New aches and pains, severe allergies, and other lesser-known symptoms happen to many pregnant women.

Sure, you've heard about morning sickness. You've probably heard the horror stories about how first trimester morning sickness sometimes becomes all-through-the-pregnancy-all-day-long sickness. And you might even be excited about the prospect of a new bra size. (Hmm, could you really go from a 32A to a 34C?)

But what about all those other symptoms of pregnancy, the ones you weren't prepared for? We've talked to moms and moms-to-be who've been through it, and a midwife who's been through it with them, and persuaded them to tell all.

Here are a few lesser-known tales about what you can expect when you're expecting.

New Pains in New Places
Many pregnant women notice pains in parts of their bodies they previously paid little attention to. Ro Harvey, the Michigan mother of three sons, reports the "joyful discovery of my sciatic nerve" during her pregnancies. "My middle son parked his baby butt on my sciatic nerve during the fifth month and never left until the day he was born. Well, except for during the times he was performing acrobatic feats inside my uterus," Harvey says. "I'd lie in bed watching his head peak at my belly button, then his back, then his feet. I'd get a hard pinch on the sciatic as his head passed, and then a dull ache when he settled back in position. No one warned me that babies seem to have an instinct for what the absolute most uncomfortable position in the world is!"

The Nutrition Dos and Don'ts of Pregnancy

You may also find yourself waking up at night with restless leg syndrome, like Jessica Miller, a first-time mom in central New Jersey who's now 35 weeks pregnant. "I had no idea that this condition even existed until someone else in a pregnancy group said she had it," Jessica says. "It's a tingling, numb feeling and extreme feeling of restlessness in the legs. I only get it at night; sometimes it happens while I'm lying on the couch. My legs just crawl and I feel like I have to move them. Once I'm up and walking, it's fine."

If you have allergies, pregnancy can aggravate them to an unbearable degree. Pennsylvanian Dawn Beck had mild allergies to cats before she got pregnant. Now 18 weeks along with her first child, she reports, "I seem to be severely allergic to cats, dogs, pretty much anything with hair!" In fact, she recently had to give her beloved dog a temporary new home with her mother-in-law because she couldn't breathe. "This has come on quite suddenly, and as time goes on it keeps getting worse," she says. "I hope it goes away after the pregnancy so I can get my dog back!"

"An empty bladder does not exist when you're pregnant!" Harvey declares. "I wasn't warned about the bladder jabs. I'd go to the bathroom, feel that joyous sense of relief, and continue on about my work. About 10 minutes after I'd left the bathroom I'd feel a foot, or an elbow, impacting on my supposedly empty bladder with the force of a stampede. Maxi-pads became my best friends."

All of these symptoms are likely to be that much more frustrating since you're going to be exhausted much of the time. "The books all tell you about fatigue, but I think all women are surprised by just how bad it can get," says Lynn Himmelreich, CNM, MPH, a midwife in the obstetrics and gynecology department at the University of Iowa in Iowa City. "Women come in and tell me, 'I was exercising up until I found out I was pregnant, and now I'm so exhausted I just can't do it.'" You may be beat, but even a little exercise can go a long way toward alleviating that exhaustion, and sometimes other symptoms as well. "Believe it or not, it really does energize you once you get up and do it."

Not all surprising pregnancy symptoms are physical. Carrie Hutton, a new mom from Arlington, Va., whose son is now four months old, describes what some call "pregnancy amnesia." "For some reason, no matter how competent you were in your pre-pregnancy life, you can no longer connect the dots. You're lucky you can still remember your name, address, and phone number!" she says.

I'm Feeling Nothing!
What if you're expecting the whole Pregnancy Platter of Symptoms -- morning sickness, swollen and tender breasts, the works -- and they fail to show up? In most cases, just consider yourself lucky and go about your business. "I get more questions from people who don't get the symptoms that the books mention than those who do," says Himmelreich. "They're concerned that it means something's wrong."

Is something wrong? Not usually. "There are plenty of pregnancies in which the woman doesn't have morning sickness or sore breasts. That's normal," Himmelreich says. (Just don't brag about it too much to the woman in the next office who can't keep a saltine down.) When you should be concerned: if pregnancy symptoms you've had suddenly disappear. "It's not usually a problem if you don't have tender breasts, for example, but it's more concerning if you had those symptoms at first and then suddenly at seven or eight weeks, they stopped," Himmelreich says.

And not all pregnancy surprises are negative. "The one thing that surprised me most was that I loved my pregnant body," Hutton says. "Although over time I became awkward, achy, and tired, I loved the way I looked while pregnant. I loved my round breasts and belly, so full of life. My skin and hair have never looked better. When I was pregnant, I felt beautiful. I had never noticed how beautiful pregnant women were before."

Coping with a High-Risk Pregnancy

GET THE SCOOP ON…
What being "high risk" means to you and your baby . Chronic conditions that can place a pregnancy at risk . Conditions that can develop during pregnancy . Coping with your anxiety . Staying sane while you're on bed rest

Coping with a High-Risk Pregnancy
There's nothing warm and fuzzy about the term high-risk pregnancy. In fact, it can be downright scary. What many people don't realize, however, is that the term high-risk pregnancy is a catch-all term that's used to describe women who are on the risk continuum at any point during their pregnancy: women who are at a slightly higher-than-average risk of experiencing complications during pregnancy or birth, or giving birth to a baby with a minor birth defect; and those who have the odds of a happy outcome firmly stacked against them, but who are willing nonetheless to take their chances at starting a family.

If you are at the low end of the risk continuum, your pregnancy may be, for all intents and purposes, perfectly normal. If, on the other hand, you're at high risk of experiencing complications, your pregnancy will be a major commitment—one that will change virtually every aspect of your life during the months ahead.

In this chapter, we talk about what being high risk is likely to mean to you and your baby. Then we discuss both chronic conditions that require special management during pregnancy and conditions that can arise during pregnancy and plunge a low-risk pregnancy into the high-risk category in the blink of an eye. We wrap up the chapter by discussing what it feels like to experience a high-risk pregnancy and offering some practical tips on staying sane during bed rest—one of the biggest challenges many women face during a high-risk pregnancy.

" Your perfect pregnancy—the one we're brought up to believe every woman gets to experience—has now become that other thing you read about in magazines. You are now in the high-risk category. Everyone, from your obstetrician to your own mother, is behaving differently toward you.
—Laurie A. Rich, When Pregnancy Isn't Perfect: A Layperson's Guide to Complications in Pregnancy "

What being high risk means to you and your baby
The term high risk is used to describe pregnancies in which the mother, the baby, or both are at higher-than-average risk of experiencing complications. You are likely to be classified as high risk if you have

a chronic medical condition that may affect your pregnancy,


a history of previous pregnancy-related complications or pregnancy-related complications during your current pregnancy,


a history of pregnancy loss.
As you can see from the following checklist, there are a number of reasons why your pregnancy may be classified as high risk.

CHECKLIST: IS YOUR PREGNANCY HIGH RISK?
Your pregnancy may be treated as high risk if

you are over 35 years old and are therefore at increased risk of giving birth to a child with a chromosomal anomaly;


you are under 17 and are therefore at increased risk of experiencing intrauterine growth restriction;


you are carrying more than one baby and are therefore at risk of experiencing a number of pregnancy-related complications, including preterm labor;


you have a chronic health condition such as diabetes, heart problems, or a blood-clotting disorder that has the potential to affect your pregnancy;


you have a history of gynecological problems such as pelvic inflammatory disease (PID), endometriosis, or large symptomatic fibroids;


you have a history of pregnancy loss (miscarriage, ectopic pregnancy, or stillbirth) or premature birth;


you have an STD, including HIV, that could be transmitted to your baby during pregnancy or at the time of birth;


you are pregnant as a result of assisted reproductive technologies (something that may put you at increased risk of having a multiple pregnancy);


you have had two or more second-trimester abortions (which may increase your chances of having problems with an incompetent cervix);


your mother took DES during her pregnancy (which may increase your chances of having difficulty carrying a pregnancy to term);


you conceived while using an IUD (something that increases your chances of experiencing a miscarriage);


you have a child with a genetic disorder or are a carrier for a genetic disorder (something that may increase your risk of giving birth to a child with that particular genetic disorder).

Watch Out!
Any pregnancy can become high risk. Although the occurrence of any of the following symptoms may not necessarily indicate a problem, you should call your caregiver immediately if you experience

vaginal bleeding or spotting

swelling in the face or fingers

a leakage of fluid or increased vaginal discharge

severe or persistent headaches

pain in the abdomen or shoulder

persistent vomiting that is not related to morning sickness

chills or a fever

a noticeable change in the frequency or strength of your baby's movements

painful or urgent urination

dizziness or faintness
" Because of my heart murmur, I need to take antibiotics before any procedure in which I will bleed. I was striving for a natural delivery, so I wasn't thrilled at the prospect of having to be attached to an IV pole, but as it turned out, the IV pole was not a hindrance at all. I was able to walk around, change positions, even get in the shower.
—Tracy, 30, mother of one "

If your doctor or midwife lacks the specialized expertise to deal with someone with your particular risk factors, you may need to switch to a high-risk-pregnancy specialist. You may find this upsetting if you've established a good rapport with your current caregiver, but switching caregivers is probably the best option for you and your baby. Candace Hurley, the founder of Sidelines (a national support group for moms on bed rest) put it this way in a recent interview with the Los Angeles Times: "You're not a Ford anymore, you're a Ferrari. You need a mechanic who works on Ferraris."

Regardless of who your caregiver is, however, your pregnancy will be more closely monitored than it would be if your pregnancy were classified as low-risk. Consequently, you may be required to make more frequent visits to the doctor, and your doctor may recommend additional tests. If complications do arise—or seem likely to arise—your doctor may prescribe certain types of medications or bed rest.

Chronic conditions that place a pregnancy at risk
Advances in obstetrical medicine have made motherhood a possibility for large numbers of women who might have been discouraged from starting a family a generation ago. Not everyone, however, is able to have a baby. Some chronic conditions place such a tremendous burden on the body that pregnancy is unlikely to occur in the first place, or if it does, the odds of miscarriage, stillbirth, or neonatal loss are extremely high. In certain situations, a woman with a serious medical condition who manages to beat the odds and become pregnant will be encouraged to terminate her pregnancy because the risks to herself or her baby, or both, are simply far too high.

If you are dealing with such a condition, the time to weigh the risks and benefits of a pregnancy is before you become pregnant. Set up an appointment with your doctor to discuss how your pregnancy may affect your condition, how your condition may affect your pregnancy, how past treatments (chemotherapy, radiation therapy, surgery, and so on) for your condition may affect your pregnancy and delivery, what warning signs you need to be aware of, what prenatal tests you may wish to consider, and what—if anything—can be done to minimize the risks to you and your baby.

Bright Idea
If you are at risk of experiencing blood-pressure problems during pregnancy, purchase a blood-pressure gauge at your local drugstore or medical supply store so that you can keep track of your blood pressure between prenatal checkups.





High blood pressure
There's high blood pressure—and then there's really high blood pressure.
If you have mild or moderate hypertension (that is, your blood pressure is from 140/90 to 160/105) and it is not complicated by other factors such as kidney disease or heart disease, your odds of developing preeclampsia are just 10%, and your chances of having a healthy baby are excellent.

If, however, you suffer from severe chronic hypertension (that is, your blood pressure is over 160/105 or your condition is complicated by either kidney disease or heart disease), having a baby will be a fairly risky venture for you. You have a 50% chance of developing preeclampsia and a 10% chance of experiencing a placental abruption, and you are at increased risk of intrauterine growth restriction, premature delivery, and maternal complications such as stroke and cardiovascular problems.

You are at highest risk of experiencing blood-pressure-related problems during your pregnancy if

you are over 40;


you have a lengthy history of hypertension (you've had problems with your blood pressure for more than 15 years);


your blood pressure is higher than 160/110 early on in your pregnancy;


you have diabetes, cardiomyopathy (a disease of the heart muscle caused by either hypertension or other problems), kidney disease, or connective tissue disease (for example, lupus);


you have previously experienced blood-clot complications;


you developed severe preeclampsia early on in a previous pregnancy;


you experienced a placental abruption in a previous pregnancy.


Watch Out!
Don't stop taking your medications without talking to your doctor first. Although certain medications (for example, epilepsy drugs) may be harmful to your baby, the risks of not taking your medications may be even higher. Only your doctor can help you decide whether it's safe to discontinue your medications during pregnancy and, if so, how you can safely wean yourself off them.



Women with extremely complicated cases of hypertension typically spend 15 days in the hospital during their pregnancies. What's more, they have a 50% chance of requiring a cesarean section, a 50% chance of experiencing major complications such as deteriorating kidney function, and a 50% chance of developing preeclampsia—with a 25% chance that the baby will die.

Heart disease
The increased blood volume during pregnancy means that your heart already has to work 50% harder than usual. That's why women with preexisting heart problems can run into difficulty during pregnancy.

Unofficially…
Heart disease is the third-leading cause of maternal death during pregnancy, exceeded only by hemorrhage and infection.



Here are the facts on some common types of heart disease and pregnancy:

Rheumatic heart disease: Rheumatic heart disease is caused by rheumatic fever—an autoimmune response to an infection (typically, untreated strep throat). If it results in mitral stenosis—a particular form of heart-valve damage—the rate of maternal mortality during pregnancy is high. Women affected by this condition require intensive monitoring and multiple cardiac drugs during labor.


Congenital heart diseases: Although the majority of congenital heart defects are mild or repair themselves spontaneously during childhood, some more serious types of congenital heart diseases can endanger a pregnant woman and her baby. Some of these diseases have maternal mortality rates of 50% and fetal mortality rates of 25% to 50%. What's more, babies who survive are also at increased risk of developing congenital heart defects themselves. Women with Eisenmenger's syndrome and primary pulmonary hypertension are advised to avoid pregnancy because of the high rates of maternal mortality associated with these problems. Women with mitral valve prolapse (a disorder in which the heart valve clicks and murmurs) don't face any significant risk during pregnancy, although some caregivers will prescribe antibiotics during labor to prevent potential complications.
Lung disorders
Like the heart, the lungs have to work harder during pregnancy. Although most pre-existing lung diseases (for example, tuberculosis and sarcoidosis) don't cause problems during pregnancy, asthma warrants special monitoring and care.

According to the U.S. Department of Health and Human Services, approximately 1% of pregnant women have chronic asthma, and another 1% will develop the disease as a complication of pregnancy.

Some women with asthma will experience an improvement (25%), others will experience a deterioration (25%), and others will find that their condition remains stable (50%). Unfortunately, there's no way to predict in advance what will happen to any particular woman.

If you are asthmatic and become pregnant, you should

avoid substances that tend to trigger asthma attacks,


minimize your exposure to colds, flus, and respiratory infections,


consider having a flu shot (particularly if you will be pregnant during flu season),


continue to take your allergy shots (with your doctor's approval),


continue to use your asthma medications (with your doctor's approval),


treat asthma attacks immediately to avoid depriving your baby of oxygen.
Kidney disease
The kidneys—which are responsible for filtering the blood—are also required to work harder during pregnancy because they must contend with the waste products that the baby releases into the mother's blood stream, as well as the increased volume of blood.

Here are the facts on kidney disease and pregnancy:

Women with mild kidney disease experience very few problems during pregnancy, but those who have more severe forms of the disease are at risk of developing pyelonephritis (an acute kidney infection that can cause permanent damage), experiencing a premature delivery, or having a baby with intrauterine growth restriction.
Watch Out!
An untreated urinary-tract infection can spread to the kidneys, causing kidney damage or premature delivery.



Women who have both chronic kidney disease and high blood pressure have a 50% chance of developing severe hypertension during pregnancy.


Women who are on dialysis prior to pregnancy will require dialysis treatments more frequently during pregnancy.


Women who are pregnant after a kidney transplant will continue to require medications to prevent rejection of the kidney. They have a 33% chance of developing preeclampsia, a 50% chance of experiencing a premature delivery, an increased risk of having a baby with intrauterine growth restriction, and a higher risk of cesarean due to pelvic bone disease or narrowing of the birth canal.
Note: To maximize their chances of giving birth to a health baby, women who have had a kidney transplant should wait two to five years before attempting a pregnancy. Women who have minimal protein in their urine, normal blood pressure, and no evidence of kidney rejection are considered to be the best candidates for a pregnancy.



Liver disorders
The liver plays a role in a number of important bodily functions. It produces substances the body needs in order to metabolize fats, vitamins, minerals, proteins, and carbohydrates; it controls blood sugar level and lipids; it stores essential vitamins, minerals, and glucose; and it detoxifies substances such as drugs, alcohol, and chemicals.

Although most forms of hepatitis do not appear to worsen during pregnancy and therefore don't appear to pose a significantly increased risk to the mother, certain liver disorders can endanger the fetus (for example, it's possible that a woman with hepatitis B or C could transmit the disease to her baby).

Some women develop a particular form of jaundice during pregnancy (intrahepatic cholestasis). It tends to develop during the third trimester, and it results in severe itching and mild jaundice. It disappears spontaneously within two days of delivery.
Note: Some studies have shown that women who experience jaundice during pregnancy may be at increased risk of experiencing a premature delivery or a stillbirth.

" If you have previously given birth to a premature baby, make sure you see a high-risk- pregnancy specialist during your next pregnancy. Ask for every test available, particularly if they don't know the cause of your first premature labor.
—Susan, 33, mother of two boys who were each premature "



Diabetes mellitus
Pregnancy can be risky for a woman with diabetes. Hormonal changes cause an increase in insulin requirements that a diabetic woman's body can't meet. If a pregnant woman does not manage to keep her blood sugars under control, she is at increased risk of experiencing miscarriage, stillbirth, or fetal death, or of giving birth to a baby with heart, kidney, or spinal defects. She is also more likely to give birth to an extremely large baby—something that can lead to problems during the delivery or necessitate a cesarean section.

Watch Out!
A family history of diabetes is one of the factors that increases your risk of developing gestational diabetes during your pregnancy.



A diabetic woman is likely to experience the best possible outcome if she manages to tightly control her blood sugars during the two months prior to becoming pregnant, as well as through her pregnancy. Blood sugar levels of 70 to 140 milligrams/deciliter in the months prior to pregnancy and an average of 80 to 87 milligrams/deciliter during pregnancy are associated with positive pregnancy outcomes. A diabetic woman can find out how well her blood sugars are under control by taking a glycosylated hemoglobin (hemoglobin Alc) test at two to three months of pregnancy. A favorable result on the test indicates that she is at no greater risk of giving birth to a baby with birth defects than any other pregnant woman.

Most of the damage that causes birth defects occurs during the first trimester. Some of the problems that can result are minor and correctable; others can be fatal. That's why it's important for a diabetic pregnant woman to check her blood levels up to six or seven times daily using a home glucose monitor and to report any problems in controlling her blood sugar levels to her caregiver. If blood sugar levels cannot be controlled through diet alone, insulin doses may be required. (Women with pre-existing diabetes—as opposed to gestational diabetes—always need insulin.)

A diabetic woman may require additional tests during pregnancy to check on the status of her eyes, her kidneys, the placenta, and the baby. What's more, her baby may need to be checked over in the neonatal intensive care unit after delivery to be observed for both respiratory problems and hypoglycemia.

Thyroid disorders
The thyroid is responsible for regulating the body's metabolic processes.

Watch Out!
The leading cause of maternal death during pregnancy is motor-vehicle accidents.

If it is overactive—a condition known as hyperthyroidism—the metabolism speeds up; the heart rate increases; and such symptoms as muscle weakness, nervousness, anxiety, heat sensitivity, flushed skin, bulging eyes, weight loss, and goiter are experienced. Pregnant women with hyperthyroidism can develop thyroid storm—a severe form of the disorder—during pregnancy. Thyroid storm is associated with an increased risk of premature delivery and low birthweight.

If the thyroid is underactive—a condition known as hypothyroidism—the metabolism slows down, causing lethargy, aching muscles, intolerance to cold, constipation, weight gain, voice deepening, facial puffiness, and dry skin.

Thyroid function needs to be monitored closely in pregnant women with either type of disorder, and where appropriate, medication should be prescribed.

Parathyroid disorders
The parathyroid is located behind the thyroid gland. It plays a role in regulating calcium levels in the body.

Too much parathyroid—a condition known as hyperparathyroidism—results in fatigue, muscle weakness, abdominal pain, bone pain and fractures, frequent urination, thirst, kidney stones, pancreatitis, stomach ulcers, and constipation. Pregnant women with this disorder are at slightly increased risk of experiencing a stillbirth or neonatal death or of giving birth to a baby with tetany (severe muscle spasms and paralysis caused by inadequate levels of calcium).

Too little parathyroid—a condition known as hypoparathyroidism—can cause bone-weakening disorders in the developing baby. Consequently, women with this disorder will be prescribed calcium and vitamin D supplements.

Pituitary disorders
The pituitary gland is responsible for regulating the flow of hormones in the body. A couple of pituitary-related disorders can cause problems during pregnancy:

Pituitary tumors: Some women have undetected pituitary tumors. Pregnancy hormones can cause these tumors to grow, causing severe headaches and visual-field disturbances (that is, spots before the eyes or obstructions to vision). If this occurs, the pregnant woman will need to be monitored by a team of specialists, including an obstetrician, an endocrinologist, and an opthamologist.


Diabetes inspidus: Diabetes inspidus is a rare condition caused by a deficiency in an antidiuretic hormone manufactured by the pituitary gland. This disorder causes increased thirst and a correspondingly increased output of urine. The condition tends to get worse during pregnancy but can be controlled through medication.


Pituitary insufficiency: Pituitary insufficiency—a deficiency in overall pituitary function—can be caused by damage from a tumor, surgery, radiation, or complications from a previous pregnancy. If the condition is not corrected during pregnancy, a woman has only a 54% chance of having a healthy baby. Women who have had previous surgery or radiation in the pituitary region or who have experienced a severe hemorrhage during a previous pregnancy—particularly if the hemorrhage was followed by an inability to lactate—should be tested for pituitary insufficiency.
Bright Idea
Read up on high-risk pregnancy at the Johns Hopkins Health Information Web site: www.intellihealth.com.

Adrenal gland disorders
The adrenal glands are responsible for maintaining the correct levels of salt in the body, for producing sex steroids (hormones), and for manufacturing other hormones known as glucocorticoids. Two types of adrenal gland disorders tend to cause problems during pregnancy:

Cushing's syndrome—the result of too much cortisone—is associated with a high rate of premature delivery and stillbirth. The syndrome is characterized by muscle weakness and wasting; thinning and reddening of the skin; an accumulation of excess fat on the face, neck, and torso; and excessive hair growth. Later stages of the syndrome may also result in high blood pressure, diabetes mellitus, and an increased susceptibility to various infections. It is difficult to diagnose during pregnancy because many of the symptoms are also associated with pregnancy: weakness, weight gain, edema, stretch marks, high blood pressure, and diabetic tendencies.


Addison's disease—the result of inadequate adrenal production—can result in life- threatening infections. It is characterized by fatigue, loss of appetite, nausea, dizziness, fainting, skin darkening, and abdominal pain.


Blood disorders
The following five blood disorders can cause problems during pregnancy:

Anemia: Anemia—a blood disorder that is caused by deficiencies in iron, vitamin B12, and folic acid—can result in fatigue; weakness; shortness of breath; dizziness; tingling in the hands and feet; a lack of balance and coordination; irritability; depression; heart palpitations; a loss of color in the skin, gums, and fingernails; jaundice of the skin and eyes; and—in particularly serious cases—heart failure. Because many women become anemic during pregnancy, you're at increased risk of experiencing these types of difficulties if you are anemic prior to pregnancy.


Sickle-cell anemia: Sickle-cell anemia is a hereditary blood disease. Women with sickle-cell anemia who become pregnant have a 25% chance of miscarriage, an 8% to 10% chance of stillbirth, and a 15% chance of neonatal death. They have a 33% chance of developing high blood pressure and toxemia and also tend to have problems with urinary tract infections, pneumonia, and lung tissue damage. Sickle-cell crises—painful episodes that can lead to organ damage due to the lack of proper blood flow into the fine capillaries—are more likely to occur during pregnancy. As if that weren't enough, a pregnant woman runs the risk of passing along sickle-cell anemia to her baby if her partner also happens to carry the gene for the disease.


Thalassemia: Thalassemia is another hereditary blood disease. Although most people with Cooley's anemia (alpha-thalassemia) die before they reach childbearing age, the handful of women who do live long enough to become pregnant often suffer severe anemia and congestive heart failure requiring blood transfusions. Those pregnant women who have the less-severe form of thalassemia (beta- thalassemia) may require blood transfusions during pregnancy and run the risk of giving birth to a baby with the disease if their partner is also a carrier.


Thrombocytopenia: Women with thrombocytopenia—a deficiency of blood platelets—are at increased risk of requiring a cesarean section. Babies born vaginally to mothers with severe thrombocytopenia may have decreased platelet counts and problems with hemorrhaging— particularly around the brain.


Von Willebrand's disease: Von Willebrand's disease is an inherited disorder that affects the blood's capability to clot. It can lead to severe blood loss during surgery, accidents, or delivery, which is why pregnant women with this disease need to be treated with intravenous clotting factors.
Autoimmune disorders
Autoimmune disorders occur when the body's immune system develops antibodies to its own body tissue, resulting in damage to its own major organs.

Here are the facts on four of the most common autoimmune disorders and pregnancy:

Lupus: A generation ago, women with lupus were advised not to have any children because of the risks to both the mother and the baby. Today, a growing number of women with the disorder are trying to have children. This is not to say that it's an easy journey to make: according to the Lupus Foundation of America, although 50% of women with lupus can expect to enjoy a normal pregnancy, 25% will experience either stillbirth or a miscarriage, and another 25% will experience preterm labor. What's more, 20% of women with lupus develop preeclampsia, and 3% give birth to babies with "neonatal lupus"—a form of the disease that lasts until the baby is six months old and that may cause a permanent heart abnormality. Women with moderate-to-severe involvement of the central nervous system, lungs, heart, kidneys, or other internal organs are advised to avoid pregnancy.
Unofficially…
Babies born before 25 weeks who weigh more than two pounds have a 50% chance of survival if they're born in a hospital that is equipped to deal with a baby who is this premature. On the other hand, babies who weigh in at three pounds or more have a 95% chance of survival.



Rheumatoid arthritis: Rheumatoid arthritis is a common form of arthritis. Its symptoms include joint pain and swelling, and stiffness (especially in the morning). Almost all women with rheumatoid arthritis go into remission during pregnancy. Unfortunately, the disease recurs in 90% of women after they give birth—25% within a month of the delivery.


Scleroderma: Scleroderma is a progressive connective tissue disorder that can cause lung, heart, kidney, and organ damage and that is characterized by both joint inflammation and reduced mobility. In 40% of cases the disease worsens during pregnancy, in another 40% there is no change, and in the remaining 20% of cases the condition actually improves. Pregnant women with the disorder face an increased risk of premature delivery and stillbirth, but the majority of babies born to mothers with scleroderma are born healthy.


Myasthenia gravis: Myasthenia gravis is an autoimmune disease that causes skeletal muscle weakness and easy fatigability. Thirty percent of women with the condition experience no change to their condition during pregnancy, 40% experience a worsening of symptoms, and 30% go into remission. There is a 25% rate of premature delivery associated with the disorder and a 10% to 20% chance that the baby will experience a temporary case of myasthenia gravis within two days of delivery.
Gastrointestinal disorders
Here's what you need to know about chronic gastrointestinal disorders and pregnancy:

Peptic ulcers: Peptic ulcers are chronic sores that protrude through the gastrointestinal tract lining and can penetrate the muscle tissue in the duodenum, stomach, or esophagus. Forty-four percent of women with peptic ulcers experience an improvement during pregnancy because the high levels of progesterone in the body stimulate the production of mucus, which can help to provide a protective shield in the stomach lining. Another 44% experience no change in their condition, however, and the remaining 12% actually report a deterioration.


Ulcerative colitis: Ulcerative colitis is an inflammatory disease of the colon and rectum. It can lead to bloody stools, diarrhea, cramping, abdominal pain, weight loss, and dehydration. It can also be linked to fever, anemia, and a high white-blood-cell count. A woman whose colitis is inactive when she becomes pregnant has a 50% to 70% chance of having it remain inactive during pregnancy—good news for both her and her baby. The condition tends to be a significant problem only if emergency surgery is required, because this type of surgery can cause premature labor or necessitate a cesarean delivery.


Crohn's disease: Crohn's disease is similar to ulcerative colitis, but it affects the entire gastrointestinal tract (that is, from the mouth to the anus), although it tends to be focused in the intestines. If Crohn's disease is active at the time of conception, a pregnant woman faces 50% odds of miscarrying. If, however, she is in remission, she has an 85% chance of having the remission continue during her pregnancy.


Bright Idea
You can reduce the likelihood of experiencing problems with your epilepsy if you take your medications as prescribed. Studies have shown that women who take their epilepsy medications as directed have an 85% to 90% chance of giving birth to a healthy baby. If morning sickness is making it difficult for you to keep your medications down, try taking them at times when your nausea is less severe or with plain crackers and a drink of milk.

Neurological disorders
Here's what you need to know about neurological disorders and pregnancy:

Epilepsy and seizure disorders: Pregnancy is risky business for a woman with epilepsy. Many of the drugs used to control the disorder are linked to birth defects; facial, skull, and limb deformities; fatal hemorrhages in newborns; unusual childhood cancers; cleft palate or lip; congenital heart disease; spina bifida; intrauterine growth restriction; and fetal death. Women with epilepsy also have a 1 in 30 chance of giving birth to a child with a seizure disorder. Not everyone faces an equal risk of running into problems;
however: women who experience frequent seizures prior to becoming pregnant are four times as likely to experience problems during pregnancy as women who don't.


Migraines: Nearly one in five pregnant women suffers from migraine headaches. Fortunately, 80% find that their condition improves during pregnancy, and others are able to avoid problems by avoiding such dietary triggers as MSG (found in Chinese food), sodium nitrates and nitrites (found in cured meats), and tyramine (found in strong cheese).


Watch Out!
If you're subject to migraines, don't allow yourself to get too hungry. Low blood sugar can trigger migraines .



Multiple sclerosis: Multiple sclerosis is a disease in which the insulating material covering the body's nerve fibers is destroyed, causing weakness in the legs, vision problems, poor coordination and balance, spasticity or trembling in one hand, loss of bladder control, and other difficulties. Women with multiple sclerosis are able to give birth to perfectly healthy babies since there is only a 1% to 5% chance that the baby will develop the disease. Women with a lack of sensation in their lower bodies are monitored closely during the ninth month in case they are unable to detect the onset of labor. They also may require a forceps or vacuum-assisted delivery since the disorder can affect their ability to push.


Cerebrovascular disease
Pregnancy can pose a significant risk to women with a history of strokes, hemorrhages, and blood clots. If a pregnant woman has a known blood-vessel disorder of the brain, such as an arteriovenous malformation, she has a 33% chance of dying during pregnancy.

Malignant diseases
As a rule of thumb, women with cancer should delay becoming pregnant until they are reasonably sure that a recurrence won't occur during pregnancy. This is because women who are diagnosed with cancer during pregnancy are often advised to terminate their pregnancy so that they can obtain the medical treatment they need. Delaying treatment can, in many cases, reduce their odds for long-term survival.



Bright Idea
You and your doctor can obtain the latest information on the effects of chemotherapeutic agents on pregnancy through the Registry of Pregnancies Exposed to Chemotherapeutic Agents. The database contains details on the known effects of cancer drugs during specific stages of pregnancy. Contact the Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA 15261, 412-624-9951, bgettig@helix.hgen.pitt.edu.



Phenylketonuria (PKU)
Phenylketonuria is a genetically transmitted disorder that can cause severe mental retardation in the newborn if it is undetected within two days of birth. People with PKU are deficient in a particular liver enzyme needed to metabolize phenylalanine, an amino acid found in most foods. Pregnant women with PKU face a higher risk of miscarriage and tend to give birth to more children with microcephaly, heart defects, mental retardation, growth restriction, and low birthweight. Women with PKU must follow a special diet during pregnancy. Studies have shown, however, that women who begin following the diet prior to becoming pregnant have better outcomes.

Group B beta-hemolytic strep
Group B Beta-hemolytic strep is a strain of bacteria that is carried by somewhere between 20% and 40% of pregnant women. Two percent of babies born to women who are infected with the bacteria develop Group B strep disease—a serious condition with a 6% mortality rate. Group B strep is more likely to be a problem if a baby is premature, if the membranes have been ruptured for more than 30 hours when labor commences, or if the woman had a previous baby who contracted a Group B strep infection. Most caregivers screen for Group B strep when a woman is 35 to 37 weeks' pregnant and prescribe antibiotics during labor to women who are carriers or who have other risk factors. (See Chapter 16).

Sexually transmitted diseases
Nearly two million pregnant women experience STDs each year. (See Table 10.1.) If you or your partner has had unprotected sex with someone since your last STD screening, you should be retested. STDs can occur at any time—even during pregnancy—and can be harmful to the unborn baby. Fortunately, there are treatments available to minimize the risk to the baby. Consider the facts for yourself:

Babies of HIV-positive mothers who have been treated with AZT prior to birth and who are delivered by cesearean section have, for example, a less than 1% chance of developing HIV, according to the National Institute for Child Health and Human Development. Babies born to women who do not receive any form of treatment, on the other hand, have a 20% to 32% chance of developing the disease.


Babies whose mothers test positive for hepatitis B can usually avoid developing the disease if they are given hepatitis B vaccine and immune globulin within 12 hours of birth. These treatments are repeated one month and six months later.
Unofficially…
According to a recent study in the British Journal of Obstetrics and Gynaecology, women with hepatitis C have an excellent chance of giving birth to perfectly healthy babies. Pregnancy doesn't worsen the disease, and it has not been linked with any pregnancy-related complications.

Psychiatric illness
Psychiatric illness is relatively common in women of reproductive age. Between 8% and 10% of women of childbearing age experience depression and approximately 1% are schizophrenic.

Although certain drugs used to treat psychiatric illness have been linked with birth defects, others are considered to be relatively safe for use during pregnancy (although, ideally, you will want to avoid taking any drug during your first trimester). Your obstetrician or your psychiatrist will be able to provide you with information on the use of your medication during pregnancy.

If you suffer from an eating disorder, you may find it difficult to allow yourself to gain weight during pregnancy. You may wish to continue with an existing treatment program or seek the services of a professional to ensure that you are able to give your baby the best possible start in life.



Unofficially…
Pregnant women are particularly susceptible to diabetes because the placenta produces hormones that counteract the effects of insulin. As a result, a pregnant woman's body needs to produce 30% more insulin than normal.


TABLE 10.1: THE NUMBER OF PREGNANT WOMEN IN THE U.S. WITH STDS EACH YEAR
STD Estimated Number of Pregnant
Women Who Get the Disease Each Year

Bacterial vaginosis 800,000

Herpes simplex 800,000

Chlamydia 200,000

Trichomoniasis 80,000

Gonorrhea 40,000

Hepatitis B 40,000

HIV 8,000

Syphilis 8,000

Total 1,976,000

Source: Goldenberg et al., 1997

Conditions that can develop during pregnancy
As we mentioned earlier, any pregnancy can change from low risk to high risk in the blink of an eye. That's why it's important to be prepared to spot the warning signals of the most common pregnancy-related complications.

Risk factors:

subsequent pregnancy,

family history of diabetes,

have previously given birth to a baby over 9 lbs.,

have experienced unexplained pregnancy losses,

overweight,

high blood pressure,

recurrent yeast infections.
You may be admitted to a hospital if your blood sugar remains high despite efforts to control your sugar levels through diet. You may require insulin injections.


Symptoms of early-stage preeclampsia include swelling of hands and feet, sudden weight gain, high blood pressure (140/90 or higher), increased protein in the urine, and headaches. Most likely to occur in:

first-time mothers,

women carrying multiples,

women with chronic high blood pressure, diabetes, kidney disease, or a family history of preeclampsia.
Mild cases can be treated through bed rest. Severe cases require hospitalization for treatment with antihypertensive drugs. The condition is cured when the baby is born, although the danger period extends to approximately 24 hours after delivery. Labor may be induced or cesarean performed if the condition progresses to a certain point.


Condition What Can Happen Risk Factors and
Warning Signs Treatment

Hyperemesis gravidarum (severe morning sickness)
Can lead to malnutrition and dehydration.
Occurs in 1/200 pregnancies. More common in first-time mothers, women carrying multiples, and mothers who have experienced the disorder during a previous pregnancy.
You will usually be hospitalized so that intravenous drugs and fluids can be administered.


Chorioamnionitis (an infection of the amniotic fluid and fetal membranes)
Can lead to premature rupture of the membranes or premature labor.
Occurs in 1/100 pregnancies. Often there are no symptoms early on except a rapid heartbeat and a fever over 100.4° F.
Treatment options include antibiotics and/or prompt delivery.


Gestational diabetes
Can lead to excessive fetal growth. An overly large baby may have to be delivered by cesarean section and may have difficulties at birth. The diabetes may continue after delivery or recur later in life.


Preeclampsia (also known as toxemia)
Associated with increased risk of placental abruption and fetal distress. In severe forms, it can cause a life-threatening condition that includes blood clotting problems, liver dysfunction, stroke, and possibly even the death of the mother or baby. When seizures are present, it is known as eclampsia.


Intrauterine growth restriction (IUGR) (also known as intrauterine growth retardation)
Can result in low-birthweight babies or infants who are less alert and responsive.
Diagnosed when the developing baby consistently measures small for dates. Most likely to occur in:

women with chronic health problems or an unhealthy lifestyle,

women with high blood pressure,

women carrying multiples,

woman having first or fifth (or later) pregnancy,

a fetus with chromosomal abnormalities.
Bed rest and/or hospitalization. Labor may be induced if it is felt that the baby will do better in the nursery than in the relatively hostile uterine environment.


Amniotic fluid-level problems: polyhydramnios (too much fluid) or oligohydramnios (too little fluid)
Polyhydramnios may indicate Rh-incompatibility problems, diabetes, or the presence of multiple fetuses. Oligohydramnios may indicate a malfunction or absence of fetal kidneys or leakage of amniotic fluid due to premature rupture of the membranes.
Suspected when a woman measures too large or too small for dates; diagnosed via ultrasound.
Polyhydramnios: If severe and causes significant symptoms or fetal compromise, can be treated by removing excess liquid through amniocentesis. Oligohydramnios: This is a serious condition that is generally treated by delivering the baby as soon as it is considered safe to do so.


Condition What Can Happen Risk Factors and
Warning Signs Treatment

Premature labor
Health of premature newborn is determined by week of gestation, type of neonatal care available, birthweight, and general health.
Contractions accompanied by cervical dilation, vaginal bleeding or discharge, or vaginal pressure between the 20th and 37th week of pregnancy. Other symptoms include menstrual-like cramps, with possible diarrhea, nausea, or indigestion. Risk factors include smoking, urinary tract infections, poor general health, diabetes or thyroid problems, bacterial infections or STDs, placental problems, physical trauma (car accident, spouse abuse), a history of premature labor, multiple fetuses, abdominal surgery during pregnancy, or a history of two second trimester miscarriages.
Bed rest, intravenous fluids, and/or the prescription of drugs to prevent labor. Note: Medications are generally effective only if your cervix is dilated less than three centimeters and is not yet effaced.


Placenta previa (placenta covering the cervical opening)
The baby cannot pass out of the mother's body without dislodging the placenta and disrupting its own blood supply. A postpartum hemorrhage may occur after the birth of the baby.
Bleeding can be triggered by coughing, straining, or sexual intercourse. More common in women who have had several children. Occurs in 1/200 pregnancies.
Bed rest, monitoring, and/or hospitalization. A cesarean section may be required.Note: If placenta previa is diagnosed n 2nd trimester, the condition may correct itself by the time you deliver.


Placental abruption (placenta prematurely separates from uterus, either partially or wholly)
Can be harmful—even fatal—to mother and baby.
Warning signs include heavy vaginal bleeding, premature labor, contractions, uterine tenderness, and lower back pain. More common in women who have had two or more children, who smoke, who have high blood pressure, or who have had a previous placental abruption. Sometimes caused by the trauma of an automobile accident. Occurs in 1/150 pregnancies.
Bed rest and careful monitoring. If fetus goes into distress, an emergency cesarean section may be necessary.


Placental insufficiency
Can result in a low-birthweight baby.
Can be caused by abnormal development, restricted blood flow due to a clot, a partial abruption, a placenta that is too small or poorly developed, a pregnancy that is postdate, or maternal diabetes.
Sometimes warrants the delivery of the baby before term.


Bright Idea
Check out the online guide to gestational diabetes at www.mediconsult.com/pregnancy/shareware/gest/.

Coping with the stress of a high-risk pregnancy
Nine months can seem like an impossibly long time when you're dealing with the stress of a high-risk pregnancy. If your pregnancy has been categorized as high risk, you may be dealing with a lot of conflicting emotions. "At some point during your confinement, you can expect to feel angry at your baby (for keeping you in bed), your husband (for getting you into bed in the first place), your doctor (for not fixing the problem), and everyone else you can think of," explains Laurie A. Rich, author of When Pregnancy Isn't Perfect: A Layman's Guide to Compli-cations in Pregnancy.

Pregnancy can have problems and trouble-free periods and either situation is normal.

Arlene Robles and Bobbie No are sisters who are both expecting a second child. They say their pregnancies have been relatively problem-free. In the four months she's been carrying the baby, No has thrown up only once, and at eight and a-half months, Robles has felt no morning sickness at all. The two have said they haven't felt particularly moody, nor have they had much jitters about having an addition to the family.



Yet further questioning reveals that each woman has her lion's share of concerns -- some similar, some very different from the other's. Both worry about having enough space in their homes for their growing families, about the pros and cons of day care for their children, and about how their careers will affect their families.



As a national sales coordinator for a San Francisco radio station, Robles thoroughly enjoys her job. With a new baby on the way, however, she's thinking more about how she could be more available for her kids.



"Working with the media in San Francisco was just where I wanted to be," says the 31-year-old. "But the long hours at work, getting up early to commute, and getting home late just isn't going to work with the kids."



It was fine when she and her husband had only Emerson, their 5-year-old son. He's already in preschool, and will soon be in kindergarten full-time. A newborn, though, would require more round-the-clock attention. Robles doesn't want to risk missing the baby's milestones, considering herself lucky enough to have caught Emerson's first words and steps, even though she worked full-time. Plus, she wants to keep an eye on how her son will adjust to being an older brother. Although she and her husband have taken him to sibling-preparation classes, in the past he's been visibly uncomfortable seeing his mom carrying a baby.



On the other hand, No isn't worried at all about her first daughter, Alani. The 7-year-old has been excited about becoming a big sister, and has many activities, such as soccer and Tae Kwon Do, to keep her busy. No's main concern is figuring out whether or not it's worth it for her to work full-time. If all or most of the money she makes goes to day care, she thinks it might be better for her to stay at home with the kids.



"Maybe I could start a home business to supplement our income," the current customer-service manager muses, seemingly confident that things will work out by the time she gives birth. "Right now I'm just concentrating on staying healthy," she says, noting her more conscious efforts to keep informed about her body and the new baby's development. The 27-year-old remembers all too well how ignorant she felt the first time around, because she was too embarrassed to ask questions of her doctor and her family. Now, she feels she is more mature, more proactive, and is reading as much as she can about pregnancy and parenthood.



The issues facing No and Robles -- such as changes in lifestyle, day care, income, career, and sibling adjustment -- are common among expecting families, according to mental health experts. Fortunately for the sisters, they are not experiencing pregnancy problems like extreme mood swings or much physical discomfort to add to the mix. Many women do have these pregnancy problems, however, and coupled with the life-altering decision-making, they can make pregnancy a very stressful time. Yet, believe it or not, this is all still normal.



"A majority of women experience ups and downs during pregnancy. It's hard not to, with physiological and other changes going on," says Diane Ross Glazer, PhD, a psychotherapist at the Encino-Tarzana Regional Medical Center. "If you're always happy during pregnancy -- that's wonderful -- that's normal, too."



Although society often paints a picture of pregnancy as a rosy time, Ross Glazer says surging hormones can make women more emotional, thereby making problems and decision-making all the more difficult. To remedy the situation, she recommends women be kind to themselves and accept their ups and downs as part of the process. She also says it's important to talk to one's partner, a trusted family member, or a friend -- someone that can provide support.



Raphael Good, MD, says it may help to think of problems that arise during pregnancy as chances for families to prepare for life change. "It's an opportunity to come apart and regroup at a higher level," says the professor of psychiatry and ob-gyn at the University of Miami School of Medicine.



Women and their partners usually learn to solve problems and adjust to changes spurred on by pregnancy, says Good, but others may need extra assistance. Anyone who becomes overly depressed, has anxiety or panic attacks, has unhealthy changes in appetite, or experiences physical or mental abuse is urged to seek professional help.



Evaluating Yourself, Relationships


During her pregnancy, Angela Soos fell deeper in love with her husband, Michael, and they both seemed closer than ever. "I was so happy he had given me a baby," says the 30-year-old Holmdel, N.J. resident. "This was something I had always wanted."



Soos appears to be one of the lucky ones. Some expectant mothers report unwanted changes in relationships with their partners. Their significant others may seem unsympathetic, or distant. Or the men may choose to forgo sex with their wives during pregnancy for a host of reasons, including being afraid to hurt the baby.



"Dads go through emotional changes as well," says Diane Sanford, PhD, president of the Women's Healthcare Partnership in St. Louis, Mo. She says it is crucial to continue to address issues with one's partner to come up with solutions that are agreeable to both parties. "For example," she explains, "If he's afraid of having sex during pregnancy, the two of you might want to take daily walks together to stay close."



Sanford also says it helps to think ahead. If you evaluate who you are and who your partner is, you could possibly predict future challenges. "Things don't come out of the blue," she says.

Good couldn't agree more. He says people and their relationships generally remain the same during, as before, pregnancy. Women who tend to be critical of their bodies, for example, may lament over how fat they're getting, while those who are comfortable with themselves, may love the way their swollen belly looks.



By the same token, the dynamic between couples during pregnancy usually reflects their relationship beforehand. Good says partners may think things have changed, but really, people's true nature comes out in times of crisis. In this case, the crisis is pregnancy.

The Pre-Baby Vacation

The nursery is ready, you're stocked up on onesies, and you've got the market cornered on diapers. You are ready for baby to come -- well, almost. Before you pack your bag and get ready for your highly anticipated trip to the hospital, pack it for a babymoon, instead.

The babymoon is the new way to describe the pre-baby vacation, before you can use the word parent to describe yourself. It's your curtain call, your last hoorah, your encore. But whether it's to Hawaii, Timbuktu, or a B&B around the corner, vacationing while with child calls for some extra consideration. Experts give WebMD traveling dos and don'ts for expectant moms.

Before You Go
Before you call the travel agent and book your trip, the first thing you should do is talk to your doctor, especially if you are in the third trimester.

"Be absolutely certain that there are no risk factors for premature pregnancy," says Thomas Ivester, MD, from the division of maternal fetal medicine at the University of North Carolina in Chapel Hill. "I think the biggest risk is that you are far from home when you deliver."

With timing in mind, the safest window of opportunity for a pregnant woman to travel is during the second trimester, or 18-24 weeks, according to the American College of Obstetrics and Gynecology (ACOG).

"While weeks 18-24 may be the safest time to travel, that doesn't exclude the rest of your pregnancy. There are just more safety issues in the first and third trimesters to consider," says Sandra Cesario, MD, from the College of Nursing at Texas Woman's University in Houston.

"Those first few weeks, you may be nauseated and tired, and it's not a good time to travel."

Also, schedule your vacation around your prenatal visits. While this trip is important, so are your trips to the doctor.

Where to Babymoon
While dashing off to an exotic location sounds nice, it's not necessarily practical. So what do you need to consider before you book a trip to the jungles of Belize while pregnant?

First, if you decide to travel internationally, you should consult with your obstetrician to evaluate both the quality of care that will be available at your exotic location of choice and what preventive measures, like vaccinations, should be taken before you go.

"If you are traveling to another country, you should check if that country requires immunizations," says Khalil Tabsh, MD, chief of obstetrics at UCLA. "If it's not a live vaccine, it is OK. If it is live, then you should check with your obstetrician." Live virus vaccines include measles, mumps, rubella, varicella, and yellow fever.

You should also consider altitude when picking your vacation spot. The CDC recommends that all pregnant women avoid altitudes higher than 12,000 feet, and in high-risk or late-stage pregnancies, avoid destinations higher than 8,200 feet -- so save the trip to Mt. Everest for another day.

Finally, do you fly or drive? The ACOG states that women can fly safely up to 36 weeks into their pregnancies.

"If you are flying, check to see if there are any restrictions with the airline you've chosen," says Cesario. "There are certain airline policies that do require a letter from your doctor that it's safe for you to travel while pregnant -- you'd hate to plan a trip and find the airline won't let you get on."

Packing Your Bag
Your doctor has given you the green light, and you are ready for the babymoon to begin. What should you do next, other than pack a pair of flip flops and a sarong?

Check that you will have access to quality medical facilities at your travel destination, in case you need them. "I would take a complete list of contact information for your doctors," says Ivester. "I would also carry along contact information for qualified or highly-rated health-care facilities in the area where you are traveling, in case you need them."


Ensure your health insurance is valid while abroad, and to be on the safe side, the CDC suggests getting a supplemental travel insurance policy and a prepaid medical evaluation insurance policy.

Know your blood type, and find out if the blood supply where you are going is screened for HIV and hepatitis B.
Babymoon Dos and Don'ts
You're booked, packed, and ready to go. Here are some tips to keep in mind while traveling while expecting.

Flying the friendly skies.
When flying, the ACOG recommends that pregnant women get up and walk every half hour if possible and flex and extend their ankles frequently to prevent blood clots. Also, wear your seat belt under your belly, and drink plenty of fluids to stay hydrated.

Road trips.
"Appropriate seat belt use is very important -- buckle it below the bulge of the belly," says Cesario. "It's a big deal because there is a myth that seat belts will hurt the baby, when they really save lives and it's always safer to wear it."

Always travel with a companion.
Remember that while you may be on vacation, your heartburn, leg cramps, and frequent bathroom trips are not, so a travel partner at the very least will give you sympathy. More practically, your companion can search for a bathroom for you when you're in the middle of nowhere and need to go.

Know when to seek medical attention.
"If a pregnant woman has bleeding, cramping, fever, pain, or contractions, she should seek medical care immediately, wherever she is," says Tabsh.

Don't drink the water.
If you're in California, don't worry about it. But if you're in the rain forest in South America, don't drink the water. According to the CDC, hepatitis E, which can be contracted through water, is not vaccine preventable and can be especially dangerous for pregnant women.

"Pregnant women should drink bottled water when traveling in developing areas," says Tabsh. "Also make sure that the meat you eat is thoroughly cooked when traveling, and avoid salads, which might have been washed with tap water that isn't clean."

Avoid mosquitoes more so than usual.
Diseases like malaria can be more severe in pregnant women and harmful to a fetus, according to the CDC. So avoid insects by wearing proper clothing, remaining indoors during dusk and dawn when mosquitoes are most active, using bed nets, and applying DEET-containing repellents. Also, talk to your doctor about preventive medicine.

"If you are traveling to endemic areas of malaria, you should be on anti-malarial medication," says Tabsh.

Avoid scuba diving and anything with impact.
"Anything that might have a high impact or high risk of falling, like bicycling or skiing, should be avoided," says Ivester. "Also avoid anything with extreme pressure changes, like scuba diving."

Relax while you still can.
"Make it a relaxing vacation," says Cesario. "Enjoy yourself and try not to do too much."

Advice for Expectant Fathers

In a lot of ways, expectant fathers have it easy. They're spared the many miseries of impending motherhood: the morning sickness, the weight gain, the pain of childbirth and the other physical discomforts -- petty and profound -- of carrying a child. Nine months of pregnancy transform a woman; her partner presumably looks more or less the same as he did before.

But while guys may not have the outward signs to prove it, the effects of becoming a father can't be underestimated.

"First-time fathers might be in for a shock," says David Swain of Sunderland, Mass., the father of a 15-month-old son. "Not the astonishment over how beautiful their child is or how proud they are of the mom, but the shock of how helpless their child is and how much they as fathers must surrender to his care."

Armin Brott, the author of The Expectant Father and Father for Life, agrees. "The psychological journey of pregnancy and childbirth is no less profound for the father that it is for the mother," he tells WebMD. "He's worried about what kind of father he'll be, how he can afford having a child, how his relationship with his wife will change. These really aren't trivial issues."

But as important as these issues are, a lot of guys have trouble talking about or coping with them. According to Brott, who has two daughters and is expecting a third, being an involved father is a struggle, a struggle against societal conventions and our own insecurities. While it may not be easy, it may be the most important and valuable struggle of your life.

Feeling Left Out
After the initial excitement of discovering that you're going to be a father, you may find yourself feeling a little aimless while your partner is pregnant or even after she gives birth. While your wife is picking out maternity clothes, being feted at baby showers, and urinating every 15 minutes, life carries on for you in much the same way. Your partner simply has an inherent, physical connection to your unborn child that you don't; this may make pregnancy and fatherhood seem frustratingly abstract. Besides being a support and sidekick, what exactly are you supposed to be doing anyway?

This lack of focus can make many men feel a little shut out. "What often happens is that fathers wind up feeling excluded really early in the pregnancy," says Brott. "And that process can get worse as the pregnancy goes on and after the child is born."

Excluded by whom? Is some sinister conspiracy at work?

Hardly, but Brott observes that traditional social forces can push men away from embracing their roles as fathers. Many men wind up excluding themselves, however unintentionally.

Staying Connected
"There's no question that some dads-to-be and even experienced fathers can feel alienated from the pregnancy and birth process," says Marcus Jacob Goldman, MD, an associate clinical professor at Tufts University School of Medicine and author of The Joy of Fatherhood: The First Twelve Months.

Goldman, the father of five sons, emphasizes that the most important way to prevent this estrangement is to have an honest and open relationship with your wife. "One of the potential problems is that men and women can take two different roads to the birth process," he tells WebMD. "They journey on parallel tracks, never interacting with each other, or maybe interacting through envy and misunderstanding."

That's a mistake, and it's important to be communicating openly right from the beginning. While expectant fathers may be boiling with anxiety and worry, they may be reluctant to tell their wives about it out of compassion. For instance, fretting about your capabilities as a father may seem trivial and selfish while your wife is hunched over the toilet throwing up a dozen times a day.

But Goldman and Brott agree that you shouldn't dismiss your concerns, and a lot of important things need to be worked out over the nine months of pregnancy.

For instance, it's common for expectant fathers to become deeply worried about the family's finances, especially if their wives have been working and will be taking time off. "A lot of guys take on extra jobs or work overtime when their wives become pregnant," says Brott. "It's almost instinctual, and driven by a fear of the unknown as much as anything else."

However, that's a decision that you and your spouse should decide together. Impulsively signing on for extra hours may not be that helpful; it may make your wife feel abandoned and you feel resentful and further excluded from the pregnancy.

According to Brott and Goldman, expectant fathers need to fight against some of the societal assumptions about parenthood.

"While a lot of women are brought up to think of themselves as a natural parent, men often think of themselves as just a secondary or back-up parent," says Brott. There's still a common perception of fathers as bumbling and inept when it comes to taking care of their children.

But even though you may not always get a welcoming reception, you need to stay involved. For instance, Brott and Goldman say that you should be accompanying your wife to at least some of the doctor appointments, even if you may feel a little awkward being there.

It's important that men not surrender their position as active and involved fathers. If you give into your fears about fatherhood and hang back, burying yourself in work and letting your wife do all of the childcare, you may find yourself feeling more like a babysitter than a parent.

"We've all seen the situation where a mother will go out for the afternoon and leave her husband in charge of the kids," says Brott, "but only after giving him a detailed list about exactly what clothes the baby should wear, what the baby should eat, what stories the baby should be read, what music the baby should listen to, and even how the baby's hair should be combed."

Being more involved earlier can prevent this from happening. "And studies show that the earlier guys get involved," Brott says, "the more involved they are as parents for the long run."

Deciding whether to take time off from work is also deeply troubling for a lot of expectant fathers. It doesn't help that for many men, the strong impulse to be home to care for their wives and babies collides with their equally strong anxieties about their finances.

If you and your wife do decide that you should take time off, Brott recommends that you talk to your boss about it as early as you can. "Your employer doesn't want you to come in one morning and say, 'Oh, my wife's in labor and I won't be back for three months,'" Brott says.

Exhibiting some tact might also be a good idea. "I strongly recommend that you don't go into your boss's office armed with a copy of the Family Leave Act and slam it down on his desk, saying 'These are what my rights are!'" says Brott. "No one wants to hear that." Instead, go in with suggestions, perhaps with the offer to work from a home office a few days a week.

Although it may not be an easy conversation, Brott says that having settled the issue with your boss early will allow you to feel much more in control.

"Men also tend to have exaggerated fears of what could go wrong with their jobs," says Brott. "Your boss may be more accommodating than you expect."

"Guys have trouble letting go of their freedoms, their routines, their self-imposed duties that they actually relish," says Swain. "But taking care of a child full-time demands that you shelve all that. The challenge of being a good dad is relinquishing some of yourself and giving it to your child."

Brott agrees. "As your kids grow, you'll learn to be more patient and understanding of people's foibles and mistakes," he says. "For instance, I used to be the most uptight person about being on time and about other people being on time. But once I had kids, I'd get ready to go and one of them would fill her diaper. By the time the diaper was changed, I was late. But it didn't matter as much anymore."

People who aren't parents might assume that parenthood causes an inward retreat; after all, new parents seem to talk about nothing but feeding and nap schedules. But Brott says that fatherhood often spurs people to have a wider and more comprehensive view of the world.

"When you have a kid, you start thinking about stuff you didn't think about before," says Brott. "You start thinking about childcare, neighborhood development, and the state of education in this country. You start worrying about landfills and disposable diapers."

"It may sound kind of silly," Brott continues, "but you may realize that you don't really want your child to grow up in the same world that you did, or you want to give them a better chance that you had, and so you start trying to change the world in any little way that you can."

Finding Support
So where can a new or expectant father find support? Organizations that lead support groups are out there if you want them, although many men tend to shy away from that sort of thing.

"Men tend not to flock to support groups," says Goldman, "although most local hospitals with OB services will have groups for interested dads."

Regardless of whether you're seeking help elsewhere, it's important that you not be too hard on yourself. Everyone feels intimidated when first taking on the role of fatherhood; in fact, many of us feel like imposters at one point or another. It's also common for new dads to feel guilty about their ambivalence toward their new child.

"Don't get suckered into thinking that fatherhood is all supposed to be great," says Goldman. "Don't feel foolish if you're enraged by your baby's frequent awakenings at night. Scream into your pillow if necessary. I did."'

And Goldman and Brott agree on the first person you should turn to for help.

"I think that the place for a guy to start getting support is with his partner," says Brott. "You need to talk to her about the things that frighten and concern you. You can do it in a reassuring way, telling her that your fears don't mean that you don't love her or that you're going to hop on the next plane to Brazil. You just need to talk."

"There may not be a solution sometimes," Brott says, "but feeling understood will make everything easier."

Working While Pregnant

More women are working outside the home than ever before. In most cases, you can plan to continue working through most of your pregnancy. That's not to say pregnancy won't affect your ability to work. You may feel extremely fatigued, especially in the early weeks, and you'll no doubt have to use the bathroom more frequently than usual. Morning sickness can certainly get in the way of a pleasant day at work. Your need to snack during the day may be against job policy. Increase in body size, back problems, swelling, and fatigue can make some jobs more difficult as pregnancy progresses. Arranging to get away for your regular checkups may conflict with your job schedule. And if complications occur, you may have no choice but to discontinue work altogether.

Although some women actually manage to work safely until the day before delivery, most will take off the last month or so. A nurse patient of mine was actually working on the day she went into labor. She walked downstairs and had her baby -- but no, she didn't finish her shift. A female colleague of mine performed a cesarean section on the morning of her own delivery. Two days later she was back at work. I don't necessarily think this approach is best for everyone, but it can be done.

A job requiring long hours is by itself not a risk factor in pregnancy. A study of physicians-in-training found that professional women who work long hours during pregnancy are just as likely to have healthy babies as other women who work more moderate hours. Researchers emphasize that these findings only apply to healthy women with no pregnancy complications, and that those women in the study who worked as long as 100 or more hours a week were more likely to have a pre-term delivery.

Even before you become pregnant, try to assess yourself and your job realistically; that way, you'll know what to expect and how to plan ahead. As your pregnancy continues, you might have to reduce the number of hours you work each day. In fact, this is often better than reducing the number of days you work, since it's less fatiguing. Lifting, prolonged sitting, or standing may be difficult as you get further along, so that a modification of your job may be in order. If your health insurance is related to your job, be sure it will continue for the duration of your pregnancy. Although most employers are understanding, I have seen a few terminate their pregnant employees and leave them not only without a job but also without insurance when these women need it the most.

Hazards of the Workplace
The possible effect of your work on your pregnancy is probably more important than the effect of your pregnancy on your work. The U.S. Supreme Court has recently ruled that women can't be barred from hazardous jobs just because they are women and capable of bearing children. The responsibility falls on employers to document potential reproductive hazards and obtain individual women's informed consent to continued employment. As a female employee considering pregnancy, you must share this responsibility. In the final analysis, you need to make yourself aware of workplace risks, evaluate them, and avoid them whenever possible. Here are some of the most common hazards you might encounter:

Lead. Lead, which is often used in manufacturing processes, has been linked to miscarriages, deformities, and premature births.
Radiation. Certain radioactive drugs and X rays emit radiation, which is linked to miscarriages and birth defects.
Chemicals. At least 26 substances have been linked to problems for pregnant women, including lead, alcohol, mercury, carbon monoxide, benzene, and toluene. Some of these substances also affect male fertility.
Viruses. Nurses and day-care workers are often exposed to the rubella virus and cytomegalovirus (CMV), both of which are hazardous during pregnancy. Rubella during the first three months of pregnancy may cause severe birth defects in the fetus; CMV can be passed along to a fetus, causing handicaps such as blindness, hearing loss, and cerebral palsy.

Quite a few jobs expose workers to teratogens, or chemical or physical agents that are harmful to a developing fetus. Health-care and laboratory jobs, hairdressing and cosmetology, housecleaning, laundry and dry cleaning, and factory work (including electronics, photography, textiles, and printing) may all expose you to potentially harmful chemicals or infectious agents. These substances can be inhaled, absorbed through the skin, or taken in by mouth. For most substances, there is an exposure level that will produce no detectable effect and a dose above which problems can occur. In some instances this "no effect" level of exposure is known; in others, it is not. In some cases, your exposure can be measured, such as when X-ray technicians wear exposure badges. Often, it can't be. It would be wise to evaluate the potential reproductive effect of any workplace exposures prior to trying to conceive.

If you're a doctor, nurse, laboratory technician, or other health-care worker, you may find yourself exposed to several hazards. These include infectious diseases such as herpes, CMV, and AIDS. Other risky exposures are to anesthetic gases and some cancer drugs, as well as chemicals used for sterilization and radiation. Most of these exposures are minor and usually cause no demonstrable problems, but minimizing exposure before and during pregnancy is certainly recommended.

Lead exposure of the kind that occurs when you work with certain paints, batteries, and ceramics can cause infertility, miscarriages, and mental retardation in your offspring. Other toxic agents to avoid include solvents such as benzene and toluene, since they can cause birth defects. They are used in dry cleaning, paint removers, and electronics manufacturing.

Sex and Pregnancy: What You Need to Know

You're bloated, nauseous, and more tired than you've ever been in your life, and sex is so far out of the picture it's not even on your radar screen.

Or ... you're feeling steamy, hot, sensuous, and wanting your partner more than you ever thought you could.

Sound like two different women? It could be. But don't be surprised if these kind of dramatic sexual mood swings are part of a single pregnancy -- yours. While most women are fairly well acquainted with their sexual appetite prior to conceiving, once pregnancy happens, everything you thought you knew about your need or desire for sex may suddenly change. What's more, the minute you think you've figured it all out, you enter a new trimester and things can change once again!

The good news: From first trimester to last, sex and pregnancy is a healthy combination. One reason is that it can help keep your pelvic floor muscles toned for delivery, which can benefit you and your baby. But it can also help you and your partner expand your emotional connection to each other. A great sex life can also help you feel more desirable and yes, even sexy, at a time when you might be feeling a little down about how you look. In fact, while it may seem hard to imagine right now, for some of you pregnancy could turn out to be one of the most sexually exciting times of your life!

Pregnancy and Sexual Desire: The First Trimester
Perhaps the most important thing you can learn about sexual desire during pregnancy is that no two days are going to be alike. Much like the time before you conceived, some days you will feel like having sex, other days you won't. The only difference is, during pregnancy these desires can fluctuate much more dramatically, particularly during your first trimester. One reason has to do with your hormone levels, which are dramatically changing during this time. In addition, don't be surprised if your newly developed maternal instincts also kick in, affecting sexual desire as well. Experts say this is a normal reaction and something you can expect during your first trimester.

"During pregnancy, not only is your body changing, but your newfound maternal feelings can trigger complex emotional responses," says registered nurse and perinatal educator Joy Hacke. Suddenly, she says, motherhood and sexuality may seem "mutually exclusive," resulting in a temporary decrease in your sexual appetite. In at least one medical study of 112 pregnant Swedish couples, researchers found 40% of women experienced as least some decline in their desire for sex during the first trimester.

Hot and Heavy: Your Second Trimester
Whatever you missed during your first trimester, you can certainly begin enjoying in your second trimester. Indeed, beginning around your 14th week of pregnancy you are likely to feel a surge of confidence and energy, as well as a return of your sexual appetite. As many of the unpleasant symptoms of your first trimester (like morning sickness) begin to fade, a whole new set of physiological changes begin occurring, and some of them can have an enormously positive effect on your desire for sex.

An increase in blood volume, for example, brings more circulation to your genitals, which in turn can increase sensitivity and excitement in your entire V zone. And, thanks to higher levels of estrogen, you may also have more vaginal lubrication, which in turn may leave you with a feeling of sexual "readiness" nearly all the time.

If your breasts are traditionally a focal point of sexual stimulation, you may experience some particularly pleasant changes and some welcome surprises in this area as well. As your milk ducts develop, the tissue inside your breast can become compressed, putting more pressure on sensitive nerve endings. This, in turn, can heighten your pleasure considerably whenever your breasts are touched or stroked. In addition, studies show that breast stimulation increases the production of the hormone oxytocin -- the "biochemical of lust." And the higher your levels of oxytocin, the greater your desire for sex!

Don't be surprised, however, if you experience "leaky breasts" during sex -- more specifically, a release of colostrum, the thin, yellow-tinged fluid that develops as a precursor to milk. While this might temporarily upset or even frighten you or partner -- or cause either one of you to momentarily feel "turned off" -- remember the leakage is normal and not dangerous to you, and not harmful to your partner, even if swallowed.

Finally, the position of your baby in your uterus during the second trimester can also create a pressure that actually enhances orgasm. This, combined with the increased blood flow to your genitals, might allow you to climax in a way you never could before. If you had some difficulty achieving orgasm before pregnancy, you may find you are climaxing easier and more often during your second trimester. If you had no problems climaxing in the past, you may find that you now are multi-orgasmic. An encouraging survey of some 17,000 women found that orgasms can be better during pregnancy than ever before!

Sex and Your Third Trimester -- What You Can Expect
Though your second trimester may have been erotic bliss, your third trimester may see your sex drive taking a dive once more, often beginning around your 24th or 26th week of pregnancy. Your growing tummy can present a real challenge to sexual comfort, while pain associated with the increased weight -- particularly backaches -- could make it difficult to find a position where sex is comfortable, let alone erotic.

In addition, all that extra genital blood flow that made touch seem so pleasurable during your second trimester may now increase to such a degree that even being lightly stroked can be painful. The extra weight of your growing baby can also leave you feeling fatigued, and combined with a lack of sleep, sex may once again be the furthest thing from your mind. In that same 1991 Swedish study mentioned earlier, researchers found that 75% of women had far less sexual desire during their third trimester.

However, also remember that when it comes to sex, nothing is ever the same for every couple. In fact, some women report they turn into a virtual "sex machine" during their third trimester -- and can't get enough love! The point is that you shouldn't be surprised by any behavior or sexual feeling you develop during pregnancy -- or by the fact that your desires may change from one week -- or even one day -- to the next. Any and all is considered normal.

The 3 Best Ways to Make Love During Pregnancy
While sex may be considered safe and even pleasurable during pregnancy, clearly, it's not always comfortable, particularly during your third trimester. Your increasing size, along with other comfort issues, can make it difficult, painful, or even seemingly impossible.

What can help: Trying some new positions -- ways of having sex that experts say can be more comfortable for you. Most important is that they don't cause you to lie on your back or have your partner's weight directly on your abdomen -- which is particularly important during the second and especially the third trimesters.

Here are three pregnancy sex positions experts say work the best.


1. Spooning. In this position, you lie on your left side, your body curled in a "C" position, with knees drawn up and arms in front. Your partner, who should be facing your back, mimics the position, curling or "spooning" around your body. For intercourse he enters your vagina from behind, while both of you remain lying on your left side.

2. Side by side. In this variation, you lie on your left side facing your partner, who is lying on his right side. He slips one leg over yours (your leg can be straight or bent), which allows him to enter your vagina at an angle, which may be more comfortable for you. This position can be very helpful if you are experiencing any vaginal irritation during intercourse or if you have mild to moderate pain during sex.

3. Woman on-top. In this position, your partner lies flat on his back and you perch your body over his in a "straddle" position, which can also make it easier for you to control what is happening and allow you to feel more comfortable as well.

Pregnancy: Sex During Pregnancy

Yes. There is no reason to change or alter your sexual activity during pregnancy unless your health care provider advises otherwise. Intercourse or orgasm during pregnancy will not harm your baby, unless you have a medical problem. Remember that your baby is well protected in your uterus by the amniotic fluid that surrounds him or her.

Your health care provider may recommend not having intercourse early in pregnancy if you have a history of miscarriages. Intercourse may also be restricted if you have certain complications of pregnancy, such as premature labor or bleeding. You may need to ask your health care provider to clarify if this means no penetration, no orgasms or no sexual arousal, as different complications may require different restrictions.

How Can I Stay Comfortable During Intercourse?
As your pregnancy progresses, changing positions may become necessary for your comfort. This may also be true after your baby is born.

A water-based lubricant may be used during intercourse if necessary.

During intercourse, you should not feel pain. During orgasm, your uterus will contract. If you have any contractions that are painful or regular, please contact your health care provider. Also, discontinue intercourse and call your health care provider immediately if you have heavy vaginal bleeding or if your water breaks (nothing should enter the vagina after your water breaks!).

Communicate With Your Partner
Talk to your partner: tell your partner how you feel, especially if you have mixed feelings about sex during pregnancy. Encourage your partner to communicate with you, especially if you notice changes in your partner's responsiveness. Communicating with your partner can help you both better understand your feelings and desires.

Will My Desires Change?
It is common for your desires to be different now that you are pregnant. Changing hormones cause some women to experience an increased sex drive during pregnancy, while others may not be as interested in sex as they were before they became pregnant.

During the first trimester, some women commonly lose interest in sex because they are tired and uncomfortable, while other women's desires stay the same.

Take Time for Intimacy
If your health care provider has limited your sexual activity, or if you are not in the mood for intercourse, remember to take time for intimacy with your partner. Being intimate does not require having intercourse - love and affection can be expressed in many ways.

Remind yourselves of the love that created your developing baby. Enjoy your time together -- you can take long romantic walks, enjoy candle-lit dinners, or give each other back rubs.

How Soon Can I Have Sex After My Baby Is Born?
In general, you can resume sexual activity when you have recovered, when your bleeding has stopped, and when you and your partner feel comfortable.

Your health care provider may recommend that you wait until after your first postpartum health care appointment before having intercourse with your partner.

After pregnancy, some women notice a lack of vaginal lubrication during intercourse. A water-based lubricant may be used during intercourse to decrease the discomfort of vaginal dryness.

Can I Get Pregnant Again If I am Breastfeeding?
Women who only feed their babies breast milk experience a delay in ovulation (when an egg is released from the ovary) and menstruation. But, ovulation will occur before you start having menstrual periods again, so remember that you can still become pregnant during this time. Follow your health care provider's recommendations on the appropriate method of birth control to use.

With Child and On the Road. Traveling While Pregnant

Everyone loves a vacation, and sometimes getting away from it all is just what the doctor ordered. But if going on vacation means traveling any great distance, you might want to think twice.

"If you're 28 weeks pregnant, this isn't the time to fly to Hawaii," says Ralph Dauterive, MD, chief of obstetrics and gynecology at the Ochsner Clinic Foundation in Baton Rouge, La.

"When my patients ask me whether it's all right to travel, I always ask them if they really want to hear my answer," says Dauterive. "Why are you taking a long trip when you're pregnant? How many times in your life are you going to be pregnant? What's your priority?"

That said, however, Dauterive adds, he's not nixing travel for all pregnant women, or for the entire term of their pregnancy. For women who are experiencing an uneventful pregnancy and are at low risk for complications, Dauterive generally considers it safe to travel until 28-30 weeks of pregnancy. The Nutrition Dos and Don'ts of Pregnancy

After that, he explains, the risk of preterm labor and complications such as ruptured membranes and bleeding, go up. If that should happen, it's best to be within 90-100 miles of your doctor and your hospital so you can get to them when you need them.

"Late in the third trimester is when things are going to happen," says Dauterive. "Traveling at such a time is not the best idea."

If you're having a complicated pregnancy or have conditions such as high blood pressure or diabetes, traveling at all is a no-no, Dauterive says.

It's not just being able to guarantee that you get the best care that makes staying close to home at the end of your pregnancy a wise choice, says Dauterive. It's making sure your baby has what he or she needs as well. "If there's a problem with the baby, and you're not at a hospital that can handle the problem, you're really rolling the dice," he cautions.

Mark Kufel, MD, an ob-gyn at Michael Reese Hospital in Chicago, takes the approach that pregnancy is a natural, physiologic process, and not a disease. His approach to prenatal care, he says, is based on this assumption, and that includes his views on traveling while pregnant.

"Travel is no more dangerous for the pregnant woman than for her non-pregnant counterparts," he says, adding, however, that some adjustments should be made.

Kufel usually recommends a maximum of six hours a day driving over long distances, with frequent breaks along the way. "This is usually the case anyway," he says, "as the bladder seems to require a little extra attention as well!" Stopping every two hours or so and walking around for 10 minutes will usually suffice. This increases blood flow from the lower extremities, he explains, and lessens the risk of blood clots, which is increased in pregnancy.

Continue to use your seatbelt when in a car, says Kufel, but as your pregnancy progresses, wear it under the abdomen. Extra pillows are also helpful in keeping you comfortable.

When it comes to flying, I. Dale Carroll, MD (aka "The Travel Doctor"), says what is and is not advisable varies greatly from one pregnancy to the next, but some general rules do apply.

For starters, she says, air travel can increase your risk of dehydration. To prevent this, drink plenty of fluids throughout the flight (but not caffeine or alcohol as these aggravate dehydration). Extra fluids may also help prevent constipation, another aggravating difficulty in pregnancy.

Prolonged sitting, especially in a cramped position, can also cause blood clots in the legs and pelvis. To minimize the risk, sit in an aisle seat so that there's room to stretch and more freedom to move around. If possible, upgrade to business class for the same reason. The extra legroom can also help prevent the swollen feet that so often complicate pregnancy.

"Don't sit for more than 90 minutes without getting up and walking around," advises Carroll.

Pregnancy, with its increased demands on the heart, can make high altitudes difficult as well, says Carroll. Because commercial airliners are pressurized, airline flights are not a problem from this standpoint unless you have heart or lung disease. But traveling to a high altitude destination could be an added stress and should not be undertaken without your doctor's go-ahead.

Many of the complications of pregnancy should also cause you to think twice before undertaking any long trips, Carroll says. If you've had bleeding during any trimester, you probably want to make sure you're in a situation where prompt medical attention -- and a safe blood supply -- are available. If you're at risk for premature labor (if you're carrying twins, for example, or have already had a pregnancy with premature labor), you may also want to stay home near your doctor. And if you have diabetes, when tight blood sugar control is so important, you may not want to change time zones and recalculate your insulin dosages.

Carroll also says it's wise to check airline rules and regulations when traveling while pregnant. Many airlines will not allow pregnant travelers to fly beyond a certain point in their pregnancy or without a note from their doctor.

And as long as you're checking ahead of time, adds Dauterive, look into your healthcare coverage. In certain managed care contracts, if you travel and deliver past 28-32 weeks outside your geographical coverage location, you may find yourself responsible for additional costs.

Planning ahead is key, agrees Kufel. If you're leaving the general vicinity of your home, he recommends taking along a copy of your medical/prenatal records. This way, if you do need medical care, you have the basics with you. This includes your medical history, your prenatal lab work, ultrasound reports, etc., all of which can be helpful in case of an emergency. Kufel also recommends asking your own doctor for a recommendation for a substitute physician in the area where you'll be traveling -- just in case.

Finally, when we're all a bit stressed out -- pregnant or not -- Kufel cautions that stress can manifest itself in a number of ways, including preterm labor or preterm contractions. "Education is key," he says. "A prepared patient is much more able to cope with stresses ... if she knows what to expect, and how to deal with the possible complications."