The Health Curve

Pregnancy Unpacked: Expert Answers to Your Top Questions - with Stacey Silverman-Fine, MD at Maven Clinic (Women's Health Series)

• Dr. Jason Arora • Season 1 • Episode 23

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Pregnancy has touched billions of families since the dawn of humankind, yet it remains surrounded by uncertainty, myths, and unanswered questions. 

In this episode of The Health Curve Podcast, host Dr. Jason Arora speaks with Dr. Stacey Silverman-Fine of Maven Clinic to demystify pregnancy from conception through delivery. In just 20 minutes, you’ll get clear, evidence-based answers to the most common pregnancy questions—what to expect in each trimester, how to manage symptoms, and the truth about diet, exercise, and labor.

Speaker 1:

Pregnancy touches almost every family on earth. We're talking hundreds of billions of times since the dawn of humankind, yet it's still full of confusion, uncertainty and questions that go unanswered. My guest again is Dr Stacey Silverman-Fine of the Maven Clinic, and in the next 20 minutes we're going to cut through the noise with some clear answers to some of the most common questions you have about pregnancy. Let's get into it, Stacey, it's so good to have you back. Thank you for coming on to the Health Curve again.

Speaker 2:

Thank you for having me. Jason, Really appreciate being here.

Speaker 1:

So today we're going to talk about pregnancy and we're going to go in a slightly different format this time. I'm going to ask you some questions and then we're all going to learn from your expertise so that we can all understand pregnancy a little bit better. So let's start with what is pregnancy and what's happening biologically in the body.

Speaker 2:

Absolutely so. Pregnancy happens when we have fertilization of an egg or eggs, with development of an embryo and eventually a fetus, hopefully within the uterus. It usually lasts about 40 weeks from the last menstrual period.

Speaker 1:

And if we were to break it down into trimesters, as most people have heard of, how does it break down?

Speaker 2:

So the trimester is basically run first trimester from the beginning of pregnancy all the way till about 14 weeks. Second trimester is 14 to 28 weeks, and then third trimester is after 14 until delivery, and then there's a fourth trimester which is considered postpartum.

Speaker 1:

And what's happening in each trimester.

Speaker 2:

In short, so, in short, what's happening is hormonal changes are occurring that lead to the development of the embryo and then fetus in the mother's womb right, and so initially what's happening is we're having a lot of growth and a lot of systemic changes in the mother's body as it's supporting this developing embryo and fetus, and then, as things progress, we're also getting some space limitations within the woman's body as she's growing the developing fetus.

Speaker 1:

Okay, let's move on to what do people need to know to help them navigate pregnancy better, if they're going through it themselves or if they're supporting someone else?

Speaker 2:

Everybody is unique. Everybody does it in their own fashion. It isn't just a condition. It's also fraught with social and cultural implications and can be a real source of joy, but also can be a source of anxiety and complexity as well. So really want to emphasize that there isn't one way to do this. Everybody does it in their unique way and comes into pregnancy with a unique set of situations that shapes what that pregnancy looks like.

Speaker 1:

So what I'm getting at with this one is, yeah, what do they need to know? Because I think I've come across a lot of people who just they're scared because they don't know what. They don't know what are the basic things people can do to prepare themselves or feel more prepared For people who are going through pregnancy for the first time, it can be quite scary.

Speaker 2:

What advice would you give them? I think advice I would give is to ask questions. People don't know what they don't know, and so it's really important to make sure that if you don't understand or you don't know what's going on, to make sure that you ask the questions, whether it be of providers, maybe it be that you engage an ally at home your partner, your friends, your colleagues, people maybe who have gone through it before that might be able to help support you and explain what might be going on. And I think really here, that's where we really need to engage a provider that really can discuss with them that everybody does this in their own unique fashion, but maybe can let them know what some of the basic things that can be expected at each phase of the pregnancy.

Speaker 1:

Let's talk about some of the common issues during pregnancy that may occur, and I think people generally find it helpful to know what they are, so they know what to look out for. What are the most common things that you see? What's going on, how are they managed and what would it be helpful for people to know in advance?

Speaker 2:

Absolutely, jason. I think really some of the common things that people can see get broken down by trimester. So in the first trimester we're having a lot of mood shifts. Hormones are really dictating the show here. We might be having some excitement, but we might also have some anxiety as well and maybe even some uncertainty and shifting identity and role shifts.

Speaker 2:

But more importantly, in that first trimester, as hormone levels surge, we can see nausea and vomiting in pregnancy and this is typically thought of as morning sickness, but really important to know that this can occur at any time of the day or night. It usually peaks at 10 weeks and then tends to subside. Tends to subside. But if it's really severe and we're not getting benefits from basic methods, such as frequent small meals, drinking our liquids between the meals, trying to stay hydrated, maybe we're adding some vitamin B6 and some other agents to help with the nausea. If we really aren't able to keep anything down or we're having intractable nausea and vomiting and a lot of decreased appetite where we're not able to get in nutrition, then I think it's really important to reach out to the provider.

Speaker 2:

In the second trimester we really think of this as the golden period. People really feel so much better, as that nausea and vomiting is going away and as energy levels are improving. But some people won't have that. Some people can have some back pain, some lower pelvic pain, they might even have some heartburn, and then, as we move into the third trimester, we're really running into space issues, as that uterus is really growing. Maybe we're not sleeping well as that uterus is really growing. Maybe we're not sleeping well, maybe we're having a lot of physical discomfort and back pain. However, if we are having severe swelling in that third trimester or headaches that aren't responsive to Tylenol, or pain in our upper abdomen, really important to reach out to your provider, as there might be something more going on.

Speaker 1:

Can you tell us about gestational diabetes?

Speaker 2:

Yes, gestational diabetes is something that we can see develop in pregnancy as a result of many factors. Firstly, pregnancy sets up what's called insulin resistance, where we just don't respond to insulin, which is what helps take our sugar and process it appropriately. There is a hormone called human placental lactogen that increases that insulin resistance and increases the risk of diabetes developing during pregnancy. If this is the case and it develops just during pregnancy, the mainstay of management is diet and exercise and really checking the blood sugars to make sure that they're managed appropriately.

Speaker 1:

Can you tell us about preeclampsia?

Speaker 2:

Preeclampsia is really still, sadly, a poorly understood phenomenon that can develop in the third trimester of pregnancy. Very rarely will it develop before this, but this is a condition where we can see elevated blood pressure. We can spill protein in the urine. This can result in a lot of swelling and, if left unmanaged, can result in really severe complications for the mother as well as the baby too.

Speaker 1:

Can you tell us about anemia in pregnancy?

Speaker 2:

Yes, anemia in pregnancy is extremely common, and there's lots of reasons why we see this. Number one we also know that as our blood volume increases in pregnancy, our red cell mass or our red blood cells don't increase at the same level that our blood volume increases. This results in what's called a dilutional effect. So it is very common for people to become anemic in pregnancy, even if they weren't before, and so iron supplementation, starting in the second trimester, is very common.

Speaker 1:

We'll get back to this conversation in just a moment, but if you're finding this episode helpful, here's a quick ask. Take a second to follow or subscribe to the Healthcare Podcast wherever you're listening, and if someone else in your life would benefit from this episode or any of the others you've heard, please send it that way. From this episode or any of the others you've heard, please send it that way. All right, let's get back to it. How often do pregnant women go into preterm labor?

Speaker 2:

So preterm labor can happen in general in about 10 to 12 percent of pregnancies in the United States and more like 10 to 11% worldwide. There are lots of reasons why this has happened and truly it's an individual characteristic or statistic that can happen depending on a lot of factors that are coming into the pregnancy. I would say here that as maternal age is increasing, we are seeing more pregnancies with assisted reproductive technologies. That may actually increase this risk even further, and truly we know that globally the incidence can vary region to region, and so some of this may bring into the consideration or into the mixture that there may be some environmental factors that are playing a role as well.

Speaker 1:

Can you tell us a bit about miscarriage? How common is it, what tends to happen when a miscarriage occurs, and what advice would you give our listeners?

Speaker 2:

Absolutely so. Pregnancy loss, sadly, is much more common than one might think. It occurs in about 10% of known pregnancies, and 80% of these will occur in the first trimester. This is one of the things that is absolutely correlated to advancing maternal age. So we know that as women age, the risk of pregnancy loss increases. Statistics will show that 10% is really in the 20 to 30 year age range, but as maternal age increases for instance, aged 40 years, that risk may increase to 40%, and if we're 45 years or older, it may be up to 80%. I think what's important to note here is that the vast majority of these are genetic or chromosomal. There are no effective interventions to prevent early pregnancy loss. I always tell patients that they need to remember that they couldn't have walked too much or ran too much, or eaten too much, laughed too much, jumped up and down too much, had too much sex. This isn't their fault. They happen and, again, are likely due to genetic abnormalities.

Speaker 1:

We're going to move into community questions now. These questions are commonly asked. I believe in pregnancy.

Speaker 2:

So let's get into it. Firstly, is exercise during pregnancy safe? Yes, exercise during pregnancy is absolutely safe. I tell patients that they can usually continue their normal exercise routine that they've been doing before pregnancy. However, we do want to avoid contact sports things that also might pose a fall risk for the patient.

Speaker 1:

Can someone who's pregnant have coffee, sushi or cheese?

Speaker 2:

So diet and pregnancy is also one of the topics that exerts a lot of anxiety for pregnant patients and expectantly so, you know, as there's so many rumors as to what they can eat or can't eat. Caffeine is one of the big ones. We do know that you can consume one to two cups of regular coffee a day, or 200 to 300 milligrams of caffeine a day. In terms of cheeses, we recommend that they all be pasteurized and sadly this might eliminate some of recommend number one that pregnant patients avoid any raw fish and also recommend that they really watch the type of fish that they're consuming. We do know that there are certain fish that are very high in mercury, things like tuna or yellowtail, halibut, swordfish. We're allowed to have those high mercury players, but only at about six ounces a week. So if a pregnant patient wants to have a tuna salad sandwich that week, that's fine, but that's going to be their mercury for the week.

Speaker 1:

Right, I'm going to run through some more community questions now. One that we got was what if I don't feel pregnant yet?

Speaker 2:

What I tell a lot of pregnant patients is enjoy it if they really feel okay in that first trimester. Not everybody has symptoms. Not everybody feels nauseated, thank goodness. Not everybody has fatigue and breast tenderness. Some people can actually skate through and feel quite well. But if there really is concerns, always consult with a provider. A provider may be able to do some tests to provide some reassurance.

Speaker 1:

Can I sleep on my back?

Speaker 2:

So position and sleeping really becomes an issue in the later part of pregnancy, more in the late second trimester or third trimester. What we tell patients is they can sleep on their back, but usually we'll recommend that they have a little tilt in the pelvis so they're not laying completely flat. The reason being is that pregnant uterus can compress the big blood vessel that returns the blood back from the maternal body back to the uterus and the heart. Most of the time if we are seeing a drop in blood flow, the mother will not feel good laying flat on her back because she will get lightheaded and dizzy as well. So really we say lying on your left or lying on your right, but if you do choose to lay on your back, just make sure you position a pillow under your hips to give a little tilt one way or the other.

Speaker 1:

Next question how much weight am I going to gain?

Speaker 2:

Weight gain in pregnancy really depends on the maternal weight coming into pregnancy or that pre-pregnancy weight. General rules of thumb are six to 12 pounds in the first trimester and then a half a pound to a pound a week thereafter, although this can be really different depending on, again, that maternal pre-pregnancy weight.

Speaker 1:

Is spotting during pregnancy normal weight Is spotting during pregnancy.

Speaker 2:

Normal Spotting in the first trimester can happen for lots of reasons. Whether it's normal or not normal is another question. We can see spotting in the first trimester because of implantation. We can see spotting in the first trimester maybe because we had some cervical irritation, maybe we had intercourse and the cervix was irritated. We can see spotting in the first trimester obviously because someone might be threatening to miscarry. We can see it because we have a pregnancy in the tube and not in the uterus, called an ectopic pregnancy. And the last one that we'll sometimes see in the first trimester is we can get bleeding behind that implantation site or behind the membranes, called a subchorionic hemorrhage, majority of implantation bleeding, subchorionic bleeding the majority of those will resolve on their own with no treatment whatsoever. But if we're having bleeding more than a pad an hour or we're having pain localized to one side or another in that first trimester, definitely important to see the provider In the second trimester and the third trimester bleeding really should be brought to the attention of a provider to further evaluate why it's going on.

Speaker 1:

Can I keep my pet after I get pregnant?

Speaker 2:

Absolutely. You can keep your pet after you get pregnant. Dogs are fine. The one that we worry about a little bit and doesn't mean you need to get rid of them are their cats. Cats actually can carry a parasite called toxoplasmosis that is excreted in their feces. You can keep your cat. You just cannot scoop that litter box. So maybe that's a positive here that somebody else has to take care of that.

Speaker 1:

Can I get vaccinated whilst I'm pregnant?

Speaker 2:

Yes, vaccines can be administered, or most vaccines can be administered during pregnancy. When we talk about an influenza vaccine or a COVID vaccine, we absolutely can get those during pregnancy and do recommend getting those during pregnancy. Rsv also is a vaccination that we do start to receive in the third trimester and prep for delivery to help provide passive immunity to the baby as well.

Speaker 1:

As a pregnant woman is coming up to labor, when should they go to the hospital?

Speaker 2:

In general, we suggest that patients go to the hospital as they're coming up to labor, when they're having regular uterine contractions. So, in general, some people have posed a 4-1-1 rule or a 5-1-1 rule. So this is at term. If we're having contractions every four to five minutes, they're lasting a minute each and that is going on for an hour in time. If we've broken our bag of water, ultimately, if we're having any heavy bleeding, we need to go in sooner rather than later and call your provider on the way. And if we're having severe abdominal pain, certainly we'd want to head in sooner rather than later as well. In that third trimester, if we're having headaches that are unresponsive to Tylenol, visual changes, pain in our upper abdomen that would warrant calling the provider and heading to the hospital as well.

Speaker 1:

Last community question how do I prepare for labor?

Speaker 2:

That's a wonderful question and preparing for labor is something that is really anxiety producing for a lot of patients. So I think what's important here is to come up with those things that are really important to you and develop what's called a birth plan and realize as well that self-advocacy is really important here. I always say to patients when they're developing this birth plan or they're heading into labor and delivery or they're in the hospital, to ask provider for alternatives to what is being suggested as needing to occur and to really spend some time understanding what the stages of labor are, engaging a provider or a doula or a midwife or somebody to help with this, and also seeking support from your loved one, from your partner, making sure that you are both supporting each other as you're going through this transitional time.

Speaker 1:

Okay, let's go through a few myth busters and some misinformation. I'm going to make a few statements and you tell me if these are true or not. When you're pregnant, you're eating for two.

Speaker 2:

False yeah, so we are not necessarily eating for two during pregnancy. We definitely know that our dietary needs and our nutritional needs do increase during pregnancy, but it is not necessarily double the amount that we needed before.

Speaker 1:

You can't fly whilst pregnant.

Speaker 2:

This is absolutely false. We can fly during pregnancy. We usually try to recommend that people don't fly until really outside the first trimester at least outside of the time when we've already had an ultrasound documenting that the pregnancy is in the uterus, that it isn't in the tube, that everything looks okay. We also don't recommend that pregnant women fly in the later third trimester In general. Recommend that pregnant women fly in the later third trimester. In general, airlines really don't want pregnant women flying. Starting anywhere between 34 to 36 weeks. The second trimester is really the best time to fly. I always tell patients that pregnancy increases the risk of blood clots in the legs and traveling whether it's long travel in a car or travel in a plane increases that risk. So, making sure you're keeping your feet moving, stretching your legs maybe we're wearing some support hose to help prevent that risk of blood clot and really keeping that circulation going. In addition, we may want to think about whether we want to wear a mask during the flight to help decrease that risk of infection.

Speaker 1:

Okay. Is a natural birth the only good way to give birth?

Speaker 2:

Natural birth is not necessarily the only good way to give birth. That may be a bias that some people have felt over recent times. However, pain management during labor is a personal choice and a personal decision Can the shape of the belly predict the gender of the child. The shape of the belly absolutely cannot predict the gender of the child. The shape of the belly really depends on a lot of factors. Some of that is the maternal habitus or body shape before pregnancy. But gender can absolutely not be predicted from the shape of the abdomen.

Speaker 1:

And one that my wife was told many times during her first pregnancy was if you're having heartburn, it's because the baby has a lot of hair. Is that true?

Speaker 2:

That is absolutely not true. Heartburn happens for a lot of reasons in pregnancy. Usually, hormones really cause that. As progesterone levels increase, we have relaxation of the smooth muscle, and smooth muscle is what lines our gastrointestinal tract. So as we're getting relaxation there, things are going to sit in that stomach a whole lot longer than they would otherwise. Relaxation there, things are going to sit in that stomach a whole lot longer than they would otherwise, which will allow food to come back up. In addition, as the pregnancy enlarges, we get less space for the stomach as well, which can increase the risk of food coming back up into the lower part of the esophagus as well.

Speaker 1:

And lo and behold, when our first child was born with a lot of hair, everyone said I told you so, stacey. Thank you so much. That was very helpful. We hope all our listeners found this helpful too. We'll be back with our next episode in this Women's Health Series.

Speaker 2:

Thank you, Jason. Thank you for having me.