According to the Food & Drug Administration (FDA), sucralose (eg. Splenda) is safe for everyone to consume, including pregnant women. As well, the FDA advises aspartame (eg. Equal or Nutrasweet) is safe during pregnancy and lactation.
Both sucralose and aspartame consumption should be limited to a moderate level.
Aspartame is not safe for everyone - particularly not for those people with PKU (a rare metabolic disorder), certain liver diseases, or high levels of phenylalanines in their blood.
The FDA notes that the safety of saccharin (eg. Sweet-n-Low) in pregnancy remains questionable so advises to avoid it in pregnancy.

If you should experience bleeding in the first trimester, it does not always suggest a miscarriage. It is not uncommon to experience light bleeding when the embryo implants in the uterus. Sometimes a blood clot can form at the implantation site and this may dissolve slowly and present itself later in the first trimester. Light bleeding may also arise from the cervix- this occasionally happens after intercourse or heavy activity.

However, due to the possible concern of a miscarriage or other pregnancy complication, please report any spotting or bleeding in pregnancy, even if the bleeding seems to have stopped. While it may turn out to be something minor, such as implantation bleeding or an irritable cervix, it could be a sign of a serious problem. You will probably need an exam to make sure you and your baby are fine and to rule out any complications.

You should seek medical attention if you have heavy bleeding especially with cramping. If you are actively bleeding (such as saturating more than three or four pads in an hour), have severe pain of any kind, and/or are experiencing dizziness or weakness, please try and contact your doctor immediately and consider heading straight for the emergency room for further evaluation.

If you have vaginal bleeding or spotting in pregnancy, it is important to know if your blood type is Rh positive or negative. Those women who are Rh negative and have vaginal bleeding will need a shot of Rh immune globulin to prevent the possibility of antibody formation against a positive blood type (if the fetus is positive). Ideally, and if indicated, the Rh immune globulin shot should be given within 72 hours of the bleeding episode.

Pregnant women should reduce caffeine intake or cut it out entirely. If you decide to have some caffeine, then be aware of your total dietary caffeine intake and try to consume less than 200 mg of caffeine (equivalent to 10-12 oz of coffee) per day from all sources. Be aware that some over-the-counter medications may contain caffeine, so be sure to check their labels.

Most adults are immune to chicken pox either from having the disease, by forming immunity from a mild exposure, or from prior vaccination. If you have had chicken pox in the past, you and your baby are protected (immune). If you are not sure, contact your obstetrician to check your immunity with a blood test. If this shows you are immune, you and your baby are protected. If this shows no immunity, it is recommended that you receive a varicella immune globulin injection within 4 days of exposure to try and prevent chicken pox.

If you need or would like to see a chiropractor during your pregnancy, just ensure that your chiropractor

• has been trained to work with pregnant women,
• uses tables that adjust for a pregnancy woman's body,
• uses techniques that avoid unneeded pressure on the abdomen.

Cord blood is the blood that remains in the umbilical cord and placenta following birth, which is usually discarded. Cord blood banking uses external facilities as a place to store and preserve your baby's cord blood. The cord blood of your baby serves as an abundant source of stem cells, which are genetically distinctive to your baby and your family. The stem cells from your baby's cord blood may be able to treat a small number of limited diseases or conditions in a parent or sibling. There are fees for privately banking and storing cord blood. The American College of Obstetrics and Gynecology cautions that patients need to be aware that the chances are remote that the stem cells from their baby's banked cord blood will be used to treat that particular child - or another member of the family - in the future. Currently there are few public cord blood banks but hopefully this will change in the future.

Circumcision is the removal of the foreskin, which is the skin that covers the tip of the penis. The American Academy of Pediatrics does not feel there is sufficient medical data to recommend routine circumcision. However, many couples still wish to have their baby boy circumcised for religious, cultural or cosmetic reasons. If you decide to have your baby circumcised, we perform the procedure with local anaesthesia usually within the first few days of life.

Let your dentist know you are pregnant. Routine dental cleaning is safe and recommended during pregnancy. Routine xrays and elective dental work should be delayed until after the birth. If xrays are needed for emergency dental work, ensure your abdomen is shielded. Postpone non-emergency dental work until the 2nd trimester or until after delivery if possible.
Local anaesthetics and most antibiotics (these include penicillin, amoxicillin, and clindamycin) are fine in pregnancy.
After 20 weeks, try not to lie flat on your back for extended periods of time.

If you have been active, you may continue exercising. Low impact exercise is encouraged. Swimming and running are acceptable as long as you are used to doing them and feel comfortable. Horseback riding, waterskiing, snow skiing, or wakeboarding are not recommended. Exercise at a moderate level so that you are able to talk normally while exercising. Avoid lying on your back after 20 weeks. Exercising at least 30 minutes a few times per week may decrease your risk of gestational diabetes, reduce backache and stress, help you sleep better, and improve muscle tone.
If any activity causes shortness of breath, pain, or bleeding discontinue the activity.
If there is a suspicion of premature labor, ruptured membranes or bleeding, please contact your physician for activity restrictions.

Feeling tired improves after 14 weeks. Taking a nap daily, especially after 34 weeks, also helps.

Yourare usually able to feel your baby move start around 18-20 weeks with your first pregnancy and 16-18 weeks with subsequent pregnancies.

Report any marked decrease or lack of movement after 26 weeks.

Eat 3-6 meals daily selecting from each of the four food groups.
Drink adequate fluids (e.g. 6-8 glasses of water) daily.
Caloric intake: You need approximately 300 calories more per day in pregnancy. Your recommended daily total caloric intake in pregnancy then will depend on your pre-pregnancy weight, body type, and activity level. For most active women and teenage young women this means about 2,500 calories per day and for sedentary women this means about 1,900 calories per day. If you are carrying twins, you will need about about 600 additional calories per day and that translates to 2,700 to 2,800 calories per day if you are of average weight. For more information please refer to ACOG's patient pamphlet on "Nutrition in Pregnancy"
Your diet should be balanced in food groups with not more than 30% fat and minimizing unnecessary carbohydrate intake. A reduction in salt intake is important. Eat plenty of fresh fruits and vegetables. Avoid sweets, starchy foods, fried foods and extra salt intake.
Protein intake should consist of lean meats, cheese, eggs, legumes, fish, and cooked seafood.
Minimize mercury consumption in fish &seafood: Certain fish accumulate high levels of mercury - therefore, avoid eating shark, swordfish, king mackerel, or tilefish. Tuna steak should be limited to 6 ounces per week. You can eat up to 12 ounces (2 to 3 meals) of other varied fish, shellfish, or canned light tuna per week.
Unpasteurized dairy products and deli meats can carry the bacteria Listeria. While Listeria is quite uncommon in the USA, it is wise to avoid regular intake of unpasteurized milk and juices; soft cheese (such as brie, feta, blue-veined cheeses); raw or undercooked meats, poultry, and shellfish; prepared meats, such as cold deli meats. Deli meats heated until steaming are safe.
Raw fish and meat may carry parasites and other microbes and therefore should also be avoided.

United States Department of Agriculture
USDA's website provides a special section about nutritional information just for pregnant or breastfeeding women. Here you can get your own "MyPyramid Plan for Mom" and choose from a menu of topics including pregnancy & breastfeeding nutritional needs, weight gain and weight loss. The USDA also informs about special health needs such as allergies, medical conditions and lactose intolerance, as well as food safety, and much more.

If a pregnant woman gets the flu, she is more likely to become very sick. The American College of Obstetrics and Gynecology (ACOG) recommends that all women who will be pregnant during the flu season (October through mid-May) be offered the vaccine. According to ACOG, flu vaccination is an essential part of prenatal care that provides protection to both women and their babies. No adverse side effects have been shown in pregnant women. The flu vaccine is a "passive" vaccine and no live or dead virus is injected, and there is no known fetal risks to passive immunization. Breastfeeding women can also safely get the vaccine. However, women with egg allergies, should not get the vaccine as the vaccine making process can include chicken eggs.

Here are resources and links to websites that will provide you with up-to-date information about the H1N1 flu virus:

The American College of Obstetricians and Gynecologists (ACOG):
Pregnant Women and the Flu Fact Sheet (pdf).

Centers for Desease Control and Prevention (CDC) online resources:
Resources for Pregnant Women
Influenza Vaccine Questions and Answers

FLU.gov:
Know what to do about the flu

Coloring your hair during pregnancy is probably safe. If you are concerned, then hold off coloring hair with permanent dyes during the first trimester and consider highlights instead of coloring your whole head of hair.

There is little known about the safety of herbal medicine and nontraditional medications during pregnancy. Many women don't consider herbal remedies to be medicine and when pregnant don't report their use to their obstetricians.

Before starting or continuing herbal medications, be aware that the FDA does not regulate them and that they may have side effects or interactions with other medications, which could be even more concerning if you are pregnant.

You can harm your baby if you raise the temperature of his/her environment over 100 degrees for prolonged periods of time. So avoid hot tubs while you're pregnant. If you have to get in, it is permitted after 12 weeks for 5-10 minutes, but drink plenty of cool fluids.

NO saunas.

Avoid excess exposure to oil based paints, lead, and mercury. You should minimize your exposure to latex paints that contain ethylene glycol and biocides. Avoid removing old paint used prior to the 1970s due to the possible risk of lead exposure.

Parvovirus is a common virus that many of us have been exposed to in the past, especially if we have or work with school age children. An infection with parovirus, also known as Fifth's Desease, causes a bright red rash and fever in children and little to no symptoms in most adults, although adults may get significant joint pain. Once you have been exposed and develop antibodies to the virus, you are no longer at risk of getting it again nor passing it to your baby in-utero. If you have a new exposure during pregnancy and are unaware of your immunity, please call your physician's office to have a blood test done to look for antibodies. If this is negative, we may want to repeat it in a few weeks to see if you develop new antibodies since the time of exposure. If your test turns positive, it may be necessary to follow your baby with ultrasound testing for a few months. It is rare for your baby to develop a problem from this infection.

Some book suggestions for newborn and infant care from our local pediatricians:

• "What to Expect the First Year," Arlene Eisnberg, Heidi Murckoff, Sandee Hathaway
• "First Feelings: Milestones in the Emotional Development of Your Baby and Child,"
  Stanley Greenspan and Nancy Thorndike Greenspan
• "Taking Care of Your Child," Robert Pantell, James Fries, and Donald Vickery
• "Solve Your Child's Sleep Problems," Richard Ferber
• "Caring For Your Baby and Young Child," Steven Shelov
• "Your Child's Health," Barton Schmidt

There are many excellent books about pregnancy and maternity related issues. Here are a few examples:

• "What to Expect When your Expecting" by Eisnbery, Murkoff, and Hathaway
• "Great Expectations" - a POGA booklet - please ask our receptionist for a copy
• "Your Pregnancy & Birth, 4th Edition," The American College of Obstetricians and Gynecologists

You should always wear your seatbelt (both shoulder and lap belts) during pregnancy. The lap belt should be worn low on the hips, not over the uterus.

For a healthy woman with a normal pregnancy, intercourse is safe during pregnancy. You and your partner may want to experiment with different positions that may be more comfortable for you. If you are having problems in your pregnancy, such as bleeding, premature labor or ruptured membranes, your obstetrician may advise you to limit or avoid intercourse.

Early in your pregnancy, try to get into the habit of sleeping on your side. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses and also makes your heart's job easier because it keeps the baby's weight from applying pressure to the large vein (called the inferior vena cava) that carries blood back to the heart from your feet and legs. Some doctors specifically recommend that pregnant women sleep on the left side but in most cases, lying on either side should be fine and help take some pressure off your back. If you do find you rolled onto your back while sleeping, don't panic, simply roll back onto one of your sides and go back to sleep. Some women will also find they need added support while sleeping which may be accomplished through use of additional pillows or a body pillow.

A certain amount of swelling, or edema, is normal during pregnancy, especially during the summer. Swelling occurs most often in the legs and mainly in the third trimester. To reduce swelling, try to rest and elevate your legs more and avoid prolonged standing or sitting. Do not take "water pills", or diuretics, during pregnancy unless directed by your obstetrician. Let your obstetrician know if you have swelling in your hands or face.

Tanning beds will not hurt your pregnancy but are not good for you.

If you have an uncomplicated pregnancy it is usually safe to travel until you are likely to go into labor. Stay closer to home after 34 to 36 weeks gestation. Frequently, the most comfortable time to travel is in the middle of the pregnancy and this is when problems are least likely to occur.

If you are traveling by car or plane, plan to walk around every 2 hours for a few minutes to maintain circulation and decrease your risk of leg clots. Try to stay adequately hydrated by drinking 8-10 glasses of water a day.

You may want to check with your travel carrier ahead of time to see if they require a note from your obstetrician that indicates that you are under the care of an obstetrician, any risks factors (or lack of), and the number of weeks gestation. Please be aware that there are risks involved with travel during pregnancy and a note will not signify permission to travel as this is a patient's free will. An obstetrician can only advise and educate a pregnant woman about the risks of travel.

If you are traveling far from home, it is recommended that you be familiar with a nearby healthcare facility in the event problems or concerns arise while away. Also, it is recommended to minimize or avoid traveling far after 32 weeks.

Twins can make you more uncomfortable and tired than usual during pregnancy because the uterus becomes much larger sooner. Consider resting more during the day. Discuss your activity level at home and at work with your doctor, some women with twins may need to restrict their activity.
You will need to increase your caloric intake more when you are carrying twins. If you are of average weight, you will need to eat about 2,700 to 2,800 calories per day and you should expect to gain up to 45 pounds.
The risk of certain complications is higher with a twin pregnancy. You are more likely to develop high blood pressure, anemia, gestational diabetes, preterm labor, and/or growth problems with the babies. Sometimes these problems can be prevented with early detection and care and this is why you have more frequent prenatal visits and ultrasounds when you are carrying twins. Be certain to report any problems or concerns to your doctor early when you are carrying twins.
In some instances twins may deliver vaginally but your chance of cesarean section is increased when you have twins. To be considered for a trial of a vaginal birth, the first twin (called "twin A") must be head down. On rare occasion, the first twin ("twin A") is delivered vaginally and the second twin ("twin B") is born by cesarean section. Twins are usually delivered in the operating room which is larger than our traditional birthing rooms; this is to accommodate for the extra medical staff & equipment and also the ability to convert to a cesarean birth if necessary.
Breastfeeding is still encouraged and preferred when you have twins. Your milk supply will increase to meet the demands of your twins. If the babies are born prematurely, then consider pumping and storing the milk until they are able to feed from the breast.
For more information, please see ACOG's patient pamphlet on "Having Twins".

Varicose veins, "varicosities," are caused when the veins in your legs get weak and enlarge with blood. They have to work harder to carry blood back up your legs to your heart. Sometimes pregnancy can aggravate this problem. The enlarging uterus partially cuts off circulation from your legs. Exercise will help. Short walks at different times during the day will help pump your blood faster. Support stockings may significantly help and are available over-the-counter or by prescription. The vulvar area can also suffer from varicosities during pregnancy. Again, rest periods spread out during your day will help and consider placing a pillow under your buttocks to elevate your hips and aid circulation during rest periods and sleep.

Prenatal vitamins recommended throughout your pregnancy and while breastfeeding. Consider taking a supplement containing 200-300mg of DHA (from fish oil or flax seed oil) as Omega-3 fatty acids may help fetal eye and brain development.

Anticipated weight gain should be 25-35 pounds or approximately 3-4 pounds per month. Mothers who are underweight before pregnancy may gain 28-40 pounds and those that are overweight before pregnancy should limit their weight gain to 15-25 pounds. Women carrying twins may gain as much as 45 pounds. For more information look under "Food and Nutrition - what should I eat during pregnancy?"