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CHAPTER 1

Preparing for a New Baby

PREGNANCY IS A TIME of anticipation, excitement, and, for many new parents, uncertainty. You dream of a baby who will be strong, healthy, and bright — and you make plans to ensure her success. You probably also have fears and questions, especially if this is your first child, or if there have been problems with this or a previous pregnancy. What if something goes wrong during the pregnancy? What if labor and delivery are difficult? What if your expectations of being a parent aren't met? These are perfectly normal feelings and fears. The nine months of pregnancy will give you time to answer questions, calm fears, and prepare for the realities of parenthood.

Some of your initial concerns may already have been addressed if you had difficulty becoming pregnant, particularly if you sought fertility treatment. But now that you're pregnant, preparations for your new baby can begin. The best way to help your baby is to take care of yourself. Regular medical and dental attention and good nutrition directly benefit both you and your baby's health. Plenty of rest and moderate exercise will help ease the physical stresses of pregnancy. Talk to your physician about your health and your baby's health, including prenatal vitamins, and avoid smoking, alcohol, using drugs (including marijuana), and eating fish containing high levels of mercury. If you are taking any medications, check with your obstetrician about their safety during pregnancy.

As pregnancy progresses, you're confronted with a long list of decisions, from planning for the delivery to decorating the nursery. Many decisions may already have happened, but others may have been postponed because your baby doesn't seem "real." However, the more actively you prepare for your baby's arrival, the more real that child will seem.

You may find yourself constantly thinking about this baby-to-be. This preoccupation is perfectly normal and actually may help prepare you emotionally for the challenge of parenthood. After all, you'll be making decisions about your child for the next two decades — at least! Now is a perfect time to start.

Giving Your Baby a Healthy Start

Virtually everything you consume or inhale while pregnant will be passed through to the fetus. This process begins as soon as you conceive. In fact, the embryo is most vulnerable during the first two months, when the major body parts (arms, legs, hands, feet, liver, heart, genitalia, eyes, and brain) are just starting to form. The chemical substances in cigarettes, alcohol, illegal drugs, and certain medications can interfere with the developmental process, and some can even cause congenital abnormalities. For instance, if you smoke cigarettes during pregnancy, your baby's birth weight may be decreased. Even breathing in smoke from the cigarettes of others (passive smoking) can affect your baby. Stay away from smoking areas and ask smokers not to light up around you. If you're a smoker, this is the time to stop — not just until you give birth, but forever. Children who grow up in a home where someone smokes have a greater risk of sudden infant death syndrome (SIDS), more ear infections and more respiratory problems during infancy and early childhood, and even an increased risk of childhood obesity. They also have been shown to be more likely to smoke when they grow up.

Alcohol consumption during pregnancy is also a concern and increases the risk for a condition called fetal alcohol syndrome (FAS), which is responsible for birth defects, low birth weight, and below-average intelligence. Fetal alcohol syndrome is the leading cause of intellectual disability in newborns. Alcohol consumption during pregnancy also increases the likelihood of a miscarriage or preterm delivery. There is evidence that the more alcohol consumed, the greater the risk to the fetus. It is safest not to drink any alcoholic beverages during pregnancy.

Chemicals from marijuana, either smoked or from edibles, can be passed to your developing baby during pregnancy. Studies are limited, but the data suggest that use of marijuana may interfere with the baby's brain development, cause intellectual disabilities, or cause behavioral problems later in life. Marijuana smoke also poses risks similar to tobacco smoke.

No illicit drug is safe to use during pregnancy. Stimulants like cocaine and methamphetamine can cause elevated maternal blood pressure, low birth weight, and premature delivery. Opioids like OxyContin and heroin cause withdrawal symptoms in newborns that can keep them hospitalized for weeks or more. If you become pregnant while using drugs, inform your obstetrician so that she can help you find safe, appropriate care.

When preparing for your baby, you may decide to paint and add new furniture to the nursery. It's important to have good ventilation in spaces you're painting, to avoid inhaling large amounts of fumes. New furniture can harbor chemicals and should be allowed to ventilate before placing your baby in or near it. Exposures do not only happen in the home; workplaces may have chemicals in use that, when inhaled, can result in harm to you and your baby. Your employer should provide you with personal protective equipment or other task assignments if you are exposed to chemicals or dust in the workplace.

You should avoid all medications and supplements except those your physician has specifically recommended. This includes not only prescription drugs you're already taking, but also nonprescription or over-the-counter products such as aspirin, cold medications, and antihistamines. Even vitamins can be dangerous if taken in high doses. (For example, excessive amounts of vitamin A have been known to cause congenital abnormalities.) Consult with your physician before taking drugs or supplements of any kind during pregnancy, even those labeled "natural."

Fish and shellfish contain high-quality protein and other essential nutrients, are low in saturated fat, and contain omega-3 fatty acids. They can be an essential part of a balanced diet for pregnant women.

However, you should be aware of the possible health risks from eating fish while pregnant. Avoid raw fish, as it may contain parasites such as flukes or worms. Cooking and freezing are the most effective ways to kill the parasites. For safety reasons, the US Food and Drug Administration (FDA) recommends cooking fish to an internal temperature of 140 degrees Fahrenheit (60 degrees Celsius). Certain types of cooked sushi such as eel and California rolls are safe to eat when pregnant.

The most worrisome contaminant in fish is mercury (or more specifically, methylmercury). Mercury has been shown to be damaging to the fetus's brain and nervous system development. The FDA advises pregnant women, women who may become pregnant, nursing mothers, and young children to avoid eating shark, swordfish, king mackerel, and tilefish (from the Gulf of Mexico) due to high levels of mercury in these fish. According to the FDA, pregnant women can safely eat an average of 8–12 ounces (two to three average servings) of a variety of other types of cooked fish each week. Five commonly eaten fish low in mercury are shrimp, canned or packaged light tuna, salmon, pollock, and catfish. Albacore tuna can be high in mercury, so canned chunk light tuna is a better choice. If there are no local health advisories about fish caught in your area, you can eat up to 6 ounces (one average meal) per week of local fish, but don't consume any other fish during that week.

While no adverse effects from minimal caffeine intake (1 to 2 cups of caffeinated coffee per day, or about 200 mg of caffeine) have yet been proven, you may want to limit caffeine to the minimum needed when you are pregnant. Remember, caffeine is also found in many soft drinks and foods such as chocolate.

Another cause of congenital abnormalities is illness during pregnancy. Take precautions against these dangerous viral infections:

German measles (rubella) can cause intellectual disability, heart abnormalities, cataracts, and deafness, with the highest risk occurring in the first twenty weeks of pregnancy. Fortunately, this illness can be prevented by immunization, although you must not get immunized against rubella during pregnancy. If you are unsure whether you're immune, your obstetrician can order a blood test. In the unlikely event that you're not immune, you must do your best to avoid sick children, especially during the first three months of pregnancy. It is then recommended you get immunized after giving birth to prevent this same concern in the future.

Chickenpox (varicella) is particularly dangerous if contracted shortly before delivery. If you have not already had chickenpox, avoid anyone with the disease or anyone recently exposed to the disease. You also should receive the preventive vaccine when you are not pregnant.

Herpes is an infection that newborns can get at the time of birth. Most often, it occurs as the infant moves through the birth canal of a mother infected with genital herpes. Babies who get a herpes viral infection may develop fluid-filled blisters on the skin that can break and then crust over. A more serious form of the disease can progress into a severe and potentially fatal inflammation of the brain called encephalitis. When a herpes infection occurs, it is often treated with an antiviral medication called acyclovir. For the last month of pregnancy, your doctor may advise taking preventive medications like acyclovir or valacyclovir to reduce the risk of an outbreak. If you have an outbreak or feel symptoms of one coming on during your delivery time, you should notify your obstetrician, and a Cesarean section (or C-section) may be recommended to decrease the risk of exposure to the baby.

Toxoplasmosis may be a danger for cat owners. This illness can be caused by a parasitic infection common in cats, but it is much more often found in uncooked meat and fish. Take care that meat is cooked thoroughly prior to consumption, and avoid tasting undercooked meat like beef tartare or carpaccio. Wash all cutting boards and knives thoroughly with hot soapy water after each use. Wash and/or peel all fruits and vegetables before eating them. Outdoor cats are far more likely to contract toxoplasmosis and excrete a form of the parasite in their stools. People who come in contact with the infected stools could become infected themselves. Someone who is healthy and not pregnant should change the cat's litter box daily; if this is not possible, gloves should be worn and hands washed well with soap and water afterward. Also, wash your hands with soap and water after any exposure to soil, sand, raw meat, or unwashed vegetables. There have been no documented cases of animal-transmitted toxoplasmosis in the United States in recent years.

Zika virus can infect pregnant women through the bite of an infected mosquito or via sexual intercourse with an infected partner, even if that partner has no symptoms. The Centers for Disease Control and Prevention (cdc.gov) can help you learn what regions host these mosquitoes, such as the tropics and the far southern portions of the United States. Pregnant women who travel to areas where Zika is present should take precautions to avoid mosquito bites, such as using DEET, wearing long sleeves and long pants, and avoiding being outside at dawn and dusk. They should also use protection during sexual intercourse if their partner has been in such areas. Zika virus can cause severe defects of the developing baby's brain and eyes. At this time, there is no vaccine against the virus.

Listeria is a bacteria that can be transmitted from raw or undercooked dairy products and meat or seafood. It causes flu-like symptoms, such as fever, muscle aches, and diarrhea, and pregnant women are more susceptible. To decrease the risk, avoid unpasteurized milk; soft cheeses made from unpasteurized milk, like feta, queso blanco, queso fresco, Camembert, Brie, or blue-veined cheeses; hot dogs, lunch meat, and cold cuts (unless heated to high temperature before consuming); and smoked seafood. Also, avoid handling raw or undercooked eggs, meat, and seafood. Wash hands frequently while cooking.

Flu. Infants under six months of age are at high risk if they acquire influenza, or the flu. One way to protect your newborn from the flu is to get the flu vaccine yourself if you are pregnant during flu season. This is especially important because pregnancy puts you at higher risk of complications from getting the flu. Adults and all children over six months of age should be immunized during flu season, typically from early fall to late spring, to prevent passing this deadly respiratory illness to young infants.

Getting the Best Prenatal Care

Throughout your pregnancy, you should work closely with your obstetrician or American Midwifery Certification Board–certified nurse midwife to make sure that you stay as healthy as possible. Regular visits up until the birth of your baby can significantly improve your likelihood of having a healthy newborn. During each visit, you will be weighed, your blood pressure checked, and the size of your uterus estimated to evaluate the size of your growing fetus.

During your pregnancy, do not forget about your oral health. Mothers can unintentionally pass cavity-causing bacteria to their newborn baby, which can increase a child's risk for tooth decay. Preventive dental work while pregnant is essential to avoid oral infections such as gum disease, which has been linked to preterm labor and low birth weight. Dental cleanings, X-rays, fillings, and annual check-ups during pregnancy are safe and important.

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Excerpted from "Caring for Your Baby and Young Child"
by .
Copyright © 2019 American Academy of Pediatrics.
Excerpted by permission of Penguin Random House.
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