Sushi Safety "Sushi is my favorite food, but I heard you're not supposed to eat it while you're pregnant. Is that true?"

Sorry to say, sushi and sashimi will have to go the way of sake (the Japanese wine often served with them) during pregnancy-which is to say, they're off the table. Same holds true for raw oysters and clams, ceviche, fish tartares or carpaccios, and other raw or barely cooked fish and shellfish. That's because when seafood isn't cooked, there's a slight chance that it can make you sick (something you definitely don't want to be when you're pregnant). But that doesn't mean you have to steer clear of your favorite Japanese restaurants. Plenty of other options exist there, even at the sushi bar. Rolls that contain cooked fish or seafood and/or vegetables are, in fact, healthy options. (But don't worry about any raw fish you've eaten up to this point.) Hot Stuff "I love spicy food-the hotter, the better. Is it safe to eat it while I'm pregnant?"

Hot mamas-to-be can continue to challenge their taste buds with four-alarm chilis, salsas, and stir-fries-as long as you can tolerate the almost inevitable heartburn and indigestion that follow. There's no risk from spicy foods during pregnancy, and, in fact, since peppers of all kinds (including hot ones) are packed with vitamin C, many of these foods are extra nutritious. So enjoy-just make sure you save room for Tums.

Spoiled Food "I ate a container of yogurt this morning without realizing that it had expired a week ago. It didn't taste spoiled, but should I worry?"

No need to cry over spoiled milk ... or yogurt. Though eating dairy products that have recently "expired" is never a particularly good idea, it's rarely a dangerous one. If you haven't shown any ill effects from your postdate snack (symptoms of food poisoning usually occur within eight hours), there's obviously no harm done. Besides, food poisoning is an unlikely possibility if the yogurt had been refrigerated continuously. In the future, however, check dates more carefully before you buy or eat perishables, and, of course, never eat foods that appear to have developed mold. For more on food safety, see the box on page 116 page 116.

"I got food poisoning from something I ate last night, and I've been throwing up. Will that hurt my baby?"

You're much more likely to suffer from the food poisoning than your baby is. The major risk-for you and your baby-is that you'll become dehydrated from vomiting and diarrhea. So make sure you get plenty of fluids (which are more important in the short term than solids) to replace those that you're losing. And contact your practitioner if your diarrhea is severe and/or your stools contain blood or mucus. See page 501 page 501 for more on stomach bugs. for more on stomach bugs.

Sugar Substitutes "I'm trying not to gain too much weight, but I love sweets. Can I use sugar substitutes?"

It sounds like a sweet deal, but the truth is that sugar substitutes are a mixed bag for expectant moms. Though most are probably safe, some research is still inconclusive. Here's how sugar substitutes stack up at the moment: Sucralose (Splenda). Made from sugar, but chemically converted to a form that's not absorbable by the body, sucralose appears right now to be the best bet for pregnant women seeking sweetness with no calories and little aftertaste. You can sweeten your coffee or tea with sucralose, and use it in cooking and baking (unlike other sugar substitutes, it doesn't lose its sweetness when heated), or buy products that have been sweetened with it (including drinks, yogurts, candy, and ice cream). Keep in mind that moderation's probably smart. Even though it seems to be safe, the product is relatively new, and no long-term data are available to confirm that. Made from sugar, but chemically converted to a form that's not absorbable by the body, sucralose appears right now to be the best bet for pregnant women seeking sweetness with no calories and little aftertaste. You can sweeten your coffee or tea with sucralose, and use it in cooking and baking (unlike other sugar substitutes, it doesn't lose its sweetness when heated), or buy products that have been sweetened with it (including drinks, yogurts, candy, and ice cream). Keep in mind that moderation's probably smart. Even though it seems to be safe, the product is relatively new, and no long-term data are available to confirm that.

Aspartame (Equal, NutraSweet). Aspartame is used in beverages, yogurt, and frozen desserts but not in baked goods or cooked foods (the sweetness doesn't survive when heated for long periods). The jury is still out on the safety of this widely used sugar substitute. Many practitioners consider it harmless and will okay light or moderate use in pregnancy. Others are less convinced of its safety and suggest that, until more is known, pregnant women be cautious in their use of this sweetener. Check with your practitioner for his or her aspartame bottom line. (Women with PKU must limit their intake of phenylalanine and are advised never to use aspartame.) Aspartame is used in beverages, yogurt, and frozen desserts but not in baked goods or cooked foods (the sweetness doesn't survive when heated for long periods). The jury is still out on the safety of this widely used sugar substitute. Many practitioners consider it harmless and will okay light or moderate use in pregnancy. Others are less convinced of its safety and suggest that, until more is known, pregnant women be cautious in their use of this sweetener. Check with your practitioner for his or her aspartame bottom line. (Women with PKU must limit their intake of phenylalanine and are advised never to use aspartame.) Saccharin. Not much research has been done on saccharin use in human pregnancy, but animal studies show an increase in cancer in the offspring of pregnant animals who ingest large quantities of the chemical. Whether a similar risk exists for human offspring is unclear (especially because animal studies don't always correlate well to human reality-after all, you're not pregnant with a baby rat). Still, combined with the fact that the sweetener crosses the placenta in humans and is eliminated very slowly from fetal tissues, most practitioners advise minimizing its use during pregnancy. Don't worry, however, about saccharin you had before finding out that you were pregnant because, again, there are no documented risks. Not much research has been done on saccharin use in human pregnancy, but animal studies show an increase in cancer in the offspring of pregnant animals who ingest large quantities of the chemical. Whether a similar risk exists for human offspring is unclear (especially because animal studies don't always correlate well to human reality-after all, you're not pregnant with a baby rat). Still, combined with the fact that the sweetener crosses the placenta in humans and is eliminated very slowly from fetal tissues, most practitioners advise minimizing its use during pregnancy. Don't worry, however, about saccharin you had before finding out that you were pregnant because, again, there are no documented risks.

Acesulfame-K (Sunett). This sweetener, 200 times sweeter than sugar, is approved for use in baked goods, gelatin desserts, chewing gum, and soft drinks. The FDA says it's okay to use in moderation during pregnancy, but since few studies have been done to prove its safety, ask your practitioner what he or she thinks before gobbling the stuff up. This sweetener, 200 times sweeter than sugar, is approved for use in baked goods, gelatin desserts, chewing gum, and soft drinks. The FDA says it's okay to use in moderation during pregnancy, but since few studies have been done to prove its safety, ask your practitioner what he or she thinks before gobbling the stuff up.

Sorbitol. This is a relative of sugar found naturally in many fruits and berries. With half the sweetness of sugar, it is used in a wide range of foods and beverages and is safe for use in pregnancy in moderate amounts. But it does present a problem in large doses: Too much can cause bloating, gas pains, and diarrhea-a trio no pregnant woman needs. This is a relative of sugar found naturally in many fruits and berries. With half the sweetness of sugar, it is used in a wide range of foods and beverages and is safe for use in pregnancy in moderate amounts. But it does present a problem in large doses: Too much can cause bloating, gas pains, and diarrhea-a trio no pregnant woman needs.

Mannitol. Less sweet than sugar, mannitol is poorly absorbed by the body and thus provides fewer calories than sugar (but more than other sugar substitutes). Like sorbitol, it is safe in modest amounts, but large quantities can cause gastrointestinal unrest. Less sweet than sugar, mannitol is poorly absorbed by the body and thus provides fewer calories than sugar (but more than other sugar substitutes). Like sorbitol, it is safe in modest amounts, but large quantities can cause gastrointestinal unrest.

Xylitol. This sugar alcohol, which is produced as a sugar substitute from plants (but is also naturally occurring in many fruits and vegetables and is even created by the body during normal metabolism), is found in chewing gum, toothpaste, candies, and some foods. One of its benefits is that it can prevent tooth decay (which is why chewing gum made with xylitol can be a very good thing). Xylitol has 40 percent fewer calories than sugar and is considered safe during pregnancy in moderation (so in other words, it's fine to chew one pack of xylitol gum-but you might not want to chew five). This sugar alcohol, which is produced as a sugar substitute from plants (but is also naturally occurring in many fruits and vegetables and is even created by the body during normal metabolism), is found in chewing gum, toothpaste, candies, and some foods. One of its benefits is that it can prevent tooth decay (which is why chewing gum made with xylitol can be a very good thing). Xylitol has 40 percent fewer calories than sugar and is considered safe during pregnancy in moderation (so in other words, it's fine to chew one pack of xylitol gum-but you might not want to chew five).

Stevia. Derived from a South American shrub, stevia has not been approved by the FDA as a sweetener (it's considered a dietary supplement). No clear research proves stevia is safe during pregnancy, so before you dip into this sweetner, check with your practitioner for his or her recommendation. Derived from a South American shrub, stevia has not been approved by the FDA as a sweetener (it's considered a dietary supplement). No clear research proves stevia is safe during pregnancy, so before you dip into this sweetner, check with your practitioner for his or her recommendation.

Lactose. This milk sugar is one sixth as sweet as table sugar and adds light sweetening to foods. For those who are lactose-intolerant, it can cause uncomfortable symptoms; otherwise it's safe. This milk sugar is one sixth as sweet as table sugar and adds light sweetening to foods. For those who are lactose-intolerant, it can cause uncomfortable symptoms; otherwise it's safe.

Honey. Everyone's all abuzz about honey these days because of its high levels of antioxidants (darker varieties, such as buckwheat honey, are the richest in antioxidants). But it's not all sweet news. Though it's a good substitute for sugar, honey is definitely not low-cal. It's got 19 more calories per tablespoon than sugar does. How's that for sticky? Everyone's all abuzz about honey these days because of its high levels of antioxidants (darker varieties, such as buckwheat honey, are the richest in antioxidants). But it's not all sweet news. Though it's a good substitute for sugar, honey is definitely not low-cal. It's got 19 more calories per tablespoon than sugar does. How's that for sticky?

Fruit juice concentrates. Unquestionably nutritious, fruit juice concentrates, such as white grape and apple, are a safe (if not low-calorie) sweetener to turn to during pregnancy. They're surprisingly versatile in the kitchen (you can substitute them for the sugar in many recipes) and they're readily available in frozen form at the supermarket. Look for them in a host of commercial products, too, from jams and jellies to whole-grain cookies, muffins, cereals, and granola bars, to pop-up toaster pastries, yogurt, and sparkling sodas. Unlike most products sweetened with sugar or other sugar substitutes, the majority of fruit-juice-sweetened products are made with nutritious ingredients, such as whole-grain flour and healthy fats. How sweet it is. Unquestionably nutritious, fruit juice concentrates, such as white grape and apple, are a safe (if not low-calorie) sweetener to turn to during pregnancy. They're surprisingly versatile in the kitchen (you can substitute them for the sugar in many recipes) and they're readily available in frozen form at the supermarket. Look for them in a host of commercial products, too, from jams and jellies to whole-grain cookies, muffins, cereals, and granola bars, to pop-up toaster pastries, yogurt, and sparkling sodas. Unlike most products sweetened with sugar or other sugar substitutes, the majority of fruit-juice-sweetened products are made with nutritious ingredients, such as whole-grain flour and healthy fats. How sweet it is.

Herbal Tea "I drink a lot of herbal tea. Is it safe to keep drinking it while I'm pregnant?"

Should you take (herbal) tea for two? Unfortunately, since the effect of herbs in pregnancy has not been well researched, there's no definitive answer to that question yet. Some herbal teas are probably safe, some probably not-and some, such as red raspberry leaf, taken in very large amounts (more than four 8-ounce cups a day), are thought to trigger contractions (good if you're 40 weeks and impatient, not good if you haven't reached term). Until more is known, the FDA has urged caution on the use of most herbal teas in pregnancy and during lactation. And though many women have drunk lots of herbal teas throughout pregnancy without a problem, it is probably safest to stay away from, or at least limit, herbal teas while you're expecting-unless they've been specifically recommended or cleared by your practitioner. Check with your practitioner for a list of which herbs he or she believes are safe and which are pregnancy no-no's.

To make sure you're not brewing up trouble (and an herb your practitioner hasn't cleared) with your next cup of tea, read labels carefully; some brews that seem from their names to be fruit based also contain a variety of herbs. Stick to regular (black) tea that comes flavored, or mix up your own by adding any of the following to boiling water or regular tea: orange, apple, pineapple, or other fruit juice; slices of lemon, lime, orange, apple, pear, or other fruit; mint leaves, cinnamon, nutmeg, cloves, or ginger (a great alleviator of the queasies). Chamomile is also considered safe in small amounts during pregnancy and can be soothing to a pregnancy-unsettled tummy. The jury's still out on green tea, which can decrease the effectiveness of folic acid, that vital pregnancy vitamin-so if you're a green tea drinker, drink in moderation. And never brew a homemade tea from a plant growing in your backyard, unless you are absolutely certain what it is and that it's safe for use during pregnancy.

Chemicals in Foods "With additives in packaged foods, pesticides on vegetables, PCBs and mercury in fish, antibiotics in meat, and nitrates in hot dogs, is there anything I can safely eat during pregnancy?"

Take heart-and take it easy. You don't have to go crazy (or hungry) to protect your baby from food hazards. In spite of anything you might have read and heard, very few substances found in food have been absolutely proven harmful to the unborn.

Still, it's smart to reduce risk whenever you can-particularly when you're reducing risk for two. And it's not that difficult to do, especially these days. To feed yourself and your baby as safely as you can, use the following as a guide to help you decide what to drop into your shopping cart and what to pass up: [image] Choose your foods from the Pregnancy Diet. Because it steers away from processed foods, it steers you clear of many questionable and unsafe substances. It also supplies Green Leafies and Yellows, rich in protective beta-carotene, as well as other fruits and vegetables rich in phytochemicals, which may counteract the effects of toxins in food. Choose your foods from the Pregnancy Diet. Because it steers away from processed foods, it steers you clear of many questionable and unsafe substances. It also supplies Green Leafies and Yellows, rich in protective beta-carotene, as well as other fruits and vegetables rich in phytochemicals, which may counteract the effects of toxins in food.[image] Whenever possible, cook from scratch with fresh ingredients or use frozen or packaged organic ready-to-eat foods. You'll avoid many questionable additives found in processed foods, and your meals will be more nutritious, too. Whenever possible, cook from scratch with fresh ingredients or use frozen or packaged organic ready-to-eat foods. You'll avoid many questionable additives found in processed foods, and your meals will be more nutritious, too.[image] Go as natural as you can, when you can. Whenever you have a choice (and you won't always), choose foods that are free of artificial additives (colorings, flavorings, and preservatives). Read labels to screen for foods that are either additive free or use natural additives (a cheddar cheese cracker that gets its orange hue from annatto, instead of red dye #40, and its flavor from real cheese, instead of artificial cheese flavoring). Keep in mind that although some artificial additives are considered safe, others are of questionable safety, and many are used to enhance foods that aren't very nutritious to start with. (For a listing of questionable and safe additives, go to Go as natural as you can, when you can. Whenever you have a choice (and you won't always), choose foods that are free of artificial additives (colorings, flavorings, and preservatives). Read labels to screen for foods that are either additive free or use natural additives (a cheddar cheese cracker that gets its orange hue from annatto, instead of red dye #40, and its flavor from real cheese, instead of artificial cheese flavoring). Keep in mind that although some artificial additives are considered safe, others are of questionable safety, and many are used to enhance foods that aren't very nutritious to start with. (For a listing of questionable and safe additives, go to cspinet.org/reports/chemcuisine.htm).[image] Generally avoid foods preserved with nitrates and nitrites (or sodium nitrates), including hot dogs, salami, bologna, and smoked fish and meats. Look for those brands (you'll find plenty in the market these days) that do not include these preservatives. Generally avoid foods preserved with nitrates and nitrites (or sodium nitrates), including hot dogs, salami, bologna, and smoked fish and meats. Look for those brands (you'll find plenty in the market these days) that do not include these preservatives.[image] Fish is a great source of lean protein, as well as baby brainbuilding omega-3 fatty acids, two good reasons to keep it on your pregnancy menu-or even to consider adding it (aversions allowing) if you've never been a fish eater before. And in fact, research has shown brain benefits for babies whose moms eat lots of fish when they're expecting. So go fish, by all means, but fish selectively, sticking to those varieties that are considered safe. According to the EPA and other experts, it's smart to avoid shark, swordfish, king mackerel, tilefish, and tuna steaks. These large fish can contain high levels of methylmercury, a chemical that in large, accumulated doses can possibly be harmful to a fetus's developing nervous system. Don't worry if you've already enjoyed a serving or two of swordfish-any risks would apply to regular consumption-just skip these fish from now on. Also limit your consumption of canned tuna (chunk light tuna contains less mercury than white) and freshwater fish caught by recreational fishers to an average of 6 ounces (cooked weight) per week; commercially caught fish usually has lower levels of contaminants, so you can safely eat more. Steer clear of fish from waters that are contaminated (with sewage or industrial runoff, for example) or tropical fish, such as grouper, amberjack, and mahimahi (which sometimes contain toxins). Fortunately, that leaves plenty of fish in the sea to enjoy safely and often (an average of 12 ounces of cooked fish per week is considered safe according to government guidelines). Choose from salmon (wild caught is best), sole, flounder, haddock, tilapia, halibut, ocean perch, pollack, cod, and trout, as well as other smaller ocean fish (anchovies, sardines, and herring are not only safe, but also loaded with omega-3) and seafood of all kinds. Remember, all fish and seafood should be well cooked. For the latest information on fish safety, contact the FDA at (888) SAFE-FOOD (723-3366) or Fish is a great source of lean protein, as well as baby brainbuilding omega-3 fatty acids, two good reasons to keep it on your pregnancy menu-or even to consider adding it (aversions allowing) if you've never been a fish eater before. And in fact, research has shown brain benefits for babies whose moms eat lots of fish when they're expecting. So go fish, by all means, but fish selectively, sticking to those varieties that are considered safe. According to the EPA and other experts, it's smart to avoid shark, swordfish, king mackerel, tilefish, and tuna steaks. These large fish can contain high levels of methylmercury, a chemical that in large, accumulated doses can possibly be harmful to a fetus's developing nervous system. Don't worry if you've already enjoyed a serving or two of swordfish-any risks would apply to regular consumption-just skip these fish from now on. Also limit your consumption of canned tuna (chunk light tuna contains less mercury than white) and freshwater fish caught by recreational fishers to an average of 6 ounces (cooked weight) per week; commercially caught fish usually has lower levels of contaminants, so you can safely eat more. Steer clear of fish from waters that are contaminated (with sewage or industrial runoff, for example) or tropical fish, such as grouper, amberjack, and mahimahi (which sometimes contain toxins). Fortunately, that leaves plenty of fish in the sea to enjoy safely and often (an average of 12 ounces of cooked fish per week is considered safe according to government guidelines). Choose from salmon (wild caught is best), sole, flounder, haddock, tilapia, halibut, ocean perch, pollack, cod, and trout, as well as other smaller ocean fish (anchovies, sardines, and herring are not only safe, but also loaded with omega-3) and seafood of all kinds. Remember, all fish and seafood should be well cooked. For the latest information on fish safety, contact the FDA at (888) SAFE-FOOD (723-3366) or cfsan.fda.gov or the EPA at or the EPA at epa.gov/ost/fish.

Something's Cooking You can find recipes that put it all together in What to Expect: Eating Well When You're Expecting. What to Expect: Eating Well When You're Expecting.

[image]Choose lean cuts of meat and remove visible fat before cooking, since chemicals that livestock ingest tend to concentrate in the fat of the animal. With poultry, remove both the fat and the skin to minimize chemical intake. And don't eat organ meats (such as liver and kidneys) very often, for the same reason.[image] When it's available and your budget permits, buy meat and poultry that has been raised organically (or grass-fed), without hormones or antibiotics (remember, you eat what your dinner ate). Choose organic dairy products and eggs, when possible, for the same reason. Free-range chickens (and eggs) are not only less likely to be contaminated with chemicals, they are also less likely to carry such infections as salmonella because the birds are not kept in cramped, disease-breeding quarters. And here's a plus when it comes to grass-fed beef: It's likely to be lower in calories and fat, higher in protein, and a rich source of those baby-friendly omega-3 fatty acids. When it's available and your budget permits, buy meat and poultry that has been raised organically (or grass-fed), without hormones or antibiotics (remember, you eat what your dinner ate). Choose organic dairy products and eggs, when possible, for the same reason. Free-range chickens (and eggs) are not only less likely to be contaminated with chemicals, they are also less likely to carry such infections as salmonella because the birds are not kept in cramped, disease-breeding quarters. And here's a plus when it comes to grass-fed beef: It's likely to be lower in calories and fat, higher in protein, and a rich source of those baby-friendly omega-3 fatty acids.[image] Buy organic produce when possible and practical. Produce that is certified organic usually is as close as possible to being free of all chemical residues. Transitional produce may still contain some residues from soil contamination but should be safer than conventionally grown produce. If organic produce is available locally and you can afford the premium price, make it your choice-just keep in mind as you load up your shopping cart that organic produce will have a much shorter shelf life (same goes for organic poultry and meats). If price is an object, pick organic selectively (see box). Buy organic produce when possible and practical. Produce that is certified organic usually is as close as possible to being free of all chemical residues. Transitional produce may still contain some residues from soil contamination but should be safer than conventionally grown produce. If organic produce is available locally and you can afford the premium price, make it your choice-just keep in mind as you load up your shopping cart that organic produce will have a much shorter shelf life (same goes for organic poultry and meats). If price is an object, pick organic selectively (see box).[image] As a precaution, give all vegetables and fruits a bath. Washing produce thoroughly is important no matter what (even organic produce can wear a coating of bacteria), but it's key to removing chemical pesticides your fruits and veggies may have picked up in the field. Water will wash off some, but a dip in or a spray with produce wash will take off much more (rinse thoroughly afterward). Scrub skins when possible and practical to remove surface chemical residues, especially when a vegetable has a waxy coating (as cucumbers and sometimes tomatoes, apples, peppers, and eggplant do). Peel skins that still seem "coated" after washing. As a precaution, give all vegetables and fruits a bath. Washing produce thoroughly is important no matter what (even organic produce can wear a coating of bacteria), but it's key to removing chemical pesticides your fruits and veggies may have picked up in the field. Water will wash off some, but a dip in or a spray with produce wash will take off much more (rinse thoroughly afterward). Scrub skins when possible and practical to remove surface chemical residues, especially when a vegetable has a waxy coating (as cucumbers and sometimes tomatoes, apples, peppers, and eggplant do). Peel skins that still seem "coated" after washing.[image] Favor domestic produce. Imported (and foods made from such produce) often contain higher levels of pesticides than U.S.-grown equivalents because pesticide regulation in other countries is often lax or nonexistent. Favor domestic produce. Imported (and foods made from such produce) often contain higher levels of pesticides than U.S.-grown equivalents because pesticide regulation in other countries is often lax or nonexistent.

Pick and Choose Organic Spending the big bucks on organic produce isn't always worth it. Here's the lowdown on when to spring for the organic and when it's safe to stick with conventional: Best to buy organic (because even after washing, these foods still carry higher levels of pesticide residue than others): Apples, cherries, grapes, peaches, nectarines, pears, raspberries, strawberries, bell peppers, celery, potatoes, and spinach. (because even after washing, these foods still carry higher levels of pesticide residue than others): Apples, cherries, grapes, peaches, nectarines, pears, raspberries, strawberries, bell peppers, celery, potatoes, and spinach.

No need to go organic on these foods (because these products generally don't contain pesticide residue on them): Bananas, kiwi, mango, papaya, pineapples, asparagus, avocado, broccoli, cauliflower, corn, onions, and peas. (because these products generally don't contain pesticide residue on them): Bananas, kiwi, mango, papaya, pineapples, asparagus, avocado, broccoli, cauliflower, corn, onions, and peas.

Consider organic for milk, beef, and poultry because they won't contain antibiotics or hormones, though they will cost more. Don't bother with so-called organic fish. There are no USDA organic certification standards for seafood (which means producers are making their own claims about why it's organic). for milk, beef, and poultry because they won't contain antibiotics or hormones, though they will cost more. Don't bother with so-called organic fish. There are no USDA organic certification standards for seafood (which means producers are making their own claims about why it's organic).

[image]Go local. Locally grown produce is likely to contain more nutrients (it's fresh from the field) and possibly sport less pesticide residue. Many of the growers at your local farmers' market may grow without pesticides (or with very little), even if their products aren't marked "organic." That's because certification is too expensivefor some small growers to afford.[image] Vary your diet. Variety ensures not only a more interesting eating experience and better nutrition but also better chances of avoiding excessive exposure to any one chemical. Switch between broccoli, kale, and carrots, for instance; melon, peaches, and strawberries; salmon, halibut, and sole; cereals made from whole wheat, corn, and oats. Vary your diet. Variety ensures not only a more interesting eating experience and better nutrition but also better chances of avoiding excessive exposure to any one chemical. Switch between broccoli, kale, and carrots, for instance; melon, peaches, and strawberries; salmon, halibut, and sole; cereals made from whole wheat, corn, and oats.

Eating Safe for Two Worried about the pesticides your peach picked up in South America? That's sensible, especially because you're trying to eat safely for two. But what about the sponge you're about to wipe that peach down with (the one that's been hanging around your sink for the last three weeks)? Have you thought about what that might have picked up lately? And the cutting board you were planning to slice your peach on-isn't that the same one you diced that raw chicken on last night before you tossed it into the stir-fry? Here's a food safety reality check: A more immediate-and proven-threat than the chemicals in your food are the little organisms, bacteria and parasites, that can contaminate it. It's not a pretty picture (or one that's visible without the help of a microscope), but these nasty bugs can cause anything from mild stomach upset to severe illness. To make sure that the worst thing you'll pick up from your next meal is a little heartburn (the last thing an expectant mom needs is another reason for gastrointestinal upset), shop, prepare, and eat with care: [image] When in doubt, throw it out. Make this your mantra of safe eating. It applies to any food you even suspect might be spoiled. Read and abide by freshness dates on food packages. When in doubt, throw it out. Make this your mantra of safe eating. It applies to any food you even suspect might be spoiled. Read and abide by freshness dates on food packages.[image] When food shopping, avoid fish, meat, and eggs that are not well refrigerated or kept on ice. Steer clear of jars that are leaky or don't "pop" when you open them and cans that are rusty or seem swollen or otherwise misshapen. Wash can tops before opening (and wash your can opener frequently in hot soapy water or in the dishwasher). When food shopping, avoid fish, meat, and eggs that are not well refrigerated or kept on ice. Steer clear of jars that are leaky or don't "pop" when you open them and cans that are rusty or seem swollen or otherwise misshapen. Wash can tops before opening (and wash your can opener frequently in hot soapy water or in the dishwasher).[image] Wash your hands before handling food and after touching raw meat, fish, or eggs. If you have a cut on your hand, wear rubber or plastic gloves while you prepare food, and remember, unless they're disposable, the gloves need to be washed as often as your bare hands. Wash your hands before handling food and after touching raw meat, fish, or eggs. If you have a cut on your hand, wear rubber or plastic gloves while you prepare food, and remember, unless they're disposable, the gloves need to be washed as often as your bare hands.[image] Keep kitchen counters and sinks clean. Same goes for cutting boards (wash with soap and hot water or in the dishwasher). Wash dishcloths frequently and keep sponges clean (replace them often, wash them in the dishwasher each night, or periodically pop dampened ones into the microwave for a couple of minutes); they can harbor bacteria. Keep kitchen counters and sinks clean. Same goes for cutting boards (wash with soap and hot water or in the dishwasher). Wash dishcloths frequently and keep sponges clean (replace them often, wash them in the dishwasher each night, or periodically pop dampened ones into the microwave for a couple of minutes); they can harbor bacteria.[image] Serve hot foods hot, cold foods cold. Leftovers should be refrigerated quickly and heated until steaming before reusing. (Toss perishable foods that have been left out for more than two hours.) Don't eat frozen foods that have been thawed and then refrozen. Serve hot foods hot, cold foods cold. Leftovers should be refrigerated quickly and heated until steaming before reusing. (Toss perishable foods that have been left out for more than two hours.) Don't eat frozen foods that have been thawed and then refrozen.[image] Measure the fridge interior temperature with a refrigerator thermometer and be sure it stays at 41F or less. Ideally, the freezer should be at 0F, though many freezers are not designed to meet that requirement; don't worry if yours isn't. Measure the fridge interior temperature with a refrigerator thermometer and be sure it stays at 41F or less. Ideally, the freezer should be at 0F, though many freezers are not designed to meet that requirement; don't worry if yours isn't.[image] Thaw foods in the refrigerator, time permitting. If you're in a rush, thaw food in a watertight plastic bag submerged in cold water (and change it every 30 minutes). Never thaw foods at room temperature. Thaw foods in the refrigerator, time permitting. If you're in a rush, thaw food in a watertight plastic bag submerged in cold water (and change it every 30 minutes). Never thaw foods at room temperature.[image] Marinate meat, fish, or poultry in the refrigerator, not on the counter. Discard the marinade after use, because it contains potentially hazardous bacteria. If you'd like to use the marinade as a dip or sauce, or to baste with, reserve a portion for that purpose before you add the meat, poultry, or fish. Use a new spoon or brush each time you baste to avoid recontaminating the marinade, or just cook for a few more minutes after the last basting. Marinate meat, fish, or poultry in the refrigerator, not on the counter. Discard the marinade after use, because it contains potentially hazardous bacteria. If you'd like to use the marinade as a dip or sauce, or to baste with, reserve a portion for that purpose before you add the meat, poultry, or fish. Use a new spoon or brush each time you baste to avoid recontaminating the marinade, or just cook for a few more minutes after the last basting.[image] Don't eat raw or undercooked meats, poultry, fish, or shellfish while you're expecting. Always cook meats and fish to medium (to 160F) and poultry thoroughly (to 165F). In general, place the thermometer in the thickest part of the food, away from bone, fat, or gristle. In poultry, place it in the dark meat. Don't eat raw or undercooked meats, poultry, fish, or shellfish while you're expecting. Always cook meats and fish to medium (to 160F) and poultry thoroughly (to 165F). In general, place the thermometer in the thickest part of the food, away from bone, fat, or gristle. In poultry, place it in the dark meat.[image] Don't eat eggs that are runny (prefer well-scrambled to sunny-side up), and if you're mixing a batter that contains raw eggs, resist the urge to lick the spoon (or your fingers). The exception to this rule: eggs that are pasteurized, since this process effectively eliminates the risk of salmonella poisoning. Don't eat eggs that are runny (prefer well-scrambled to sunny-side up), and if you're mixing a batter that contains raw eggs, resist the urge to lick the spoon (or your fingers). The exception to this rule: eggs that are pasteurized, since this process effectively eliminates the risk of salmonella poisoning.[image] Wash raw vegetables thoroughly (especially if they won't be cooked before eating). Those fresh blueberries from the farmers' market might have been grown organically-but that doesn't mean they're not sporting a layer of bacteria. Wash raw vegetables thoroughly (especially if they won't be cooked before eating). Those fresh blueberries from the farmers' market might have been grown organically-but that doesn't mean they're not sporting a layer of bacteria.[image] Avoid alfalfa and other sprouts, which are often contaminated with bacteria. Avoid alfalfa and other sprouts, which are often contaminated with bacteria.[image] Stick to pasteurized dairy products, and make sure those that you use have been refrigerated continuously. Soft cheeses, such as imported feta, Brie, blue cheeses, and soft Mexican-style cheese made from unpasteurized milk, can be contaminated with listeria (see Stick to pasteurized dairy products, and make sure those that you use have been refrigerated continuously. Soft cheeses, such as imported feta, Brie, blue cheeses, and soft Mexican-style cheese made from unpasteurized milk, can be contaminated with listeria (see page 501 page 501) and should be avoided by pregnant women, unless heated until bubbly. Domestic cheese is almost always pasteurized except for those made from "raw milk."[image] Hot dogs, deli meats, and cold-smoked seafood can also be contaminated. As a precaution, even ready-cooked meats or smoked fish should be heated to steaming before eating (use them in casseroles). Hot dogs, deli meats, and cold-smoked seafood can also be contaminated. As a precaution, even ready-cooked meats or smoked fish should be heated to steaming before eating (use them in casseroles).[image] Juice should be fully pasteurized, too. Avoid unpasteurized or flash pasteurized juice or cider, whether it's bought at a health food store or a roadside stand. If you're not sure whether a juice is pasteurized, don't drink it. Juice should be fully pasteurized, too. Avoid unpasteurized or flash pasteurized juice or cider, whether it's bought at a health food store or a roadside stand. If you're not sure whether a juice is pasteurized, don't drink it.[image] When eating out, avoid establishments that seem to ignore basic sanitation rules. Some signs are pretty obvious: Perishable foods are kept at room temperature, the bathrooms are unclean, it's open season for flies, and so on. When eating out, avoid establishments that seem to ignore basic sanitation rules. Some signs are pretty obvious: Perishable foods are kept at room temperature, the bathrooms are unclean, it's open season for flies, and so on.

[image]Drive yourself to the health food market, but don't drive yourself crazy. Though it's smart to try to avoid theoretical hazards in food, making your life stressful in the pursuit of a natural meal isn't necessary. Do the best you can-and then sit back, eat well, and relax.

PART 2.

Nine Months & Counting From Conception to Delivery

CHAPTER 6.

The First Month.

Approximately 1 to 4 Weeks.

CONGRATULATIONS, AND WELCOME to your pregnancy! Though you almost certainly don't look pregnant yet, chances are you're already starting to feel it. Whether it's just tender breasts and a little fatigue you're experiencing, or every early pregnancy symptom in the book (and then some), your body is gearing up for the months of baby making to come. As the weeks pass, you'll notice changes in parts of your body you'd expect (like your belly), as well as places you wouldn't expect (your feet and your eyes). You'll also notice changes in the way you live-and look at-life. But try not to think (or read) too far ahead. For now, just sit back, relax, and enjoy the beginning of one of the most exciting and rewarding adventures of your life. to your pregnancy! Though you almost certainly don't look pregnant yet, chances are you're already starting to feel it. Whether it's just tender breasts and a little fatigue you're experiencing, or every early pregnancy symptom in the book (and then some), your body is gearing up for the months of baby making to come. As the weeks pass, you'll notice changes in parts of your body you'd expect (like your belly), as well as places you wouldn't expect (your feet and your eyes). You'll also notice changes in the way you live-and look at-life. But try not to think (or read) too far ahead. For now, just sit back, relax, and enjoy the beginning of one of the most exciting and rewarding adventures of your life.

Your Baby This Month Week 1 The countdown to baby begins this week. Only thing is, there's no baby in sight-or inside. So why call this week 1 of pregnancy if you're not even pregnant? Here's why. It's extremely hard to pinpoint the precise moment when sperm meets egg (sperm from your partner can hang out in your body for several days before your egg comes out to greet it, and your egg can be kept waiting for a day for the sperm to make their appearance). The countdown to baby begins this week. Only thing is, there's no baby in sight-or inside. So why call this week 1 of pregnancy if you're not even pregnant? Here's why. It's extremely hard to pinpoint the precise moment when sperm meets egg (sperm from your partner can hang out in your body for several days before your egg comes out to greet it, and your egg can be kept waiting for a day for the sperm to make their appearance).

What isn't hard to pinpoint, however, is the first day of your last menstrual period (LMP, which you're having right now-so mark the calendar), allowing your practitioner to use that as the standard starting line for your 40-week pregnancy. The upshot of this dating system (besides a lot of potential for confusion)? You get to clock in two weeks of your 40 weeks of pregnancy before you even get pregnant (how's that for a head start?).

Week 2 Nope, still no baby yet. But your body isn't taking a break this week. In fact, it's working hard gearing up for the big O-ovulation. The lining of your uterus is thickening (feathering its nest for the arrival of the fertilized egg) and your ovarian follicles are maturing-some faster than others-until one becomes the dominant one, destined for ovulation. And waiting in that dominant follicle is an anxious egg (or two, if you're about to conceive fraternal twins) with your baby's name on it-ready to burst out and begin its journey from single cell to bouncing boy or girl. But first it will have to make a journey down your fallopian tube in search of Mr. Right-the lucky sperm that will seal the deal. Nope, still no baby yet. But your body isn't taking a break this week. In fact, it's working hard gearing up for the big O-ovulation. The lining of your uterus is thickening (feathering its nest for the arrival of the fertilized egg) and your ovarian follicles are maturing-some faster than others-until one becomes the dominant one, destined for ovulation. And waiting in that dominant follicle is an anxious egg (or two, if you're about to conceive fraternal twins) with your baby's name on it-ready to burst out and begin its journey from single cell to bouncing boy or girl. But first it will have to make a journey down your fallopian tube in search of Mr. Right-the lucky sperm that will seal the deal.

Your Baby, Month 1 Week 3 Congratulations-you've conceived! Which means your soon-to-be baby has started its miraculous transformation from single cell to fully formed baby boy or girl ready for cuddles and kisses. Within hours after sperm meets egg, the fertilized cell (aka zygote) divides, and then continues to divide (and divide). Within days, your baby-to-be has turned into a microscopic ball of cells, around one fifth the size of the period at the end of this sentence. The blastocyst-as it is now known (though you'll almost certainly come up with a cuter name soon)-begins its journey from your fallopian tube to your waiting uterus. Only 8 more months-give or take-to go! Congratulations-you've conceived! Which means your soon-to-be baby has started its miraculous transformation from single cell to fully formed baby boy or girl ready for cuddles and kisses. Within hours after sperm meets egg, the fertilized cell (aka zygote) divides, and then continues to divide (and divide). Within days, your baby-to-be has turned into a microscopic ball of cells, around one fifth the size of the period at the end of this sentence. The blastocyst-as it is now known (though you'll almost certainly come up with a cuter name soon)-begins its journey from your fallopian tube to your waiting uterus. Only 8 more months-give or take-to go!

Week 4 It's implantation time! That ball of cells that you'll soon call baby-though it's now called embryo-has reached your uterus and is snuggling into the uterine lining where it'll stay connected to you until delivery. Once firmly in place, the ball of cells undergoes the great divide-splitting into two groups. Half will become your son or daughter, while the other half will become the placenta, your baby's lifeline during his or her uterine stay. And even though it's just a ball of cells right now (no bigger than a poppy seed, actually, but a lot sweeter), don't underestimate your little embryo-he or she has already come a long way since those blastocyst days. The amniotic sac-otherwise known as the bag of waters-is forming, as is the yolk sac, which will later be incorporated into your baby's developing digestive tract. Each layer of the embryo-it has three now-is beginning to grow into specialized parts of the body. The inner layer, known as the endoderm, will develop into your baby's digestive system, liver, and lungs. The middle layer, called the mesoderm, will soon be your baby's heart, sex organs, bones, kidneys, and muscles. The outer layer, or ectoderm, will eventually form your baby's nervous system, hair, skin, and eyes. It's implantation time! That ball of cells that you'll soon call baby-though it's now called embryo-has reached your uterus and is snuggling into the uterine lining where it'll stay connected to you until delivery. Once firmly in place, the ball of cells undergoes the great divide-splitting into two groups. Half will become your son or daughter, while the other half will become the placenta, your baby's lifeline during his or her uterine stay. And even though it's just a ball of cells right now (no bigger than a poppy seed, actually, but a lot sweeter), don't underestimate your little embryo-he or she has already come a long way since those blastocyst days. The amniotic sac-otherwise known as the bag of waters-is forming, as is the yolk sac, which will later be incorporated into your baby's developing digestive tract. Each layer of the embryo-it has three now-is beginning to grow into specialized parts of the body. The inner layer, known as the endoderm, will develop into your baby's digestive system, liver, and lungs. The middle layer, called the mesoderm, will soon be your baby's heart, sex organs, bones, kidneys, and muscles. The outer layer, or ectoderm, will eventually form your baby's nervous system, hair, skin, and eyes.

Make the Pregnancy Connection Log on to whattoexpect.com-your interactive pregnancy companion. Just fill in your due date, and you'll get weekly reports on your baby's growth and development, plus access to useful tools like the Pregnancy Planner and Baby Name Finder. Connect with other moms on the message boards, create your own blogs and profile pages, and make new friends!

Pregnancy Timetable Though most women count their pregnancies in months, your doctor or midwife will do the calculations in weeks. And that's where things can get a little tricky. The average pregnancy lasts 40 weeks, but because counting begins from the first day of your last menstrual period (LMP)-and ovulation and conception don't take place until two weeks after that (if your periods are regular)-you actually become pregnant in week 3 of your pregnancy. In other words, you've already clocked two weeks by the time sperm meets egg. This may sound very confusing, but as your pregnancy progresses and you experience pregnancy milestones traditionally marked by weeks (baby's heartbeat heard with Doppler around 10 weeks; the top of the uterus reaches your belly button at 20 weeks), you'll start to make sense of the weekly calendar.

Though this book is organized in chapters by month, corresponding weeks are also provided. Weeks 1 to 13 (approximately) make up the first trimester and include months 1 to 3; weeks 14 to 27 (approximately) comprise the second trimester and include months 4 to 6; and weeks 28 to 40 (approximately) are the third trimester and include months 7 to 9.

What You May Be Feeling While it's true that pregnancy has its share of wonderful moments and experiences to cherish, it also has a boatload (make that a bloatload) of less than fabulous symptoms. Some you're probably expecting to have (like that queasy feeling that might already be settling in). Others you'd probably never expect (like drooling-who knew?). Many you'll probably not discuss in public (and will try your best not to do in public, like passing gas), and many you'll probably try to forget (which you might, by the way, since forgetfulness is another pregnancy symptom).

Symptoms? Starting Soon Most early pregnancy symptoms begin making their appearance around week 6, but every woman-and every pregnancy-is different, so many may begin earlier or later for you (or not at all, if you're lucky). If you're experiencing something that's not on this list or in this chapter, look ahead to the next chapters or check it out in the index.

Here are a couple of things to keep in mind about these and other pregnancy symptoms. First, because every woman and every pregnancy is different, few pregnancy symptoms are universal. So while your sister or best friend might have sailed through her pregnancy without a single nauseous moment, you might be spending every morning (and afternoon and evening) hovering over the toilet. Second, the symptoms that follow are a good sampling of what you might expect to experience (though you almost certainly, thankfully, won't experience them all-at least not all at once), but there are plenty more where these came from. Chances are just about every weird and wacky sensation you feel during the next nine months (both the physical ones and the emotional ones) will be normal for pregnancy, and normal for you. But if a symptom ever leaves you with a nagging doubt (can this really be normal?), always check it out with your practitioner, just to be sure.

Though it's unlikely that you'll even know you're expecting this month (at least not until the very end of the month), you might begin noticing something's up-even this early on. Here's what you might experience this month:

A Look Inside There's definitely no way to tell this book by its cover yet. Though you may recognize a few physical changes in yourself-your breasts may be a little fuller, your tummy a tad rounder (though that's from bloat, not baby)-no one else is likely to have noticed. Make sure you take a good look at your waist: It may be the last time you'll see it for many months to come.

Physically [image] Possible staining or spotting when the fertilized egg implants in your uterus, around five to ten days after conception (fewer than 30 percent of women experience such so-called implantation bleeding) Possible staining or spotting when the fertilized egg implants in your uterus, around five to ten days after conception (fewer than 30 percent of women experience such so-called implantation bleeding)[image] Breast changes (possibly more pronounced if you typically have breast changes before your period, and possibly somewhat less pronounced if you've had babies before): fullness, heaviness, tenderness, tingling, darkening of the areolas (the pigmented area around your nipples) Breast changes (possibly more pronounced if you typically have breast changes before your period, and possibly somewhat less pronounced if you've had babies before): fullness, heaviness, tenderness, tingling, darkening of the areolas (the pigmented area around your nipples)[image] Bloating, flatulence Bloating, flatulence[image] Fatigue, lack of energy, sleepiness Fatigue, lack of energy, sleepiness[image] More frequent urination than usual More frequent urination than usual[image] Beginnings of nausea, with or without vomiting (though most women don't start feeling queasy until around six weeks of pregnancy), and/or excess saliva Beginnings of nausea, with or without vomiting (though most women don't start feeling queasy until around six weeks of pregnancy), and/or excess saliva[image] Increased sensitivity to smells Increased sensitivity to smells Emotionally [image] Emotional ups and downs (like amped-up PMS), which may include mood swings, irritability, irrationality, inexplicable weepiness Emotional ups and downs (like amped-up PMS), which may include mood swings, irritability, irrationality, inexplicable weepiness[image] Anxiousness while waiting for the right time to take a home pregnancy test Anxiousness while waiting for the right time to take a home pregnancy test What You Can Expect at Your First Prenatal Visit Your first prenatal visit probably will be the longest you'll have during your pregnancy-and definitely will be the most comprehensive. Not only will there be more tests, procedures (including several that will be performed only at this visit), and data gathering (in the form of a complete medical history), but there will be more time spent on questions (questions you have for the practitioner, questions he or she will have for you) and answers. There will also be plenty of advice to take in-on everything from what you should be eating (and not eating) to what supplements you should be taking (and not taking) to whether (and how) you should be exercising. So be sure to come equipped with a list of the questions and concerns that have already come up, as well as with a pen and notebook (or The What to Expect Pregnancy Journal and Organizer The What to Expect Pregnancy Journal and Organizer).

One practitioner's routine may vary slightly from another's. In general, the exam will include: Confirmation of your pregnancy. Your practitioner will check the following: the pregnancy symptoms you are experiencing; the date of your LMP to determine your estimated date of delivery (EDD), or due date (see Your practitioner will check the following: the pregnancy symptoms you are experiencing; the date of your LMP to determine your estimated date of delivery (EDD), or due date (see page 20 page 20); your cervix and uterus for signs and approximate age of the pregnancy. A pregnancy test (urine and blood) will most likely be performed. Many practitioners also do an early ultrasound, which is the most accurate way of dating a pregnancy.

A complete history. To give you the best care possible, your practitioner will want to know a lot about you. Come prepared by checking records at home or calling your primary care doctor to refresh your memory on the following: your personal medical history (chronic illness, previous major illness or surgery, known allergies, including drug allergies); nutritional supplements (vitamins, minerals, herbal, and so on) or medications (over-the-counter, prescription) you are presently taking or have taken since conception; your family medical history (genetic disorders, chronic diseases, unusual pregnancy outcomes); your gynecological history (age at first period, usual length of your cycle, duration and regularity of periods); your obstetrical history (past live births, miscarriages, abortions), as well as the course of past pregnancies, labors, and deliveries. Your practitioner will also ask questions about your social history (such as your age and occupation) and about your lifestyle habits (what you typically eat, whether you exercise, drink, smoke, or use recreational drugs) and other factors in your personal life that might affect your pregnancy (information about the baby's father, information on your ethnicity). To give you the best care possible, your practitioner will want to know a lot about you. Come prepared by checking records at home or calling your primary care doctor to refresh your memory on the following: your personal medical history (chronic illness, previous major illness or surgery, known allergies, including drug allergies); nutritional supplements (vitamins, minerals, herbal, and so on) or medications (over-the-counter, prescription) you are presently taking or have taken since conception; your family medical history (genetic disorders, chronic diseases, unusual pregnancy outcomes); your gynecological history (age at first period, usual length of your cycle, duration and regularity of periods); your obstetrical history (past live births, miscarriages, abortions), as well as the course of past pregnancies, labors, and deliveries. Your practitioner will also ask questions about your social history (such as your age and occupation) and about your lifestyle habits (what you typically eat, whether you exercise, drink, smoke, or use recreational drugs) and other factors in your personal life that might affect your pregnancy (information about the baby's father, information on your ethnicity).

A complete physical examination. This may include assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at future visits; notation of your height and your weight (prepregnancy and present, if they're already different); a look at your arms and legs for varicose veins and swelling to serve as a baseline for comparison at future visits; examination of external genitalia and of your vagina and cervix (with a speculum in place, as when you get a Pap smear); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also possibly through the rectum and vagina; assessment of the size and shape of the bony pelvis (through which your baby will eventually try to exit). This may include assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at future visits; notation of your height and your weight (prepregnancy and present, if they're already different); a look at your arms and legs for varicose veins and swelling to serve as a baseline for comparison at future visits; examination of external genitalia and of your vagina and cervix (with a speculum in place, as when you get a Pap smear); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also possibly through the rectum and vagina; assessment of the size and shape of the bony pelvis (through which your baby will eventually try to exit).

The Wholly Healthy Pregnancy Not surprisingly, getting regular medical care in the form of prenatal visits makes a big difference in the outcome of your pregnancy. Women who see a practitioner regularly during pregnancy have healthier babies, and they are less likely to deliver prematurely and to have other serious pregnancy- related problems.

But though your health care should begin with your belly when you're expecting, it shouldn't end there. It'll probably be easy to remember to see your prenatal practitioner regularly (it's worth it just to hear the baby's heartbeat!), but will you remember to take care of the rest of you, even the less apparently pregnant parts?

To keep yourself wholly healthy during your whole nine months, stay on top of all your health care maintenance. Pay a visit to your dentist for a cleaning and a checkup; most dental work, particularly the preventive kind, can be done safely during pregnancy and may actually prevent pregnancy complications. Check in with your internist, family physician, or specialist if you have any chronic conditions or other medical problems that will need monitoring (make sure your pregnancy practitioner's in the loop about other care you're receiving). And see your allergist, if necessary. You probably won't begin a course of allergy shots now, but you may need to look into different treatment options now that you're breathing for two.

If new medical problems come up while you're expecting, don't ignore them, even if you're already in over your head with pregnancy-related symptoms. Check any issue out (even ones that seem relatively innocuous-a persistent sore throat or a chronic headache) with an appropriate physician. Your baby needs a wholly healthy mother.

A battery of tests. Some tests are routine for every pregnant woman; some are routine in some areas of the country, or with some practitioners and not others; some are performed only when circumstances warrant. The most common prenatal tests given at the first visit include: Some tests are routine for every pregnant woman; some are routine in some areas of the country, or with some practitioners and not others; some are performed only when circumstances warrant. The most common prenatal tests given at the first visit include: [image] Urinalysis to screen for glucose (sugar), protein, white blood cells, blood, and bacteria. Urinalysis to screen for glucose (sugar), protein, white blood cells, blood, and bacteria.[image] A blood test to determine blood type and Rh status, hCG levels, and to check for anemia and possibly for vitamin D deficiency. A blood test to determine blood type and Rh status, hCG levels, and to check for anemia and possibly for vitamin D deficiency.[image] Blood screens to determine antibody titer (levels) and immunity to such diseases as rubella. Blood screens to determine antibody titer (levels) and immunity to such diseases as rubella.[image] Tests to disclose the presence of infections such as syphilis, gonorrhea, hepatitis B, chlamydia, and HIV. Tests to disclose the presence of infections such as syphilis, gonorrhea, hepatitis B, chlamydia, and HIV.[image] A Pap smear for the detection of abnormal cervical cells. A Pap smear for the detection of abnormal cervical cells.

Depending on your particular situation, and if appropriate, you may also receive: [image] Genetic tests for cystic fibrosis, sickle cell anemia, Tay-Sachs, or other genetic diseases. Genetic tests for cystic fibrosis, sickle cell anemia, Tay-Sachs, or other genetic diseases.[image] A blood sugar level test to check for any tendency toward diabetes, especially if you have a family history of diabetes, have high blood pressure, have previously had an excessively large baby or one with birth defects, or gained excessive weight with an earlier pregnancy. (All women receive a glucose screening test for gestational diabetes at around 28 weeks; see A blood sugar level test to check for any tendency toward diabetes, especially if you have a family history of diabetes, have high blood pressure, have previously had an excessively large baby or one with birth defects, or gained excessive weight with an earlier pregnancy. (All women receive a glucose screening test for gestational diabetes at around 28 weeks; see page 297 page 297.) An opportunity for discussion. Here's the time to bring out that list of questions and concerns. Here's the time to bring out that list of questions and concerns.

What You May Be Wondering About Breaking the News "When should we tell friends and family that we are expecting?"

This is one question only you can answer. Some expectant parents can't wait to tell everyone they know (not to mention a fair number of strangers) the good news. Others tell only selectively at first, starting with those nearest and dearest (close relatives and friends, perhaps), and waiting until their condition is obvious before making the pregnancy common knowledge. Still others decide they'd rather put off issuing any announcements until the first trimester has been successfully completed or until prenatal testing has been finished up.

For the Other Pregnant Half There isn't a page in this book that isn't intended for both expectant mothers and fathers. As a father-to-be, you'll gain plenty of insight into the pregnancy experience (as well as make some sense out of those crazy symptoms your spouse has been complaining about) by reading along with her, month by month. But because you're likely to have some questions and concerns that are uniquely yours, there's a chapter dedicated to you-the other pregnant half. See Chapter 19: Fathers Are Expectant, Too.

So talk it over, and do what feels most comfortable. Just remember: In spreading the good news, don't forget to take the time to savor it as a twosome.

For tips on when to break the news at work, see page 188 page 188.

Vitamin Supplements "Should I be taking vitamins?"

Virtually no one gets a nutritionally perfect diet every day, especially early in pregnancy, when round-the-clock morning sickness is a common appetite suppressant, or when the little nutrition some women manage to get down often doesn't stay down (sound familiar?). Though a daily vitamin supplement can't take the place of a good prenatal diet, it can serve as some dietary insurance, guaranteeing that your baby won't be cheated if you don't always hit the nutritional mark you're aiming for, especially during the early months when so much of your baby's most crucial construction occurs.

And there are other good reasons to take your vitamins. For one thing, studies show that women who take a vitamin supplement containing folic acid and vitamin B12 during the first months of pregnancy (and even prior to pregnancy) significantly reduce the risk of neural tube defects (such as spina bifida) in their babies, as well as help prevent preterm birth. For another, research has shown that taking a supplement containing at least 10 mg of vitamin B during the first months of pregnancy (and even prior to pregnancy) significantly reduce the risk of neural tube defects (such as spina bifida) in their babies, as well as help prevent preterm birth. For another, research has shown that taking a supplement containing at least 10 mg of vitamin B6 before and during early pregnancy can minimize morning sickness (and who needs a better reason than that?). before and during early pregnancy can minimize morning sickness (and who needs a better reason than that?).

Good formulations designed especially for expectant mothers are available by prescription or over-the-counter. (Ask your practitioner for a recommendation and see page 103 page 103 for details on what the supplement should contain.) Don't take any kind of dietary supplements other than such a prenatal formula without your practitioner's approval. for details on what the supplement should contain.) Don't take any kind of dietary supplements other than such a prenatal formula without your practitioner's approval.

Some women find that taking the typical horse-size prenatal supplement increases nausea, especially early in pregnancy. Switching vitamin formulas or pill types may help, as may taking your pill with food (unless you usually throw up after eating) or taking it during the time of day when you're least likely to be nauseous. A coated pill is often easier to tolerate, as well as easier to swallow. If even that bothers you, you might consider a chewable supplement or a slow-release one. If your nausea is particularly bad, look for a formulation that's higher in vitamin B6 (ginger is another good addition for the queasy set). But be sure any formula you select approximates the requirements for supplements designed for pregnancy and doesn't contain any extras that might not be safe (such as herbs). If your practitioner prescribed your supplement, check with him or her before switching. (ginger is another good addition for the queasy set). But be sure any formula you select approximates the requirements for supplements designed for pregnancy and doesn't contain any extras that might not be safe (such as herbs). If your practitioner prescribed your supplement, check with him or her before switching.

In some women, the iron in a prenatal vitamin causes constipation or diarrhea. Again, switching formulas may bring relief. Taking a pregnancy supplement without iron and a separate iron preparation (your doctor can recommend one that dissolves in the intestines rather than in the more sensitive stomach-or one that is a slow release) may also relieve symptoms.

"I eat a lot of cereals and breads that are enriched. If I'm also taking a prenatal supplement, will I be taking in too many vitamins and minerals?"

You can get too much of a good thing, but not usually this way. Taking a prenatal vitamin along with the average diet, which includes plenty of enriched and fortified products, isn't likely to lead to excessive intake of vitamins and minerals. To take in that many nutrients, you'd have to be adding other supplements beyond the prenatal ones-which an expectant mother should never do unless advised by a physician who knows that she's pregnant. It's wise, however, to be wary of any foods (or drinks) that are fortified with more than the recommended daily allowance of vitamins A, E, and K, because these can be toxic in large amounts. Most other vitamins and minerals are water-soluble, which means any excesses that the body can't use are simply excreted in the urine. Which is, by the way, the reason why supplement-crazy Americans are said to have the most expensive urine in the world.

Fatigue "Now that I'm pregnant, I'm tired all the time. Sometimes I feel as if I won't even be able to get through the day!"

Can't lift your head off the pillow each morning? Dragging your feet all day? Can't wait to crawl into bed as soon as you arrive home at night? If it seems like your get-up-and-go has left the building-and doesn't plan to be back anytime soon-it's not surprising. After all, you're pregnant. And even though there might not be any evidence on the outside that you're busily building a baby, plenty of exhausting work is going on inside. In some ways, your pregnant body is working harder when you're resting than a nonpregnant body is when running a marathon-only you're not aware of the exertion.