A False Screen.

You undergo screening tests for the reassurance you hope they'll provide, but unfortunately, what happens so often instead-particularly with the triple or quad screen-is a false positive (it seems things might not be okay when ultimately it turns out they're just fine). There goes the reassurance you were hoping to find-and here comes the needless anxiety and worry you were so hoping to avoid.

That's why it's so important to start off the screening process with an open discussion with your practitioner about the high rate of false positives and what it really means if you get one. What you'll hear is this reassuring news: More than 90 percent of moms who get that positive screen will end up having perfectly normal and healthy babies. Talk about positive!

How safe is it? Amniocentesis is extremely safe; the risk that the procedure will result in a miscarriage is believed to be as low as 1 in 1,600. You may experience a few minutes to no more than a few hours of mild cramping after the procedure. Some doctors recommend resting for the remainder of the day; others don't. Rarely, slight vaginal bleeding or amniotic fluid leakage may be experienced. If you notice either, report it at once. The chances are very good that both the leakage and the spotting will stop after a few days, but bed rest and careful observation are usually recommended until it does. Amniocentesis is extremely safe; the risk that the procedure will result in a miscarriage is believed to be as low as 1 in 1,600. You may experience a few minutes to no more than a few hours of mild cramping after the procedure. Some doctors recommend resting for the remainder of the day; others don't. Rarely, slight vaginal bleeding or amniotic fluid leakage may be experienced. If you notice either, report it at once. The chances are very good that both the leakage and the spotting will stop after a few days, but bed rest and careful observation are usually recommended until it does.

How to Freak Out a Pregnant Woman.

Happily, most ultrasound exams show that all is going (and growing) well with baby. But for some women, a level 2 ultrasound may go something like this: One minute you're starry-eyed as you gaze at the ultrasound screen, marveling at the miraculous image of your baby floating blissfully inside you. The next minute, the technician is calling for the doctor, who knocks you right off cloud nine and into a state of panic with a few frightening words: "We see something-a soft marker-that might indicate a problem."

But before you panic, it's important to gain some reassuring perspective. Though "soft markers" on an ultrasound (detected during 5 to 10 percent of second-trimester ultrasounds, depending on the marker) are subtle characteristics that may indicate an increased risk of a chromosomal problem (most often Down syndrome or trisomy 18), these characteristics are also found in plenty of babies who are perfectly healthy. In fact, very few babies who show these soft markers (such as choroid plexus cyst, echogenic foci, or pyelectasia, to name a few) actually end up having a chromosomal abnormality. Which means that in the majority of cases, these so-called abnormal findings don't indicate anything abnormal at all.

Your practitioner may suggest some more tests (like an amnio) to find out for sure, but in the meantime, take a deep breath and remember that sometimes technology-which can bring so much joy-can also bring unneeded worry.

Second-Trimester Ultrasound.

What is it? Even if you had an ultrasound in your first trimester to date your pregnancy or as part of the combined or integrated screening test, you'll probably also get an ultrasound in your second trimester. This level 2, or "targeted," ultrasound is a much more detailed scan that focuses closely on fetal anatomy and can be used to check in on the growing fetus for a variety of other reasons as pregnancy progresses. It also can be a lot more fun to look at, because it gives a far clearer picture of your baby-to-be. Even if you had an ultrasound in your first trimester to date your pregnancy or as part of the combined or integrated screening test, you'll probably also get an ultrasound in your second trimester. This level 2, or "targeted," ultrasound is a much more detailed scan that focuses closely on fetal anatomy and can be used to check in on the growing fetus for a variety of other reasons as pregnancy progresses. It also can be a lot more fun to look at, because it gives a far clearer picture of your baby-to-be.

These days, as ultrasound images become ever sharper, even nonexperts (like parents) are able to tell a head from a bottom, and much more. During your level 2 ultrasound, and with the help of the technician or doctor, you may be able to spot your baby's beating heart; the curve of the spine; the face, arms, and legs. You may even catch sight of your baby sucking its thumb. Usually, the genitals can be seen and the sex surmised, although with less than 100 percent reliability and depending on baby's cooperation (if you'd like to keep the sex a surprise until delivery, make sure you let the doctor or technician know this in advance). In most cases, you'll be able to bring home a souvenir of your exam, a "photo" or a copy of the 3-D or 4-D digital video to show to friends and family.

When is it done? It is usually performed between 18 and 22 weeks. It is usually performed between 18 and 22 weeks.

How safe is it? No known risks and many benefits have been associated with the use of ultrasound. And many practitioners order ultrasound exams, at least once in a woman's pregnancy, often several times. Still, most experts advise that ultrasound be used in pregnancy only when a valid indication exists. No known risks and many benefits have been associated with the use of ultrasound. And many practitioners order ultrasound exams, at least once in a woman's pregnancy, often several times. Still, most experts advise that ultrasound be used in pregnancy only when a valid indication exists.

If a Problem Is Found In the vast majority of cases, prenatal diagnosis yields the results that parents hope for-that all is well with their baby-to-be. But when the news isn't good-when something does turn out to be wrong with their baby-the information provided by such a heartbreaking diagnosis can still be valuable to parents. Teamed with expert genetic counseling, it can be used to make vital decisions about this and future pregnancies. Possible options include: Continuing the pregnancy. This option is often chosen when the defect uncovered is one the couple feels that both they and the baby they're expecting can live with, or when the parents are opposed to abortion under any circumstance. Having some idea of what is to come allows parents to make preparations (both emotional and practical) for receiving a child with special needs into the family, or for coping with the inevitable loss of a child. Parents can also begin working through the reactions (denial, resentment, guilt. that can come with discovering their baby has a problem, rather than waiting until after delivery. They can learn about the particular problem in advance and prepare to ensure the best possible life for their child. Joining a support group-even one online-can help make coping somewhat easier. This option is often chosen when the defect uncovered is one the couple feels that both they and the baby they're expecting can live with, or when the parents are opposed to abortion under any circumstance. Having some idea of what is to come allows parents to make preparations (both emotional and practical) for receiving a child with special needs into the family, or for coping with the inevitable loss of a child. Parents can also begin working through the reactions (denial, resentment, guilt. that can come with discovering their baby has a problem, rather than waiting until after delivery. They can learn about the particular problem in advance and prepare to ensure the best possible life for their child. Joining a support group-even one online-can help make coping somewhat easier.

Terminating the pregnancy. If testing suggests a defect that will be fatal or extremely disabling, and retesting and interpretation by a genetic counselor confirms the diagnosis, some parents opt to terminate the pregnancy. Should you decide to terminate, an autopsy, in which fetal tissue is carefully examined afterward, may be helpful in determining the chances that the abnormality will repeat in future pregnancies. Most couples, armed with this information and the guidance of a physician or genetic counselor, do try again, with the hope that the tests and the pregnancy will be completely normal next time around. And most often they are. If testing suggests a defect that will be fatal or extremely disabling, and retesting and interpretation by a genetic counselor confirms the diagnosis, some parents opt to terminate the pregnancy. Should you decide to terminate, an autopsy, in which fetal tissue is carefully examined afterward, may be helpful in determining the chances that the abnormality will repeat in future pregnancies. Most couples, armed with this information and the guidance of a physician or genetic counselor, do try again, with the hope that the tests and the pregnancy will be completely normal next time around. And most often they are.

Prenatal treatment of the fetus. Treatment may consist of blood transfusion (as in Rh disease), shunts or surgery (to drain an obstructed bladder, for instance), or administration of enzymes or medication (such as steroids to speed lung development when a baby must be delivered early). As technology advances, more kinds of prenatal surgery, genetic manipulation, and other treatments may also become common. Treatment may consist of blood transfusion (as in Rh disease), shunts or surgery (to drain an obstructed bladder, for instance), or administration of enzymes or medication (such as steroids to speed lung development when a baby must be delivered early). As technology advances, more kinds of prenatal surgery, genetic manipulation, and other treatments may also become common.

Donating the organs. If diagnosis indicates that the fetal defects are not compatible with life, it may be possible to donate one or more healthy organs to an infant in need. Some parents find that this provides some consolation for their own loss. A maternal-fetal specialist or neonatologist may be able to provide helpful information in such a situation. If diagnosis indicates that the fetal defects are not compatible with life, it may be possible to donate one or more healthy organs to an infant in need. Some parents find that this provides some consolation for their own loss. A maternal-fetal specialist or neonatologist may be able to provide helpful information in such a situation.

As far as prenatal diagnosis has come, it's still important to remember that it's far from infallible. Mistakes happen, even in the best labs and facilities, even with the most skilled professionals wielding the most high-tech equipment-with false positives being much more common than false negatives. That's why further testing and/or consultation with additional professionals should always be used to confirm a result that indicates there is something wrong with the fetus.

It's also important to keep in mind that for the vast majority of couples, it will never come to that. Most expectant mothers who undergo prenatal testing receive the diagnosis they're hoping for right from the start: All is well with their baby and their pregnancy.

CHAPTER 4.

Your Pregnancy Lifestyle OF COURSE YOU'RE EXPECTING TO make some adjustments in your everyday life now that you're expecting (good-bye baby-tees, hello. baby-on-board tees). But you might also be wondering just how drastically your lifestyle will have to change now that you're living for two. How about that predinner cocktail-will it have to wait until postdelivery? Those regular dips in the hot tub at the gym-are those washed up, too? Can you wipe your bathroom sink with that smelly (but effective) disinfectant? And what's that you heard about cat litter? Does being pregnant really mean you have to think twice about all those things you've never given a second thought to-from letting your best friend smoke in your living room to zapping your dinner in the microwave. In a few cases, you'll find, the answer is an emphatic yes (as in "no wine for me, thanks"). But in many others, your expectant self will be able to continue doing business-and pleasure-as usual, with maybe just a side of caution ("Honey, it's your turn to change the cat litter-for the next nine months!"). make some adjustments in your everyday life now that you're expecting (good-bye baby-tees, hello. baby-on-board tees). But you might also be wondering just how drastically your lifestyle will have to change now that you're living for two. How about that predinner cocktail-will it have to wait until postdelivery? Those regular dips in the hot tub at the gym-are those washed up, too? Can you wipe your bathroom sink with that smelly (but effective) disinfectant? And what's that you heard about cat litter? Does being pregnant really mean you have to think twice about all those things you've never given a second thought to-from letting your best friend smoke in your living room to zapping your dinner in the microwave. In a few cases, you'll find, the answer is an emphatic yes (as in "no wine for me, thanks"). But in many others, your expectant self will be able to continue doing business-and pleasure-as usual, with maybe just a side of caution ("Honey, it's your turn to change the cat litter-for the next nine months!").

What You May Be Wondering About Sports and Exercise "Can I keep up with my regular exercise program now that I'm pregnant?"

In most cases, pregnancy doesn't mean giving up the sporting life; just remember that while you're carrying a new life, moderation makes sense. Most practitioners not only permit but encourageexpectant moms whose pregnancies are progressing normally to continue their accustomed workout routines and athletic pursuits for as long as is practical-but with several caveats. Among the most important: Always check with your practitioner before continuing or beginning an exercise program, and never exercise to the point of fatigue. (See page 215 page 215 for more information.) for more information.) Caffeine "I use coffee to keep me going all day. Do I have to give up caffeine while I'm pregnant?"

No need to surrender your Starbucks card entirely-though you may have to start pulling it out a little less often. Most evidence suggests that drinking up to approximately 200 mg of caffeine a day is safe during pregnancy. Depending on how you take your coffee (black or with lots of milk), that could mean limiting yourself to about two cups (give or take) a day. Which means you're good to go (and fuel your get-up-and-go) if you're a light to moderate coffee drinker-but that you'll have to reassess your intake if you've got a more serious java jones (five-shot lattes, twice a day, come to mind?).

Why go so low? Well, for one thing, you share those lattes-like everything you eat and drink when you're expecting-with your baby. Caffeine (found most famously in coffee but also available in other foods and beverages) does cross the placenta-though to what extent (and at what dose) it affects a fetus is not completely clear. The latest information indicates that heavier caffeine intake early in pregnancy slightly increases the risk of miscarriage.

And there's more to the caffeine story. Sure, it has impressive pick-me-up powers, but it also has equally notable diuretic powers, causing calcium and other key pregnancy nutrients to be washed out of your system before they can be thoroughly absorbed. Another downside to this diuretic effect: more frequent urination, which is the last thing a pregnant woman needs (you'll be peeing plenty on your own now that you're expecting). Need more motivation for cutting down? Caffeine's stimulating effects may exacerbate your mood swings, making them even more volatile and intense than they already are (or than they will be once your hormones rev into action). It can also prevent you from getting the rest your body's craving more than ever, especially if you drink it after noon. Plus excessive caffeine may interfere with the absorption of the iron both you and your baby need.

Different practitioners have different recommendations on caffeine consumption, so check in with yours for a bottom line on your favorite brew. When calculating your daily caffeine intake, keep in mind that it's not necessarily as easy as counting cups. Caffeine isn't just found in coffee-it's also in caffeinated soft drinks (too many Mountain Dews will have to be a Mountain Don't), coffee ice cream, tea, energy bars and drinks, and chocolate (though the amount varies from product to product). You'll need to know, too, that dark brews sold in coffeehouses contain far more caffeine than homemade; likewise, instant coffee contains less than drip does (see box, next page).

How do you cut down on a hefty caffeine habit (or cut it out altogether)? That depends on what's in the caffeine for you. If it's a part of your day (or many parts of your day-an eye-opener when you wake up, a companion on your way to work, a desktop fixture, an afternoon pick-me-up) that you're not anxious to part with, there's no need to. Just make your morning joes regular and your afternoons decaf. Or order your latte with mostly decaf shots instead of regular-or with less espresso and more milk (you'll get a bigger calcium bonus anyway).

If it's the lift you crave-and that your body has become accustomed to-cutting back will be a taller order (make that a Venti order). As any coffee lover is well aware, it's one thing to be motivated to cut back on or kick caffeine altogether and another thing to do it. Caffeine is addictive (that's where the craving comes in), and quitting-or even cutting way back on-a heavy habit comes with its own set of withdrawal symptoms, including headache, irritability, fatigue, and lethargy. That's why it's a good idea to ease off heavy consumption gradually. Try cutting back a cup at a time, and give yourself a few days to adjust to the lower dose before cutting back by another cup. Another way to cut back: Take each cup half-caf, gradually going full decaf in more and more cups-until your total caffeine consumption is down to that two-a-day-or-less goal.

Caffeine Counter How much caffeine do you get per day? It may be more-or less-than you think (and more or less than that approximate target of 200 mg). Check out this handy list, so you can do the math before you belly up to the coffee bar: [image] 1 cup brewed coffee (8 ounces) = 135 mg 1 cup brewed coffee (8 ounces) = 135 mg[image] 1 cup instant coffee = 95 mg 1 cup instant coffee = 95 mg[image] 1 cup decaf coffee = 5 mg 1 cup decaf coffee = 5 mg[image] 6 ounces caffe latte or cappuccino = 90 mg 6 ounces caffe latte or cappuccino = 90 mg[image] 1 ounce espresso = 90 mg 1 ounce espresso = 90 mg[image] 1 cup tea = 40 to 60 mg (green tea has less caffeine than black tea) 1 cup tea = 40 to 60 mg (green tea has less caffeine than black tea)[image] 1 can of cola (12 ounces) = about 35 mg caffeine 1 can of cola (12 ounces) = about 35 mg caffeine[image] 1 can of diet cola = 45 mg 1 can of diet cola = 45 mg[image] 1 ounce milk chocolate = 6 mg 1 ounce milk chocolate = 6 mg[image] 1 ounce dark chocolate = 20 mg 1 ounce dark chocolate = 20 mg[image] 1 cup chocolate milk = 5 mg 1 cup chocolate milk = 5 mg[image] 8 ounces coffee ice cream = 40 to 80 mg 8 ounces coffee ice cream = 40 to 80 mg

No matter what's been driving you to the coffee bar, cutting back on or kicking caffeine will be less of a drag (literally. if you follow these energizing solutions: [image] Keep your blood sugar (and thus your energy level) up. You'll get a natural, longer-lasting boost from eating and snacking on healthy foods often, especially complex carbs and protein (a combo that will give you the lift that keeps on lifting). Keep your blood sugar (and thus your energy level) up. You'll get a natural, longer-lasting boost from eating and snacking on healthy foods often, especially complex carbs and protein (a combo that will give you the lift that keeps on lifting).[image] Get some pregnancy-appropriate exercise each day. Exercise also raises the energy roof, while releasing those feel-good endorphins. Adding fresh air to the exercise mix will give you an extra energy boost. Get some pregnancy-appropriate exercise each day. Exercise also raises the energy roof, while releasing those feel-good endorphins. Adding fresh air to the exercise mix will give you an extra energy boost.[image] Clock in enough sleep time. Getting the rest your body needs at night (which will probably be easier to do without all that caffeine keeping you wired) will help you feel more refreshed in the morning, even before you've filled your first mug. Clock in enough sleep time. Getting the rest your body needs at night (which will probably be easier to do without all that caffeine keeping you wired) will help you feel more refreshed in the morning, even before you've filled your first mug.

Drinking "I had a couple of drinks at least a couple of times before I knew I was pregnant. Could the alcohol have harmed my baby?"

Wouldn't it be nice to get an instant message from your body alerting you the moment sperm and egg met up? ("Just wanted to let you know we have a baby on board-time to switch to Evian.") But since that biotechnology doesn't exist (not yet, at least), many moms-to-be are oblivious that baby making has begun until several weeks into their pregnancies. And in the meantime, they're apt to have done a thing or two they wouldn't have done if they'd only known. Like having a few, a few times too many. Which is why your concern is one of the most common ones brought to the first prenatal visit.

Fortunately, it's a concern that you can cross off the list. There's no evidence that a couple of drinks on a couple of occasions very early in pregnancy, when you didn't even know you were pregnant, can harm a developing embryo. So you-and all the other moms who didn't get the message right away-can relax.

That said, it's definitely time to change that drink order now. Although you've probably heard of some women who drank lightly during pregnancy-one glass of wine nightly, for instance-and delivered perfectly healthy babies, there's just no research to support that this is a completely safe bet. In fact, the Surgeon General, ACOG, and the American Academy of Pediatrics (AAP) advise that no amount of alcohol is safe for pregnant women. That recommendation-and the research behind it-also leads to this recommendation: Although you shouldn't worry about what you drank before you knew you were pregnant, it would be prudent to take a pass for the rest of your pregnancy. (You can also ask your own practitioner about what he or she recommends.) Why such a strong edict from the medical community? It's to be on the safe side-always the best side to be on when you have a baby on board. Though nobody knows for sure whether there is a safe limit when it comes to alcohol consumption during pregnancy (or whether that limit would be different in different women), it is known that alcohol enters the fetal bloodstream in about the same concentrations present in the expectant mother's blood. In other words, a pregnant woman never drinks alone-she shares each glass of wine, each beer, each cocktail equally with her baby. Since it takes the fetus twice as long as its mother to eliminate the alcohol from its system, the baby can be at the point of passing out when the mother is just pleasantly buzzed.

Heavier drinking (generally considered to be the consumption of five or six drinks of wine, beer, or liquor a day) throughout pregnancy can result not only in many serious obstetrical complications but also in fetal alcohol syndrome (FAS). Described as "the hangover that lasts a lifetime," this condition produces infants who are born undersized, usually mentally deficient, with multiple deformities (particularly of the head and face, limbs, heart, and central nervous system) and a high mortality rate. Later, those who survive display vision, learning, behavioral, and social problems, and they generally lack the ability to make sound judgments. They are also more likely to end up with a drinking problem of their own by the time they reach 21. The sooner a heavy drinker stops drinking during pregnancy, the less risk to her baby.

The risks of continued drinking are definitely dose related: The more you drink, the more potential danger to your baby. But even moderate consumption (one to two drinks daily or occasional heavy bingeing on five or more drinks), if it occurs throughout pregnancy, is related to a variety of serious problems, including increased risk of miscarriage, labor and delivery complications, low birthweight, stillbirth, abnormal growth, and developmental and low IQ problems in childhood. Such drinking has also been linked to the somewhat more subtle fetal alcohol effect (FAE), characterized by numerous developmental and behavioral problems.

Passing up a drink during pregnancy is as easily done as said for some women, especially those who develop an aversion to alcohol (its taste and its smell) in early pregnancy, which sometimes lingers through delivery. For others, particularly those who are accustomed to unwinding with a Cosmo at the end of the day or to sipping a glass of red with dinner, abstinence may require a concerted effort and may include a lifestyle change. If you drink to relax, for example, try substituting other methods of relaxation: music, warm baths, massage, exercise, or reading. If drinking is part of a daily ritual that you don't want to give up, try a Virgin Mary (a Bloody Mary without the vodka) at brunch, sparkling juice or nonalcoholic beer at dinner, or a juice spritzer (half juice, half sparkling water, with a twist)-served at the usual time, in the usual glasses (unless, of course, these look-alike beverages trigger a yen for the real stuff). If your spouse joins you on the wagon (at least while in your company), the ride will be considerably smoother.

If you're having trouble giving up alcohol, ask your practitioner for help and for a referral to a program that can help you quit.

Smoking "I've been smoking cigarettes for 10 years. Will this hurt my baby?"

Happily, there's no clear evidence that any smoking you've done prior to pregnancy-even if it's been for 10 or more years-will harm a developing fetus. But it's well documented (as well as plastered on cigarette packs) that smoking during pregnancy, particularly beyond the third month, isn't just hazardous to your health-but to your baby's, too.

(Don't) Put That in Your Pipe Your baby will thank you, also, for not smoking cigars and pipes-and for avoiding situations where they're being smoked. Because they aren't inhaled, cigars and pipes release even more smoke into the air than cigarettes do, which makes them even more potentially harmful to your baby. Want to announce your expected pride and joy with something safe and festive? Pass out chocolate cigars instead.

In effect, when you smoke, your fetus is confined in a smoke-filled womb. Its heartbeat speeds and, worst of all, due to insufficient oxygen, it can't grow and thrive as it should.

The results can be devastating. Smoking can increase the risk of a wide variety of pregnancy complications, including (among the more serious of these) ectopic pregnancy, abnormal placental implantation, premature placental detachment, premature rupture of the membranes, and possibly early delivery.

There is also strong evidence that a baby's development in utero is adversely and directly affected by an expectant mother's smoking. The most widespread risks for babies of smokers are low birthweight, shorter length and smaller head circumference, as well as cleft palate or cleft lip and heart defects. And being born too small is the major cause of infant illness and perinatal death (those that occur just before, during, or after birth).

There are other potential risks as well. Babies of smokers are more likely to die from SIDS (sudden infant death syndrome). They are also more prone to apnea (breathing lapses) and, in general, they aren't as healthy at birth as babies of nonsmokers, with three-pack-a-day maternal smoking associated with a quadrupled risk of low Apgar scores (the standard scale used to evaluate an infant's condition at birth). And evidence indicates that, on average, these children will suffer long-term physical and intellectual deficits, especially if parents continue to smoke around them. They are particularly prone to a lowered immune system, respiratory diseases, ear infections, colic, TB, food allergies, asthma, short stature, obesity, and problems in school, including attention deficit hyperactivity disorder (ADHD). Studies also show that pregnant women who smoke are more likely to have children who are abnormally aggressive as toddlers and who continue to have behavioral problems and even psychotic problems into adulthood. Children of mothers who smoked while pregnant are hospitalized more often in their first year of life than children of mothers who did not smoke while pregnant. These children are also more likely to grow up to be smokers themselves.

The effects of tobacco use, like those of alcohol use, are dose related: Tobacco use reduces the birthweight of babies in direct proportion to the number of cigarettes smoked, with a pack-a-day smoker 30 percent more likely to give birth to a low-birthweight child than a nonsmoker. So cutting down on the number of cigarettes you smoke may help some. But cutting down can be misleading because a smoker often compensates by taking more frequent and deeper puffs and smoking more of each cigarette. This can also happen when she tries to reduce the risk by using low-tar or low-nicotine cigarettes.

An Early Baby Present There are no sure things when it comes to making a baby, but there are plenty of ways of improving your chances of having the best outcome possible: an uncomplicated pregnancy and delivery, and a perfectly healthy, full-term bundle of joy. And giving up smoking and drinking definitely tops the list.

Of course, there's the possibility that you can have that happy outcome even if you smoke or drink your way through pregnancy (or even smoke or drink lightly but regularly)-after all, everybody's heard of women who have done both and delivered healthy babies, right on time. But there's also the chance-and depending on how much smoking or drinking you do, a very significant risk-that you and your baby wouldn't be that lucky. Consider that different mothers and different babies are affected differently by pregnancy smoking and drinking (and there's no way to predict how you and your baby will be affected). Consider, too, that some of the deficits-physical and intellectual-linked to maternal smoking and drinking don't always show up at birth but often years later (a seemingly healthy infant can grow into a child who is often sick, who is hyperactive, or who has trouble learning).

Giving up pregnancy-unfriendly habits like drinking and smoking isn't always easy-and sometimes it's a real struggle. But giving your baby the very best chances of being born healthy is definitely the very best gift you can give.

Breaking the Smoking Habit Congratulations-you've decided to give your baby a smoke-free environment, in utero and out. Making that commitment is the first and most important step. Realistically, however-as you probably already know if you've tried quitting before-it's not the most difficult step. Actually quitting is. But with a lot of determination and a little help from the following tips, you can can do it. do it.

Identify your motivations for quitting. When you're pregnant, that's easy. You've never had a more motivating reason. When you're pregnant, that's easy. You've never had a more motivating reason.

Choose your method of withdrawal. Do you want to go cold turkey or taper off? Either way, pick a "last day" that isn't far off. Plan a full schedule of fun and distracting activities for that date-those you don't associate with smoking (in places, preferably, that don't allow smoking).

Identify your motivations for smoking. For example, do you smoke for pleasure, stimulation, or relaxation? To reduce tension or frustration? To have something in your hand or mouth? To satisfy a craving? Perhaps you smoke out of habit, lighting up without thinking about it. Once you understand your motivations, it'll help you find substitutes: [image] If you smoke mainly to keep your hands busy, try playing with a pencil, beads, or a straw. Knit, play Sudoku on the computer, squeeze a stress ball, catch up on your e-mail, play video games, paint, doodle, do a crossword puzzle-anything that might make you forget to reach for a cigarette. If you smoke mainly to keep your hands busy, try playing with a pencil, beads, or a straw. Knit, play Sudoku on the computer, squeeze a stress ball, catch up on your e-mail, play video games, paint, doodle, do a crossword puzzle-anything that might make you forget to reach for a cigarette.[image] If you smoke for oral gratification, try a substitute: a toothpick, gum, raw vegetables, popcorn, a lollipop or hard candy. If you smoke for oral gratification, try a substitute: a toothpick, gum, raw vegetables, popcorn, a lollipop or hard candy.[image] If you smoke for stimulation, try to get your lift from a brisk walk, a workout session at the gym, an absorbing book, a long chat with a friend. If you smoke for stimulation, try to get your lift from a brisk walk, a workout session at the gym, an absorbing book, a long chat with a friend.[image] If you smoke to reduce tension and relax, try exercise instead. Or relaxation techniques. Or listening to soothing music. Or a long walk. Or a massage. Or making love. If you smoke to reduce tension and relax, try exercise instead. Or relaxation techniques. Or listening to soothing music. Or a long walk. Or a massage. Or making love.[image] If you smoke for pleasure, seek pleasure in other pursuits, preferably in no-smoke situations. Go to a movie, visit baby boutiques, tour a favorite museum, attend a concert or a play, have dinner with a friend who's a nonsmoker. Or try something more active, like a prenatal fitness class. If you smoke for pleasure, seek pleasure in other pursuits, preferably in no-smoke situations. Go to a movie, visit baby boutiques, tour a favorite museum, attend a concert or a play, have dinner with a friend who's a nonsmoker. Or try something more active, like a prenatal fitness class.[image] If you smoke out of habit, avoid the settings in which you habitually smoke and friends who smoke; frequent places with no-smoking rules instead. If you smoke out of habit, avoid the settings in which you habitually smoke and friends who smoke; frequent places with no-smoking rules instead.[image] If you associate smoking with a particular beverage, food, or meal, avoid the food or beverage, or eat the meal in a different location. (Say you smoke with breakfast but you never smoke in bed. Have breakfast in bed for a few days. You always smoke with your coffee? Have that latte in the coffeehouse, where smoking's not on the menu.) If you associate smoking with a particular beverage, food, or meal, avoid the food or beverage, or eat the meal in a different location. (Say you smoke with breakfast but you never smoke in bed. Have breakfast in bed for a few days. You always smoke with your coffee? Have that latte in the coffeehouse, where smoking's not on the menu.)[image] When you feel the urge to smoke, take several deep breaths with a pause between each. Hold the last breath while you strike a match. Exhale slowly, blowing out the match. Pretend it was a cigarette and crush it out. When you feel the urge to smoke, take several deep breaths with a pause between each. Hold the last breath while you strike a match. Exhale slowly, blowing out the match. Pretend it was a cigarette and crush it out.

If you do slip up and have a cigarette, put it behind you. Don't give a second thought to the cigarette you smoked-think instead about all the ones you passed up. Get right back on your program, knowing that every cigarette you don't smoke is going to help your baby. Don't give a second thought to the cigarette you smoked-think instead about all the ones you passed up. Get right back on your program, knowing that every cigarette you don't smoke is going to help your baby.

Try to look at smoking as nonnegotiable. When you were a smoker, you couldn't smoke in theaters, subways, at the mall, in many restaurants, and probably at your workplace. That was that. Now try telling yourself that you can't smoke, period-and that's that.

Let your baby inspire you. Post copies of your baby's ultrasound picture everywhere you might be tempted to smoke (make it your screensaver, frame it on the kitchen table, tape it on your dashboard, carry one in your bag). No ultrasound yet? Post pictures of adorable babies that you've cut out from magazines.

Get some support. There's plenty of help for smokers who want to quit. Look into hypnosis, acupuncture, and relaxation techniques, which have made quitters out of many smokers. If you're comfortable with a group approach to quitting, consider programs run by Nicotine Anonymous (misery often loves company-and support), the American Lung Association, the American Cancer Society, and SmokEnders, which have helped millions of smokers break the habit. Or seek support online from other pregnant women who are trying to call it quits. There's plenty of help for smokers who want to quit. Look into hypnosis, acupuncture, and relaxation techniques, which have made quitters out of many smokers. If you're comfortable with a group approach to quitting, consider programs run by Nicotine Anonymous (misery often loves company-and support), the American Lung Association, the American Cancer Society, and SmokEnders, which have helped millions of smokers break the habit. Or seek support online from other pregnant women who are trying to call it quits.

If at first you don't succeed, try, try again. Nicotine is a powerful drug, and giving it up isn't easy, but it can be done. Many smokers don't succeed the first time they try quitting, yet they do if they keep trying. So don't beat yourself up when you slip up-pat yourself on the back for your efforts, and then up your efforts. You can do it! Nicotine is a powerful drug, and giving it up isn't easy, but it can be done. Many smokers don't succeed the first time they try quitting, yet they do if they keep trying. So don't beat yourself up when you slip up-pat yourself on the back for your efforts, and then up your efforts. You can do it!

Note: Check with your doctor to find out if using nicotine patches, lozenges, or gums while you're expecting is recommended in your case.

But the news isn't all bad. Some studies show that women who quit smoking early in pregnancy-no later than the third month-can eliminate all of the associated risks. For some smoking women, quitting will never be easier than in early pregnancy when they might develop a sudden distaste for cigarettes-probably the warning of an intuitive body. Sooner is better, but quitting even in the last month can help preserve oxygen flow to the baby during delivery.

If you're concerned that quitting will cause you to gain extra weight, keep in mind that although there is no evidence that smoking actually keeps weight down (many smokers are overweight, after all), it is true that some smokers gain weight while in the process of quitting. Interestingly enough, those who gain some weight while trying to break the smoking habit are more likely to succeed-and they find it fairly easy to drop those few pounds later. Trying to diet while trying to quit usually leads to failure in both arenas. What's more, dieting while growing a baby is never a good idea. So though you should definitely pack away the cigarettes for good, don't worry if you start packing on a few more pounds than you otherwise would have. There's never been a better reason for both.

Since nicotine is an addictive drug, most people experience withdrawal symptoms when they quit smoking, though the symptoms and their intensity vary from person to person. Besides the obvious craving for tobacco, some of the most common symptoms are irritability, anxiety, restlessness, tingling or numbness in the hands and feet, lightheadedness, fatigue, and sleep and gastrointestinal disturbances. Some people also find that both physical and mental performance are impaired at first. Most find that they initially cough more, rather than less, because their bodies are suddenly better able to bring up all the secretions that have accumulated in the lungs.

To try to slow the release of nicotine and the jitteriness that may result, avoid caffeine, which can add to the jitters. Get plenty of rest (to counter fatigue) and exercise (to replace the kick you used to get from nicotine). Avoid activities that require a lot of focus and concentration if you find you're in something of a fog, but keep busy by doing mindless tasks. Hanging out wherever smoking is prohibited by your state laws may also help. If you experience serious depression as part of withdrawal, talk to your practitioner immediately.

The worst effects of withdrawal will last a few days to a few weeks. The benefits, however, will last a lifetime-for you and your baby. See box, previous page, for more tips on how to quit.

Secondhand Smoke "I don't smoke, but my husband does. Will this hurt our baby?"

Smoking doesn't affect just the smoker. It affects everyone around him, including a developing fetus whose mother happens to be nearby. So if your spouse (or anyone else you spend time with) smokes, your baby's body is going to pick up nearly as much contamination from tobacco smoke by-products as if you were lighting up.

If your spouse says he can't quit smoking, ask him to at least do all his smoking out of the house, away from you and the baby (but remember that smoke and its by-products will stick to his clothes and skin, which means you'll still get some exposure to them). Quitting, of course, would be better, not just for his own health, but also for the baby's long-term well-being. Parental smoking-mother's or father's-increases the risk of SIDS in infancy, of respiratory problems at all ages, and of damage to the lungs even into adulthood. And it ups the chances that your children will become smokers one day.

You probably won't be able to get friends and other relatives to kick the habit, but you may be able to get them to curb their smoking around you (otherwise, you'll have to spend less time around them). Keeping smoking coworkers out of your breathing space will be easier to do if there are laws protecting nonsmokers in your workplace (many states have such laws). If the law isn't on your side, try tactful persuasion-show them this section on the dangers of secondhand smoke to a fetus. If that fails, try to get a regulation passed where you work that limits smoking to certain areas, such as a lounge, and prohibits smoking in the vicinity of nonsmokers. If all else fails, try to move your work space for the duration of your pregnancy.

Marijuana Use "I smoke pot occasionally-basically only socially-and have for years. Could this have caused harm to the baby I'm now carrying. And is smoking pot during pregnancy dangerous?"

You can safely put past pot behind you. While it's usually recommended that couples trying to conceive pass on pot because it can interfere with conception, you're already pregnant-so that won't be a problem for you. And there's no present evidence that the marijuana you've smoked before you conceived will harm your fetus.

But now that you're pregnant, it's time to get off the pot. All the research isn't in yet, and the research that has been done so far isn't the most helpful kind. That's because it's hard to study marijuana use-like many lifestyle choices-in a vacuum. Often those who smoke pot during pregnancy are also drinking alcohol, smoking cigarettes, or using other drugs, making the data inconclusive (is it the pot or the beer or the cigarettes that resulted in a poor fetal outcome?). Other times, pregnant women who smoke marijuana may have less than optimal prenatal care, so it's hard to know whether a bad outcome came from the pot or the lack of prenatal care. What is known so far about marijuana use during pregnancy is that the drug passes through the placenta, which means that when you smoke pot, you're sharing it with your unborn baby. Some studies show that marijuana use is associated with poor fetal growth and babies born small for gestational age; other studies show no such relationship. Still other studies have shown even more negative effects-from tremors and withdrawal-like crying during the newborn period to attention, learning, and behavioral problems later on in childhood.

With no sure proof that it's safe to smoke pot during pregnancy-and some evidence that suggests it may be quite harmful-it's wise to treat marijuana as you would any other drug during pregnancy: Just say no.

If you have already smoked early in your pregnancy, don't worry. But if you're tempted to continue using it, try some of the suggestions for quitting tobacco (and alcohol)-kicking one addiction is similar to kicking another. Focus especially on healthy forms of relaxation that'll net you that natural high (yoga, meditation, massage, even endorphin-releasing exercise). If you can't seem to stop smoking pot, speak to your practitioner or seek other professional help as soon as possible.

Cocaine and Other Drug Use "I did some cocaine a week before I found out I was pregnant. Now I'm worried about what that could have done to my baby."

Don't worry about past cocaine use; just make sure it was your last. On the upside: A single use of cocaine before you found out you were pregnant isn't likely to have had any effect. On the downside: Continuing to use it during pregnancy could be dangerous. How dangerous isn't quite clear. Studies on cocaine use during pregnancy aren't that easy to interpret, mostly because cocaine users are often also smokers-which means that it's difficult to separate the probable negative effects of cocaine use from the documented negative effects of smoking. What numerous studies have shown is that cocaine not only crosses the placenta once it develops, but it can damage it, reducing blood flow to the fetus and restricting fetal growth, particularly that of the baby's head. It is also believed to lead to birth defects, miscarriage, premature labor, low birthweight; jitteriness and withdrawal-like crying in the newborn; as well as numerous long-term problems for a child, including neurological and behavioral problems (such as difficulty with impulse control, with paying attention, and with responding to others), motor development deficits, and possibly lower IQ scores later on in childhood. Certainly, the more often an expectant mother uses cocaine, the greater the risk to her baby.

Tell your practitioner about any cocaine use since you've conceived. As with every aspect of your medical history, the more your doctor or midwife knows, the better care you and your baby will receive. If you have any difficulty giving up cocaine entirely, seek professional help immediately.

Pregnant women who use drugs of any kind-other than those that have been prescribed by a physician who knows they are pregnant-are putting their babies at risk. Every known illicit drug (including heroin, meth, crack, Ecstasy, "ice," LSD, and PCP) and many prescription drugs that are often abused (including narcotics, tranquilizers, sedatives, and diet pills) can, with continued use, cause serious harm to a developing fetus and/or to your pregnancy. Check with your practitioner or another knowledgeable doctor about any drugs you've used during pregnancy. Then, if you are still using drugs, get professional support (from a certified addiction counselor, an addictionologist, or a treatment center) to help you quit now. Enrolling in a drug-free-pregnancy program now can make a tremendous difference in the outcome of your pregnancy.

Cell Phones "I spend hours a day on my cell phone. Could this have any effect on my baby?"

Look who's talking (on the cell phone): practically everyone. And luckily, there's no need to put your cell out of service now that you're talking for two. No pregnancy risks have ever been suggested from cell phone use. And there are plenty of good reasons to keep connected to your cell phone-it can allow you to be available for that call from the doctor or midwife you can't wait for at home, to make consultation appointments with pediatricians while you're waiting at the obstetrician's, to alert a spouse at the first signs of labor when you're nowhere near a landline. A cell phone may also allow you to be more flexible in your workday and in the amount of time spent chained to a desk (which might result in more time for needed rest and relaxation or baby preparations).

That said, cell phones aren't completely risk free. Driving while talking on a handheld cell phone is unsafe-at any speed and under any circumstances (and illegal in some areas)-particularly when the hormone-induced fog of pregnancy leaves you more easily distracted than usual. Even a hands-free phone conversation can be risky if it takes your attention off the road. Play it smart and pull over to a safe area before placing your calls.

Microwaves "I use my microwave practically every day to heat up food or even cook. Is microwave exposure safe during pregnancy?"

Amicrowave oven can be a mother-to-be's best friend, helping to make healthy eating-on-the-run possible-with a minimum of effort and cooking odor. And happily, all the research indicates that microwaves are completely safe to use during pregnancy (and at all other times). Two sensible precautions: Use only cookware that is specifically manufactured for use in the microwave, and don't let plastic wrap touch foods during microwaving.

Hot Tubs and Saunas "We have a hot tub. Is it safe for me to use it while I'm pregnant?"