First Trimester Education

Aka: First Trimester Education, Pregnancy Education in the First Trimester, Prenatal Patient Education, Antepartum Counseling

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II. Approach

  1. See Pregnancy Risk Assessment
  2. See Preconception Counseling

III. Images

  1. fetalPlant.jpg

IV. History: Habits

  1. See Nutrition in Pregnancy
  2. See Exercise in Pregnancy (includes Lifting Restrictions in Pregnancy)
  3. See Medications in Pregnancy
  4. See Travel in Pregnancy
  5. Wear Seat Belts (three point Seat Belt)
  6. Sexuality
    1. Regardless of frequency or timing, sexual intercourse is safe and does not impact maternal or fetal outcomes
    2. Specific circumstances may limit sex (e.g. Placenta Previa)
    3. Kong (2019) J Obstet Gynaecol 39(4): 455-60 [PubMed]
  7. Reduce adverse health risks
    1. Tobacco Cessation
      1. Tobacco associated with 4600 U.S. perinatal deaths per year
    2. Alcohol Abstention
      1. See Fetal Alcohol Syndrome
    3. Marijuana
      1. Associated with low birth weight and NICU admission
      2. Heavy use is associated with Cannabinoid Hyperemesis and Preterm Labor
      3. Avoid in pregnancy
        1. Metz (2018) Obstet Gynecol 132(5): 1198-1210 +PMID:30234728 [PubMed]
        2. Bailey (2020) Perinatol 40(10):1477-82 +PMID:32139807 [PubMed]
    4. See Substance Abuse in Pregnancy
    5. Illicit Drug use Cessation
    6. Intimate Partner Violence
    7. Obesity (see Nutrition in Pregnancy)
    8. Avoid Teratogen Exposure
      1. See Teratogen Exposure
      2. See Medications in Pregnancy
      3. Includes Herbal Teratogens (e.g. ginkgo, Ephedra, Ginseng)
      4. Reevaluate all OTC and prescribed medications
    9. Avoid Heavy Metal exposure
      1. See Mercury Content in Fish
      2. Associated with abnormalities in fetal neurologic development
    10. Avoid solvent exposure
      1. Avoid solvent exposure (toluene, benzene) or ensure adequate ventilation
      2. Associated with risk of Miscarriage, Stillbirth, preterm birth and IUGR
    11. Avoid radiation exposure
      1. See Radiation Exposure in Pregnancy
      2. See CT-associated Radiation Exposure
  8. Pelvic Floor Exercise (e.g. Kegal Exercise)
    1. Started early and continued throughout pregnancy reduces Urinary Incontinence risk postpartum
    2. Hay-Smith (2008) Cochrane Database Syst Rev (4):CD007471 +PMID: 18843750 [PubMed]
  9. Relaxation Positions
    1. Incline
      1. Lie back with head and back against incline chair
      2. Pillow under hips and behind head and neck
    2. Semi-prone
      1. Prone or slightly on side propped up
      2. Pillows under one hip and head
      3. One knee flexed to assist in propping
  10. Activities to avoid
    1. Avoid excessive heat, such as in hot tubs and saunas (increased Miscarriages and Neural Tube Defects)
    2. Avoid hair treatments with hair dye or hair straightening products (unknown effect)
      1. May be associated with childhood Acute Leukemia
      2. Couto (2013) Chem Biol Interact 205(1): 46-52 [PubMed]

V. Symptoms

  1. See Pregnancy Symptoms
  2. Discomforts to expect
    1. Fatigue
    2. Nausea or Vomiting
  3. Symptoms prompting urgent evaluation
    1. Vaginal Bleeding
    2. Abdominal Cramping

VI. Labs

  1. Weeks 8 to 18
    1. Obstetric Ultrasound for dating and surveillance
  2. Aneuploidy Screening and Neural Tube Defect Screening
    1. See Aneuploidy Screening
    2. Requires education starting in first trimester
    3. First trimester screening (Nuchal Translucency, Free bHCG, PAPPA) at 9-11 weeks
    4. Second trimester screening (AFP, uE3, HCG, Inhibin) at 15-19 weeks
  3. Advanced Testing for women for over 35 years (or abnormal screening results)
    1. Chorionic Villus Sampling at 9 to 13 weeks
    2. Amniocentesis at 16 to 18 weeks

VII. Prevention: Neural Tube and other congenital defects

  1. See Nutrition in Pregnancy
  2. Prenatal Vitamins with Folic Acid 400 mcg (600 Dietary Folate Equivalents or DFE) per day
    1. Reduce risk of Neural Tube Defect
  3. Limit Vitamin A intake to under 8000 IU qd
    1. Over 15000 IU/day Vitamin A associated with defects

VIII. Prevention: Infectious agents to avoid (and to notify provider if exposure occurs)

  1. Toxoplasmosis (e.g. cat litter)
    1. See Toxoplasmosis Prevention
  2. Listeria (see Nutrition in Pregnancy)
  3. Varicella Zoster Virus (see VZV for Post-exposure Prophylaxis)
  4. Parvovirus B19

IX. References

  1. Caro (2020) Am Fam Physician 102(7):420-6 [PubMed]
  2. Ramirez (2023) Am Fam Physician 108(2): 139-50 [PubMed]
  3. Zolotor (2014) Am Fam Physician 89(3): 199-208 [PubMed]

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