Pregnancy

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Congratulations, It’s Twins!

Thursday, October 31st, 2013

An increasing number of expectant parents are hearing those words these days. If you are expecting twins (or more), then one of two things has happened. In natural twinning, either your body has released two eggs, and they have both been fertilized, or one fertilized egg has split into two. The former will result in fraternal twins; the latter, identical.

Learning that you are expecting twins is normally quite a shock. It can take some time for the news to sink in, and for all the concerns and questions to arise. You may be concerned about pregnancy complications or what the birth will be like; you make also worry about being able to cope with having two babies at once. These concerns are completely normal and common.

Realize that the majority of twin pregnancies turn out just fine. You can probably expect to be tired throughout the pregnancy and require a lot of rest; this is your body telling you what it needs, so be sure to listen. Some pregnancy symptoms can be exacerbated with twins, such as morning sickness (which can actually occur any time of day). Your higher levels of hCG will often mean more nausea and possibly vomiting than women with singleton pregnancies experience.

Later in your pregnancy, you may also experience other symptoms to higher degrees, such as shortness of breath, constipation, heartburn, and bloating. Back or hip pain may also be more of a problem as your babies grow.

Another difference you will notice in your twin pregnancy is increased weight gain. Understand that if your are average weight, you will need to gain more weight than women who are carrying only one fetus – but also realize that it needn’t be a lot more. While mothers of a singleton pregnancy need only eat 100-300 calories more per day, a mother of twins needs to ingest about 500 more calories per day. More may be advised if she is underweight to start with; if she is overweight, less is fine, as long as the babies are growing and healthy.

Mothers of twins should expect more prenatal care, as well. More ultrasound examinations are common to keep an eye on how well your twins are doing. You will also have regular blood pressure and urine checks, because as a pregnant woman expecting twins, you have a higher likelihood of developing high blood pressure, gestational diabetes, preeclampsia, and anemia.  Because of the higher risk of depleting the maternal iron and calcium stores with a twin gestation, additional supplementation with prenatal iron and calcium is prescribed in order to prevent anemia or osteoporosis later in life.

Look out for the same danger signs as in any other pregnancy and report them to your doctor immediately. If you aren’t sure whether a symptom is normal or not, or even if you just feel instinctively that something isn’t right, consult with your doctor to be on the safe side. Report any of the following symptoms to your doctor:

  • Severe headaches
  • Sudden swelling
  • Vomiting
  • Abdominal pain
  • Excessive fatigue

Take all the help you can get during this challenging pregnancy. Let others care for older children regularly so you can rest; allow your partner to run errands and do more than his or her normal share of the housework. The important thing for you to focus on is keeping yourself rested and healthy. And try not to worry; the fact is that the most likely outcome of your twin pregnancy is two healthy, normal babies.

– Yvonne S. Thornton, M. D., M. P. H.

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Sex during Pregnancy: When to Indulge, When to Abstain

Thursday, October 24th, 2013

Pregnant women and their partners often have questions about sex. Is it safe during pregnancy? Will it induce labor? How long do we have to wait after delivery to have sex? In spite of doctors’ reassurances, many pregnant women still have fears related to sexual intercourse while they are pregnant, such as whether it could cause miscarriage or otherwise harm the fetus. In addition, body image, physical discomfort, and fatigue often curtail the sex lives of pregnant women.

In fact, for women with low-risk pregnancies, sex is perfectly safe. Studies have shown a slightly increased risk of preterm labor in women who had sex and symptoms of lower genital tract infection, but in low-risk women with no symptoms of infection, sex does not in any way increase the risk of preterm labor. Fears of harming the fetus are also unfounded; the fetus is very well-protected and completely oblivious to the mother’s sexual activity.

Women at increased risk for complications, such as those who have a history of preterm labor, incompetent cervix, or multiple gestation, may be advised by their doctors to abstain from sex, but even in these women, an increased risk of complications may not exist. Studies have not shown elevated risks of preterm labor even in women with higher-risk pregnancies, despite the fact that these women are often cautioned that sex could be dangerous for them. Studies also show that women with twin pregnancies and women with cervical cerclage due to incompetent cervix have no greater risk than other pregnant women of preterm labor caused by sex. Although these women are commonly advised not to have sex, the evidence does not exist to support these concerns.

What studies have shown is that women with a higher number of sexual partners throughout their lifetimes do have an increased risk of preterm labor. This is probably because in these women there exists a higher probability of asymptomatic bacterial colonization in the genital tract, which does present a higher risk. Therefore, women with high-risk pregnancies should, at a minimum, be screened for bacterial vaginosis before engaging in sexual intercourse.

It should be said that regardless of actual risk, abstaining from sex causes no harm and is a simple intervention that can be implemented to remove any doubt about whether sex during pregnancy is safe. Therefore, in women with high risk pregnancies, this is still a reasonable recommendation, until further studies present even more solid evidence.

Besides preterm labor, other possible complications thought to arise from having sex during a high-risk pregnancy are venous air embolism, antepartum hemorrhage in placenta previa, and pelvic inflammatory disease.

As for whether sex can be used to induce labor in a full-term pregnancy, there is no evidence showing that it works. Nipple and genital stimulation have commonly been recommended as ways to induce labor by supposedly promoting the release of natural oxytocin, and prostaglandins in semen have been said to encourage cervical ripening. However, there is no scientific evidence to prove that these methods have any effect. But again, there is no harm in trying them in low-risk pregnancies, either.

The bottom line is that there are very few known risks involved in sexual intercourse or other sexual activity during pregnancy, so don’t worry.  I fondly remember my grandmother saying, “Why would you want to have sex?  You’re already pregnant!”  With that said, abstinence may be a reasonable action to take to remove the risk altogether in high-risk pregnancies, but still, the evidence does not show that this makes a difference in the outcome of the pregnancy. After delivery, follow your doctor’s instructions and your own physical and emotional comfort level in deciding when to resume intercourse.

– Yvonne S. Thornton, M. D., M. P. H.

 

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What Prenatal Screening Tests Should You Expect?

Monday, October 14th, 2013

Prenatal tests are diagnostic procedures used to uncover potential chromosomal or structural fetal disorders. All expectant mothers, but particularly mothers over 35, should have thorough prenatal testing because of the increased risk of birth defects and other abnormalities. These are a few of the tests your doctor may want you to have; talk to him or her about others that may be necessary or helpful.

Maternal Alpha-Fetoprotein

Alpha fetoprotein (AFP) is a protein normally produced by the liver and yolk sac of a developing baby during pregnancy. AFP levels decrease soon after birth. AFP probably has no normal function in adults. The amount of AFP in the blood of a pregnant woman can detect abnormalities in the fetus, be they chromosomal or structural, such as Down syndrome or spina bifida, respectively.

This test is routinely administered to every pregnant woman, except those over 35 who will be having amniocentesis. If screening reveals worrisome levels (too high or too low) of AFP in the mother’s circulation, additional tests like amniocentesis are administered to further investigate the problem.

Cell free fetal DNA testing

Noninvasive prenatal testing that uses cell free fetal DNA from the plasma of pregnant women is now being offered as a screening tool for fetal aneuploidy (Down syndrome and  other trisomies). The only problem with cell free fetal DNA testing is that it requires informed patient consent after pretest counseling and should not be part of routine prenatal laboratory assessment. Cell free fetal DNA testing should not be offered to low-risk women or women with multiple gestations because it has not been sufficiently evaluated in these groups. A negative cell free fetal DNA test result does not ensure an unaffected pregnancy.  So why have this test?  Because many patients do not wish to be stuck with a needle or have any invasive testing done.  To me, it just delays the inevitable, but it is important that my readers know it exists.  A patient with a positive test result should be referred for genetic counseling and should be offered invasive prenatal diagnosis, i.e., chorionic villus sampling or amniocentesis, for confirmation of test results.

Ultrasound

Ultrasound, or sonogram, is a test commonly administered during pregnancy that uses sound waves (not X-rays) to render an image of your baby inside your womb. Ultrasound is safe to use throughout pregnancy, and can be helpful in determining  an accurate gestational age  if the Mom is uncertain and can detect gross abnormalities, such as anencephaly or open neural tube defects.  Ultrasound has also been used to attempt to screen for Down syndrome by using specific markers, such as thickness of the fold behind the neck, or abnormal kidneys or absence of or abnormal development of the nasal bone.

Ultrasound is typically used at 16-20 weeks, when fetal structures have grown large enough to be seen somewhat clearly, and many abnormalities can be detected. The ultrasound technician checks to make sure the skull is present, the spinal column has closed, and various organs are present and developing normally, including the heart. Ultrasound does have its limitations; for example, it is not a perfect way to detect fetal heart malformations, as this study shows. That is because the fetal heart is so tiny and complex. Nonetheless, ultrasound remains a safe and effective tool for detecting many potential fetal problems.  However, there is a tendency to overuse and abuse ultrasound in an attempt to “have a picture of the baby in utero.”   Any imaging study needs to be performed because of a medical indication and not for entertainment.

Amniocentesis

Amniotic fluid contains the baby’s metabolic products and desquamated fetal skin cells, and therefore can be tested for genetic disorders that may be present. During amniocentesis, ultrasound is used to detect pockets of amniotic fluid, and a small amount of it is drawn out through a needle inserted into the amniotic sac. This fluid will then be used for chromosomal analysis as well as checked for AFP.

Amniocentesis can detect conditions characteristic of chromosomal and developmental disorders. It is used in conjunction with ultrasound.  Amniocentesis has the advantage of actually examining the chromosomes, not just the structure and appearance.

Chorionic Villus Sampling

Chorionic villus sampling (CVS) is the best-kept secret in obstetrics, which is a pity because it provides the earliest opportunity for prenatal diagnosis. In contrast to ultrasound and amniocentesis at 16 to 20 weeks, CVS is done in the tenth to the twelfth week of pregnancy, with the tenth week calculated as starting at nine weeks and one day.

Chorionic villi are the beginnings of the placenta. Rapidly growing, fingerlike projections in the sidewalls of the uterus, they look like sea kelp. By means of a soft catheter introduced vaginally and guided by ultrasound, a sample of these villi can be aspirated and sent to the laboratory for culturing. The cells are dividing very rapidly at this early stage and they grow quickly in the culture, giving results in seven days, in contrast to amniocentesis, which takes two weeks for results. As well as providing material for a chromosomal analysis, CVS allows us to rule out Tay-Sachs, sickle-cell anemia, and any inborn error of metabolism or enzymatic problem. The only thing this test does not do is establish the AFP level, but because every woman not having amniocentesis is screened with a blood test for AFP, this is not a problem.

Chorionic villus sampling yields the same information as an amniocentesis done five, six, or seven weeks later. The presence of anomalies can be confirmed at ten weeks—before the pregnancy is showing, before the woman is feeling fetal movement, and before there is the degree of bonding with the baby that is likely to have taken place by 20 weeks. Thus, if the findings give rise to a decision not to continue with the pregnancy, it can be interrupted with a D and C with far less morbidity and psychological stress than occasioned by a second trimester termination.

Even parents who know that they would never terminate a pregnancy regardless of the circumstance should undergo prenatal testing because education and preparedness can make such a difference in the quality of life for parents and children. You can find more detailed information on these and other common prenatal tests, as well as advice on deciding how to proceed in the event that a test reveals something troublesome, in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

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Thinking of Giving Birth at Home? Read This First

Thursday, October 3rd, 2013

More and more women are choosing a home birth experience when it comes time to start, or add to, their families. They say that childbirth is completely natural, that it is not a disease and there is no reason to be in a hospital bed. That their bodies know just what to do; that women have been giving birth at home for much longer than they have been going to hospitals. They say that they are perfectly healthy; maybe they have even given birth before with no complications. And they fear that “interference” from doctors and nurses and machines will mar their birth experience.

Most of this is perfectly true. But here’s something else that’s true. Did you know that the mortality rate is three times higher for babies born at home, compared with babies born in hospitals? The problem is that childbirth is notoriously unpredictable. Even if a woman is healthy and her entire pregnancy has been normal; even if she has already had an uneventful labor and delivery in the past, there is no way to predict some of the circumstances that may arise, or when medical intervention may become necessary.

The birth of your baby is indeed a very special time, and if you can have the experience you really want, that’s great. But remember that you also have a responsibility to keep your baby safe. So, with that in mind, how can you get the birth experience you desire without subjecting your baby to an increased risk of danger?

Choose a Midwife Who Practices in a Hospital Setting

Many women want a midwife to deliver their babies because they believe that midwives offer more personalized attention and try to interfere as little as possible with the natural course of events during labor and delivery. Many midwives practice in hospitals, and this is the ideal setting for birth in case of an emergency – which, again, you cannot predict. Yes, women have been giving birth at home for millennia. But the infant mortality rate is lower now than it ever has been. That’s because most women now give birth in hospitals.

Add a Doula to Your Support Team

A doula is a non-medical support person who can attend to your needs, help make you comfortable, help keep you focused, rub your back, bring you ice chips, and whatever else it is you might need, leaving your coach free to focus on you as well as his or her own experience.

Make the Hospital More Like Home

Get to know your hospital’s maternity floor ahead of time; being familiar with the setting will help you feel more comfortable. And feel free to bring things that are comfortable and homey, like a favorite blanket, pair of pajamas, or mug. After your delivery, you may necessarily be visited by medical personnel who will want to check your vital signs and make sure you and your baby are recovering well – but you can make the most of the times when you, your partner, and your baby are alone together by turning off the TV, dimming the lights, and getting to know each other. Celebrate with a glass of sparkling wine, play cards, decide on a name if you haven’t yet – do whatever you would do at home.

Making some compromises can keep you and your baby safer while still giving you a special birthing experience. Remember that the doctors are not there to get in the way, but to help you, especially if there is an emergency. You can read more about this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

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High Rate of Smoking Relapse After Pregnancy and Delivery

Monday, August 5th, 2013

It is no secret that smoking can have an incredibly harmful effect on a growing fetus. Smoking during pregnancy can lead to major problems, from fetal deformities to miscarriages and stillbirths. All women are encouraged to quit smoking well before conceiving, and those that do not are encouraged to quit smoking as quickly as possible after discovering that they are pregnant. There are many intervention programs in place to help women who smoke quit during pregnancy. However, there has been a lot of concern in recent years that smoking cessation during pregnancy is not permanent.

Studies have shown that upwards of 48 percent of women who do quit smoking during pregnancy will relapse afterwards, with a sharp increase in relapse occurring up to a point about six months after delivery. Traditional intervention programs designed to help women quit smoking during pregnancy have shown low success rates in helping a woman quit smoking overall.

This is important because the risks of second-hand smoke are still much higher than is safe, especially with the association of second-hand smoke and the development of childhood asthma. Women are encouraged to make every attempt to quit smoking, not only for their own health, but also for the health of their families.

It is becoming increasingly obvious that quitting during pregnancy—when there is a strong motivation to quit—does not have the lasting effects that could be hoped for. Additionally, the stressful time after delivery is often debilitating to a woman’s efforts to remain nicotine-free.

It is strongly suggested that women who quit smoking during pregnancy seek some sort of aid, counseling, or even medical intervention after delivery in order to prevent smoking relapse. There are a number of products and coping strategies available that can help. While it is admirable to want to quit, it may not be wise to attempt to go “cold turkey”, even for women who have gone without a cigarette for up to, or over, nine months.

Women should remember that their lives change in many ways after they deliver a child. The coping strategies a woman develops during pregnancy may not work in the postpartum period, especially without the motivation of being pregnant to prevent smoking relapse. As a woman’s Ob-Gyn will most likely be the doctor a woman sees the most during the postpartum period, they are an incredible resource for helping their patients stay off the cigarettes for good.

I have helped many women quit smoking in my years as a doctor, and with help a good number of those women never smoke again.  Women need to take extra steps to quit smoking permanently to ensure both their health and that of their families.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Teen Pregnancy May Be Associated With Obesity Risk in Later Life

Thursday, August 1st, 2013

Concern about the increased prevalence in teen pregnancies has raised a lot of questions societally as well as within the medical community. It is no secret that an event such as childbirth can play a large role in a woman’s health, and the potential changes that may take place are increased in a teenager, whose body is still growing and changing throughout adolescence. From very real concerns such as the potential for premature delivery to the psychological effects of becoming a mother at a very young age or giving a child up for adoption, there is much fodder for examination and research.

One study has even suggested that there is a potential association between adolescent pregnancy and obesity later in life. However, it is important to note that this association is still vague at best, and researchers have yet to uncover a cause for this heightened obesity risk.   While it is possible that the associations between adolescent pregnancy and obesity is caused by the physiological changes that take place in the female body (and in particular the adolescent female body) during pregnancy, there are also many factors –primarily psychological and sociological—to take into consideration in order to determine the underlying cause of this association.  I believe that these young women, obese or not obese, gain so much weight when they are pregnant that obesity is the result of the pregnancy and they cannot lose the weight postpartum, given the additional responsibilities of raising a child.

Demographically speaking, adolescent mothers are more likely to be from a racial minority, to have lived in poverty, or to have attained a lower educational level than many of their peers. Four out of five black women are either overweight or obese.  It is highly likely that at least part of the association between adolescent pregnancy and weight gain is due to this “crossover”, as women of these demographics are also those most likely to be classed as overweight or obese. This is part of the difficulty in determining whether or not there are other physiological factors to take into account.

My take on the conclusions of this study and the entire situation of pregnant adolescents  and future obesity is that these young women are looking for acceptance and have very low self-esteem.  Their feelings are exploited by their male counterparts, who have a biological imperative to be intimate and not be rebuffed. Consequently, sexual intercourse is a form of being “accepted” and “loved”, only to find out later that the girl is pregnant, has gained excessive weight during the pregnancy and is now alone being responsible for a new life.  Her old habits (no exercise and cheap fast food) with a low or nonexistent income lead to her obesity and that of her child.  Then, it becomes a vicious cycle.

Regardless of the reasons for the prevalence of overweight and obese women among those who were pregnant as teenagers, studies like these highlight the importance of increased contraceptive aid and sexual education among female adolescents. At present, it seems that the primary association between these two groups of women, i.e.,  those who become pregnant as teenagers and those who are classed as overweight or obese in adulthood,  is a lack of education or awareness about their bodies.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Use of Decongestants During Pregnancy May Be Linked to Birth Defects

Monday, July 22nd, 2013

Women have a long checklist list of products to avoid during pregnancy, from alcohol and caffeine to more serious chemicals that can seriously affect fetal development. However, the effects of certain medicines and other products have largely been unknown. One of the more common medications that women ask if they can use during pregnancy is the simple decongestant—something which most people take for granted. For a woman who is already suffering the discomfort of pregnancy, the idea of asking her to shoulder the burden of a stuffy nose and sinus pressure may seem a little harsh. However, new studies are suggesting that decongestants taken in the first-trimest of pregnancy may be a major item on the “to avoid” checklist, as they have been linked to birth defects.

The decongestants that researchers focused on in the study included both oral and nasal remedies. While the correlations between certain types of decongestants and potential birth defects still requires further investigation, this finding presents and opportunity to discuss one of the more important aspects of obstetric medicine. The simple fact of the matter is that there is no way to know all of the potential risks a woman faces during pregnancy.   Some women may not even know they are pregnant when taking these over-the-counter decongestants.  Therefore, any woman in the childbearing years who is not using effective contraception should think twice about relieving symptoms of an annoying stuffy nose as a trade-off  for increasing the risk of a child with birth defects.

While research has come a long way in identifying major risk factors, a number of other risk factors are still unknowns. This is even more so the case as new products are released into the market, new chemicals make their way onto store shelves, and ultimately pregnant women are exposed to an increasingly wider range of products during pregnancy. It is also a good reminder of the importance a woman should place on responsible behaviors during pregnancy, which include rethinking her normal habits and routines and consulting with a medical professional before taking any medication—even ones that seem fairly mild or harmless.

I hesitate to call women who take these products irresponsible or negligent—after all, not everyone is a doctor and not everybody has the access to medical information that can tell her at a glance what is and is not safe. That is why part of a responsible pregnancy is not only knowing to avoid certain products and materials, but is developing a good relationship with the medical professional in charge of one’s healthcare during pregnancy.

– Yvonne S. Thornton, M. D., M. P. H.

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Studies Show Lack of Evidence that IVF Causes Birth Defects

Monday, June 24th, 2013

From the moment a woman realizes she is pregnant, she is overwhelmed with worries about the health of her future child. These worries are only compounded when the woman in question has had a difficult time becoming pregnant. Those women who have undergone infertility treatment in order to conceive have perhaps the most difficult task ahead of them as they await the delivery of their child—a wait that is made only more difficult by the belief that many people have that infertility treatments cause birth defects and birth complications at a higher rate than among women who conceived naturally.

It certainly raises a lot of questions. If it were true that births after infertility treatment produced higher rates of birth defects, it would also raise quite the moral dilemma. Do doctors and potential parents have the right to produce children that may suffer health problems and defects? Infertility treatments have been the subject of much debate since the first test-tube baby was born, and many people are still uncomfortable with the idea. However, for millions of parents who would have been unable to conceive, IVF is a blessing. It’s my opinion that everybody has the right to become a parent, and thought it is wonderful that many parents can conceive naturally, it is also wonderful that there is an option for parents who face more difficulty in having children.

Thankfully, studies have shown that the worries people have about children produced through IVF may be unfounded. The rate of birth defects in children born through IVF are no higher than the rates among children born through natural conception once parental factors have been taken into account. People who are still worried about the health “risks” of IVF for children in this day and age need to learn to trust the research rather than the propaganda, and they need to stop spreading misinformation that might lead parents who turn to treatment to conceive to feel guilty about their decision.

– Yvonne S. Thornton, M. D., M. P. H.

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Obesity a Direct Cause of Preterm Birth

Monday, June 17th, 2013

Though mothers shouldn’t be forced to think they need to remain svelte throughout their pregnancies, and shouldn’t be shamed of healthy weight gain during pregnancy, there is one serious issue that women need to keep in mind when they are preparing to become pregnant. It is impossible to plan out every step of a pregnancy, and there will always be unexpected complications that arise during the 40 weeks to delivery. However, there are precautions that women can take to prevent serious problems and to decrease the risk of preterm delivery, according to one study.

One of the biggest risk factors for preterm delivery is obesity in pregnant women. One study in Sweden has shown that not only is preterm delivery a risk, but some obese mothers shown signs of extreme preterm delivery. Even though this cohort study was conducted in a country that is not as heterogeneous as the United States, this is a serious concern, and one that may have serious implications for both doctors and potential parents. The most important thing for everybody involved in a birth with one of these risk factors to keep in mind is that such complications are not only possible, but that they are heightened due to the circumstances. Everybody involved must make plans for the possibility of an earlier birth, and everybody involved should be more open to the possibility of safety measures such as bed rest, gestational diabetes, kidney and heart problems as well as a host of other medical issues that can arise. In general, women who are obese when pregnant will likely need to be in contact with their physician more often than a woman who maintains a healthier weight.

Women who have not yet become pregnant and who are considered obese may want to speak with their doctors about their options before pregnancy. Even a small weight loss can be enough to curtail some of the biggest problems related to pregnancy, while a significant weight loss can have even more lasting effects. However, remember that any weight loss plan must be discussed in detail with your doctor—making yourself unhealthy just to drop a few pounds will not do your or your family any favors.

– Yvonne S. Thornton, M. D., M. P. H.

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Talking With Your Doctor About Sexuality During Pregnancy

Thursday, June 13th, 2013

Pregnancy can be a wonderful experience, but it can also provoke a lot of mixed emotions in women. From joy to depression and anxiety, and just about everything in between, women will likely experience a full range of emotions. Their mental state is also not helped by the hormonal shifts that are taking place inside their bodies as they prepare for pregnancy and birth.

One of the most common complaints among pregnant women is the shift they experience in their sexual desire. It is hard to predict the shifts that will occur—some women may experience heightened sexual urges, while others may experience a drop or a complete lack of sexual interesting altogether. Some studies have shown a tendency for sexual practices to drop trimester by trimester, with an overwhelming majority of women not having sex in their last trimesters. Among the reasons for this seem to be concern in both men and women that sex could potentially complicate the pregnancy or cause harm to the unborn child.

It is up to the woman to decide whether or not she has an interest in sex. However, women should not feel as if they have to suppress their sexuality just because they are pregnant. It is imperative for women to open a dialogue with their doctors and to feel comfortable discussing sexual issues with her doctor. This can vastly help improve her understanding of what is and is not harmful during pregnancy, and can do much to reduce her anxieties.

Many women have a healthy and natural sex drive throughout their pregnancies, and some may even report an increase in sexual interest toward their second and third trimesters. They should not avoid sexual intercourse simply because they feel that it might do harm to their pregnancy. By speaking with their doctors, they can learn whether or not there are any real risks related to sexual activity, and in many cases they will realize their anxieties are unwarranted.

– Yvonne S. Thornton, M. D., M. P. H.

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