Pregnancy Diary: The First Trimester

By Courtney McCrimmon

Some women manage to fly gracefully through their first twelve weeks of pregnancy without ever indicating they are pregnant – never caught retching in the office bathroom,   their stomachs remaining  perfectly in place, emotions at least appearing balanced. I am not one of those women.

In fact, this pregnancy, my second, found me around my ninth week clutching my boss’s desk with my head between my knees, desperately trying to avoid throwing up in front of her. When she asked me if I was OK, I said something along the lines of “No. In fact, I think I’m dying. Actually, I’m pregnant.”

Despite my best intentions to wait until after the first trimester ended,  especially given my Advanced Maternal  Age (AMA) status, the nausea I experienced felt paralyzing at times, and while my clothes still fit at nine weeks they no longer did at twelve.  I am happy I shared my news earlier than traditionally recommended but it made me wonder. Why, during perhaps the most difficult trimester of pregnancy, when even the smell of dry cereal can make a pregnant woman gag and her exhaustion is at its height, is she expected to keep the information private? Biologically, what puts her at a greater risk for miscarriage at eight weeks as opposed to eighteen?

To understand what information is most important for women to know during their first trimester, I turned to Draion Burch, M.D., an obstetrician and gynecologist (ob-gyn) with Magee-Womens Hospital of UPMC.  He advised that planning for your first trimester start early with a pre-conception check-up with an ob-gyn in order to identify risk factors that could affect their pregnancy.

According to Dr. Burch, women can expect to experience any of the following symptoms during their first trimester: nausea, vomiting, breast tenderness, food aversions, food cravings, increased urination, heartburn, fatigue, constipation, dizziness, fainting, mood swings, bloating, vaginal spotting, darkening of the areolas and headaches.

“If you experience significant nausea and vomiting, which we often refer to as morning sickness but can actually last throughout the day, try eating smaller, more frequent meals five to six times a day,” said Dr. Burch. “You could try the BRAT diet (banana, rice, applesauce, toast), but make sure you include high protein snacks like milk and yogurt. Avoiding spicy and fatty foods should help, as should drinking plenty of water and beverages containing electrolytes. Do your best to avoid smells that bother you.”

I also asked Dr. Burch to walk us through the first obstetric appointment after becoming pregnant. 

“At your first prenatal visit, your doctor will test your urine and blood, and obtain cultures from your cervix. You may have to have a PAP smear to screen for cervical cancer,” Dr. Burch said. “We test everyone for HIV, gonorrhea and chlamydia, Hepatitis B, and syphilis so please don’t be offended by those tests!”

Doctors will also check a pregnant woman’s blood for a variety of factors, including determining her hemoglobin level, blood type, Rubella status, and blood glucose levels if she is at risk of diabetes. There are also carrier screening blood tests that can be ordered depending on ethnicity and family history such as cystic fibrosis, sickle cell disease, thalassemia, or Tay-Sachs disease.

“All of these tests are conducted to make sure you are in the best health possible to carry your baby,” Dr. Burch said.

As for when the “safest” time is to announce your pregnant, Dr. Burch said the majority of miscarriages occur before the thirteenth week and can be caused by several factors.

“It’s important to emphasize to women that they cannot control most miscarriage factors. In fact, the most common cause of miscarriage is chromosome problems in the baby. Most of these problems are chance occurrences and unlikely to happen with another pregnancy,” he said.

During the first trimester, women have the option of screening for various birth defects and Down’s syndrome.  Dr. Burch also walked me through the testing process.

“If you choose to have your baby screened for birth defects in the first trimester, you will have your blood drawn and tested for pregnancy-associated protein plasma A and human chorionic gonadotropin.  You may also have an ultrasound to look at your baby’s skin thickness at the back of the neck, also known as neck-nuchal translucency. These tests look for trisomy 18, which is another chromosomal defect, and Down’s syndrome. The ultrasound, blood work and your age are combined to help understand your risk of having a baby with a birth defect.”

Whether you are riddled with early-pregnancy symptoms – like me! - or flying through the first trimester seamlessly, make sure to rest when you feel the need to, and take good care of yourself. Stay hydrated, eat food you think you can keep down and relax when possible. And don’t hesitate to take any concerns you have to your ob-gyn.

This is the one in an occasional series examining pregnancy from the viewpoint of an expectant mom. Courtney McCrimmon is a Manager in the Media Relations department at UPMC.