The journey to get there varies as broadly and uniquely as each woman’s life and composition. It may be long and challenging, or perhaps so immediate as a surprise, and there is all the nuance between. I have sat with more women than I can count, delighting in the newness of this life-changing announcement, “I’m pregnant!” I have humbly been the first of very few in all these women’s lives to share in this wonderful secret, and the joy I feel never fades with each report. Sometimes there are tears and many times laughter, but then, the realization sets it. Everything is about to change. NOW WHAT?

It is one of the big questions I am asked on a near daily basis, when a patient discovers she is pregnant and now all sorts of new fears and concerns arise. Suddenly all the activities of late come under scrutiny; “I haven’t been taking my prenatal every day!” “Oh no, I had a glass or two of wine last weekend!” “I did a really intense boot camp class the other day!” “I may have overdosed on sushi this week!” “IS IT OK?”

The truth is, it is all okay.

To begin reassuring my patients, I explain the physiological pilgrimage a fertilized egg makes through the female reproductive tract over the course of 7-9 days to get to implantation, and how that growing embryo is too preoccupied with cell division to concern itself with their current diet and activities. For now that is. Then I focus on the 5 essentials I strongly believe are most important.

1. Make sure you get enough sleep. Fatigue is the first and most common early pregnancy sign, and is your body telling you to slow down. You are busily creating a new human being in there and the first weeks involve a staggering amount of growth and development. The fatigue is natural! Try to avoid the temptation of excessive caffeine to energize and just lie down for a little while, squeeze in naps where you can, and start getting to bed a little earlier.
2. The question of food and nutrition is always one of the first and in general most of the women I work with who have been trying to conceive already have a healthy diet in place. However there is the caveat of food safety, as infection from Listeria monocytogenes can cause miscarriage or infection in the fetus. Avoid soft cheeses such as Brie, Camembert, blue cheese, feta, and queso fresco, which do not state that they have been pasteurized. Deli meats and hot dogs carry this risk as well because contamination can occur before packaging. The CDC also notes that smoked seafood should be avoided.
Caffeine consumption in pregnancy is a controversial topic, and an ever-swaying pendulum of right or wrong. Most doctors and health care practitioners will agree that one small cup a day won’t hurt you. My general rule of thumb when it comes to pregnancy, including questions of coffee, travel or otherwise, is if you’re worried about it – don’t do it. Your stress load does not need any additions, so stay away from things that you will spend the entire time during, and for a while after, worrying over. What I always say is that should anything happen, like a miscarriage, heaven forbid, you don’t want to carry that regret. So if you think you may regret it, don’t bother.
What TO eat is more straightforward. If you are not already, focus on unprocessed, organic, nutrient dense foods such as fresh fruits, leafy veggies, and plenty of protein! For vegetarians that rely on fish for their main protein source, know which are your best choices; such as salmon, flounder and hake, and what to avoid like swordfish, mackerel and shark. For further reference, the FDA compiled a helpful list. 
Hydration is essential in avoiding those potential early pregnancy headaches; try your best to get a good 2 liters a day at least.
3. Make sure you are taking a good quality prenatal and DHA each day. Prenatal vitamins exist in order to ensure that you get proper amount of folic acid, minimum 600mcg, vital to the prevention of neural tube defects in your baby. It may be worthwhile to get your levels tested, as some women have the MTHFR gene mutation that makes their system unable to absorb folic acid, unless it comes in methylated form. Additionally, quality omega/fish oil for DHA supplementation is important in fetal brain and nervous system development. The American Pregnancy Association recommends a minimum of 300mg per day.
4. With exercise it is best to follow some continuity. If you have a routine established, you needn’t change it too dramatically. However, intense and high impact workouts should be reduced (that’s you Soul Cycle and Barry’s Boot Camp junkies!) and augmented with less severe activities like yoga, barre classes, and Pilates. The fatigue of your first 13 weeks may dictate this anyways. Don’t stress over missing a workout if your body is screaming for a nap!
5. And lastly, there is the reoccurring topic of STRESS. Obviously you can’t quit your job or hand off your other children during this time of enormous change. But what you can do is treat yourself really tenderly. Make time for rest, quiet, and avoid any excessive stressors that don’t need your attention for the time being. Maybe take up a little meditation. Expectful and Circle & Bloom have created wonderful guided meditations for expectant mothers.  
This is a starting point, as there is much more to know and learn about what happens next in pregnancy, many more questions that can lead you down a veritable wormhole of information. There are wonderful resources available out there, from which to choose your information thoughtfully. One of my favorite books by Sally Fallon of the West A. Price Foundation, The Nourishing Traditions Book of Baby & Child Care, is such a valuable guide because it covers, in depth, aspects of pregnancy nutrition, postpartum and infant care, as well as controversial matters such as vaccines and autism, with evidence based information.
What I wish to express most of all, and I tell my patients the same, is that the road ahead will be a kaleidoscope of emotions, unprecedented physical changes and a genuinely wonderful transformative voyage. And you are not alone! The people around you, friends, family, partners, and health care providers will be there to make sure you pass through it gently. There is no true way to be fully prepared. Much like navigating the challenges of infertility there is an aspect of surrendering to the process. It is naturally so, as this teaches us the profound lessons in preparation for parenting.

If you are reading this as a newly pregnant woman, my warm wishes for the journey ahead!



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