Seaweeds: There are thousands of different types of seaweeds, but some of the most popular edible variations are dulse, kombu, nori, and wakame. They are easy to find at natural food stores, and can be mixed into soups and salads, or eaten by themselves. If you can’t stomach eating seaweed, you can also find it powdered in capsules as a supplement. Also, it’s important to also make sure the seaweed is sourced from areas that aren’t known contaminated ocean waters. These are a known food to offset radiation exposure.
• Miso: A traditional Japanese seasoning produced by fermenting rye, beans, rice, or barley with salt and the fungus kojikin, has also been shown to help combat radiation exposure.
Other foods that help the body decrease the effects of radiation: apples, beets, broccoli, Brussels sprouts, cabbage, garlic, guavas, kale, nutritional yeast, onions, oranges, pineapple, plums, quince, and watercress.
In short, my advice to you when traveling while pregnant:
• Sport the support hose.
• Have a shot of wheatgrass and liberally use cold-pressed olive oil.
• Take a bolstered vitamin regimen throughout your trip.
• Enjoy gallivanting without a stroller while you still can!
Supplements
In addition to your prenatal, which should already include a B complex, consider adding:
• Calcium 1,000 mg
• Magnesium 500 mg
• Vitamin C with bioflavanoids 2 to 5 grams
• Vitamin E d-alpha-tocopherol about 900 IU per day
Notable mention: Selenium protects DNA from radiation damage and helps prevent damage to the skin surface too. You can get selenium directly from food by eating a daily dose of two cups of nettle infusion, one-half ounce of kelp, two ounces of cooked burdock root, or one cup of probiotic-rich yogurt. Many types of mushrooms also contain significant amounts of selenium.
Environmental Concerns
When it comes to exposure to environmental toxins and other concerns, I feel the same about pregnancy as I do about life in general. For better or worse, we don’t live in—nor are we bringing a baby into—a bubble. We live in a modern world with modern concerns, and I suppose we can only hope and rely on our genetics and immune systems continuing to modify themselves enough to adapt and buffer the inevitable allergens and toxins that we’re bound to encounter. So, it is unrealistic (and will probably drive you nuts) trying to avoid everything that has potential detriment to pregnancy. I’ll present what the current literature says about some of the common things to avoid, and figuring that most of these are unavoidable for you, and I’ll provide some ways to offset their potential infringement.
Cell Phones
It’s true. Cell phones do emit electromagnetic radiation (EMR) and can affect you by increasing free radicals, which can lead to oxidative stress, which is basically an imbalance in your body’s ability to detoxify or repair tissue damage.
Thankfully, as usual, nature has an answer. The bees heard the buzz, and one of the components of the honeybee hive, propolis, has been shown to be a potent free-radical scavenger and antioxidant. Other antioxidants that you may want to boost up on include Vitamin C (food sources include berries; broccoli; Brussels sprouts; cantaloupe; cauliflower; grapefruit; honeydew; kale; kiwi; mangoes; nectarines; orange; papaya; red, green, or yellow peppers; snow peas; sweet potato; strawberries; and tomatoes) and vitamin E (food sources include broccoli, carrots, chard, mustard and turnip greens, mangoes, nuts, papaya, pumpkin, red peppers, spinach, and sunflower seeds).
Ginkgo biloba has also been shown to prevent mobile phone-induced oxidative stress by preserving antioxidant enzyme activity in the brain. And don’t store your phone in your bra or near your uterus!
Microwaves
It would seem that exposure to microwave radiation like fetal ultrasounds would be pretty innocuous. The risk that is attributed to normal exposure from these types of radiation is approximately 0.003 percent (thousands of times smaller than congenital risks independent of this exposure). Having said that, I always feel weird when I stand in front of a microwave, and as science is always evolving and uncovering potential risks. I still vote for minimizing your exposure. Stovetop popcorn is better anyway.
X-rays
X-rays are their own animal. Although it is preferable not to get an x-ray while pregnant, if a medical condition warrants it, your radiologist and physician will work to minimize the amount of radiation exposure you have.
Listeriosis
Listeria monocytogenes, the bacteria responsible for causing the infection known as listeriosis, has a rich history in obstetrics. Its namesake is Joseph Lister, the surgeon who realized that washing his hands between assisting deliveries minimized the mortality rates of women and their babies.
Now that we’re clear on hand washing as a routine method of sanitation, we just have to watch out for processed and prepared foods infected with this bacterium. That’s why hot dogs, deli meat, soft and unpasteurized cheeses, and smoked fish are always on the list of pregnancy no-nos.
The symptoms of listeriosis during pregnancy are difficult to distinguish from regular old pregnancy symptoms—fatigue and aches. So diagnosis and treatment (especially since Listeria’s whole job is to protect itself from its host’s immune response) can be difficult. Considering this, it’s best to outright avoid known potential causes. If you do contract listeriosis, the usual course will be high-dose antibiotics and ultrasound monitoring of the baby.
Toxoplasmosis
Toxoplasmosis (from a parasite called Toxoplasma gondii) usually doesn’t have any symptoms, but can occasionally present with flu-like symptoms such as swollen lymph nodes in your throat or armpits, body aches, and a temperature. If you are symptomatic, or if you think you may have been exposed to toxoplasmosis, you can get a blood test done to rule it out. The blood test can also check which type of antibody (if any) that you have: IgG antibodies means you’ve contracted this infection in the past and usually won’t be infected again, whereas IgM antibodies indicate that it’s a more recent infection (in the last eight weeks) and that your baby is at a slight, but potential, risk.
You can test the amniotic fluid, and the baby’s blood can be drawn after birth as well. More than half of the babies who have been exposed to toxoplasmosis never have symptoms. However, sometimes symptoms can show up months or years later and affect their vision or hearing. Like most things in pregnancy, your baby is more susceptible to infection earlier on in your pregnancy.
If there is confirmed toxoplasmosis, some people turn to antibiotics to combat it.
The most common to least common sources for contracting toxoplasmosis are:
• Undercooked or raw meat
• Raw cured meat, such as salami or Parma ham
• Unpasteurized goats’ milk
• Cat litter
• Soil
Avoid the activities and substances above, or at least wear gloves for changing litter and gardening.
Mold
Damp or water-damaged environments can result in a host of microbial growths of mold and bacteria and their by-products. This kind of exposure has been associated with a variety of respiratory and other health issues in moms and babies. If this is a problem in your home, it’s pretty difficult to successfully eradicate. So, nesting during pregnancy may take on a new meaning—as you might want to look for a completely new place to live.
When to Announce Your Pregnancy
Your pregnancy announcement is a very personal decision. There is no right or wrong time. It’s true that as your pregnancy goes along, there’s less chance of miscarriage and more security in telling people. On the other hand, there can be something triumphant and liberating about making an announcement earlier on. Even though this may feel like a risk, indulging in your news and sharing with those who feel right to share with might feel incredibly supportive and give you more of the resources you need and deserve during the formative weeks.
There are many ways and times to let people know about your very personal development. You might prefer one-on-one discussions with those close to you, or you might fancy making a group announcement via social media, email, or another format. Regardless of how or who you tell, just think of each new person who knows as someone else you can potentially rant to about your pregnancy stuff.
When to announce at work can be a slightly more strategic matter. If you feel intimidated about the security of your position once you’re pregnant, consult resources such as the Family and Medical Leave Act to know exactly what your rights are. I recommend approaching your boss or human resources department with a plan around your absence and reintegration. You may have come a long way to position yourself where you are in your company, and you might be perfectly capable of maintaining a work-life balance after your baby is born. Or, this might be a wonderful time to reevaluate what you’d like to do regarding your job. Babies have a funny way of helping you reprioritize.
Preparing Birth Announcements
If you’re planning to send birth announcements to your friends and family, prepping them in advance and inserting pictures after baby is born can be a stress-relieving strategy later on. I’ve seen birth announcements from a simple email with the pertinent info (name, date of birth, birth weight, length) to glossy catalogs of the baby’s first months and announcements on paper seeded with wildflowers that the recipient can then plant as an ongoing symbol of your little one’s new growth. (You can check the resources section under baby announcements for leads on that last one.)
Checklist for Month Two
• If you haven’t already had your first check-up, it’s time (including the nuchal translucency test if that’s part of your plan).
• Evaluate your decisions around genetic testing and schedule an amniocentesis or CVS, and nuchal translucency test if you’re opting for any of these procedures.
• You may want to find some looser-fitting clothes at this stage to support your comfort, including a bra without underwire.