Your Health

In Good Hands: Prenatal Visits

Congratulations! Now that you’re pregnant, you’ll be seeing your OB/GYN regularly. Here’s what to expect at your routine checkups.

The First Visit
The first appointment with your doctor is typically eight to 10 weeks from the date of your last menstrual period. “We do a lot of talking at the first visit,” says Karen Callen, M.D., a Brown & Toland OB/GYN at Golden Gate Obstetrics and Gynecology. “I ask about general health, medical history, medications and any previous pregnancies. I also ask about family health history—both the mom’s and the baby’s father.” 

You’ll also have a complete physical examination, including a Pap smear, blood pressure check and a weigh-in. Urine and blood samples will be tested for blood count, Rhesus or Rh factor (a blood protein), immunities and the presence of diseases such as hepatitis. 

An ultrasound will give your physician—and you—a look at your developing baby. Even at eight to 10 weeks, the fetus can be seen and a heartbeat is detectable. An ultrasound is also very helpful in establishing an accurate due date.

You’ll also receive a wealth of information about genetic testing. “Genetic screening has changed significantly in last five to seven years,” says Dr. Callen. “Tests used to be based simply on age. Now we’re better able to assess risk for the specific pregnancy.” Most genetic screenings aren’t done until 10 or 12 weeks, she adds. “Giving couples the information on their first visit allows them time to think about their choices and whether they want to be tested.” 

Subsequent Visits
Following the initial appointment, you’ll see your practitioner every four weeks up until 28 weeks of pregnancy. Then you’ll switch to every two weeks. At 36 weeks, you’ll start weekly visits.

At each checkup, your doctor will assess the size of the fetus, test your urine for protein and glucose, measure your blood pressure and weigh you. The optimum amount of pregnancy weight gain will depend on your BMI to start with. (BMI, or body mass index, is a measurement of body fat based on height and weight.) For women with a medium-range BMI, the recommended pregnancy weight gain is 25 to 30 pounds total (unless you’re carrying multiples). Women with lower BMIs will be advised to gain slightly more, and women above the norm will be encouraged to gain only half a pound per week.

As you approach your due date, your provider will also review the signs of labor and remind you what to do when the big day comes.

Questions, Questions
At your prenatal appointments, your doctor will ask you about certain milestones, such as whether you’re starting to feel your baby kick. This is also a great time to raise your questions about the many issues that come up. Dr. Callen’s website has answers to expectant mothers’ frequently asked questions, as well as information on morning sickness, exercise, stretch marks and much more. Just go to www.goldengateobgyn.org and click on the Pregnancy tab.

Gestational Diabetes
It’s not uncommon for women to develop a temporary case of diabetes while pregnant. Why? Excess glucose circulates in the blood because the body isn't producing enough insulin to break down sugar.
 
All that sugar can lead to an overly large baby, complicating delivery. Gestational diabetes also puts the baby at higher risk for developing diabetes later in life. “Immediately postpartum,” says Dr. Callen, “the baby can have problems maintaining normal blood sugar levels, which can be dangerous.”

Between 24 and 28 weeks, you’ll have a blood test to screen for gestational diabetes. If a problem shows up, the first line of defense is modifying your diet with healthier food choices. When that doesn’t reverse the condition, or when dietary restriction interferes with ample weight gain, then insulin is the best treatment.

Once the baby is born, gestational diabetes usually clears up on its own, but just to be sure, blood glucose levels will be tested six weeks postpartum.