Overview

Seeing a positive pregnancy test can bring a whirlwind of emotions, excitement, nerves, and maybe a little overwhelm. Finding out you are pregnant instantly changes your world. It can feel daunting to think about everything you need to learn and do. This episode walks you through the essential first steps after discovering you are expecting, from building healthy habits and choosing a care provider to understanding early prenatal care and navigating lifestyle changes. By taking it one step at a time, you can feel confident that you are setting yourself and your baby up for a healthy start.

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Have an Open Mind

While you may have ideas about what to expect during pregnancy, birth, and life as a new parent, it is essential to keep an open mind. You will have many options throughout your journey. The more you learn, the more choices you discover. Understanding your options allows you to make informed decisions that are best for you and your baby. As you learn more about the evidence behind different interventions and work closely with your doctor or midwife, you may find that your preferences evolve. Keeping an open mind will help you stay flexible and confident as you navigate pregnancy and birth.

How Pregnancy Duration is Measured

Everything in your prenatal care is timed according to how far you are in your pregnancy. Pregnancy is measured in weeks leading up to the birth of your baby. Your baby is due at the start of your 40^th week. You can also break your pregnancy into trimesters of 12-14 week periods. The first trimester is through week 12. The second trimester spans weeks 13-27. The third trimester goes from week 28 until your baby is born.

Health Insurance 

In the United States, the average cost of vaginal birth is nearly $10,000, and the average price for a cesarean section is close to $14,000. There are tools and strategies you can use to save money on your medical bills. Insurance can help cover the cost of prenatal care and birth. Tax-advantaged accounts like flexible spending or health savings accounts can save you money on the expenses you have to pay.

If you have health insurance, ensure you understand how your insurance works and what is covered for your prenatal care and birth. If you feel like you are not in a financial position to obtain insurance, there are resources like Medicaid or subsidies. The hospital or birth center where you plan to have your baby may offer reduced rates based on income or other discounts. You can also negotiate a payment plan. Even if money is tight, you have options. See this episode to learn about the cost of birth, how your insurance works, how to minimize costs, and tips on getting coverage assistance.

Your Care Provider

Your care provider is the cornerstone of your prenatal care and birth experience. You will work with this expert resource throughout pregnancy to make critical decisions. Your comfort and trust in your care provider are more important than their qualifications, where they went to school, and how many babies they have delivered. Ultimately, who your care provider is will significantly impact your experience and how your baby enters the world. When choosing your care provider, you want to research, explore your options, and shop around to find the right fit. This episode covers what to look for when choosing or changing your doctor or midwife and specific questions to find a care provider that is the right fit. Ideally, you find the right fit from the start. You can always change your care to another doctor or midwife if you do not feel supported by your current provider.

Prenatal Appointments

Your first prenatal appointment usually isn’t until you are eight weeks pregnant. After your first appointment, you see your care provider every four weeks for the first and second trimesters. Starting in the third trimester, at week 29, you will have an appointment every other week. Beginning in week 36, you see your care provider weekly. Appointments can be every few days if you go past your due date. You can expect to have around 14 appointments throughout your entire pregnancy.

Your Birth Partner  

A critical role that is often overlooked is your birth partner. This could be your spouse or partner, or a friend or family member; someone who will support you every step of the way. Involving your partner throughout your pregnancy can make a big difference. If possible, encourage them to attend prenatal appointments with you. This helps your care provider include them, gives them a better understanding of what you are experiencing, and allows them to ask questions. During labor and birth, your partner can be an invaluable advocate, helping to ensure your preferences are respected and offering you support. The more you include them leading up to birth, the better.

Announcing Your Pregnancy 

As tempting as it may be, you may not want to run out and tell everyone you are pregnant right away. While I don’t want to alarm you, miscarriage is more common than you may realize. A miscarriage refers to a pregnancy loss before 20 weeks. It’s estimated that 10 to 20% of known pregnancies end in miscarriage. According to the American College of Obstetricians and Gynecologists, about 10% of clinically recognized pregnancies result in a loss. The actual number may be even higher since some losses happen before someone realizes they are pregnant or has a pregnancy confirmed by a doctor.

It is common to have some anxiety about the possibility of miscarrying. Especially early on, you may have some signs or symptoms of pregnancy, but you don’t look pregnant, and you can’t feel your baby moving or kicking. The risk of miscarriage does decrease as pregnancy progresses. About 80% of losses happen in the first trimester. This is why many people wait until 12 weeks to make a big public announcement.

When you decide to share the news, you don’t necessarily have to tell everyone at once. You could let a few individuals in on the secret early and then break it to all of your family and friends at the 12-week mark. Perhaps you want to wait even longer to tell your work. The bottom line is to announce your pregnancy when you are comfortable.

Cut Out Any Major Bad Habits 

As soon as you find out you are pregnant, you should cut out significant bad habits. Start with the obvious: alcohol, cigarettes, and drugs. If you had a big party night before discovering that you were pregnant, don’t stress. The important thing is that you kick these habits as soon as you know you are pregnant. If you take any prescription medications, contact your doctor or midwife right away to ensure they are safe to continue taking during pregnancy.

Taking Steps for a Healthier Lifestyle 

Finding out you will be a parent is the perfect time to focus on building healthy habits. The foundation of being healthy is staying hydrated, eating healthy whole foods, getting adequate sleep, and exercising.

Staying Hydrated

Water makes up around 60% of your total body weight, and every cell needs water to function. Staying hydrated helps you regulate body temperature, aids digestion, transports nutrients and oxygen to cells, and helps you absorb nutrients and eliminate waste. These processes are also crucial for your baby during pregnancy, and you have increased water requirements when you are pregnant. Plus, if you do not drink enough water, you can exacerbate many common pregnancy symptoms like constipation, Braxton Hicks contractions, edema (swelling), and migraines.

A study based on data from the National Birth Defect Prevention Study found decreases in the risk of congenital disabilities when pregnant mothers increased their water consumption. This included neural tube defects, oral clefts, musculoskeletal defects, and congenital heart defects. One study found that dehydration in mothers resulted in lower weight, height, head circumference, and chest circumference of their babies.

The American College of Obstetricians and Gynecologists recommends drinking 64-96 ounces (1.9-2.8 liters) of water every day. One of the simplest indicators of whether you are hydrated is the color of your urine. Ideally, your urine is a light shade of yellow. See this episode for more information on staying hydrated during pregnancy, the best water source, and electrolyte supplementation.

Diet

During pregnancy, your body has higher nutritional needs to support your increased energy demands and your baby’s growth and development. Whether you already follow a healthy diet or need to make some changes, pregnancy is an ideal time to focus on nourishing your body and building healthy eating habits. This might mean adding more fruits and vegetables, reducing sugar, or being more mindful of your food choices. While you are eating for two, the American College of Obstetricians and Gynecologists states that no extra calories are needed in the first trimester if you are pregnant with a single baby. In the second trimester, you will need an additional 340 calories per day, and in the third trimester, about 450 extra calories a day.

There are many varying opinions on diet, and nutrition is very individualized. That said, the closest thing to the perfect diet is to eat healthy, whole foods. The bulk of your diet should be foods that were alive, whether these are plants or animals. “Real food,” as Lily Nichols, RDN, CDE, puts it in her book, Real Food for Pregnancy. She writes, “In a nutshell, real food is made with simple ingredients that are as close to nature as possible and not processed in a way that removes nutrients.” I highly recommend her book if you want an evidence-based deep dive into what you should eat during pregnancy.

Prenatal Vitamin 

Ideally, you start taking a prenatal vitamin before you get pregnant. The next best time to start is when you find out you are expecting. Taking a high-quality prenatal vitamin is one of the easiest things to ensure you have all the vitamins and nutrients you and your baby need during pregnancy. You have an increased need for specific nutrients during pregnancy, and it is challenging to meet these requirements with your diet alone. Prenatal vitamins contain higher amounts of nutrients like folate, folic acid, and iron than standard multivitamins. My #1 recommendation for a high-quality prenatal vitamin is the Zahler Prenatal +DHA.

Probiotics 

You may also consider taking a daily probiotic or including more probiotic-rich foods in your diet. Your gastrointestinal system (AKA your gut) does much more than digest food; it is a key player in your immune system, mood regulation, and overall health, especially during pregnancy. Your gut microbiome consists of trillions of bacteria, both good and bad. Maintaining a healthy balance between them is key to keeping everything functioning properly.

A recent review found that probiotic supplementation during pregnancy seems protective. Probiotics may improve insulin resistance and reduce the risk of gestational diabetes. Researchers found that probiotics may influence brain activity to reduce anxiety and depression. Probiotics are found to make vaginal flora friendlier to beneficial bacteria and enhance anti-inflammatory or reduce pro-inflammatory cytokines. Researchers also found that probiotics may decrease eczema in breastfed infants and prevent allergic reactions. In addition, probiotics can impact common pregnancy symptoms like constipation and reduce your risk for group B strep and preeclampsia.

This episode covers probiotics, how to incorporate pregnancy-safe probiotic-rich foods in your diet, the risks and benefits of a probiotic supplement, and how to choose the right one. If you simply want a recommendation, I would recommend a few. AG1 is a fantastic source of pre- and probiotics. This is my source of supplements for my gut health, and it also covers many other areas of health. If you prefer a supplement containing probiotics and not other vitamins, minerals, or nutrients, Garden of Life makes an excellent probiotic and offers a probiotic specifically for pregnancy, which is a great option. As with any supplement, please consult your doctor or midwife before taking it.

Sleep

The growing body of research on sleep demonstrates the absolute necessity of sleep for every biological function. This includes learning, memory, brain function, mental health, appetite regulation, immune system function, metabolic function, gut microbiome health, and even cardiovascular health. The scientific literature is well established that sleep is a critical component for all aspects of health, especially during pregnancy. 

You can imagine that the importance of sleep increases during pregnancy for both your and your baby’s health. Fatigue is very common early in your pregnancy, and you will likely be sleeping more. Surveys show sleep increases in the first trimester (average 7.4 to 8.2 hours).

Listen to your body and understand that you will likely need more sleep early in your pregnancy. Some simple tips can significantly impact the quality and quantity of your sleep. Maximizing your exposure to natural light in the morning can help regulate your sleep-wake cycle. Minimizing bright and blue light exposure after sunset supports your body’s natural melatonin production. This includes reducing screen time in the evenings. A consistent sleep schedule, even on weekends, can make a significant difference. See this episode for more evidence-based tips to improve your sleep.

Exercise

As you can imagine, there are many benefits of exercise in pregnancy. Regular exercise can decrease your risk of complications like gestational diabetes, preeclampsia, and cesarean birth and promote a healthy weight gain. Working out can also ease common pregnancy symptoms like constipation and back pain. In addition, living an active lifestyle will improve your physical and mental health in the short and long term.

The American College of Obstetricians and Gynecologists recommends that pregnant women get at least 150 minutes of moderate-intensity aerobic activity weekly. They define moderate aerobic activity as one in which you move large muscles of the body in a rhythmic way enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing. Moderate-intensity aerobic activity could mean anything from a brisk walk to general gardening like raking, weeding, or digging.

While organizations, like ACOG, do consider evidence when making recommendations, they are focused on all pregnant women and tend to be conservative. Some of the recommendations for pregnancy are so conservative that many expecting mothers may feel afraid to do anything with any risk. The truth is that nearly every form of exercise can be modified to be safe during pregnancy. There are separate episodes with in-depth information on exercise, cardio, strength training, and yoga.

If you already have a consistent workout routine, you can continue it as long as it feels good. If you do not get very much physical activity, walking is something nearly everyone can do. Even a daily walk around your block can be a good start to exercise. Evidence shows that walking during pregnancy decreases the risk for gestational diabetes, and glucose levels are 4%–21% lower after a 25-40 minute low-intensity walk. Walking is also associated with a 33% decrease in risk for preeclampsia. Another benefit is that walking is associated with a 29-44% decrease in excess weight gain during pregnancy. The distance and time walked affected the decline in the risk of weight gain. Plus, there is evidence that it can also lead to a healthier birth weight for your baby and reduce the risk of preterm birth.

Taking Care of Your Mental Health and Managing Stress

Taking care of your health also includes your mental health. Stress during pregnancy can affect your baby in many ways. Physiological changes can impact your developing baby. Stress that puts you at a higher risk for some complications can affect the health and development of your baby. How you and your baby are affected by both short and long-term stress is a function of your stress response and ability to turn it off. The good news is that understanding your stress response and learning about evidence-based tools to manage stress will minimize the adverse effects for both you and your baby and positively impact your mental health. See this article on stress in pregnancy for more information.

Social connection is an often-overlooked factor that can greatly benefit your mental health. A study found that social support played the most significant role in distinguishing whether pregnant women experienced healthy, psychological, or physical stress. Social support was defined as others with whom to talk and spend time and on whom to rely for material help. Pregnancy can be isolating, especially early on when you may be reluctant to share the news. Please prioritize your social connections with others and lean on your partner and support system when needed.

What You Should Avoid or Exercise Caution With

It is easy to find lists of foods, drinks, activities, and even everyday tasks, like cleaning a cat’s litter box, that you should avoid during pregnancy. Health agencies often recommend avoiding these things entirely because it is simpler than explaining the nuance behind each one. Understanding why certain items carry risks can help you make informed decisions about what you are comfortable with. Many episodes linked throughout this article explore these topics in more detail if you want to dive deeper.

Alcohol

Alcohol is one of the first things to avoid once you see that positive pregnancy test. You may wonder whether any amount is safe, how it could affect your baby, or whether an occasional drink is okay. If you ask your doctor or midwife, you will usually hear one of two answers: either absolutely no alcohol in any quantity or that an occasional glass of wine with a meal is acceptable. While it is clear that drinking large amounts of alcohol is harmful, all major medical organizations, including the CDC, the American Academy of Pediatrics, and ACOG, advise against any alcohol use during pregnancy.

Many expecting moms ask, “I went out and had a party night or a couple of party nights before I knew I was pregnant. Is my baby going to be okay?” As soon as you know or suspect you are pregnant, you must watch your alcohol consumption. There is no sense in stressing out over the party night you had before you realized you were pregnant. Many women have been in that same situation and had perfectly healthy babies. You cannot change the past, but you can make mindful choices moving forward. Even the American College of Obstetricians and Gynecologists acknowledges that serious harm is unlikely if you drank before you knew you were pregnant.

Check out this episode for the evidence on everything from the party night you had before you realized you were pregnant, enjoying a drink or two during pregnancy, and whether you need to pump and dump if you drink while breastfeeding.

Caffeine

Caffeine is another substance with which you should exercise caution. Trying to figure out how much caffeine is safe during pregnancy and breastfeeding can be challenging. Like so many things, you can always take the most conservative approach and abstain from caffeine during pregnancy. There is no definitive evidence showing an amount of caffeine that is 100% safe during pregnancy. Most studies use 200 mg daily as the cut-off for low or moderate consumption. This aligns with most recommendations by ACOG and other national and global health agencies. To put this into perspective, an 8-ounce cup of coffee contains 95-200 mg of caffeine, black tea 14-70 mg, green tea 24-45 mg, and 12 oz. (355 ml) Coca-Cola 23-35 mg.

See this episode for a deep dive into how you process caffeine during pregnancy and the recommendations and research on the safety of caffeine during pregnancy and breastfeeding. This episode

Foods and Drinks to be Mindful About

Some foods carry risks during pregnancy, and it is easy to find long lists of foods you shouldn’t eat. Cutting these items out of your diet can be challenging, especially if they are foods you enjoy or eat regularly. If you would like more in-depth information on food safety during pregnancy, this episode dives into the evidence beyond the do-not-eat list, including a few foods that don’t typically appear on the list but may still be worth paying attention to. The most common foods with which to exercise caution are discussed below.

Unpasteurized Foods

Pasteurization is a process that heats foods to eliminate bacteria and pathogens for safety and extends shelf life. Many of the foods that are more susceptible to harboring bacteria and pathogens are pasteurized. Unpasteurized foods primarily include milk, juices, and some cheeses.

Deli Meats

Deli meats frequently appear on lists of foods to avoid. This is due to the risk of listeria. There is a massive incentive for restaurants, delis, and companies that sell deli meats to ensure their food is safe. The risk of listeria is low, but it can be dangerous during pregnancy. You could decide to eliminate deli meats from your diet during pregnancy. Another option to eliminate the risk of listeria is to go with a hot sandwich. Heating the meat to 165° Fahrenheit (74° Celsius) will kill off bacteria. 

Fish

ACOG recommends 2-3 servings (8-12 ounces in total) of fish per week. They recommend a maximum of six ounces of albacore tuna (commonly canned tuna). ACOG recommends avoiding fish with the highest levels of mercury (tilefish from the Gulf of Mexico, swordfish, shark, and king mackerel). The dilemma of limiting your fish intake to 12 ounces per week is that it is nearly impossible to get enough omega-3s, specifically DHA. There is a lot of nuance when examining the evidence on fish consumption during pregnancy, and you can learn more in this episode.

It is also recommended to avoid raw or undercooked fish, such as sushi, during pregnancy. Although fish intended for raw consumption is often frozen to kill parasites, it can still carry bacteria or viruses. While these risks are always present, pregnancy makes you more vulnerable, and exposure could lead to serious complications for your baby.

Undercooked Eggs and Meat

The same concerns about bacteria contaminating raw or undercooked fish apply to raw or undercooked eggs or meat. The risk of a food-borne illness (think food poisoning) is always there, but with your baby on the way, you may want to be cautious or avoid it altogether.

Activities to Exercise Caution With

In addition to foods and drinks, there are some activities you should exercise caution with.

Cleaning the Litter Box and Gardening

If you have a cat, being around your cat is perfectly fine; however, their feces and the sand they bury it in can contain a parasitic infection called toxoplasmosis. For a healthy adult, toxoplasmosis typically does not cause serious issues. This is extremely common, with estimates suggesting over 40 million Americans are infected. However, if you become infected just before or during pregnancy, it can pose significant risks to your baby, including congenital disabilities such as hearing loss, vision problems, and intellectual disabilities.

The good news is that if you have ever been infected with toxoplasmosis, you are likely immune, and your immunity also protects your baby. Nearly a quarter of adults in the United States are estimated to be seropositive, meaning they have been exposed and have immunity. The only way to know this would be to get a blood test; toxoplasmosis screening is not routinely done in the United States. Unless you know you are seropositive, ask your partner, a friend, or a family member to come by and clean out the litter box for you.

If you have an outdoor cat or stray cats who use your garden as a litter box, it is also possible to contract toxoplasmosis from the soil while gardening. If you garden, wear gloves and wash your hands thoroughly afterward. Avoid touching your face while gardening, and always wash any fruits, herbs, or vegetables before eating them.

Heat Exposure 

There is a concern about an elevated core temperature during pregnancy causing neural tube defects, spontaneous abortion, and other abnormalities. For this reason, some activities that expose you to heat, like practicing Bikram yoga, going in a hot tub or sauna, and even taking a hot bath, warrant caution. If you enjoy and would like to keep doing these activities, there is more nuance.

ACOG advises against hot yoga or hot pilates, which may cause you to become overheated. Interestingly, there is research comparing core temperatures during a 60-minute yoga class in a room at 70 °Fahrenheit (21.1 °Celsius) compared to a room heated to 92 °F (33.3 °C). The study did not find a difference in the core temperature increase between the two rooms. The highest recorded temperature of all participants was 102.4°F, just over the 102°F (38.9 °C) threshold we prefer to keep temperatures below during pregnancy. In a room heated to a temperature higher than 92°F (33.3 °C), you could see more of an increase in core temperature.

Hot tubs and saunas are typically not advised during pregnancy due to the risk of elevated temperatures. Similar to the research on hot yoga, there has been research on how hot tub and sauna use affects core temperatures. The main takeaway from this research is that the normal use of hot tubs or saunas is unlikely to raise your body temperature to potentially teratogenic levels. Most participants remove themselves because they feel overheated before their core temperature reaches dangerous levels. If you decide to use a hot tub or a sauna, there is a difference between occasionally spending a few minutes or being in for an extended period every day. You should get out and cool off as soon as you start to feel uncomfortably warm.

It is a myth that you should not take a bath when you are pregnant. You can enjoy a bath during your pregnancy, but don’t make it scalding hot. When you are submerged in water, your body cannot sweat to cool down. By all means, please enjoy a bath if you would like to. Pay attention to the temperature and how you are feeling, and get out if you start to feel overheated.

Exposure to Harmful Chemicals

The first trimester is the most sensitive period of pregnancy, as it is when your baby’s organs and systems are developing. Many women become more mindful about chemical exposures during this time since some substances can cross the placenta. Pregnancy also heightens your sense of smell and can make your skin more sensitive, which may affect how you react to products. Two key areas to be cautious about are household chemicals and personal care products.

Safe Cleaning Products

Some household cleaners, like strong drain or oven cleaners, are particularly toxic. If possible, have your partner or someone else use these products. Always use gloves, work in well-ventilated areas, and spray cleaners onto a cloth rather than directly on surfaces to limit the chemicals in the air. Choosing fragrance-free and milder formulas is an easy way to reduce exposure to potentially harmful substances. For more guidance on safe cleaning products, see this episode.

Skin Care

A few ingredients in skincare products should be avoided during pregnancy, and there are others you may want to be cautious about. The biggest concern is around vitamin A compounds. Oral isotretinoin, used for severe acne, is strongly associated with congenital disabilities and should be completely avoided. Topical retinoids, like tretinoin (Retin-A) and other vitamin A derivatives (such as retinaldehyde, retinol, and retinyl palmitate), are absorbed in small amounts through the skin. Still, it is generally recommended to avoid these during pregnancy out of caution.

The American College of Obstetricians and Gynecologists also advises against using other prescription acne medications during pregnancy, including hormonal therapies and tetracyclines, which are linked to an increased risk of congenital disabilities. If you have questions about skincare products, check with your doctor or dermatologist.

If you like the skincare products you currently use, and they do not contain ingredients specifically cautioned against by ACOG, don’t change a thing. Finding products that work well for your skin and hair can be challenging. If you start reacting differently to your current products due to increased skin sensitivity, it may be time to cut back on products or find different ones. You can always bring a product to your next prenatal appointment and talk to your doctor or midwife about any questions or concerns. Like cleaning products, simply opting for fragrance-free products will eliminate your chemical exposure. For a deeper dive into which ingredients to avoid, how to find safe products, and how to understand marketing claims like “non-toxic,” see this episode.

Adjusting During Your Pregnancy

Once you are pregnant, you need to be cautious or mindful about many things. It can be overwhelming initially to feel like everything carries some risk. With a few exceptions, all of these cautions have nuance. You can always avoid anything with risk to be as safe as possible. You can also educate yourself with evidence-based information and decide whether you are comfortable consuming certain things or participating in specific activities. Please ask your doctor or midwife if you have any questions about participating in activities or consuming foods.

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