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The Potential Risks to a Pregnancy during the First Trimester

HIGHLIGHTS:

  • A pregnancy is categorized into 3 trimesters, totaling 9 months altogether (40 weeks or 280 days). Each of these trimesters carries its own set of risks.
  • In the first three months or first trimester of a pregnancy, most women tend to feel nauseous, vomit and lose their appetite. This means that the fetus may not be getting sufficient nutrition and that the mother may begin to display signs of vitamin or mineral deficiencies. Where mothers suffer from increasingly severe symptoms during this period, they should consult with a doctor about potential methods of treatment.
  • Vaginal bleeding is considered a dangerous condition that can affect women during any stage of their pregnancy, which may also pose a risk to the lives of both mother and baby. If you are suffering from such a condition, you should seek urgent medical attention.

 

The first trimester refers to the initial 3 months of a pregnancy, with those in the medical field categorizing the whole pregnancy into 3 trimesters, totaling 9 months altogether (40 weeks or 280 days). Nevertheless, some pregnancies may last up to 42 weeks or 294 days, and each of these three trimesters carries its own particular set of risks.

Fetal growth and development during the first trimester

A pregnancy age is determined by counting from the woman’s last period, while the subsequent growth of the fetus is classified in terms of structural growth and organ function development.

At 5-6 weeks, the fetus shows signs of development in the central and spinal nervous systems.

At 8-12 weeks, the fetus is usually around 2.5-6 cm in length with a large head, obvious growth in terms of arms and legs, as well as the beginnings of a heartbeat.

Factors which affect fetal growth

These include genetics, environment, nutrition and the behavioral aspects of the mother.

Genes and genetic disorders found in the family will affect the growth of the fetus, meaning it may be placed at risk, especially where the mother has a history of any of the following types of pregnancies:

  • An infant fatality, either during or after the birth, including at least 2 miscarriages prior to the current pregnancy
  • A premature birth (before the pregnancy reached 37 weeks)
  • A history of preeclampsia, chronic hypertension, overt diabetes mellitus, autoimmune diseases

Environment is a factor which cannot be overlooked. Any environmental factors that the parents have been exposed to can affect a pregnancy, including toxins found in the home, in items used for cleaning or in other household products which may have been contaminated with chemicals, as well as smoke in houses where the inhabitants smoke indoors.

The environment also refers to the pregnancy’s internal situation, meaning the amniotic sac, amniotic fluid, placenta and uterus, all of which must be in full working order. Moreover, the medication used by the pregnant mother-to-be is also important because some drugs can place the fetus at risk. As a result, pregnant women must not take any drugs other than those prescribed by their doctor.

Eating while pregnant

Diet and nutrition play a crucial role during a pregnancy. The diet must be varied and balanced, while the amount consumed must be moderated, especially during the initial 1-3 months. Pregnant women should be eating a diet consisting of the 5 main food groups in moderation, with a particular emphasis on foods high in folic acid, as this substance plays a key role in the production of the fetus’s various organs and brain cells.

Food suitable for women in the first trimester of a pregnancy (click to read)

There are also certain foods that should be avoided altogether during the first trimester of a pregnancy, including raw food, food containing MSG, rich food, especially those high in sugar and fats. Furthermore, all caffeinated beverages and alcohol should be given up for the duration of a pregnancy.

The intake of the following types of food should be increased:

Protein:  Try to get your protein from various sources, with a focus on protein from fish, soy, eggs and skinless meat, or by drinking 1-2 glasses of milk per day.

Vitamins: Increasing vitamin intake will help keep your body strong and balanced, while also aiding fetal growth and development. Fruit and vegetables are the best sources of vitamins but, if women wish to take vitamin supplements, such as Vitamin A, B, C, D, E and K, they should first consult their doctor. Moreover, in cases where a pregnancy is causing bouts of constipation, an increase in fiber rich foods is recommended.

Various minerals: Iron is a particularly important mineral as it is a key ingredient in the mother and child’s blood hemoglobin. Foods that contain high levels of iron include liver, red meat, egg yolk and milk. However, most pregnant women will be required to take iron supplements as the levels of iron contained in the food consumed is often not sufficient for their needs.

Folate: This substance is crucial to brain and central nervous system growth. In cases of fetal folate deficiencies, the bones of the cranium or spinal column may not fuse properly. It is therefore recommended that women begin increasing their folate intake at least 3 months prior to conception, with green vegetables, soy beans, oranges, bananas and folate-added milk.

Calcium: Calcium plays a fundamental role in the development of bones and teeth. It can be found in milk and food, such as cartilage and small fish, while calcium supplements are also available.

Water: During a pregnancy, hydration takes on extra importance to the woman’s body. Consequently, the intake of water should be increased in order to aid circulation and ease the symptoms of constipation. Additionally, increasing the intake of water can help to prevent against dehydration, which is an extremely serious risk for pregnant women.

Foods to be reduced

Carbohydrates: These can be reduced by lowering the intake of flour-based products, rice, taro and potatoes, as well as avoiding sugary food, especially sweet fruits like durian. Sugar cane, white sugar, coconut juice and fizzy drinks should also be reduced because, in addition to the heightened risk of obesity, these foods can also increase both the mother and baby’s risk of developing diabetes.

Fatty acids: Occurring as a result of the breakdown of numerous fats, fatty acids can be categorized into 2 main types. The first type is saturated fat, which pregnant women should be reducing due to it being a major cause of coronary artery disease. Red meats, pork fat, coconut oil and palm oil are all high in saturated fats. Mothers should also be trying to drink milk that is low fat or fat free.

The other type is unsaturated fat, which provides the body with energy and helps to reduce the presence of cholesterol, thereby reducing the risk of heart disease. More importantly, the following types of unsaturated fats are of benefit to fetal development: Omega 3 and Omega 6 fatty acids, which are categorized as essential fatty acids as the body is unable to self-produce, meaning that diet is the only way for the body to access them. Ocean fish and seaweed products contain Omega 3 fatty acids, while Omega 6 fatty acid can be found in safflower oil, sunflower oil and corn oil.

Additionally, DHA and ARA, which are long chain unsaturated fats, are also crucial to the development of the fetus’s brain and eyeball cells.

Omega 9 fatty acids play a key role in the development of the brain’s neuron cell fibers (Axon and Dendrite) as well as the neuron’s fiber casing. It can be found in various foods, including butter, peanut oil, pork fat and olive oil.

Essential advice for pregnant women

In addition to developing an understanding of what it means to be pregnant and getting the right nutrients through a healthy diet, the first thing a woman should do when she finds out that she is pregnant is to register the care of her pregnancy with a trusted medical facility. Once this is done, getting regular exercise, drinking plenty of clean water (at least 6-8 glasses per day), and avoiding alcoholic or caffeinated drinks are essential. Women who smoke should quit, get sufficient rest and only take the medication(s) prescribed by a doctor to help ensure the health of mother and baby.

Moreover, mothers should keep a close eye on their personal hygiene and be careful not to expose themselves to chemicals, such as hair dye, some forms of makeup and perfumes.

Another aspect which should not be overlooked is sexual intercourse while pregnant. Both parties should be careful not to cause any strong impacts to the mother’s abdomen.

General advice which could potentially aid fetal development

A mother who remains in a positive state of mind throughout the duration of a pregnancy will help the fetus make a strong start in terms of development. This can be achieved by regularly listening to her favorite music and putting on some relaxing music for the child to listen to while in the womb. This will help both speech and audio development, with general guidelines being to place the speaker close to the abdomen before pressing play and listening to the soothing sounds for around 10 minutes per day.

Risk factors to be on the lookout for during the first trimester

Hyperemesis gravidarum (morning sickness): Most mothers will tend to experience severe morning sickness during the first trimester, including nausea, vomiting and a loss of appetite. However, mothers should continue to eat properly as a lack of nutrition could lead to mineral deficiencies that could affect both mother and baby, potentially resulting in the fetus not receiving sufficient nutrition for the development of its brain. For mothers who do experience mineral and vitamin deficiencies, if the symptoms associated with morning sickness also deteriorate, immediate medical attention should be sought.

Vaginal bleeding: Bleeding stemming from the vagina poses a potentially fatal risk to both mother and child. The condition is particularly dangerous as it can occur at any time throughout a pregnancy, so any signs of its arrival should necessitate the mother seeking emergency medical attention.

Severe lower abdominal pain: Lower abdominal pain is a regular occurrence for most pregnant women due to the uterine muscles expanding to support the developing fetus. However, where that pain becomes unbearably severe or continues for many hours at a time, medical attention should be sought to identify the cause of pain.

The risks posed to pregnant women during their first trimester can also depend on any congenital health disorders, including high blood pressure, kidney disease, cardiovascular disease, anemia, thyrotoxicosis and thalassemia. Furthermore, the mother’s age can also increase the risks posed to her pregnancy, with mothers aged under 16 or over 40 always advised to consult a doctor before attempting to conceive.

Paying particular care and attention to the mother’s health during the first trimester of a pregnancy is essential. Eating a varied and healthy diet, partaking in regular light exercise, practicing mental wellbeing, and avoiding stress also play their part, as does being on the lookout for and not underestimating any irregular symptoms that may arise. This means placing your pregnancy under the care of a trusted medical institution and undergoing preeclampsia risk screening during those first three months, as such screening can reduce the risks by up to 90% and help to prevent preeclampsia 70% of the time. Crucially, pregnant women should always keep their doctor’s appointments, consult with their doctor should any irregularities occur, and avoid taking any medication not prescribed by a doctor in order to ensure the health of both mother and baby.


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Chantarat Suratanakavikul, M.D. Summary: Obstetrics And Gynaecology Maternal And Fetal Medicine