First Trimester

Summary: We recommend Ashford Hospital, but that is where Dr Anneliese Perkins provides pregnancy and birthing options so we are a little biased.

Ashford Hospital is a private, not-for-profit hospital and is a proud member of the Adelaide Community Healthcare Alliance Incorporated (ACHA) in South Australia. They have a wonderful, caring, professional and friendly team dedicated to supporting you and your pregnancy needs. See the Ashford Hospital website for details on preparing for pregnancy classes or to organise a tour.

Summary: We recommend eating twice as healthy, not eating for two. Avoid soft cheese, raw eggs and undercooked meats. Don't avoid allergenic food that you are not allergic to.

The Raising Children Network has a great section on Healthy Eating For Pregnancy. The most important point is to eat healthy - two serves of fruit and five serves of vegetables daily in particular. There are some foods to avoid, in particular foods that are prone to Listeria and Salmonella like soft cheese, raw eggs and undercooked meats. There has been a variety of advice regarding foods that can trigger allergies like peanuts, eggs and milk. The current recommendation is that pregnant women should not be avoiding foods that they are not allergic to. If you have allergies or any questions please seek advice from your doctor or your obstetrician.

Food Standards Australia also has a general section on Pregnancy and Healthy Eating for women who are planning pregnancy or who are pregnant.

The Royal College of Obstetricians and Gynaecologists have also produced two brochures Healthy Eating and Vitamin Supplements and Why Weight Matters.

Summary: In most cases we recommend daily supplementation of Iodine, 150 micrograms for at least one month before pregnancy, throughout the pregnancy and while breastfeeding.

Iodine is an essential nutrient that we all need in small amounts. Iodine is stored in the thyroid however because the thyroid can only store small amounts any excess is lost through excretion. The National Health and Medical Research Council is preparing to undertake a review of Nutrient Reference Values (NRV) including iodine. The main health concern of mild iodine deficiency during pregnancy and breastfeeding is its negative effect on the brain and nervous system of unborn children and infants.

The Mater Mothers site also has an excellent discussion on Iodine Supplements in Pregnancy.

Summary: Nausea & vomiting (morning sickness) is common but usually only requires treatment in severe cases.

Nausea and vomiting (commonly called morning sickness) is a common problem, especially during the first 12 weeks of pregnancy. However it can occur at any time of day (not just the morning) and in a small number of cases can persist through the whole pregnancy. In most cases it can be managed without medication however in some cases it can lead to weight loss and dehydration and may require treatment. Queensland Health have prepared a brochure on Managing Morning Sickness. RCOG also has information on Nausea In Pregnancy (pregnancy sickness).

Summary: We recommend the Influenza vaccine and Diphtheria, Tetanus, and Pertussis containing vaccines.

The Australian Immunisation Handbook has an excellent section on Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants. In general, the Influenza vaccine and Diphtheria, Tetanus, and Pertussis containing vaccines are recommended and other vaccinations are not routinely recommended. However, your personal circumstances are very important in this regard so please seek advice from your doctor or obstetrician particularly if you are planning to travel overseas.

Summary: Babies may have a different blood group to their mother because they can inherit a different one from their father. All pregnant women should have a blood test at their first antenatal visit to check their blood group and to look for the presence of anti-red blood cell antibodies. If prophylaxis or treatment is required, we will discuss with you.

Your body has the natural ability to recognise any germs in your bloodstream and to produce protective immune factors called antibodies. These antibodies help to destroy germs and defend you from infections. Once you develop these antibodies, your body can quickly recognise that particular germ and produce antibodies targeted against it. This process is called immunisation. Your immune system can have a similar antibody reaction if cells from a different person enter your blood stream. This process is called alloimmunisation. A woman may become alloimmunised because of a previous blood transfusion. However, it most commonly occurs because of a previous pregnancy. This is because very tiny amounts of baby’s blood may cross the placenta into the mother’s bloodstream during birth and stimulate an antibody reaction in the mother. These antibodies may then affect the next pregnancy. Approximately 85 per cent of pregnancy alloimmunisation involves the Rhesus blood group.

All pregnant women should have a blood test at their first antenatal visit to check their blood group and to look for the presence of anti-red blood cell antibodies. About one per cent of women will have anti-red blood cell antibodies detected in pregnancy and require further follow up.

Women who do not have anti-red blood cell antibodies but have a Rhesus ‘negative’ blood group will need further blood tests at 28 weeks gestation and at the time of delivery. About 15 per cent of women fall into this group.

RANZCOG have produced a Patient Information Resource on Red Blood Cell Alloimmunisation with additional information.

The Australian Red Cross Blood Service has some information on Anti-D prophylaxis but if you have any questions we strongly recommend you seek advice from your doctor or your obstetrician.

Summary: If we feel additional testing or screening is advised we will discuss the implications with you. If you have questions on the different types of testing or screening available please do not hesitate to Contact Us to arrange a consultation.

With advances in medical knowledge have come advances in the types of tests that are available to pregnant women, for example testing for genetic defects. Historically, some testing (for example an amniocentisis or chorionic villus sampling (CVS)) has been associated with an increased risk of miscarriage which can lead to difficult decisions for pregnant women. Increasingly non invasive screening is possible (commonly called Non-invasive Prenatal Test or NIPT) which eliminates some of the increased risks. However these are screening tests that advise on statistical levels of risk and further testing is sometimes necessary to provide certainty. RANZCOG have produced a Patient Information Resource for prenatal testing.

Cystic Fibrosis: To have a child with cystic fibrosis, both parents must be a carrier of the gene changes that cause cystic fibrosis. If both parents are carriers , then with each pregnancy there is a 25% risk of that child having cystic fibrosis. Cystic Fibrosis Australia has extensive information available on cystic fibrosis.

Down Syndrome: Down syndrome, or trisomy 21, is a genentic condition. The rate of Australian babies born with Down syndrome is approximately 1:1,100. Down syndrome is caused by an extra chromosome 21 (hence the name trisomy 21). Down syndrome Australia has extensive information available on Down syndrome.

Amniocentesis and Chorionic Villus Sampling: In some circumstances we may recommend additional testing. It can be a difficult decision for pregnant women to make due to research showing an increased incidence of miscarriage following these test. RANZCOG have produced Patient Information Resources on Amniocentesis and Chorionic Villus Sampling. The RCOG have produced a brochure on Amniocentesis and Chorionic Villus Sampling

Harmony Prenatal Screening Test: The Harmony Prenatal Test is a blood screening test for trisomies 21 (Down syndrome), 18, and 13 that delivers accurate results from as early as 10 weeks of pregnancy. Further information can be found on the Harmony Prenatal Test website.

Summary: In general, flying is not harmful for you or your baby but you must carefully check the terms and conditions of your airline carrier before making a booking. Take steps to minimise the risk of a DVT.

The RCOG has produced an excellent brochure on Air Travel and Pregnancy. In general - for an uncomplicated pregnancy - flying is not harmful for you or your baby. However - many airlines have implemented their own policies in this regard so it is important that you careful check the terms and conditions associated with your airline carrier before making a booking. Some airlines will require you to hold a certificate from your doctor that is no more than 10 days old stating that you are "fit to fly", while others may ban you from flying from as early as 28 weeks gestation.

There is an increased risk of developing a Deep Vein Thrombosis (DVT) while flying, due to sitting for a prolonged length of time. Pregnant women also have a higher risk of developing a DVT compared with women who are not pregnant so it is important to take steps to reduce the risk of a DVT, see the RCOG brochure for more information.

RANZCOG have produced a Patient Information Resource on Travel with additional information.

Summary: We recommend eliminating exposure to smoking (direct and 'second hand') both before and during pregnancy.

Smoking in particular can have many serious negative impacts on pregnancy and development. While there are many 'bad' chemicals in cigarettes, nicotine and carbon monoxide in particular can reduce the supply of oxygen to the developing baby. We strongly recommend that pregnant mothers do not smoke and that family members and friends abstain from smoking around pregnant women. The Royal College of Obstetricians and Gynaecologist has produced this leaflet on Smoking and Pregnancy. There are also resources like Quitline to help with strategies to reduce or quit smoking.

Summary: We recommend eliminating exposure to alcohol both before and during pregnancy.

Alcohol consumption in pregnancy can be a little controversial and over the last 20 years the official stance on whether low levels of alcohol consumption is safe in pregnancy has shifted a couple of times. However the official recommendation since around 2009 and our recommendation is that pregnant women should not consume alcohol. The reason for the controversy was, in part, because the linkage between very low levels of alcohol intake and harm was inconclusive. However what has been conclusively shown is that the threshold level at which harm can occur is small and, given such a small threshold before harm occurs, the most responsible recommendation is to recommend abstinence. The Royal College of Obstetricians and Gynaecologist has produced this leaflet on Alcohol and Pregnancy.

Summary: Please seek advice from your doctor or your obstetrician before pregnancy if you routinely take medications or drugs.

It is not possible to effectively cover prescription medications without taking into account your personal circumstances. However, in nearly all cases your prescription medication requirements can be accommodated through effective consultation with your doctor and your obstetrician. If you are considering pregnancy and are on prescription medications or other drugs we recommend you Contact Us to arrange a consultation so that your personal circumstances can be properly assessed.

Just as in day-to-day living it is possible to become ill, the same applies while pregnant. If you have any particular concerns we recommend you Contact Us to arrange a consultation. However the RCOG have prepared a number of information brochures that may be of assistance.

• Chickenpox
• Genital Herpes and Pregnancy
• Malaria and pregnancy
• Epilepsy In Pregnancy

Summary: It is important that a nuchal transluceny screening test is taken at 12 weeks to identify an increased risk of genetic complications.

A nuchal translucency scan is a measure of the thickness of the fluid at the back of the baby's neck. The reason for taking this measurement is because research has shown that if the fluid is thicker than normal it can reflect an increased risk of Trisomy 18, Down syndrome or other complications. It is a screening test, so it is not definitive but it can show an increased risk. If you have an increased risk of genetic complications it may be strongly recommended to undertake a diagnostic test like Chorionic Villus Sampling or Amniocentesis to determine definitively if there is a concern.

In a small number of cases there are some less common complications that can occur in the first trimester. In particular, early miscarriage can be particularly traumatic especially in cases of IVF or where there is a history of difficulty conceiving. Bears Of Hope is one organisation that can provide information and support to try and help in these difficult circumstances. The RCOG have prepared a number of brochures that cover some of the less common complications:

• Bleeding and pain in early pregnancy
• Early Miscarriage
• Recovery from surgical management of miscarriage
• Recurrent Miscarriage
• Ectopic pregnancy
• Gestational Trophoblastic Disease