Chapter List

• Introduction
• Achilles Tendon
• Adrenal Glands
• Ankles
• Appendix
• Arteries
• Back
• Belly Button
• Birth Control
• Birthmarks
• Bladder
• Blood
• Body Hair
• Body Type
• Brain
• Breasts
• Cervix
• Childbirth
• Chin
• Circulatory System
• Clitoris
• Collarbone
• Digestive System
• Ears
• Elbows
• Emotions
• Endocrine System
• Energy
• Esophagus
• Eyes
• Fallopian Tubes
• Fat
• Feet
• Fertility
• Fingernails
• Gallbladder
• Gums
• Gynecological Exam
• Hair
• Hands
• Heart
• Hips
• Hormones
• Intestines
• Jaw
• Joints
• Kidneys
• Knees
• Larynx and Vocal Cords
• Lips
• Liver
• Lungs
• Lymphatic System
• Medical Tests
• Menopause
• Menstrual Cycle
• Moles
• Mouth
• Muscular System
• Neck
• Nervous System
• Nose
• Nutrition
• Ovaries
• Pain Relief
• Pancreas
• Pelvis
• Pregnancy
• Rectum
• Reproductive System
• Respiratory System
• Ribs
• Salivary Glands
• Scalp
• Sex
• Sexually Transmitted Diseases
• Shins
• Shoulders
• Sinuses
• Skeletal System
• Skin
• Skull
• Spine
• Spleen
• Stomach
• Stress
• Sweat Glands
• Tailbone
• Tear Ducts
• Teeth
• Throat
• Thyroid
• Toenails
• Tongue
• Tonsils
• Underarms
• Urinary System
• Urine
• Uterus
• Vagina
• Veins
• Vulva
• Wrists
• Shaping Up
• The Total Body Shaping Workoout
• Abdominals
• Biceps
• Buttocks
• Calves
• Chest
• Forearms
• Neck3
• Shoulders3
• Thighs
• Triceps
• Aerobic Conditioning

Pregnancy

There's no mistaking the telltale signs of baby fever.

If it's your first, you may have found yourself gravitating toward piles of Oshkosh B'Gosh overalls instead of Levi's 501 jeans. Or maybe you catch yourself looking at infants when you're in the supermarket.

If this is your second or third pregnancy, the telltale signs probably take the form of practical planning. Maybe you're talking to your husband about the best times to get pregnant or when you'll move your toddler into her "big girl" bed to free up the crib. Or you're telling your friends, "We're thinking about having another one."

Preparing for Pregnancy

Whether you're aiming to get pregnant next year or in the next few months, you should be getting ready now. This means eating right, getting plenty of exercise and maintaining a healthy weight, says Kathleen Kuhlman, M.D., maternal fetal medicine specialist at Thomas Jefferson University in Philadelphia. "There is just really no substitute for being healthy going into the pregnancy."

This is particularly true for women over age 30. When you're past the nearly foolproof bloom of youth, family-inherited medical problems such as diabetes and high blood pressure may develop. If that happens, your pregnancy can get much more difficult.

While most women see their doctors after they get pregnant, it's best to get a checkup ahead of time in order to spot any underlying, potentially complicating conditions, such as high blood pressure, says Dr. Kuhlman. Here's what your doctor may recommend.

Take a history lesson. A woman should know as much as she can about her genetic background, says Dr. Kuhlman. If someone in your family has cystic fibrosis or mental retardation, it's important to let your doctor know. She may advise you to undergo genetic counseling to determine what the various risks are. In some rare cases your best bet may be not to get pregnant--but this is something you'll want to take up with an expert.

Aim for your ideal. Ask your doctor what your healthy weight should be, then do your best to reach that target before getting pregnant. Women who are underweight have a higher chance of having a preterm delivery or giving birth to a smaller baby, says Dr. Kuhlman.

Overweight women tend to have larger babies, "which are more likely to cause problems with delivery or cesarean section," says Jennifer Niebyl, M.D., professor and head of obstetrics and gynecology at the University of Iowa Hospital and Clinics in Iowa City.

There are also other risks associated with being overweight during pregnancy. That extra weight can put you at higher risk for diabetes, high blood pressure and back pain.

Slim slow and steady. While being overweight during pregnancy can cause problems, you don't want to crash diet and try to lose weight all at once. A weight-loss program should never be started during pregnancy, says Dr. Kuhlman. If you are overweight and not yet pregnant, talk to your doctor about starting a sensible weight-loss plan.

Don't forget the folic acid. One of the most important things a woman can do to protect her baby is take extra folic acid, according to Dr. Kuhlman. This vitamin has been shown to significantly reduce the risk of having a baby with a neural tube defect, such as spina bifida, which is a defect in the spinal column.

It doesn't take much folic acid to help prevent this condition, which can leave a child seriously handicapped. To be on the safe side, doctors recommend getting 0.4 milligram a day, either as a supplement (the folic acid form) or in foods that are high in folate, the the natural form of folic acid. Foods high in folate include lentils, lima beans, spinach and wheat germ.

Begin taking folic acid before you get pregnant, says Dr. Kuhlman. The neural tube begins to form around the time a pregnant woman misses her period, and it's closed at 28 days after conception. So if you wait until you're already pregnant before taking folic acid, that may be too late to get the extra protection.

Ask about medicines. While some medications are perfectly safe for a pregnant woman, others are not. The risk varies with timing: Often the greatest danger is during the first six weeks--a time when many women don't even know that they're pregnant. If you are planning on getting pregnant soon, says Dr. Kuhlman, ask your doctor ahead of time what medications you can take and which you should steer clear of.

Iron out anemia. If you already have iron-deficiency anemia when you get pregnant, you may have an increased risk for preterm delivery. Unless you do something to compensate for the lack of iron and other dietary inadequacies, you might have a low-birth- weight baby, according to Theresa Scholl, Ph.D., professor of obstetrics and gynecology at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School in Piscataway.

Doctors recommend that you have a blood test to find out if you're iron deficient before you're pregnant. "It's really hard to catch up if you're anemic when you start pregnancy," says Dr. Niebyl. If your iron is at low ebb, your doctor will probably recommend taking supplements.

Toss the cigs and spare the child. Women should aim to begin pregnancy in a state of the best possible health, says Lawrence Devoe, M.D., professor of obstetrics and gynecology and director of maternal fetal medicine at the Medical College of Georgia in Augusta. It's especially important to stop smoking before you get pregnant, since cigarettes are associated with so many health problems, ranging from high blood pressure to lung cancer.

Look at your bloodline. If you're Jewish, you should be tested to find out if you have the gene causing Tay-Sachs disease, says Dr. Kuhlman. This is an inherited condition that can cause mental retardation, paralysis and early death. You don't have to be 100 percent Jewish to be at risk, she adds.

Tay-Sachs disease is only inherited if both the father and the mother carry the affected gene. If you're a carrier, your husband should be tested, too--and if it turns out that he isn't a carrier, you can rest assured that your baby won't be at risk.

Surprise, Surprise

While many woman plan their pregnancies months or even years ahead, more than half the time the stork pays a surprise visit. Women often assume it's something that only happens to teens, but it's not, says Anita L. Nelson, M.D., associate professor of obstetrics and gynecology at the University of California, Los Angeles, UCLA School of Medicine and director of the women's medical clinic at Harbor-UCLA Medical Center in Torrance. Two-thirds of unintended pregnancies happen in women over 20.

Accidental pregnancies may occur when birth control methods fail or, more commonly, when a couple neglects to use any contraception, says Paul Blumenthal, M.D., assistant professor of obstetrics and gynecology at Johns Hopkins University Medical Center in Baltimore. Some women assume that they are less likely to get pregnant as they approach their forties, so they may be more casual about using contraceptives.

If you want a planned rather than an unplanned pregnancy, it's important to continue using your birth control method until you're ready for a child, stresses Dr. Blumenthal. Though a child may be welcome, an unintended pregnancy can be stressful for anyone.

Until you reach menopause, you need to assume that you can still get pregnant, advises Kimberly Yonkers, M.D., assistant professor of psychiatry and gynecology at the University of Texas Southwestern Medical Center in Dallas.

Weighting Around

Once you get pregnant, your body will undergo tremendous changes, some almost immediately. No one enjoys the morning sickness, back pain, fatigue and emotional ups and downs, but for many women those discomforts are offset by the thoughts and expectations associated with having a healthy baby.

"Women sort of feel like their bodies have taken over and are totally out of control," says Christine Olson, Ph.D., professor of nutrition in the Division of Nutritional Sciences at Cornell University in Ithaca, New York.

Contributing to the out-of-control feeling during pregnancy is weight gain. A woman generally puts on 15 to 35 pounds in nine months. How much of this extra weight is "ideal" depends on how much you weighed before you got pregnant.

"The more underweight you are, the more you have to gain during a pregnancy," says Dr. Kuhlman. "The more overweight you are, the less you need to gain."

A woman who was below her ideal body weight before she got pregnant is usually advised to gain 25 to 40 pounds. If you're right at your ideal weight when pregnancy begins, plan on gaining 25 to 30 pounds, doctors advise. An overweight woman should have a gain of somewhere between 15 and 25 pounds.

Where's all that weight going? Well, if you gain 30 pounds, about 11 pounds goes to the baby, while 6 pounds ends up in your own womb, breasts, buttocks and thighs. Another 7 pounds or so is blood and fluid, and the rest is the amniotic fluid and placenta.

While every woman gains weight during pregnancy, the pounds pile on at different rates. "Some women who are really bothered by nausea will probably lose several pounds in the first trimester," explains Dr. Olson. "That is perfectly within the range of 'normal' and not something that should cause panic."

In the second and third trimesters, however, the pounds steadily accumulate. A woman typically gains between half a pound and a pound per week. "So it's pretty rapid during the second and third trimesters," Dr. Olson says.

Keeping Up with Change

To help you keep track of the changes in your body--and evaluate whether your pregnancy is on course--here are some methods that doctors recommend.

Query your doc. If your doctor forgets to bring up the issue of weight, don't hesitate to ask her, says Dr. Olson. She can help you calculate how much you're likely to gain--and understand your goals during the coming months.

Keep a chart. During each checkup--and before you leave the doctor's office--ask for a copy of the weight-gain table that's included in your medical chart, suggests Dr. Olson. That way you can also chart the changes yourself, weighing yourself daily or weekly so you and the doctor have a continuous profile.

Don't fear the future. Although weight gain during pregnancy is a good thing, many women worry that they won't ever get back to their prepregnancy weight after childbirth. In most cases this isn't a problem: Women can usually get back to their prepregnancy weight within six months to a year after giving birth, says Dr. Olson.

Intestinal Blues

We have all heard stories of pregnant women who endure horrible nausea--who feel so ill during the first three months of pregnancy that the very thought of food is almost more than they can bear. Less dramatic, but certainly more common, are those who never get terribly sick, but have stomach upset that just doesn't go away--especially during the first three months of the pregnancy.

Despite the term morning sickness, pregnant women may have to fight this inner battle at any time of the day and night. True, it's often worst when the stomach is empty--that's why morning can be such a difficult time for many pregnant women.

There are some techniques to help keep your stomach calm. Here's what experts recommend.

Don't fast. "Keep some food in your stomach at all times," advises Dr. Niebyl. "Having crackers in the morning or cheese or protein snacks at night can help." To prevent nausea, it's generally best to eat small meals frequently rather than have a few large meals with long intervals between.

Quell queasiness with complex carbs. For some women spicy foods such as sausage pizza trigger morning sickness. For others, heavy, fatty foods such as doughnuts may cause problems, says Dr. Niebyl. As a rule, it's best to eat mainly rice, grains and complex carbohydrates--foods that are readily digested and that are easy on the stomach.

Treat yourself gingerly. Ginger has been shown to help ease morning sickness, says Dr. Niebyl. You can buy ginger tea in health food stores. Or try ginger ale or a snack of low-fat ginger cookies.

Take a B₆ balm. Studies have shown that taking vitamin B₆ can help relieve nausea, says Dr. Niebyl. She recommends taking 25 milligrams of the vitamin three times a day. "It's very cheap and very safe, and it works in a significant proportion of patients." Just be sure to check with your doctor first, since this amount of B₆ is far above the Daily Value of 2 milligrams.

The Span of Expansion

Throughout the nine months of pregnancy, your breasts will enlarge--in some cases to twice their prepregnancy size. Your nipples will also get larger, as well as darker.

Even before then--in fact, from the very beginning of pregnancy--your breasts may begin to feel sore and tender. Indeed, nipple tenderness, erectness or sensitivity might be your first, early indicator that you're pregnant.

Apart from breast changes, you'll find that your skin undergoes many changes as well. Itching is common. Stretch marks may appear on your belly as well as on your breasts. Or you might observe temporary changes in the color of your skin--a dark line running down the center of your stomach, for example. Some women get a brownish "stain," called chlorasma, across their faces when they're pregnant. (These changes in skin color generally go away during pregnancy or after childbirth.)

While all these changes are going on, you need some strategies to deal with the vagaries of your new body. Here are some ways to get relief.

Move up a cup. Good support is critical for relieving breast pain. As your breasts enlarge during pregnancy, you'll want to move up to a larger bra size as well, suggests Dr. Kuhlman. Experts recommend cotton bras with wide shoulder straps and deep bands under the cups to provide extra comfort and support.

Make peace with new marks. You can't prevent stretch marks, and there's no way to eliminate them once they occur, says Dr. Niebyl. And they're unpredictable. "Some women carry twins and don't get a single stretch mark, while another woman might carry a small baby and get many of them. You just have to wait and see."

Warming Up to the Idea

Having a baby is one of life's truly uplifting moments. The months leading up to it, however, can be emotionally turbulent.

"The first and third trimesters tend to be times when women are more anxious and perhaps a little bit more sad than usual," says Katherine L. Wisner, M.D., director of Women's Services in the Mood Disorders Program at Case Western Reserve University in Cleveland. What's more, many women don't sleep well during much of pregnancy, which can exacerbate feelings of sadness and fatigue.

During the first trimester--particularly if it's your first pregnancy--don't be surprised if you worry about the whole prospect of motherhood. Your concerns may range from how you'll manage financially to how you'll cope with changes in your lifestyle. Many women worry about the changes their bodies are going through, as well as the possibility of miscarriage.

This phase usually doesn't last, and with the second trimester often comes a time of relative peace and comfort, says Dr. Wisner. This is the time when women are excited, because they begin to feel the baby move and aren't yet burdened by the physical heaviness of the pregnancy, she adds.

By the third trimester, women are usually less worried about their future as moms and more anxious about what labor will be like, says Dr. Wisner.

As your pregnancy progresses it's important to keep your feelings in perspective. Here are some ways to do that.

Get ready for the roller coaster. One thing is certain: You will have emotional ups and downs, says Dr. Wisner. Some days you may cry a lot, or be angry or simply not want to get out of bed. Remind yourself that this is normal, that you're not alone--and that the feelings will pass, says Dr. Wisner.

Reach out to others. Being with other pregnant women during your pregnancy--and with new moms after your baby is born--is a great way to deal with the challenges. You'll discover which problems are universal, and which seem to be yours alone. "Using other women for support is very, very important," says Dr. Wisner.

Find experts you can trust. It's not always easy finding a doctor you feel comfortable with and can talk to, but this is perhaps the best way to allay anxiety and help keep your worries in check, says Dr. Wisner. Make sure you have a doctor who will answer all your questions and will take your calls when you don't feel right about something that's happening.

Feeding Your Growing Family

Women have always joked about their appetites during pregnancy. Although some women feel so queasy that they never want to eat, others have appetites that they never dreamed were possible. Then there are those cravings that some women get--for chocolate, for example, or "comfort" foods such as meat loaf or mashed potatoes.

"Cravings are natural during pregnancy, as long as they don't get out of hand," says Dr. Kuhlman. Eating too much of one food or craving nonfoods such as dirt or cornstarch is a signal to consult with your doctor, she says.

Since you're eating for two, experts

How a child grows. Here's the development of the womb during a normal pregnancy--showing the position of the uterus from the third to ninth month.

Here are the basics of keeping your body well-stocked for your baby--and for you.

Find the farm food. Soda and candy are out. Fruits, vegetables and low-fat dairy products are in. According to Dr. Olson, it's important to eat several servings a day of vegetables, fruits, whole grains and dairy foods, such as low-fat or skim milk and cheeses.

Even if you're in an office all day and the only "pantry" is the vending machine down the hall, try to make smart choices, advises Dr. Olson. Pick juice or milk instead of soda, for example. Instead of a candy bar, have the peanuts or have crackers with peanut butter. Better yet, start the habit of bringing fresh vegetables or fruit to the office.

calcium. The same stuff that keeps your bones strong is also crucial for the growing fetus, says Dr. Scholl. So it's important to get more of this mineral than you ordinarily would.

Experts recommend that pregnant women get 1,200 milligrams of calcium a day. An eight-ounce glass of milk or an eight-ounce serving of yogurt contains about 300 milligrams. If you aren't getting enough calcium in your diet, your doctor may recommend taking a supplement. A possible bonus is that calcium supplements may help reduce the risk of pregnancy-related high blood pressure and preterm delivery, says Dr. Scholl.

Pregnancy in Motion

As the months go by and your body gets progressively heavier, the very idea of exercise may seem laughable. But for many women--particularly those who normally enjoy walking, biking or other forms of exercise--going an entire nine months without a workout can feel like cruel punishment.

"Pregnancy should not be a state of confinement," says Raul Artal, M.D., professor and chairman of the Department of Obstetrics and Gynecology at State University of New York at Syracuse Health Science Center and College of Medicine and author of Pregnancy and Exercise. If you enjoy exercise and want to continue your workouts, there's generally no reason not to--assuming, of course, that your overall health remains good.

Some women, however, develop pregnancy-related conditions that make it unwise to exercise. If you have high blood pressure, your doctor may advise you not to exercise until you've come to term. Exercise may also be out of the question if you've had preterm labor during this pregnancy or a previous one--or if you've had persistent bleeding during the second or third trimester. Doctors will usually advise against strenuous exercise if there's any retardation in the growth of the fetus, signs or risk of premature labor or any potential complications related to the condition of the cervix.

Even if your doctor says that it's fine to exercise, it's important to remember that your body has been undergoing a host of changes that may make it necessary to tailor your workouts. Here are some of the subtle and not-so-subtle changes that could affect your workout or your daily walk.

Cardiovascular changes. Pregnancy causes the heart to pump more blood even at rest, which means you may get tired more easily.

Larger uterus and breasts. Your center of gravity shifts, so it's easier to lose your balance.

Changes in breathing. Your body needs more oxygen to function even when you're resting. This means less oxygen is available during aerobic exercise.

Higher metabolism. Your body has to work more vigorously during pregnancy, so it's not that surprising that it produces more heat. Even light exercise may elevate your body temperature to an uncomfortable level.

Working Out New Workouts

With a consistent but somewhat modified exercise schedule, you have a good chance of staying fit right through your pregnancy. Keeping in mind any cautions from your doctor--as well as the body changes that could affect your usual workout--here are some exercise guidelines tailored for the pregnant you.

Do what you've done before. If you've been active prior to your pregnancy, there's no reason to stop, says Dr. Artal. If you didn't exercise before, however, pregnancy isn't the time to take up vigorous sports. You can always do that later, after the baby is born.

Watch your back. Since pressure from the fetus can interfere with circulation, it's best to avoid exercises that require you to lie on your back, according to Dr. Artal. When you lie on your back, the additional weight of the fetus puts pressure on a vein that returns blood to the heart.

Keep it moderate. Remember, the oxygen in your body is less available to your muscles, because it is needed by the growing fetus--so don't overdo it. Don't push yourself to the point of exhaustion, says Dr. Artal. As soon as you start feeling tired, take a break. You can always start up again once you're rested.

Stay cool. Because your body temperature is already elevated during pregnancy, you want to avoid raising it too much more during exercise, cautions Dr. Artal. You can keep the temperature lower if you wear loose-fitting clothing. Also, don't exercise in extremely hot weather and always drink plenty of water to keep yourself hydrated.

Honor gravity. Remember, some exercises will be more challenging, because your center of gravity has shifted. Choose exercises where balance isn't so critical, such as walking, swimming or riding a stationary bike rather than playing tennis or racquetball, recommends Dr. Artal.

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