Congratulations!   You may be wondering if, even if you are quite happy with a vegetarian diet, your growing baby needs meat.  Nope!  Maintaining a vegetarian or vegan diet during your pregnancy is safe and healthy.  The important thing is eating a variety of foods that supply you and your developing baby with the nutrients you both need.  

Make sure your diet is rich in fiber and complex carbohydrates like whole grain breads, pastas, and brown rice.  Also, incorporate calcium rich foods like leafy greens and dairy products (if you consume milk), and iron rich foods such as enriched grains, spinach, and raisins.  Vitamin C can be found in citrus fruits and veggies like broccoli, peppers, and sweet potatoes.  Dark green leafy vegetables, take kale and chard and legumes such as beans and chickpeas are a great daily source of folic acid.  Protein can sometimes be a challenge so if you are avoiding meat, poultry, fish and eggs, stock up on beans, nuts, soy products like tofu, and quinoa.  Vitamin B 12 is the one nutrient that can only be found in animal sources such as dairy products, eggs and fish.  If you are a vegan, your doctor may have you take a Vitamin B 12 supplement in addition to your prenatal vitamin.  A wide variety of fruits, vegetables, nuts, legumes and grains will help keep you healthy throughout your pregnancy.  

Something to consider, though... the foods you used to enjoy may not sit as well with you during the next nine months, especially during the queasy days of the first trimester.   Progesterone slows down the smooth muscles of your intestines and you’ll want to avoid getting blocked up. You also may have food cravings and aversions.  So listen to your body, give it what it wants and balance it out with what it needs. 

Whether or not to have prenatal diagnostic testing is a personal decision that all pregnant women, regardless of their age, need to make for themselves. 

The older our ovaries get, the greater the likelihood of a chromosomal abnormality.   (The egg and sperm each carry 23 chromosomes,  giving each cell in the fetus 46 chromosomes altogether.) The majority of  pregnancies  with an atypical number of chromosomes will end in miscarriage.  However a few, most commonly Trisomy 21 (otherwise known as Down Syndrome in which there is an extra chromosome number 21), will continue to term.  Women age 35 and older are considered “advanced maternal age”.  35 was chosen as the "threshold" age because the risk of having a baby with Trisomy 21 at age 35 is equal to the risk of miscarriage from an amniocentesis - approximately one in 250.  But otherwise, there is nothing magical about age 35.  Our risk of having a chromosomally abnormal fetus increases as we age but fortunately there are screening and diagnostic tests we can use to find out if the baby is healthy.

Each state has its own prenatal diagnostic program to screen for birth defects. For instance, in California you can elect to have a blood test done between 10 and 14 weeks of the pregnancy.  The results of this blood test can be combined with a measurement of the fetus’ neck thickness (nuchal translucency) which gives a screening risk for both Trisomy 21 and Trisomy 18.  Between fifteen and twenty weeks, another blood test is performed which is combined with the other two measurements to give a final screening number (Sequential Integrated Screening).  This test will pick up pregnancies affected by one of these age related chromosomal abnormalities in about 90 percent of cases.  One can also choose to have only the first and second trimester blood tests (Serum Integrated Screening) or only the second trimester blood test (Quad Marker Screening)  though the test will be less sensitive.  Screening tests will let you know if there is an increased or decreased risk.  They will not give you a final answer but they also do not have complications associated with diagnostic tests. 

A new type of screening called "Noninvasive Prenatal Testing" or NIPT was introduced recently and is offered by several commercial companies.  Essentially a sample of the mother's blood is taken after the 10th week of pregnancy.  Chromosomes reside in the cell nucleus but when cells break apart, fragments of the DNA can be found in the bloodstream. With NIPT,  fragments of the fetus' DNA are separated out from fragments of the mother's DNA and analyzed. The test looks for abnormal amounts of fetal chromosome 21 as well as 18, 13, and gender chromosomes.  (In other words, you can find out the sex of the baby along with the results if you wish.) It is extremely sensitive in picking up these chromosomal abnormalities.  At this point, this screening option is only recommended for women in a high risk group -- age over 35, state screening or nuchal translucency results in the high risk category, or another factor such as a previously affected pregnancy.  

If any of these screening tests return with an increased risk or if you are in a high risk category (over 35, for example) and would feel more comfortable with definitive results, you can elect to have a diagnostic test which will give you the actual chromosomes of the baby.   Chorionic villus sampling (CVS) is performed between nine and fourteen weeks and involves taking a tiny sample of cells from between the baby and the placenta.  An amniocentesis is another diagnostic test and is done between sixteen and twenty weeks .  A needle is carefully placed into the uterus under ultrasound guidance and amniotic fluid with cells the baby has shed is withdrawn.  In both of these procedures, the cells are then grown and the chromosomes analyzed with results available in two weeks.  Neither of them hurt - they feel like a pinch or a shot.  While they offer more conclusive results than the screening tests, they also incur a small amount of risk such as bleeding, infection, or miscarriage of the pregnancy.  It is also routine to have an ultrasound to check the baby’s anatomy sometime between eighteen and twenty weeks.  

Ultimately, you and your partner should discuss your feelings about screening and diagnostic tests to check for birth defects.  Some couples will choose not to have any screening done while others will strongly desire early tests.  Even if you do not feel that knowing of a chromosomal irregularity will change how you proceed with your pregnancy, the information may help you prepare for your baby.  All of these options should be discussed with your obstetrician.  The decision of how to proceed is yours.

It is wonderful that you want to continue exercising during your pregnancy - you go!

If you have been running consistently prior to becoming pregnant, you can certainly continue running your three to five miles a day as long as it feels comfortable.  Exercising at least thirty minutes, most days of the week helps build  muscle tone, strength and endurance.  Additionally, regular physical activity helps with sleep, digestion, and, so importantly, mood.  Keeping your weight gain reasonable (twenty five to thirty five pounds overall if you start off at average weight) is much easier with consistent exercise and you decrease your chance of ending up with gestational diabetes.  Plus, maintaining your strength throughout your pregnancy will make the delivery and recovery that much more of a breeze!  

Pregnancy, however, is not the time to train for a marathon or start a vigorous exercise campaign if you’ve been a couch potato up until now.  Start slowly with walking, swimming, and low impact aerobics for cardio.  Prenatal yoga is a fabulous way to build your strength and flexibility.  After the first three months, avoid lying flat on your back - it decreases blood flow and oxygenation to the uterus.  Stop exercising if you feel tired, faint, or short of breath.  Make sure you drink plenty of water to avoid dehydration and wear appropriate layers so you do not overheat.  Of course, any bleeding or regular contractions is a sign to quit and check in with your obstetrician.  And contact sports, skiing, and scuba diving are off limits for now.

Over the course of the next nine months, you may notice changes in your posture and balance.  You may experience lower back discomfort, sciatic nerve pain down the back of your leg  and pelvic pressure as the pregnancy advances. In addition, your pregnant body makes more hormone called relaxin which loosens joints.  While this is fabulously important in helping prepare the pelvis for labor, it can increase risk of injury by relaxing other joints in the body.  Exercises that were once easy may become uncomfortable as you grow.  As always, listen to your body and don’t overdo it.  Modify your routine as your body changes and have fun with it.  Start a pregnant women walking club at your local mall or park or meet other mommies-to-be at a prenatal yoga class.  Many women are able to exercise all the way through their pregnancies... Brava!

Restless Leg Syndrome (RLS) is characterized by prickly, tingly, painful sensations in the legs.

Those affected can have an irresistible urge to move the legs and can even have uncontrolled jerks. It is a movement disorder that affects five to ten percent of the population but can temporarily affect up to forty percent of pregnant women!

The symptoms tend to worsen at night and can be relieved by moving, shaking or massaging the legs. Of course, with all that moving around, RLS interferes with sleep and those affected often complain of insomnia and sleepiness. While the condition is most commonly seen in the third trimester of pregnancy, the good news is that it usually resolves soon after delivery.  Anemia has been suggested as a possible cause, and should certainly be checked for and treated, but its increase during pregnancy is more likely hormonal.  

So, what are you to do when those “pins and needles” are keeping you up at night? 

First of all, try to exercise daily. In addition, stretch those lower extremity muscles morning and evening and massage your legs before bed. Avoid caffeine and, of course, smoking. And try to maintain healthy sleep habits. Go to bed and wake up at the same time each day. Not napping during the day is helpful. Stay away from heavy meals and sugar close to bed time. And avoid activities that can make it hard to fall asleep like television or reading right before you doze off. 

Try to turn any LED alarm lights away from you and put electronics away. And since stress only increases the symptoms, keep your bedroom a worry-free, work-free zone reserved only for sleep and sex. Here’s a suggestion:  about half an hour before your scheduled sleep time, put away your smart phone and the computer. Shut off the TV. Take a warm bath. In your bedroom, stretch out your body and give your legs a good massage. Consider turning on relaxing music or putting in ear plugs to block out any outside noise. Hopefully you and your baby will finally get some much deserved rest.

There are so many prenatal vitamins on the market, available both by prescription and over-the-counter, that choosing one to take during your pregnancy can be quite overwhelming. 

Prenatal vitamins are a multivitamin intended for women who are trying to conceive, are pregnant, or are nursing.  They are meant to supplement a healthy diet with daily additional minerals and vitamins and are important for the well being of both the mother and the developing baby.  Prenatal vitamins are specifically formulated to primarily ensure adequate intake of folic acid, iron, and calcium.  Folic acid is important in the prevention of defects in the spinal cord or brain.   Spina bifida is the most common example of a neural tube defect.  Since the development of the baby’s  central nervous system starts before many women even know they are pregnant, adequate intake of folic acid, at least 400 mcg a day, is recommended at least a month prior to conceiving.  Some prescription prenatal vitamins have a special type of folic acid that is more bioavailable branded as Metafolin.  Iron, at least 27 mg a day, is recommended to help prevent anemia, low blood count,  which is very common as the pregnancy progresses. Iron, however, can also lead to constipation and for some women, upset stomach, so there are varying doses of iron in different prenatal vitamins depending on need and side effects.  Calcium is important for the bone health of both the mother and baby.  While 1,000 mg a day is recommended, most prenatal vitamins have between 200 and 300 mg with the rest of the daily requirement meant to be from dietary sources.  

Prenatal vitamins generally also contain vitamin B 12, C, and D, as well as thiamine, riboflavin, niacin and zinc.  Vitamin A, in high doses, can have serious consequences for a developing baby and should therefore be limited to less than 4,000 IU a day.  

Many prenatal vitamins are now incorporating Docosahexaenoic acid (DHA) an omega-3 fatty acid, either into their supplement or as an additional softgel capsule because of reports of improved brain and eye development in the baby.  

Prenatal vitamins come in many different sizes and forms such as gel tabs or solid tablets. There are even chewable and liquid forms for those who have difficulty swallowing a pill. Some are meant to be taken just once a day while others spread the daily dosages across several pills.  Be sure you understand the daily dose you are receiving from the number of vitamins per day you are recommended to take.  It is possible to have too much of a good thing so do not go over the daily recommended allowance by taking additional vitamins or supplements without checking with your obstetrician.  Also, some prenatal vitamins have a stool softener to help with constipation.  If you switch from one brand of vitamins to another, you may notice changes in your digestion, your bowel movements and even the color of your urine. The bottom line is that you should choose a prenatal vitamin that has enough of what you need, and not too much of what you don’t need, and is easy for you to take and tolerate during your pregnancy and the months that follow.  

We all look forward to vacations. They are so anticipated and often come when you feel you couldn't go another week without one. While the goal, once the vacation has begun, is to unwind, planning for the week of relaxation and preparing to leave can be ridiculously stress-inducing. In my case, that does not make the time off that much sweeter - just makes me more wound up. 

So for our vacation with the kids this summer we decided to take the pressure off and spend a week at our family cabin in California's San Bernardino Mountains. Minimal planning. Minimal prep. This was what I actually needed this year to make the week off truly a time to exhale.  Other than family time, I blissfully had no real agenda at all. But, while I envisioned a week of reading by the fire and hikes with the children, my husband had a somewhat different vacation idea. He had a master plan. It was all about the holy grail of catching crawdads. 

 Did he mean crawfish? The things I ate during a college Mardi Gras road trip? Now, my family has been going up to Big Bear Lake since I was eight years old. We bought this cabin in 1976. Please don't do the math. And I have never once, in all my years of fishing alongside my father, walking along the lake, or hanging out by the Marina seen a single crawdad. But my husband, armed with childhood visions of himself and his friends catching crawdads by creeks in Colorado, was unswayed. And he passed the bug onto the very excited children.

Would one call it obsessed or prepared?  I'm not sure.  After hours of web searches, Dave ordered a crawdad trap off the Internet. It looked like mesh cornucopia horns that locked together. We bought organic nitrate-free bacon ends from Trader Joe's as bait.  Only the best for our little crawdads. And we purchased enough corn, potatoes, onions, garlic and andouille sausage for the biggest crawdad bake this side of Mississippi. Not to mention the online search for the country's  number one crawdad gumbo seasoning,  "Slap Your Mama".  Offense taken to the name, but it had no MSG so I let it go... Yes,  we received that via Amazon prime as well. We armed ourselves with two huge pots for cooking all those crawdads we were going to catch.  Ready! We packed up our car and our dreams and headed for the mountains. Big Bear Lake was an oasis of vanilla scented pines and 70 buck "good for a whole year" fishing permits. In other words, Heaven.

The plan was to drop the trap in the cool of the evening. By the morning we'd have about a dozen critters in the trap and then we'd fish with sticks, string, and bacon pulling in another dozen or so. The rest of the day would be spent preparing for the feast of the crawfish bake.

Not so much.

We dropped the trap each night in water not too shallow or deep, where those crawfish would be sure to smell the bacon and raw chicken. We found areas around the lakes with big rocks, perfect for those crawfish to hide under.  We thought we saw baby crawfish at one fishing spot- turns out they were baby catfish.  How could those crawfish resist homemade poles of sticks, fishing line, and weights?

My son was sure at one spot a crawdad had taken the bacon off his line then escaped when he went to pull him up. The kids never lost their optimism.  Dave, Gotta love him, kept wanting to try just one more place. Slowly, trying not to be too obvious, I began to use the ingredients we'd brought up for the bake.

On our second to last evening in Big Bear, on our way to a night hike in Fawnskin, we decided to drop the trap one last time at the same location where the boy saw the "one that got away".    The next morning at the crack of dawn Dave and the boy drove half way around the lake again to pull out their trap.  They were holding onto the dream and the stakes were high.  A crawfish! One beautiful real actual crawfish!!

They brought that guy home full of pride.  He lived in the bucket with some lake water and rocks and Dave gave us lessons on how to pick him up without getting ourselves pinched. When it was finally time to bring him back to his spot in the lake, my little boy moaned "I'm so sad to put him back.  We had such good times."

It was a wonderful vacation week, which was indeed filled with fireside Rummy Q games, reading marathons, hikes in the mountains, kayaking in the lake, and s'mores galore. But the highlight?  Definitely catching that single crawdad.

Bravo, Dave!