First Trimester Pregnancy: Everything You Need to Know from a Fertility Doctor

You're pregnant, now what? Whether you have been trying for a while or it's a complete surprise, after you get that positive pregnancy test, it can send a panic. What are you supposed to do? What are you not supposed to do? There's so many questions and this video is here to help you navigate the first trimester. I'm Dr. Laura Shaheen. I'm a double board certified OBGYN and reproductive endocrinologist helping people get through the first trimester for almost 20 years. And especially my patients that have been struggling with infertility, they've done treatment, whether it's an embryo transfer, IUI, or just a surprise pregnancy, it can be so amazing to finally see that positive pregnancy test, but it can also start a panic. So many of my patients have been so focused on all of the steps they needed to do to optimize to get a positive pregnancy test. And now that it's here, they sort of feel like, oh my gosh, now what? And so this video is for anyone that is in their first trimester of pregnancy and wants to learn how to survive and thrive and take care of themselves through this very, very important time in pregnancy. In this video, we're gonna go over three main topics. Number one, we're gonna review exactly what the first trimester is, what is going on with your body, and what is going on with the developing baby. Topic number two, we're gonna go over common symptoms of first trimester of pregnancy, what's normal and when to worry. And topic number three, we're gonna go over the five most common questions my patients ask me about the first trimester. We're gonna answer them one by one. Now stick around to the end of this video because I'm gonna give you top tips on how to really take care of yourself through this very, very special time. Topic number one, what is the first trimester and what's going on? The first trimester of pregnancy is actually from the very start of pregnancy through 13 weeks and six days. So basically up until about 14 weeks of pregnancy. It's about three and a half months of pregnancy. The way it's timed is when you actually have a positive pregnancy test, you're technically about four weeks pregnant because we date from the first day of the last menstrual period. Now, if you've done fertility treatment, I know that can get confusing because we often will do the pregnancy test about 10 days after an embryo transfer. And you sort of say to yourself, well, the embryo has only been inside for 10 days. How can I be four weeks pregnant? It's a little bit arbitrary, but just basically remember when you first have a positive pregnancy test, you're about four weeks pregnant. So we're talking about that moment for the next 10 weeks until you are 14 weeks pregnant. When you're 14 weeks pregnant and on, you're getting into the second trimester and then later on the third trimester. We're talking about this first 14 weeks, which is really only, again, about 10 weeks of knowing that you're pregnant. I know that's confusing, but you gotta understand what we're talking about. During this time, it is absolutely amazing. The embryo is going from a ball of cells that's called a blastocyst. It's about a hundred cells and it's implanted into the uterus and turning into a full-fledged fetus with a heartbeat, a little brain, spinal cord, gut is starting. It is absolutely amazing how much happens in this really precious time. All the organs are forming. Your body is changing tremendously. Your cardiac output is increased. You are feeling things, things are changing. And this little tiny ball of cells, you can't even see without a microscope, is turning into a full-blown fetus that is about the size of a kiwi. It's about 8.5 centimeters in size or about three and a half inches. It is absolutely amazing. And your body is changing so much during this time, just like that baby growing. It is just incredible. So topic number two, what are common symptoms and what's common, what's normal, what's not normal? When should we worry? We're gonna talk about the seven most common symptoms. Number one, fatigue. Oh my gosh, this is almost universal. And personally, I remember feeling like I got hit by a Mack truck and I was just lying on my couch. So your body is changing so much. I talk to my patients about, your body's actually like it's running a marathon. Your heart is working harder. Your cardiovascular system is dealing with increased cardiac output. Your kidneys are working harder. Just your whole body is changing. And yet on the outside, you might look the same. And you might have not even told people that you're pregnant yet. It's just incredible how much is changing. And fatigue, being tired is almost universal. It's really, really common. I remember just wanting to put my head down on my desk in the middle of a work day and just take a quick nap because I was so exhausted. And I did try to nap as much as possible. Not during the work day, but man, those weekends were really, really, really, really important. And even afternoons when I got home, little nap, taking care of myself. Oh my gosh, just so, so tired. Symptom number two, smell and food aversion. Not everybody gets this, but it's pretty common to love a certain type of food. And then all of a sudden, you just don't wanna see it anymore or smells can be pretty triggering. It's a pretty common thing, but not everybody will have these symptoms. Symptom number three, nausea and vomiting. I don't know why they call this morning sickness because it can occur any time of the day or night. It's not every pregnancy, but about 50 to 80% of pregnancies, people will report nausea and vomiting and just an upset stomach. There's lots of theories as to why this happens. It's most common from week four to week nine. And very often it can get better through the second and third trimester. There are people that feel this way throughout their pregnancy. I feel so sorry for them, but it often will get better after the first trimester. Some things that can help are eating small frequent meals and really bland food. So sometimes spicy and fatty foods can make us feel more upset and an empty stomach can make you feel more upset. Sometimes ginger can be helpful. Sometimes acupressure, there's a point kind of right in your wrist that can be really helpful. If these things are not helping you feel better, talk to your doctor. There are some medications that can help. And if you're really not able to keep food and water down, if you are not feeling well, you should definitely talk to your doctor. There are times people do get admitted or sometimes feel a lot better with some hydration, with IV fluids or other types of medication. Definitely stay in touch with your doctor. You wanna make sure that you are safe and you're getting enough hydration and nutrition for both you and the pregnancy. Symptom number four, breast tenderness. This is really common. It's due to hormonal changes and fluid shifts and common to have tender, full, swollen breasts. Symptom number five, frequent urination. So again, your kidneys are working harder, fluid shifts are happening, and it's pretty common to have to go multiple times in the bathroom more often than you have in the past. And even getting up at night to go to the bathroom. Symptom number six, heartburn. Oh, I felt this one. Your esophagus and your stomach is not necessarily working the same way with the high levels of progesterone. It can slow down gastric emptying and it can relax the esophagus to allow some of that stomach acid to come back up into your esophagus. And it can be so uncomfortable. Really common, talk to your doctor about treatment options, but just super common symptom. And the seventh common symptom is constipation. Again, it comes back to that progesterone hormone. It's the dominant hormone in pregnancy and it can slow down not only gastric emptying, but emptying of the rest of the intestine. So constipation is really common. Hydration is important. Fiber is important. Moving around a little bit, like actually just walking and moving your body helps your bowels move. And then talk to your doctor about different treatment options. The third topic is answering the most common questions that I get from my patients that are finally pregnant. There are five common questions that almost every patient asks. And so I wanna answer them for you right now. Question number one is weight gain. Should I be trying to gain weight? Is it strange that I'm not gaining weight? Like I feel like in order to have a healthy pregnancy, I gotta put on weight. Well, everybody's really different in the whole pregnancy. People can gain anywhere from 15 to 30 pounds, depending on kind of their pre-pregnancy weight and a lot of different factors. But most people will gain weight in the second or third trimester. In the first trimester, sometimes people can gain around three to five pounds, but it's not necessary to gain weight in the first trimester in order to have a healthy pregnancy. Question number two, is cramping normal? Yes, but it can be so worrisome and triggering, especially if you've had a miscarriage in the past. Cramping can sometimes make you worry that, oh, that's it, I'm having another miscarriage. But your body is changing so much. The progesterone is relaxing ligaments, your uterus is growing, and it's really common to have cramping in a perfectly healthy pregnancy. Always ask your doctor if you're worried, but cramping, it can be a normal part of the first trimester. Question number three, bleeding, spotting, is that normal? So not necessarily normal, I would say, but about 30% of perfectly normal pregnancies that go on to deliver a beautiful baby have some sort of spotting or bleeding in the first trimester. Spotting and bleeding can be a sign of a miscarriage or cramping, especially on the one side associated with bleeding, could be a sign of an ectopic pregnancy. This is important to talk to your doctor if you're having spotting and bleeding, but a lot of pregnancies will have this. If you think about how much your uterus has to change, the fact that this pregnancy and the placenta are growing into the wall of the uterus, that it is such a vascular organ, there's such a great blood supply, the uterus is absolutely amazing. And this placenta is growing into it, and of course it could hit blood vessels and there could be a little bit of bleeding. It can be a part of the normal implantation, and it's just so nerve wracking when you see spotting and you see bleeding, again, especially if you've had a miscarriage before, talk to your doctor, get your questions answered, but the short story is that spotting and bleeding do not necessarily mean that it's an abnormal pregnancy. Question number four, what foods to avoid? Such a common question, so many different recommendations, and honestly, where you live in the world, there could be different recommendations. So I will tell you the basic understanding of what you should get is that your immune system changes drastically when you're pregnant. Your immune system is suppressed, it's allowing the development of this pregnancy, and with an immunosuppression, with that high progesterone immunosuppression, you are more susceptible to bacteria on food. So you wanna avoid food with a high bacteria content in order to prevent getting food poisoning or getting sick. That is the key. So foods that have a high bacteria content are uncooked foods, so avoid raw meat, raw fish. I know, if you're thinking about people in Japan eating sushi all the time, I know, but it is a higher risk for pregnant people because there could be bacteria on that sushi. That is why it is recommended to avoid. You want to avoid unprocessed dairy, so like raw milk, raw cheeses. These things can have listeria, they can have salmonella. Listeria infection has been associated with really, really ill pregnant people, and even miscarriage. So this is where these recommendations come from. Other things that can have high bacteria content are deli meats. If you're eating hot dogs, you've really gotta cook it thoroughly. And then the other thing people ask a lot about is fish. So if you're eating fish, you're cooking it, you don't wanna have it raw, but how much fish? Well, some fish have a high level of mercury, and you want to limit your exposure to mercury while the baby's brain and spinal cord are developing, which is so important, especially in the first trimester. So avoid, there are great lists online for fish and which ones to avoid and which ones are safer, but some kind of guidelines are larger fish that are eating smaller fish have a higher chance of having mercury because they're kind of eating all these little fish that might've been exposed to it. So big fish like king mackerel, swordfish, big tuna, those are ones to avoid. And other fish like salmon, sardines, anchovies are typically safer. The FDA does say that fish is important. It's a wonderful source of nutrients and omega-3 fatty acids, which are great for baby's brain development. And that if you're gonna eat fish, try to limit it to two or three servings per week, and a serving is about eight to 12 ounces. Another food, something you ingest to think about is caffeine. In general, high levels of caffeine intake have been associated in some studies, but not all with a slightly higher chance of miscarriage. Most doctors will recommend limiting your caffeine intake to less than 200 or 250 milligrams a day. In general, one cup of coffee in the morning is probably okay because that's typically less than 250 milligrams of caffeine, but talk to your doctor if you're worried at all and think about your caffeine consumption. And question number five, what about exercise? Exercise is so important for your mental health, your physical health. You might not really feel like exercising a lot because you are so tired and your body is working so hard, but moving your body is important. I talk to my patients about avoiding really strenuous exercise or starting a brand new routine. You don't wanna all of a sudden train for a long distance run like a marathon when you've never done that before and all of a sudden you're pregnant. You wanna avoid things that can dehydrate you, so really strenuous exercise or like hot yoga. I don't love that because it's so important to stay hydrated and if you're really just sweating out profusely, it's just gonna be harder to stay hydrated. I think about types of exercise that are high injury, so downhill skiing, wakeboarding, water skiing, just things that you could fall, you could have a really traumatic twisting and I just think about this pregnancy is so precious. So just think about staying healthy, moving your body, but just not too strenuous. But also don't be completely sedentary, just move a little bit. Long walks, prenatal yoga is wonderful. Hiking can be great. Strength training, wonderful. Low impact rides on your Peloton if that's what you enjoy. Jogging is fine, but maybe just modify how far you go and how hard you're running. Talk to your doctor if you are curious about your personal situation, but exercise is important, just maybe modify. So we've already gone over a lot for what to expect and all about the first trimester. We explained what the first trimester was and exactly what's going on with your body and the developing pregnancy. We talked about what symptoms to expect and a little bit of tips on how to know if something is normal or not normal. And we reviewed five of the most common questions that my patients ask me in the first trimester. Now I wanna leave you with some top tips on how to take care of yourself in the first trimester. So rest, listen to your body, take naps, hydrate, make sure you're constantly drinking a little bit of water, just stay hydrated, it's just so important. Remember to take your prenatal vitamin. Actually taking a prenatal vitamin for a month before you get pregnant decreases the risks of nausea and vomiting in pregnancy. And taking a prenatal vitamin up to three months before you get pregnant actually decreases a lot of pregnancy complications. So just don't forget to take a prenatal vitamin. Now, if you're starting to have a lot of nausea and vomiting and it is just too tough to take that whole prenatal vitamin, think about switching to just folic acid. Sometimes the iron in a prenatal vitamin is really hard for our bodies to digest in the first trimester and we don't really need that iron typically until the second or third trimester. But the folic acid, that's the one that you really need in that first trimester to decrease the risk of neural tube defects. Got a whole video here on how to choose a prenatal vitamin. And I go into that topic of folic acid versus methylated folate in that video. A little too much to go into right here but I hope these tips are helpful. And finally, you've got to stop some things if you haven't already, make sure you stop smoking and exposure to tobacco. And this means in your household too, secondhand smoke can be very harmful to the developing pregnancy. Stop alcohol, of course. Nobody knows how much alcohol is safe and fetal alcohol syndrome results from the fetus being exposed to alcohol in pregnancy and especially in early pregnancy when those organs are developing. And finally, marijuana, stop marijuana. I know some people really feel that it's probably safe but studies show it can be associated with preterm labor, miscarriage and other pregnancy complications. I've got a whole video here on marijuana and its impact on women for fertility as well as early pregnancy and I hope that that's helpful. I hope you learned something from this video today. Like this video if you did, comment with questions that you have, other topics you'd like me to cover and make sure and subscribe to this channel so you get my weekly video all about reproductive health. And until next week, wishing you love, luck and pineapples.