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Any woman who has gone through a miscarriage can attest to how upsetting the experience can be. Women who are also dealing with infertility can find the emotional pain of dealing with a miscarriage to be particularly overwhelming, leaving them with a lot of miscarriage questions. While suffering a miscarriage can make a woman feel alone and isolated, dealing with a pregnancy loss is actually very common.

 

What is a Miscarriage?
The term miscarriage refers to the loss of a fetus up to the 20th week of pregnancy. After the 20th week, loss of the fetus is known as a stillbirth. It is estimated that between 15% and 20% of all recognized pregnancies end in miscarriage. The risk of miscarriage is typically highest during the first 12 weeks of pregnancy. A blighted ovum accounts for 30% of miscarriages that occur prior to the eighth week of pregnancy.

While there is nothing abnormal about experiencing one miscarriage before achieving a successful pregnancy, some couples may deal with multiple miscarriages. Recurrent pregnancy loss affects 0.5% to 1% of all pregnancies. If you are experiencing recurrent miscarriage, it is important to make an appointment for a medical evaluation. Repeated losses may indicate fertility problems that should be investigated.

Miscarriage Symptoms
Typically, the most obvious signs of miscarriage are bleeding and abdominal cramping. Although some light vaginal bleeding is common during the first trimester, heavy bleeding is not. Other miscarriage symptoms include:

severe abdominal pain
backache
chills or running a fever

If you notice any of these symptoms of miscarriage, contact your healthcare provider right away or head to your nearest hospital emergency room.

Miscarriage Causes
The most often cited reason for a miscarriage is genetic abnormalities with the fetus, which is believed to account for as much as 60% of all miscarriages. These abnormalities are not thought to pose any problems for future pregnancies.

Other less common causes of miscarriage include:

Uterine infection
Use of alcohol, cigarettes, recreational drugs and certain medications
Poor production of progesterone early in pregnancy
Uterine abnormalities
Fibroids (can occasionally interfere with implantation)
Immunological factors (thought to possibly account for as much as 25% of all repeated miscarriages)

In general, if a woman has only had one miscarriage, it is unlikely that any medical evaluation to determine the cause will be initiated. This is because as much as 90% of women go on to have a normal, healthy pregnancy after a single miscarriage. If you have had two or more consecutive miscarriages, though, your healthcare provider will probably want to investigate the issue.

To determine the miscarriage cause, a pelvic exam will likely be done. During this time, your healthcare provider will examine the size and shape of your uterus as well as take a sample from the cervix and vagina to test for infection. Blood tests for both partners will also be ordered to see if any chromosomal abnormalities or hormonal imbalances in either partner can be detected. Finally, if possible, the miscarried fetus will be evaluated for chromosomal abnormalities or any other reasons that can give insight as to why the miscarriage occurred.

Miscarriage Prevention
While there is no surefire way to avoid a miscarriage, there are numerous steps you can take to lower your risk.

Follow a healthy diet and exercise regularly
Quit smoking and cut out alcohol before you start trying to conceive
Avoid using recreational drugs
If you are using prescribed medications, speak with your doctor about how these medications may interfere with your fertility and discuss the option of switching if necessary
Begin taking folic acid supplements before you are pregnant

Women with chronic conditions, such as diabetes or thyroid problems, should have these disorders under control before becoming pregnant. Poor management of a chronic illness can contribute to recurrent pregnancy loss.

In women who have experienced multiple miscarriages, treatment may be possible for the underlying cause. Genetic counseling in those who have been found to have a chromosomal problem is a possibility. Structural problems with the uterus may be fixed through surgery, although this won’t necessarily guarantee a successful pregnancy. It is possible that some other factor which was missed is actually contributing to the repeat miscarriages.

When necessary, the use of certain medications, including heparin, baby aspirin and IVIg therapy, can be helpful. If porr progesterone production is a factor, progesterone supplements may be administered.

Although no treatment can assure a pregnancy, achieving a successful pregnancy after miscarriage is entirely possible. Discussing your desire for children with your health care provider before you start trying to conceive can help you assess your risk for miscarriage.

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Pregnancy and Childbirth

I

INTRODUCTION

Pregnancy and Childbirth, terms for the gestation period of the human reproductive cycle.

II

PREGNANCY

Pregnancy starts when a male’s sperm fertilizes a female’s ovum (egg), and the fertilized ovum implants in the lining of the uterus (see Fertilization; Reproductive System). Because pregnancy changes a woman’s normal hormone patterns, one of the first signs of pregnancy is a missed menstrual period (see Menstruation). Other symptoms include breast tenderness and swelling, fatigue, nausea or sensitivity to smells, increased frequency of urination, mood swings, and weight gain. Some women also experience cravings for unusual substances such as ice, clay, or cornstarch; this condition, called pica, can indicate a dietary deficiency in iron or other nutrients. By the 12th week of pregnancy many of these symptoms have subsided, but others appear. For example, a woman’s breasts usually increase in size, and her nipples darken. The most obvious symptom is weight gain; most physicians now recommend a gain of about 9 to 12 kg (about 22 to 26 lb) by the end of pregnancy.

The first few months of pregnancy are the most critical for the developing infant, because during this period the infant’s brain, arms, legs, and internal organs are formed. For this reason a pregnant woman should be especially careful about taking any kind of medication except on the advice of a physician who knows that she is pregnant. X rays should also be avoided, and pregnant women should avoid smoking and alcohol consumption.

III

COMPLICATIONS

Most women worry about the health of their unborn child, especially mothers over the age of 35, when genetic problems are more common. Safe, effective tests are available that can detect genetic disorders which cause mental retardation and other problems. The most common test is amniocentesis, and in about 95 percent of the cases tested the baby is found to be normal. Some doctors recommend that all pregnant women over the age of 35 have an amniocentesis test.

Although most pregnancies proceed normally, certain complications can develop. One rare but life-threatening complication is ectopic pregnancy, in which the fertilized egg implants outside the uterus, in the abdomen, or in a fallopian tube. Symptoms include sudden, intense pain in the lower abdomen about the seventh or eight week of pregnancy. If not promptly treated by surgical means, ectopic pregnancy can result in massive internal bleeding and possibly death.

About 15 percent of all pregnancies end in miscarriage, most of which occur between the 4th and 12th weeks of pregnancy. A physician should be contacted immediately if a woman suspects that she is pregnant and then experiences severe abdominal cramping or vaginal bleeding.

Toxemia is another potentially serious complication of late pregnancy. Symptoms include high blood pressure; rapid, large weight gain, due to edema (swelling), of as much as 11 to 13 kg (25 to 30 lb) in a month; and protein in the urine. If untreated, toxemia can lead to seizures and coma and death of the infant. Once severe toxemia is diagnosed, the infant is usually delivered as soon as possible to protect both mother and child. The condition disappears with birth.

IV

LABOR AND CHILDBIRTH

A normal pregnancy lasts about 40 weeks, or 280 days, after the beginning of the last menstrual period. Occasionally women go into labor before the expected date of birth, resulting in a premature infant. About 7 percent of all infants are premature—that is, born before the 37th week of pregnancy. Babies born just a few weeks early usually develop normally. Recent advances in the care of premature infants now allow many babies who are born after only 25 to 26 weeks of pregnancy to survive. Even babies born after only 23 weeks of pregnancy have survived, although survival rates for such highly premature infants are low.

Delivery, the process by which the baby is expelled from the uterus through the birth canal and into the world, begins with irregular contractions of the uterus that occur every 20 to 30 minutes. As labor progresses, the contractions increase in frequency and severity. The usual length of labor for a first-time mother is about 13 to 14 hours, and about 8 or 9 hours in a woman who has given birth previously. Wide variations exist, however, in the duration of labor.

Most women prefer some kind of anesthesia to alleviate the pain associated with childbirth. Natural (unmedicated) childbirth, however, is becoming more popular, in part because many women are aware and concerned that the anesthesia and medication given to them is rapidly transported across the placenta to the unborn baby. Heavy doses of anesthesia can make the newborn baby less alert after birth.

Other options available regarding childbirth include regional (local) anesthesia, in which only those areas of the mother that are affected by the pain of childbirth are numbed. Such anesthesias include a lower spinal block and epidural anesthesia, in which the pelvic region is anesthetized. Another option is cesarean section, in which the baby is surgically removed from the uterus. Cesarean section is usually performed only for a specific medical reason.

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also called  Extrauterine Pregnancy,

In tubal ectopic pregnancy the ovum becomes implanted in one of the fallopian tubes. This condition is not uncommon, occurring about once in 250 to 300 pregnancies and more frequently in blacks than Caucasians. It may be brought about by anything that interferes with the propulsion of the fertilized ovum from the fallopian tube toward the uterine cavity—e.g., inflammation of the fallopian tube, developmental malformation of the sacs within its canal, or kinking of the tube.

If transport to the uterus is sufficiently delayed, the ovum becomes too large for easy passage and becomes imbedded in the wall of the fallopian tubule. Tubal ectopic pregnancy in early stages is similar in some respects to normal pregnancy; implantation of the ovum in the tubal wall is much like that which occurs in the uterus. Also, as pregnancy begins to develop, placental tissue, like that of intrauterine gestation, develops. Eventually, however, the placenta removes itself from the tubal wall, and the fetus is discharged as a whole mass or in smaller fragments if it disintegrates.

The symptoms of tubal ectopic pregnancy in early stages are so minor that they might be ignored by the patient. Depending upon the part of the tube in which the ovum has become implanted, the tubal pregnancy can abort, through tubal rupture, any time from 6 to 18 weeks after cessation of menstrual periods (on occasion there will be no history of missed periods). Once the fetus begins to disintegrate or is discharged, bleeding will follow.

Pain is associated at some time with nearly every tubal pregnancy. During the final stages of separation and expulsion in a tubal pregnancy, the patient experiences pain and bleeding. Surgical exploration of the abdomen and removal of the affected tube and replacement of lost blood are often essential to prevent death.

Ovarian ectopic pregnancy is a relatively rare condition in which the ovum is fertilized before its discharge from the follicle. Symptoms, termination, and treatment are similar to those of tubal pregnancy, but gestation may progress slightly further before rupture and bleeding occur.

Abdominal ectopic pregnancy occurs when the placenta is attached to some part of the peritoneal cavity other than the uterus or tube. While a few of these pregnancies are a result of implantation in the abdominal lining, most are the result of expulsion of a tubal pregnancy. The condition can be suspected in the first three months of pregnancy if pain and bleeding are experienced. Abdominal pregnancy can reach term. Prompt surgical removal of the fetus is necessary, because an unrecognized and untreated abdominal pregnancy can result in infection or calcification leading to the formation of a lithopedion (calcified dead fetus) and death of the mother.

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Biological Tests of Pregnancy

Outward early indications of pregnancy are missed menstrual periods, morning nausea, and fullness and tenderness of the breasts; but the positive and certain signs of gestation are the sounds of the fetal heartbeat, which are audible with a stethoscope between the 16th and the 20th week of pregnancy; ultrasound images of the growing fetus, which can be observed throughout pregnancy; and fetal movements, which usually occur by the 18th to the 20th week of pregnancy.

Persons who note their body temperature upon awakening, as many women do who wish to know when they are ovulating, may observe continued elevation of the temperature curve well beyond the time of the missed period; this is strongly suggestive of pregnancy.

During the early months of pregnancy, women may notice that they urinate frequently, because of pressure of the enlarging uterus on the bladder; feel tired and drowsy; dislike foods that were previously palatable; have a sense of pelvic heaviness; and are subject to vomiting (which can be severe) and to pulling pains in the sides of the abdomen, as the growing uterus stretches the round ligaments that help support it, singly or together. Most of these symptoms subside as pregnancy progresses. The signs and symptoms of pregnancy are so definite by the 12th week that the diagnosis is seldom a problem.

Biological tests for pregnancy depend upon the production by the placenta (the temporary organ that develops in the womb for the nourishing of the embryo and the elimination of its wastes) of chorionic gonadotropin, an ovary-stimulating hormone.

In practice, the tests have an accuracy of about 95 percent, although false-negative tests may run as high as 20 percent in a series of cases. False-negative reports are frequently obtained during late pregnancy when the secretion of chorionic gonadotropin normally decreases. The possibility not only of false-negative but also of false-positive tests makes the tests, at best, probable rather than absolute evidence of the presence or absence of pregnancy. Chorionic gonadotropin in a woman’s blood or urine indicates only that she is harbouring living placental tissue. It does not tell anything about the condition of the fetus. In fact, the greatest production of chorionic gonadotropin occurs in certain placental abnormalities and disorders that can develop in the absence of a fetus.

Tests using immature mice (the Aschheim-Zondek test) and immature rats have been found to be extremely accurate. Tests using rabbits (the Friedman test) have been largely replaced by the more rapid and less expensive frog and toad tests.

The use of the female South African claw-toed tree toad, Xenopus laevis, is based on the discovery that this animal will ovulate and extrude visible eggs within a few hours after it has received an injection of a few millilitres of urine from a pregnant woman. The male common frog, Rana pipiens, will extrude spermatozoa when treated in the same way. Both of these tests are considered somewhat unsatisfactory because false-positive reactions are not uncommon.

Several immunological reaction tests in common use are based upon the inhibition of hemagglutination (clotting of red cells). A positive test is obtained when human chorionic gonadotropin (HCG) in the woman’s urine or blood is added to human chorionic gonadotropin antiserum (rabbit blood serum containing antibodies to HCG) in the presence of particles (or red blood cells) coated with human chorionic gonadotropin. The hormone from the woman will inhibit the combination of coated particles and antibody, and agglutination does not occur. If there is no chorionic gonadotropin in her urine, agglutination will occur and the test is negative.

Several “signs” noted by the physician during an examination will suggest that a patient may be in the early months of pregnancy. Darkening of the areola of the breast (the small, coloured ring around the nipple) and prominence of the sebaceous glands around the nipple (Montgomery’s glands); purplish-red discoloration of the vulvar, vaginal, and cervical tissues; softening of the cervix and of the lower part of the uterus and, of course, enlargement and softening of the uterus itself are suggestive but not necessarily proof of pregnancy.

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Bleeding may occur at various times in pregnancy. Although bleeding is alarming, it may or may not be a serious complication. The time of bleeding in the pregnancy, the amount, and whether or not there is pain may vary depending on the cause.

Bleeding in the first trimester of pregnancy is quite common and may be due to the following:

miscarriage (pregnancy loss)
ectopic pregnancy (pregnancy in the fallopian tube)
gestational trophoblastic disease (a rare condition that may be cancerous in which a grape-like mass of fetal and placental tissues develops)
implantation of the placenta in the uterus
infection

Bleeding in late pregnancy (after about 20 weeks) may be due to the following:

placenta previa (placenta is near or covers the cervical opening)
placental abruption (placenta detaches prematurely from the uterus)
unknown cause
What is placenta previa?

Placenta previa is a condition in which the placenta is attached close to or covering the cervix (opening of the uterus). Placenta previa occurs in about one in every 200 live births. There are three types of placenta previa:

total placenta previa – the placenta completely covers the cervix.

 

partial placenta previa – the placenta is partially over the cervix.

 

marginal placenta previa – the placenta is near the edge of the cervix.
What causes placenta previa?

The cause of placenta previa is unknown, but it is associated with certain conditions including the following:

women who have scarring of the uterine wall from previous pregnancies
women who have fibroids or other abnormalities of the uterus
women who have had previous uterine surgeries or cesarean deliveries
older mothers (over age 35)
African-American or other minority race mothers
cigarette smoking
placenta previa in a previous pregnancy
Why is placenta previa a concern?

The greatest risk of placenta previa is bleeding (or hemorrhage). Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This causes the area of the placenta over the cervix to bleed. The more of the placenta that covers the cervical os, the greater the risk for bleeding. Other risks include the following:

abnormal implantation of the placenta
slowed fetal growth
preterm birth
birth defects
infection after delivery
What are the symptoms of placenta previa?

The most common symptom of placenta previa is vaginal bleeding that is bright red and not associated with abdominal tenderness or pain, especially in the third trimester of pregnancy. However, each woman may exhibit different symptoms of the condition or symptoms may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is placenta previa diagnosed?

In addition to a complete medical history and physical examination, an ultrasound (a test using sound waves to create a picture of internal structures) may be used to diagnose placenta previa. An ultrasound can show the location of the placenta and how much is covering the cervix. A vaginal ultrasound may be more accurate in diagnosis.

Although ultrasound may show a low-lying placenta in early pregnancy, only a few women will develop true placenta previa. It is common for the placenta to move upwards and away from the cervix as the uterus grows, called placental migration.

Treatment for placenta previa:

Specific treatment for placenta previa will be determined by your physician based on:

your pregnancy, overall health, and medical history
extent of the condition
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

There is no treatment to change the position of the placenta. Once placenta previa is diagnosed, additional ultrasound examinations are often performed to track its location. It may be necessary to deliver the baby, depending on the amount of bleeding, the gestational age, and condition of the fetus. Cesarean delivery is necessary for most cases of placenta previa. Severe blood loss may require a blood transfusion.

What is placental abruption?

Placental abruption is the premature separation of a placenta from its implantation in the uterus. Within the placenta are many blood vessels that allow the transfer of nutrients to the fetus from the mother. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. The larger the area that detaches, the greater the amount of bleeding. Placental abruption occurs about once in every 120 births. It is also called abruptio placenta.

What causes placental abruption?

Other than direct trauma to the uterus such as in a motor vehicle accident, the cause of placental abruption is unknown. It is, however, associated with certain conditions, including the following:

previous pregnancy with placental abruption
hypertension (high blood pressure)
cigarette smoking
multiple pregnancy
Why is placental abruption a concern?

Placental abruption is dangerous because of the risk of uncontrolled bleeding (hemorrhage). Although severe placental abruption is rare, other complications may include the following:

hemorrhage and shock
disseminated vascular coagulation (DIC) – a serious blood clotting complication.
poor blood flow and damage to kidneys or brain
stillbirth
postpartum (after delivery) hemorrhage
What are the symptoms of placental abruption?

The most common symptom of placental abruption is dark red vaginal bleeding with pain during the third trimester of pregnancy. It also can occur during labor. However, each woman may experience symptoms differently. Symptoms may include:

vaginal bleeding
abdominal pain
uterine contractions that do not relax
blood in amniotic fluid
nausea
thirst
faint feeling
decreased fetal movements

The symptoms of placental abruption may resemble other medical conditions. Always consult your physician for a diagnosis.

How is placental abruption diagnosed?

The diagnosis of placental abruption is usually made by the symptoms, and the amount of bleeding and pain. Ultrasound may also be used to show the location of the bleeding and to check the fetus. There are three grades of placental abruption, including the following:

 

 

Grade 1 – small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother.
Grade 2 – mild to moderate amount of bleeding, uterine contractions, the fetal heart rate may shows signs of distress.
Grade 3 – moderate to severe bleeding or concealed (hidden) bleeding, uterine contractions that do not relax (called tetany), abdominal pain, low blood pressure, fetal death.

Sometimes placental abruption is not diagnosed until after delivery, when an area of clotted blood is found behind the placenta.

Treatment for placental abruption:

Specific treatment for placental abruption will be determined by your physician based on:

your pregnancy, overall health, and medical history
extent of the disease
tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

There is no treatment to stop placental abruption or reattach the placenta. Once placental abruption is diagnosed, a woman’s care depends on the amount of bleeding, the gestational age, and condition of the fetus. Cesarean delivery is performed for most cases of placental abruption and emergency delivery may be needed if hemorrhage occurs. Severe blood loss may require a blood transfusion.

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Blood is the life-maintaining fluid that circulates through the body’s heart, arteries, veins, and capillaries. It carries away waste matter and carbon dioxide, and brings nourishment, electrolytes, hormones, vitamins, antibodies, heat, and oxygen to the tissues.

What is anemia?

Anemia is a condition of too few red blood cells, or a lowered ability of the red blood cells to carry oxygen or iron. Tissue enzymes dependent on iron can affect cell function in nerves and muscles. The fetus is dependent on the mother’s blood and anemia can cause poor fetal growth, preterm birth, and low birthweight.

What are the most common types of anemias to occur during pregnancy?

There are several types of anemias that may occur in pregnancy. These include:

anemia of pregnancy
In pregnancy, a woman’s blood volume increases by as much as 50 percent. This causes the concentration of red blood cells in her body to become diluted. This is sometimes called anemia of pregnancy and is not considered abnormal unless the levels fall too low.
iron deficiency anemia
During pregnancy, the fetus uses the mother’s red blood cells for growth and development, especially in the last three months of pregnancy. If a mother has excess red blood cells stored in her bone marrow before she becomes pregnant, she can use those stores during pregnancy to help meet her baby’s needs. Women who do not have adequate iron stores can develop iron deficiency anemia. This is the most common type of anemia in pregnancy. It is the lack of iron in the blood, which is necessary to make hemoglobin – the part of blood that distributes oxygen from the lungs to tissues in the body. Good nutrition before becoming pregnant is important to help build up these stores and prevent iron deficiency anemia.
vitamin B12 deficiency
Vitamin B12 is important in forming red blood cells and in protein synthesis. Women who are vegans (who eat no animal products) are most likely to develop vitamin B12 deficiency. Including animal foods in the diet such as milk, meats, eggs, and poultry can prevent vitamin B12 deficiency. Strict vegans usually need supplemental vitamin B12 by injection during pregnancy.
blood loss
Blood loss at delivery and postpartum (after delivery) can also cause anemia. The average blood loss with a vaginal birth is about 500 milliliters, and about 1,000 milliliters with a cesarean delivery. Adequate iron stores can help a woman replace lost red blood cells.
folate deficiency
Folate, also called folic acid, is a B-vitamin that works with iron to help with cell growth. Folate deficiency in pregnancy is often associated with iron deficiency since both folic acid and iron are found in the same types of foods. Research shows that folic acid may help reduce the risk of having a baby with certain birth defects of the brain and spinal cord if taken before conception and in early pregnancy.
What are the symptoms of anemia?

Women with anemia of pregnancy may not have obvious symptoms unless the cell counts are very low. The following are the most common symptoms of anemia. However, each woman may experience symptoms differently. Symptoms may include:

pale skin, lips, nails, palms of hands, or underside of the eyelids
fatigue
vertigo or dizziness
labored breathing
rapid heartbeat (tachycardia)

The symptoms of anemia may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is anemia diagnosed?

Anemia is usually discovered during a prenatal examination through a routine blood test for hemoglobin or hematocrit levels. Diagnostic procedures for anemia may include additional blood tests and other evaluation procedures.

hemoglobin – the part of blood that distributes oxygen from the lungs to tissues in the body.
hematocrit – the measurement of the percentage of red blood cells found in a specific volume of blood.
Treatment for anemia:

Specific treatment for anemia will be determined by your physician based on:

your pregnancy, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

Treatment depends on the type and severity of anemia. Treatment for iron deficiency anemia includes iron supplements. Some forms are time-released, while others must be taken several times each day. Taking iron with a citrus juice can help with the absorption into the body. Antacids may decrease absorption of iron. Iron supplements may cause nausea and cause stools to become dark greenish or black in color. Constipation may also occur with iron supplements.

Prevention of anemia:

Good pre-pregnancy nutrition not only helps prevent anemia, but also helps build other nutritional stores in the mother’s body. Eating a healthy and balanced diet during pregnancy helps maintain the levels of iron and other important nutrients needed for the health of the mother and growing baby.

Good food sources of iron include the following:

meats – beef, pork, lamb, liver, and other organ meats
poultry – chicken, duck, turkey, liver (especially dark meat)
fish – shellfish, including clams, mussels, oysters, sardines, and anchovies
leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards
legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans
yeast-leavened whole-wheat bread and rolls
iron-enriched white bread, pasta, rice, and cereals

The following is a list of foods that are a good source of iron. Always consult your physician regarding the recommended daily iron requirements.

Iron-Rich Foods

Quantity

Approximate Iron
Content (milligrams)

Oysters

3 ounces

13.2

Beef liver

3 ounces

7.5

Prune juice

1/2 cup

5.2

Clams

2 ounces

4.2

Walnuts

1/2 cup

3.75

Ground beef

3 ounces

3.0

Chickpeas

1/2 cup

3.0

Bran flakes

1/2 cup

2.8

Pork roast

3 ounces

2.7

Cashew nuts

1/2 cup

2.65

Shrimp

3 ounces

2.6

Raisins

1/2 cup

2.55

Sardines

3 ounces

2.5

Spinach

1/2 cup

2.4

Lima beans

1/2 cup

2.3

Kidney beans

1/2 cup

2.2

Turkey, dark meat

3 ounces

2.0

Prunes

1/2 cup

1.9

Roast beef

3 ounces

1.8

Green peas

1/2 cup

1.5

Peanuts

1/2 cup

1.5

Potato

1

1.1

Sweet potato

1/2 cup

1.0

Green beans

1/2 cup

1.0

Egg

1

1.0

Vitamin supplements containing 400 micrograms of folic acid are now recommended for all women of childbearing age and during pregnancy. These supplements are needed because natural food sources of folate are poorly absorbed and much of the vitamin is destroyed in cooking. Food sources of folate include the following:

leafy, dark green vegetables
dried beans and peas
citrus fruits and juices and most berries
fortified breakfast cereals
enriched grain products

 

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What to do before (and during) your next pregnancy to lessen the chance for birth defects?

If you are planning to become pregnant, taking certain steps can help reduce risks to both you and your baby. Proper health before deciding to become pregnant is almost as important as maintaining a healthy body during pregnancy.

The first few weeks are crucial in a child’s development. However, many women do not realize they are pregnant until several weeks after conception. Planning ahead and taking care of yourself before becoming pregnant is the best thing you can do for you and your baby.

One of the most important steps in helping you prepare for a healthy pregnancy is a pre-pregnancy examination (often called preconception care) performed by your physician before you become pregnant. A preconception visit includes assessments of your overall health and identification of potential risk factors that may complicate pregnancy. Women can receive advice and treatment for medical conditions such as diabetes or heart disease that may be changed by pregnancy. By preparing in advance, you can be your healthiest before becoming pregnant. A preconception examination may include any/all of the following:

family medical history – an assessment of the maternal and paternal medical history – to determine if any family member has had any medical conditions such as high blood pressure, diabetes, and/or mental retardation.
genetic testing – an assessment of any possible genetic disorders – as several genetic disorders may be inherited, such as sickle cell anemia (a serious blood disorder which primarily occurs in African-Americans) or Tay-Sachs disease (a nerve breakdown disorder marked by progressive mental and physical retardation which primarily occurs in individuals of Eastern European Jewish origin). Some genetic disorders can be detected by blood tests before pregnancy.
personal medical history – an assessment of your personal medical history to determine if there are any of the following:
medical conditions that may require special care during pregnancy , such as epilepsy, diabetes, high blood pressure, anemia, and/or allergies
previous surgeries
past pregnancies – including the number, length of pregnancy (gestation), previous pregnancy complications, and/or pregnancy losses
vaccination status – an assessment of current vaccinations/inoculations to assess immunity to rubella (German measles), in particular, since contracting this disease during pregnancy can cause miscarriage or birth defects. If a woman is not immune, a vaccine may be given at least 3 months before conception to provide immunity.
infection screening – to determine if a woman has a sexually transmitted infection or urinary tract infection (or other infection) that could be harmful to the fetus and to the mother.
Reducing the risk of complications:

Other steps that can help reduce the risk of complications and help prepare for a healthy pregnancy and delivery include the following:

smoking cessation
If you are a smoker, stop smoking now. Studies have shown that babies born to mothers who smoke tend to be lower in birthweight. In addition, exposure to secondhand smoke may adversely affect the fetus.
proper diet
Eating a balanced diet before and during pregnancy is not only good for the mother’s overall health, but essential for nourishing the fetus.
proper weight and exercise
It is important to exercise regularly and maintain a proper weight before and during pregnancy. Women who are overweight may experience medical problems such as high blood pressure and diabetes. Women who are underweight may have babies with low birthweight.
medical management (of preexisting conditions)
Take control of any current or preexisting medical problems, such as diabetes or high blood pressure.
preventing birth defects
Take 400 micrograms (0.4 mg) of folic acid each day, a nutrient found in some green leafy vegetables, nuts, beans, citrus fruits, fortified breakfast cereals, and some vitamin supplements. Folic acid can help reduce the risk of birth defects of the brain and spinal cord (also called neural tube defects). If you have a family history of spina bifida, congenital heart defects (heart defects present in a newborn), or cleft lip/palate, your physician may prescribe extra folic acid based on your family history.
avoid exposure to alcohol and drugs during pregnancy
Be sure to inform your physician of any medications (prescription and over-the-counter) and/or herbal supplements you are currently taking – all may have adverse effects on the developing fetus.
avoid exposure to harmful substances
Pregnant women should avoid exposure to toxic and chemical substances (i.e., lead and pesticides), and radiation (i.e., x-rays). Exposure to high levels of some types of radiation and some chemical and toxic substances may adversely affect the developing fetus.
infection control
Pregnant women should avoid the ingestion of undercooked meat and raw eggs. In addition, pregnant women should avoid all contact and exposure to cat feces and cat litter, which may contain a parasite called toxoplasma gondii that causes toxoplasmosis. Other sources of infection include insects (i.e., flies) that have been in contact with cat feces and should be avoided during pregnancy. Toxoplasmosis can cause a serious illness in, or death of, the fetus. A pregnant woman can reduce her risk of infection by avoiding all potential sources of the infection. A blood test before or during pregnancy can determine if a woman has been exposed to the toxoplasma gondii parasite.
daily vitamins
Begin taking a prenatal vitamin daily, prescribed by your physician, to make certain that your body gets all the necessary nutrients and vitamins needed to nourish a healthy baby.
identifying domestic violence
Women who are abused before pregnancy may be at risk for increased abuse during pregnancy. Your physician can help you find community, social, and legal resources to help you deal with domestic violence.

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