What to expect when you're expecting (30 page)

1 cup chocolate milk = 5 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:

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).

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.

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.

“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 alert
ing 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.

“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.