First Trimester Education

1. See Also
   1. Second Trimester Education
   2. Third Trimester Education
   3. Postpartum Education
   4. First Obstetric Visit
   5. Prenatal Visit
   6. Nutrition in Pregnancy
   7. Travel in Pregnancy
   8. Exercise in Pregnancy
   9. Medications in Pregnancy
2. Approach
   1. See Pregnancy Risk Assessment
   2. See Preconception Counseling
3. History: Habits
   1. See Nutrition in Pregnancy
   2. See Exercise in Pregnancy (includes Lifting Restrictions in Pregnancy)
   3. See Medications in Pregnancy
   4. Wear Seat Belts (three point Seat Belt)
   5. Sexuality
      1. Regardless of frequency or timing, sexual intercourse is safe and does not impact maternal or fetal outcomes
      2. Kong (2019) J Obstet Gynaecol 39(4): 455-60 [PubMed]
   6. 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)
   7. 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
   8. Activities to avoid
      1. Avoid 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]
4. Symptoms
   1. Discomforts to expect
      1. Fatigue
      2. Nausea or Vomiting
   2. Symptoms prompting urgent evaluation
      1. Vaginal Bleeding
      2. Abdominal Cramping
5. 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
6. 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
7. Prevention: Infectious agents to avoid (and to notify provider if exposure occurs)
   1. See Toxoplasmosis Prevention
   2. Listeria (see Nutrition in Pregnancy)
   3. Varicella Zoster Virus (see VZV for Post-exposure Prophylaxis)
   4. Parvovirus B19
8. References
   1. Caro (2020) Am Fam Physician 102(7):420-6 [PubMed]
   2. Zolotor (2014) Am Fam Physician 89(3): 199-208 [PubMed]