General advice in first trimester



Dietary

1. To avoid toxoplasmosis, avoid raw meats (e.g. raw ground beef, rare lamb, uncooked pork), unpasteurised goat's milk, eating unwashed vegetables and fruits, and avoid handling cats' litter.

2. To avoid listeriosis, drink only pasteurised or UHT milk, and avoid eating ripened soft cheese (e.g. Camembert, Brie or blue-veined cheese), pate, undercooked food.

3. To avoid salmonella, avoid eating raw or partially cooked eggs or food that may contain them (e.g. some types of mayonnaise or mousses), and raw or partially cooked meat (e.g. poultry and shellfish).

4. Go generous on fruits and vegetables.

5. Fish is healthy but some health authorities have recommended pregnant women to eat no more than 2 portions of oily fish, such as mackerel or salmon, a week. This is because too much mercury may be found in oily fish which can be harmful to an an unborn baby's development. Also avoid eating more than 2 fresh tuna steaks or 4 medium-sized cans of tuna a week, and avoid eating shark, swordfish or marlin.

6. Avoid drinking too much alcohol - we know that alcohol binges may be associated with fetal alcohol syndrome in some patients, hence avoid alcohol or limit yourself to not more than 1 glass a day.

7. Avoid coffee as recent studies show that too much coffee consumption may be associated with an increase in risk of miscarriage - limit yourself to 0-1 cup of coffee per day.

8. Tea - There isn't any similar studies with tea but I would generalise the study to include tea as tea also contain caffeine and we don't really know if it is the caffeine or other constituents in the coffee that is associated with the increased risk of miscarriages.


Read Patient information leaflet on healthy eating and supplements in pregnancy

Supplements 1. Folate 0.4-5 mg every morning - this reduces the risk of fetal brain and spinal abnormalities e.g. anencephaly and spina bifida.

2. Other multivitamins containing iron and calcium supplements - I generally avoid these till after 12 weeks as they may exacerbate nausea and vomiting which is rather common during the first trimester.

3. DHA supplements - These are now quite popularly taken during pregnancy as DHA is an important constituent of the brain and the retina, and is thought to be useful for the development of the brain and retina in the fetus. I normally start on this from 12 weeks gestation.

Habits 1. Avoid smoking.

2. Avoid certain medications - tell the GP that you are pregnant.

3. Eat well - You may have to modify your meals to small frequent meals and actively avoid smells or foods that may cause you to have more nausea and vomiting during this period.

4. Have regular physical activity 3-5 times a week - brisk walking and swimming are some good activities.

5. Sexual intercourse - in general, sexual intercourse does not cause complications unless there are risk factors e.g. bleeding during pregnancy, a low-lying placenta, high risk for preterm labour.

When to see the doctor 1. Have an ultrasound scan at about 6-7 weeks - this is to date the pregnancy accurately, to determine if it is one or more babies, and to confirm that the pregnancy is within the uterus (and not an ectopic pregnancy).

2. Inform the doctor of any:family history of children with disabilities / genetic diseases, vaginal bleeding and/or abdominal paiin.

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