Toxins and Pregnancy: The First Trimester
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DR. MAURICIO LEVINE: You are finally pregnant and very excited about this new life growing inside you. But what is really going on during those first twelve weeks? I am Dr. Mauricio Levine, Board Certified OBGYN and today well be discussing all the amazing things that happen during the first trimester. This is Preggie Pals, episode 90.
ANNIE LAIRD: Welcome to Preggie Pals broadcasting from the Birth Education Center of San Diego. Preggie Pals is your weekly online, on-the-go support group for expecting parents and those hoping to become pregnant. I’m your host Annie Laird. Thanks to all of our loyal listeners who have joined the Preggie Pals Club. Our members get special episodes, bonus content after each new show, plus special giveaways and discounts. Another way for you to stay connected is by downloading our free Preggie Pals app, which is available in the Android and iTunes market place. If you’re not able to be in here, we broadcast from San Diego, so you might not be able to get in here on weekend during a taping, but you can stay involved in our program by becoming involved in our virtual panelist program. You can go online and submit questions. And our expert panelist will be entering them on the show. And you can participate in conversations from anywhere in the world. See our website www.preggiepals.com for more details.
Alright so welcome to Preggie Pals everybody let’s get started with our panelist introductions. I’ll start off, I’m your host Annie Laird. I have three girls, an elementary school age daughter, and then two daughters who are toddlers very close in age I wish twins. So newborn and a it’s almost like having twins. So a lot it keeps me busy, it keeps me on my toes. My day job I do a, I may a government contractor, I teach. So, Janine, on to you
JANINE RIVERA: I also have three daughters, they’re five and my twin girls are two and a half. And I am a birth educator and doula and just starting to put my foot back out in the world. I was a teacher, school teacher for several years before having children. And so I am excited about being a part of the birth world
ANNIE LAIRD: Yeah. Go ahead Nancy.
NANCY BAILEY: Hello I’m Nancy, I work with Annie as a government contractor with. And my husband and I our first baby in may. We been a two pug household for four years now
ANNIE LAIRD: You have your fur babies.
NANCY BAILEY: There are first baby girl that works back things so we’re very excited.
ANNIE LAIRD: Awesome!
ANNIE LAIRD: Today in Preggie Pals we’re doing an app review. The app that we’re reviewing is GS Preschool games. Now this is a free app, it’s designed for kids in the age group from three to six, although I did have my eight year old review it as well. And she was playing at it for a while. We got her off of watching little sister duty so she was very in to that playing games on my iPhone. I don’t let her have my iPhone a lot. The description app is that it fosters learning, imagination and free play. And it also says that kids enjoy playing these games for hours without getting bored at the same time learning skills which are carefully incorporated in the design of each game. You guys got a chance to play around with this app? I’ll let you share what you thought about it and then I’ll show my eight year old side
JANINE RIVERA: My daughter frequently if she’s up from her rest time before my younger ones are up I’ll let her play a little bit on my phone. So, yeah I could see her having a little bit of fun with that and having this nine different choices. She certainly would be able to go back like “oh I’m done doing this go back and do something else”. We definitely keep her engaged, I think. And it would, it’s nice if, that it would tell you what to do and she can follow the directions and it’s a way to learn. Listening and doing and following directions
NANCY BAILEY: And clean up looks like a breeze too. Because I’m sure with all those puzzle pieces around that’s pretty difficult. I’m looking at our small square footage and I think that these type of games are the bridge I’d like to go
ANNIE LAIRD: Yeah. Oh just the, Nancy just wait for all the legos to come out and then yeah. You always miss one of them so that’s a nice thing with iphone games. Those not all the pieces of be cleaning up you don’t have to be with dealing with that
NANCY BAILEY: That’s where the pugs are coming because they’ll find those little pieces
ANNIE LAIRD: So, what do you guys think? Thumbs up, thumbs down on this app.
NANCY BAILEY: Thumbs Up.
JANINE RIVERA: I think it’s interesting
ANNIE LAIRD: Yeah, my eight year old liked it too so she resisted me taking the phone away from her eventually so, yeah. So I think across the board, a thumbs up from all three panelist.
ANNIE LAIRD: Today on Preggie Pals we’re starting a brand new series and it’s focused on all the different trimesters of pregnancy. Our expert who is joining us to talk about the first trimester is Dr. Levine. He’s an active staff member of Sharp Chula Vista Medical Center and Scripps Memorial Hospital in Chula Vista. He’s certified by the American Board of Obstetrics and Gynecology and by the American College of Obstetrics. Dr. Levine, welcome to the show and thanks for joining us today.
DR. MAURICIO LEVINE: Thank you. Thank you for inviting me
ANNIE LAIRD: Yeah. It’s great to have you here. Now, how are the trimesters normally divided up, I think, I used to get so confused especially my first pregnancy. Looking online and I think that’s especially with the first time pregnant that mom’s you know exactly that you are ten weeks and three days pregnant you know. On my third pregnancy I was actually I had a couple of miscarriages so it was like my seventy pregnancy I was like “somewhere in the first trimester”. But I think it, It is confusing of where’s that break that normally obstetricians have “okay this is the first trimester”
DR. MAURICIO LEVINE: We count the first trimester of the first twelve weeks of pregnancy.
ANNIE LAIRD: Okay
DR. MAURICIO LEVINE: With the pregnancy as you know its forty weeks. Starting to count from the last menstrual period come of the weeks. But really the pregnancy starts at the time of conception. Two weeks after the period
ANNIE LAIRD: Okay
DR. MAURICIO LEVINE: Many patients are confused because they’re asking about months
ANNIE LAIRD: Right
DR. MAURICIO LEVINE: But we tell them it’s more accurate to say that the due date is at forty weeks after the last period
ANNIE LAIRD: Okay
DR. MAURICIO LEVINE: And the first trimester ends at twelve weeks
ANNIE LAIRD: Okay. So generally, if you’re talking like fourteen a day eludial phase form the period starts to the time of when you actually get pregnant for the conception that’s two weeks right off the bat there. So, so you’re saying that twelve weeks includes that first two weeks of the when the period starts
DR. MAURICIO LEVINE: From the last period, and that’s one, I want to be clear with that because sometimes patients get confused
ANNIE LAIRD: Yeah, yeah. Now, what kind of stages does the baby goes through in the first trimester? You know we talk about, baby your fetus or right and there’s a lot of other technical terms of what stages that that the baby goes though
DR. MAURICIO LEVINE: The first trimester we are going to talk about the embryo and all the fetus. So, it’s the embryo where it’s getting formed all his different organs are being formed and we consider fetus up to twenty weeks. So the first twelve weeks is just the embryo, that’s why it’s so important that patients are being careful to not to be exposed to different type of toxins or things that can harm the pregnancy. So many patients don’t even know that they are pregnant but the time where you really want to be careful to be not to be exposed to any teratogen like we call. It’s before twelve weeks.
ANNIE LAIRD: I imagined during that first trimester that’s really when all of the organs are just forming of like you know, this cell becomes a liver cell and this cell becomes a cell that’s gonna be in the eye and it’s pretty amazing.
DR. MAURICIO LEVINE: Exactly, by the eight weeks of pregnancy the baby’s embryo which is it’s already formed
ANNIE LAIRD: Now the baby kind of starts off with a tail, doesn’t he or she, or when does the tail kind of go when can it becomes that the tail bone right
DR. MAURICIO LEVINE: Yes you know each time we are going to see the development each week, but as I said by eight weeks the embryos are already formed from eight to twelve weeks it’s growing and the exposure to, like I said before toxins are going to be worse after the two to four weeks of pregnancy
ANNIE LAIRD: Now what kind of toxins should pregnant women I wouldn’t say you know, can be worry you don’t want to worry too much, you know. How many pregnant women that I’m sure you hear this a lot in your practice they come in for the first prenatal and say “oh I had a good time out with my husband and we split a bottle of wine and I didn’t even know I was pregnant” I mean is that something that that women should be worried about?
DR. MAURICIO LEVINE: Yeah it happens very often that patients don’t know they are pregnant. Sometimes they even come on the second trimester because they don’t have any symptoms. Other patients have a lot of symptoms from the beginning.
ANNIE LAIRD: Yeah. How common is miscarriage during this stage of pregnancy?
DR. MAURICIO LEVINE: Miscarriage is approximately happen fifteen percent of the cases. Depending on
ANNIE LAIRD: Did you say five zero?
DR. MAURICIO LEVINE: Fifteen. One five
ANNIE LAIRD: Oh fifteen. Wow!
DR. MAURICIO LEVINE: It depends on the age. For example in elderly patients could be a little bit more often. Up to 20%. Younger patients could be between twelve and fifteen percent.
ANNIE LAIRD: That sure seems like a really high number. I guess you know, when I had my first miscarriage, I had no idea tells us reaching out to other women how common that it is
DR. MAURICIO LEVINE: It’s very common and the most common reason for miscarriages are chromosomal abnormalities. Where as I said before if it happens at the time where it’s going to affect the whole embryo, the body miscarriage it.
ANNIE LAIRD: And of either of you guys you could chime in on that you know at least in my personal experience with that, I think that that was a bit of a comfort to hear from my doctor hear from my midwife that you know likely it was you know nothing that I personally did it was just miscarriage is one that is very sad unfortunate things it was just kind of, I got unlucky you know
JANINE RIVERA: Yeah I’ve had a lot of friends that, I haven’t experienced for myself but it’s certainly like you said that is so much more common that I would’ve thought now with my friends all being at you know childbearing. And how many of them have experienced it and recognizing yeah that it’s a loss and it was they really you know to it took up some time to process and to to try again. And then recognizing that it, it was probably for the best whatever reason you know that that pregnancy ended like you said there’s some sort of complications in the embryo that that baby would have had problems maybe later so it’s the body’s way of like flushing out
DR. MAURICIO LEVINE: It’s the body’s way of rejecting it before it happens to have a malformation where the miscarriage does mature and the you can they kind of having a malformation on the baby
ANNIE LAIRD: Yeah
DR. MAURICIO LEVINE: So it’s better for the body to reject it when that occurs from the beginning
ANNIE LAIRD: Yeah . And it’s a very just tough subject but one that I think is so prominent within that first trimester especially after a woman has had a miscarriage you’re a little bouncing needles next time around waiting and for. I almost feel that in, Dr. Levine, you know chime in if this is the case or isn’t the case of just a fact of a woman can get to that first appointment get through the first trimester, have a heartbeat. Usually everything at that point is pretty straightforward
DR. MAURICIO LEVINE: Yes plus many patients are already experienced the miscarriage as I said before it’s pretty common. They come very scared for the second pregnancy and it’s important that patients at least and still understand that this is could be recurrent but it is a more likely. Most of the times it happens one time and then the patients have normal pregnancies. There are certain conditions where there could be a habitual abortion where it happens repetitively and you have to do some work up why’s and reason. But they want to make sure that people understand that most of the times, it is only one time and the future pregnancies could be as normal as an uncomplicated as any pregnancy
ANNIE LAIRD: Yeah , that’s great to hear. Alright, well when we come back we’re going to be discussing what kind of changes are going on with mom during the first trimester. We’ll be right back
ANNIE LAIRD: Welcome back, today we’re talking about the first trimester pregnancy with Dr. Levine. Doctor what kind of changes, we already talked in before the break about what was going on with the embryo and what was going on with the baby. And why it’s so important to avoid toxins as you were saying because that embryo is developing. But what’s going on with mom’s body, as far as physical changes that’s going on with her?
DR. MAURICIO LEVINE: Like we said before, some patients don’t even know that they are pregnant in the first trimester. Some of them expect changes in their bodies. The changes mainly are, physically for example breast tenderness, frequency urinating and nausea, vomiting, the sleepiness or tiredness people are very tired. And that happens because the hormones are increasing.
The main hormone in pregnancy is the HCG, that’s the Gonadotropin chorionic hormone, and that hormone goes up by since the conception. Let’s say by the week six to eight that’s when people start becoming symptomatic, becoming to be nauseous and vomiting. I reassure my patients, by twelve weeks that hormone goes to the peak, your body gets used to it and then the symptoms disappear ninety nine percent of the cases. Now these symptoms can be mild, moderate or very severe.
In mild cases, patients can just go by changing the diet stop having greasy or spicy food, eating more crackers. For example I tell them don’t worry if you don’t eat for a few days, but drink. Drink a lot of water keep hydrated. If that doesn’t work then we treat them with medications like tablets, sometimes suppositories, even injections. If that doesn’t work and patient gets dehydrated, sometimes you have to put patients on in hospital. I’ve had patients that are really very sick we call it Hyperemesis Gravidarum and it’s important to reassure the patient no matter how sick you are in the first trimester, your pregnancy is going to be uncomplicated passing twelve weeks. And most of the times after twelve weeks all these symptoms go away
ANNIE LAIRD: Yeah that does seem to be the major complaint I think during first pregnancy at least among my group of friends it’s just “aw, I feel so nauseous” or you know what about the other panelist here in the studio, during your first trimesters, Nancy now you’re well in your second trimester now, well what was the major was morning sick or was it something else
NANCY BAILEY: I was very sleepy and then I develop that super power of super scent which is not as cool as the other ones but I had to change my deodorant even because I just could not handle the smell or that the excuse not to have cook dinner too much because handling that raw meat just kind of felt quesy so that was mostly my two big things and now those were those are gone
ANNIE LAIRD: That’s awesome, yeah
NANCY BAILEY: It’s just it was a very big difference
ANNIE LAIRD: Yeah. My first pregnancy I couldn’t handle any kind of raw pork which was terrible because I had this great recipe for grilled pork tenderloin. And we had it at least once a week but like I said you get that super smell, yeah
DR. MAURICIO LEVINE: I have a lot of patients are common in the second trimester. You we’re right. I feel perfect and I didn’t believe it when I was so sick at the beginning
ANNIE LAIRD: Yeah. Did you experience any kind of nausea?
JANINE RIVERA: Terrible, terrible morning sickness, yes.
ANNIE LAIRD: Was that with both of your pregnancies?
JANINE RIVERA: Yes. The first one was pretty severe but then being pregnant with twin girls , oh my gosh, I thought I was dying. It was really intense and I had what you’re saying that I think it would’ve been diagnosed as the hyper, what is it the
DR. MAURICIO LEVINE: The Hyperemesis Gravidarum!
JANINE RIVERA: Yeah I needed to use suppository like everything because I couldn’t hold anything down so it’s pretty and you wonder how long is this going to last. There’s no way I can make it forty weeks. But it does go away
ANNIE LAIRD: I remember with my third, with my third baby you know, my husband was deployed and the thoughts was just like no I just it will be okay if I would die right now, because I just feel that miserable
JANINE RIVERA: Yeah. I’m glad you say that because I feel bad having that I add those thoughts it was like take me away. It’s that intense. Yes, it was so, yes. It was awful
ANNIE LAIRD: I was in the, and Nancy probably knows this. I was intending and telling people at my day job that I was as pregnant as early as it was but it was just
NANCY BAILEY: You couldn’t hide that. I asked Annie oh that new ginger ale type how do you like that and it those literally Oh I’m pregnant! What I can’t even. That was pretty funny I was just trying to get a product review on a new ginger ale
JANINE RIVERA: she’s a little sensitive about it
NANCY BAILEY: I didn’t want to whisper it around the office oh Annie’s pregnant
ANNIE LAIRD: Yeah well especially since I just been hired there too I think I was new at the job within like three months or something so. But yeah I was like, yeah I just couldn’t hide it I was just, I was just a particular shade of green
JANINE RIVERA: I’m surprised you could go to work. I literally was lying on the couch.
ANNIE LAIRD: Well it sounds like I didn’t have it as bad as you had
JANINE RIVERA: I was like laid out. Someone please parent my older child because I cannot
ANNIE LAIRD: Well that’s what Nick Junior’s for
JANINE RIVERA: We watch a lot of Einstein baby whatever or something rather
DR. MAURICIO LEVINE: What happen after twelve weeks? You felt better
JANINE RIVERA: I did feel a lot better. It took time it took maybe into the fourteen weeks
DR. MAURICIO LEVINE: Usually I tell my patients between twelve and fourteen weeks you are going to feel perfect you can still tell your husband you are not allowed to cook
JANINE RIVERA: Right I can’t and by the time I felt better nauseous then I was so uncomfortable big because I was pregnant with twins so it was a whole different world of uncomforted
ANNIE LAIRD: Now Dr. Lavine is there anything to and maybe this is just an old wives tell that women that are pregnant with girls have worst morning sickness then with boys
DR. MAURICIO LEVINE: No, I really don’t think it has nothing to do with it
JANINE RIVERA: I was hoping you’d say yes
DR. MAURICIO LEVINE: I’d say yes, I think it has to do with their hormones and the way the body reacts as I said to the different hormones. The HCG as I mentioned before is the one that’s rising. And the time of the peak at twelve weeks that’s when they feel better. Now have to remember that also the estrogens are increased the progesterone is increased. That’s why people complain of breast tenderness because you have an increase on the amount of estrogen. There are changes that has nothing to do with the sex of the embryo
ANNIE LAIRD: Now what can moms expect as far as prenatal care during her first trimester?
DR. MAURICIO LEVINE: The first trimester what first to find out confirmed of the pregnancy it’s life and it’s in the uterus. It screens the patients for anemia, screen the patients for all the infections. Mainly in high risk cases we can offer prenatal screening as far as genetic counseling. I educate the patients basically on what are they allowed to do and what they are not allowed to do as far as exercise, food, medications. I usually tell my patients, exercise, intercourse, it’s okay as long as there is no bleeding or cramping.
ANNIE LAIRD: Imagine this would be a great time to start up some cross fit craze you know if you’re a pregnant mom that’s if you’re not laid out with morning sickness in your couch yeah. So, what kind of exercise
DR. MAURICIO LEVINE: What I usually tell my patients whatever you are used to do before you are pregnant. I’ve had patients are they never did any exercise. They said it’s now the time to start. Other patients are they are aerobics instructors where they are fitted and that’s what they do all day. They can continue with their lives as long as there are no bleeding or cramping. As far as diet, patients are allowed to eat basically. Everything I tell them to avoid certain things for example, not to eat raw food fish, because of the mercury. Like sushi for example, I told them to avoid the amount of caffeine and avoid amount of alcohol. Caffeine tends to interfere with the absorption of the iron.
So, if people are. They are not able to stop the caffeine completely, at least minimize one day or one cup a day, I could say but they, things that can be avoided the better. First trimester specifically for medications. Although certain medicines you can take Tylenol for example if there is pain. If you can avoid any exposure is the best the first trimester but it’s okay to take some medications over the counter. I take advantage also to talk about smoking. If patients are smokers. We know it smoking is not good for the patient anytime. And some patients are motivated to stop smoking at the beginning of the pregnancy
ANNIE LAIRD: That’s what my mom did back in the seventies, so she said it was one of the hardest things she’d ever done
DR. MAURICIO LEVINE: And sometimes pregnancies are enough reason to for them to be motivated so I take advantage of that also. The screening and the counseling we get from the first trimester
ANNIE LAIRD: Now how many weeks pregnant are moms when they normally come in to your practice for that first visit?
DR. MAURICIO LEVINE: Like I said before there are
ANNIE LAIRD: If they know that they are pregnant
DR. MAURICIO LEVINE: We have patients that come right away two weeks before and that’s great sometimes some kind of anxiety because sometimes the uterus is not enlarged enough to be able to say that they are pregnant we the pelvic exams. We have to do all the testing. Sometimes they come so early that the ultrasound cannot even pick up gestational sac. And that’s the reason we have to do some HCG levels. If the HCG is going up that means that the pregnancy is in the right place. Everything is normal if they start experiencing these symptoms we know that that HCG is going up. All the patients come in a little bit later some patients come in the second trimester because they didn’t find out that they are pregnant. Because they have a history of irregular periods and they didn’t know the cause of pregnancy
ANNIE LAIRD: Yeah. Well with those HCG levels rising up , I remember being so sick, that was the one thing. You know Janine you talked about laid down the couch of just. I kept thinking to myself before like okay you know, I‘ve had loses before but this means that it’s healthy baby and that’s one thing that I held into when I felt like dear God, just kill me right now
JANINE RIVERA: Yes. You’re right I do remember thinking the same thing
DR. MAURICIO LEVINE: But at least you know it’s a good sign that HCG is going up and your baby is alive. And you baby’s alive and you have a intrauterine pregnancy that one to do better, it’s a best case scenario
ANNIE LAIRD: Well thanks to Dr. Levine for joining us today. For more information about Dr. Levine and his OBGYN practice as well as information about any of our panelist, visit the episode page on our website. This conversation continues for members of our Preggie Pals Club. After the show Dr. Levine will share his advice to moms. Now, we’re in the middle of flu season right now and you know you hear things about the flu shot, should you get the flu shot, should you not get the flu shot? What type of flu shot should you get? So, we’re going to continue with that after this in the bonus content
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ANNIE LAIRD: That wraps up our show for today, we appreciate you listening to Preggie Pals, don’t forget to check out our sister shows Parent Savers, for parents with newborns, infants and toddlers. Our show The Boob Group for moms who breastfeed their babies, and our new show, Twin Talks for parents of twins. Next week, we are talking about resuming your sexual relationship with your partner after pregnancy. This is Preggie Pals, your pregnancy, your way
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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