4. When You’re Underweight

If you are underweight when you begin pregnancy, you face special challenges. You may need to gain between 28 and 40 pounds during your pregnancy. However, studies show that 20% of all pregnant women fail to gain the amount of weight their healthcare provider recommends.

Weight loss during the first trimester can happen if you have morning sickness. If you’re underweight and lose weight because of morning sickness or other problems, talk to your healthcare provider.

Gaining weight gives your baby the nutrients it needs to grow and to develop. If you need to gain extra weight during pregnancy, use the tips below to help you reach that goal.

• Don’t drink diet sodas or eat low-calorie foods.

• Choose nutritious foods to help you gain weight, such as cheeses, dried fruits, nuts, avocados, whole milk and ice cream.

• Eat higher-calorie foods.

• Add nutritious, calorie-rich snacks to your daily menu.

• Avoid junk food with lots of empty calories.

• You may need to exercise less, if you burn too many calories when you work out.

• Eating small, frequent meals may help.

Make a good nutrition plan at the beginning of pregnancy. Ask your healthcare provider about seeing a dietician to help you.

5. Vaccinations and Immunizations

Immunizations and vaccinations protect you from diseases. A vaccine is usually given by injection or taken orally. Each vaccine dose contains a very small amount of a weakened form of the disease. When you receive a vaccine, your immune system makes antibodies to fight the disease in the future. In most cases, this is enough to keep you from getting a disease. However, in some cases, it doesn’t prevent the disease entirely but lessens the symptoms.

Vaccines come in three forms—live virus, killed (dead) virus and toxoids (chemically altered proteins from bacteria that are harmless). Most vaccines are made from killed viruses; it’s nearly impossible to get the disease after receiving this type of vaccine. With a live-virus vaccine, the virus is so weakened that if your immune system is normal, you probably won’t get sick from it.

Many women of childbearing age in the United States and Canada have been immunized against measles, mumps, rubella, tetanus and diphtheria. A blood test for measles and rubella is necessary to determine immunity. Physician-diagnosed mumps or a mumps vaccination is necessary to know you’re immune.

Risk of Exposure. During pregnancy, try to reduce your chance of exposure to disease and illness. Avoid visiting areas known to have diseases. Avoid people (usually children) who are sick. But it’s just about impossible to avoid all exposure to all diseases. If you’re exposed, or if exposure is unavoidable, the risk of the disease must be balanced against the likely effects of vaccination.

The vaccine must also be measured in terms of its effectiveness and its expected effect on a pregnancy. There’s not a lot of information on harmful effects of a vaccine on the developing baby. However, live-measles vaccine should never be given to a pregnant woman.

Vaccinations You Should Have during Pregnancy. The only immunizing agents recommended for use during pregnancy are the Tdap (or DPT) vaccine and the flu vaccine. The Tdap vaccine (tetanus, diphtheria, pertussis) can help you avoid whooping cough. Be sure to get a Tdap booster if it’s been 10 years since your last one. If you work in the garden, with your hands in dirt, you need a booster.

If you get the flu during pregnancy, you may have complications, such as pneumonia. Pregnancy can alter your immune system, which can increase your risk.

It is recommended that all women who will be pregnant during flu season get a flu shot. A flu shot can protect you against three strains of influenza. Flu shots can be given safely during all three trimesters. Talk to your healthcare provider about it.

Other Vaccines during Pregnancy. As many as 35% of all pregnant women are at risk of getting measles, mumps or rubella because they haven’t been vaccinated or they have been vaccinated but their immunity has weakened. The MMR vaccine should be given before pregnancy or after delivery. The Centers for Disease Control and Prevention (CDC) recommends a woman should wait at least 1 month to get pregnant after receiving the MMR vaccine.

A pregnant woman should receive a vaccination against polio only if her risk of exposure to the disease is high. Only inactivated polio vaccine should be used.

If your healthcare provider believes you may be at risk for getting hepatitis B, it’s safe to take the vaccine during pregnancy. Talk to your healthcare provider if you have concerns.

Ask about receiving the pneumococcal vaccine if you have a chronic medical condition, such as lung problems, asthma or heart problems. This vaccine protects you against bacteria that can cause pneumonia, meningitis and ear infections. A plus to taking this vaccine is that antibodies you make after taking the vaccine pass to your baby and may protect him or her from ear infections for up to 6 months!

Human papillomavirus (HPV) vaccine is a series of shots over 6 months to protect against HPV. HPV is responsible for 70% of cervical cancers and 90% of genital warts cases. Don’t have this vaccine during pregnancy; it’s not recommended. If a woman discovers she is pregnant while she is receiving the vaccine, she should delay finishing the series until after she gives birth. Women who are breastfeeding can receive the vaccine.

Thimerosal Use during Pregnancy. Thimerosal is a preservative used in vaccines that contains ethyl mercury. It was barred from childhood vaccines several years ago but is still used in most flu vaccines. Some experts recommend pregnant women ask for a thimerosal-free flu vaccine.

The Centers for Disease Control and Prevention (CDC) believes it’s OK for pregnant women to receive flu vaccine that contains thimerosal. They state the benefits of flu vaccine with thimerosal outweigh the risk. The American College of Obstetricians and Gynecologists (ACOG) has issued a similar statement.

Until 2001, thimerosal was used in RhoGAM preparations. However, thimerosal is no longer used in RhoGAM in this country.

6. Influenza (Flu)

The flu seems to be a problem every year because different flu viruses come and go. In 2009 and 2010, the H1N1 flu affected many people. When an outbreak of H1N1 or other type of influenza occurs, it can impact a pregnant woman more greatly because of her altered immune system.

If you are pregnant when a breakout occurs, you should receive the specific flu vaccine and the seasonal flu vaccine. You can be vaccinated any time during pregnancy. There are ways to protect yourself in addition to getting a seasonal flu shot. Use “social distancing” to protect yourself. Avoid crowded areas, use a mask and wash your hands frequently (flu virus can live up to 2 hours on surfaces like doorknobs and telephones).

Before you get a flu shot, go to bed extra early the night before. When you’re well rested, your body produces twice as many infection-fighting antibodies.

Follow your healthcare provider’s guidelines about using medicine you are advised to take. The benefits of taking a medicine outweigh any risk to the baby. Treatment should begin as soon as possible; don’t wait for lab results to confirm the type of flu.

7. Rubella Immunity

It’s a good idea to get checked to see if you are immune to rubella before you get pregnant. Rubella (German measles) during pregnancy can be responsible for various pregnancy problems. Because there’s no known treatment for rubella, the best approach is prevention.

If you’re not immune, you can receive a vaccination after delivery, while you take reliable birth control. Don’t have a vaccination shortly before or during pregnancy because of the possibility of exposing baby to the rubella virus.

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