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Do You Have Anemia?

Anemia is a word that you have probably heard many times, but maybe you aren’t exactly sure what it means. Perhaps you even know some of the symptoms, including feeling fatigued, or headaches. So, what is anemia? It starts with hemoglobin. Hemoglobin is a protein in your blood that carries oxygen. Iron is needed for your body to make hemoglobin. When hemoglobin is lower than normal, this is called anemia.

In nonpregnant females, hemoglobin less than 12 is considered anemic. Due to regular physiologic changes in pregnancy, a lower cut-off is used to diagnose anemia which varies by trimester. In the first and third trimesters, hemoglobin less than 11 is considered anemic, while 10.5 is used as the cut-off in the second trimester.

Anemia occurs in almost one-third of reproductive age women and up to 40% of pregnancies. The most common cause of anemia is not having enough iron available in your body to produce adequate hemoglobin levels. This is called iron-deficiency anemia.

The amount of iron your body needs in pregnancy varies a lot depending on your gestational age. At baseline, 1 mg per day is required for the normal turnover of red blood cells. In the first trimester, your needs increase to 2 mg per day and continue to increase up to 7 mg per day as you approach your due date. Iron can be found in many foods, including meat, lentils, beans, and spinach. Additionally, many foods are fortified with iron, such as fortified breakfast cereals and cream of wheat. Another good way to get more iron is through your prenatal vitamin.

For women diagnosed with iron-deficiency anemia, additional supplementation of iron either by mouth or intravenously (IV) may be recommended. Taking iron orally is easy and inexpensive but can cause a metallic taste, nausea, diarrhea, or constipation. Iron given through an IV is usually reserved for those who need more rapid iron replacement, such as those within a month of their due date, those who don’t tolerate oral iron supplementation, or those with a history of bariatric surgery, which can impair iron absorption.

Now that you know what anemia means and how common it is, you may feel a little worried about being anemic. You say to yourself, “I do feel tired! I do get headaches! Isn’t that part of being pregnant?” You are right! It might just be part of being pregnant. Rest assured, we routinely screen for anemia in pregnancy with your initial prenatal labs and again at the end of the second trimester when screening for gestational diabetes. This way, we can identify anemia appropriately and start treatment to resolve it.

Dental Health and Pregnancy

If you’re pregnant, Congratulations! That’s great! So now, let’s talk about your teeth. Oral and dental health is an often-overlooked part of a healthy pregnancy. While women often avoid seeing a dentist for treatment or a hygienist for cleanings out of concern for their growing baby, it is not only safe to be seen for regular cleanings and dental work; it is also recommended. In addition, the oral health of the mother affects the infant and pregnancy.

A common concern during pregnancy is whether or not taking x-rays is safe. Dental x-rays are very low dose and are safe at any point throughout pregnancy. Wearing a lead apron is standard at most dental offices. Taking x-rays is an essential part of diagnosing cavities and infections and is considered a routine part of a good dental exam. Women should continue to see the dentist and hygienist regularly. It may be easier during the second trimester when nausea has subsided, and it is still comfortable to lay on your back.

During pregnancy, hormone changes alter the response of your gums to plaque and can cause more inflammation, known as gingivitis. Using a soft brush twice a day can help keep plaque to a minimum. There is some evidence that inflammation from gingivitis can increase the risk of pregnancy complications, so it is vital to keep your gums healthy.

One of the unfortunately familiar parts of pregnancy is vomiting and acid reflux. Stomach acid can be hard on teeth. While you may feel the urge to brush your teeth immediately after vomiting to remove the taste, it is best to avoid brushing for at least 30 minutes to keep from brushing stomach acid into the enamel and eroding it. The best option is to rinse with water and 1 tsp baking soda to neutralize the stomach acid if tolerated. If that isn’t tolerated, rinse out with some plain water or fluoride-based mouth rinse instead. Acid reflux can erode tooth enamel and can be safely treated with over-the-counter medications.

If you need dental care for a cavity or infection, the typical medications used by dentists are safe. Including antibiotics and medicines for “Numbing you up.” It may, however, be best to avoid Nitrous Oxide (laughing gas).

So, in short, dental health is essential because you need your teeth for the rest of your life. Therefore, you should not neglect your dental care during your pregnancy.

Pregnancy and COVID-19

While pregnancy can be a joyous time in your life, it can also bring nervousness and uncertainty. This is especially true during the ongoing COVID-19 pandemic. Many pregnant women have questions about how COVID-19 may affect their pregnancy or their baby. The knowledge we have about coronavirus and pregnancy is continually evolving, and continuing research will bring us more information.

At the current time, there is no evidence being pregnant makes a woman more likely to get COVID-19. However, pregnant women should be aware that they are at higher risk of severe symptoms if infected. Compared to non-pregnant women, women who are pregnant and sick with the virus are more likely to be admitted to the hospital, put on a ventilator, or require additional life support. Some data shows that pregnant women who test positive for coronavirus may be at increased risk for blood clots. It is recommended that pregnant patients hospitalized with the virus use blood thinners. Some experts even suggest that all pregnant women with COVID-19 should take blood thinners, but more research is necessary on this topic. Pregnant women are also at higher risk of dying from COVID-19 than non-pregnant women, although this is rare.

While we do not have a lot of information about how the virus may affect your baby in the womb, some research has found that pregnant women with COVID-19 are more likely to have preterm labor and delivery. Current data shows that exposure to the virus does not increase the risk of birth defects. While it is unknown exactly how often the virus may be passed from mother to baby, there is likely a small risk of this happening if a mother is COVID-positive at the time of delivery. Most newborns who test positive for COVID-19 will have no or mild symptoms.

Due to these risks and unknowns, pregnant women should be extra careful about protecting themselves from the coronavirus. Wear a mask when you are in public areas, and practice social distancing with people who are not part of your household. Wash your hands frequently, limit travel, and avoid activities where it may be challenging to protect yourself. You may need to be creative about approaching your pregnancy, such as hosting virtual parties instead of standard baby showers and family events. You should also be aware that your hospital may require testing for COVID-19 before delivery and limit the number of people who can visit you and your baby at the hospital.

You should continue to receive prenatal care throughout your pregnancy according to your provider’s recommendations. If you develop symptoms of COVID-19 during pregnancy, such as a fever, cough, or loss of taste or smell, it is essential to let your healthcare provider know. They can give you more information about testing and treatment. While it may be a stressful time to be pregnant, know that we are here for you both during and after your pregnancy to answer your questions, and take care of you and your baby.



“If You Are Pregnant, Breastfeeding, or Caring for Young Children.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Nov. 2020, 

Mayo Clinic

“Understand How COVID-19 Might Affect Your Pregnancy.” Mayo Clinic, Mayo Clinic, 5 Nov. 2020, 

6 Things to Know Before Trying to Get Pregnant

Preparation is key to running a successful race. Getting pregnant is similar. Preparing for pregnancy is very beneficial to the outcome. Watch Canyon View Women’s Care provider, Kristen Wright, FNP to learn what can be done to be ready for the big event of pregnancy.

3 Steps to Control Weight During Pregnancy

With more than four million babies born in the United States each year, it’s easy to forget how miraculous each newborn really is. Once an egg is fertilized it must undergo millions of cell division and differentiation in order to develop into a normal baby.

Since you have little or no control over the genetic programming and replication of a fertilized egg, it makes sense to focus on the things that you do have control over, to balance the scales in your favor. You can control how you take care of your body and how you respond to environmental factors or chronic illness.

When you prevent the scale from tipping toward the heavy end, it will be easier to become pregnant and carry a child successfully. Weight control also has a profound impact on avoiding certain chronic health conditions that are a direct result of being overweight.

Whether you are trying to get pregnant or are already pregnant, you can increase your chance of delivering a healthy newborn by managing your weight appropriately. Here are three simple steps to help you on this journey.   

  1. know your BMI
  2. set a target gain
  3. monitor your weight

know your BMI:  Before knowing how much weight you should expect to gain during pregnancy, you must first know where you stand prior to conception. This is typically measured by calculating your body mass index (BMI). BMI measures how appropriate your weight is for your specific height. BMI is not perfect as it doesn’t take into account age, sex or body type but does give a general idea of how appropriate your weight is. BMI is easy to calculate and accurate for most people.

Use the following online calculator to calculate your BMI

BMI Calculator (Click)

BMI Ranges

underweight –

       BMI of less than 18.5

normal –

BMI range of 18.5-24.9

overweight –

BMI range of 25-29.9

obese –

greater than 30

set a target gain:  It is helpful to know how much weight you should expect to gain during pregnancy. A shorter or smaller woman should aim to gain amounts at the lower end of the range. The current recommendations set by the IOM in 2009 are:

normal BMI – 

25 to 35 pounds

underweight –        

28 to 40 pounds

overweight –            

15 to 25 pounds

obese –

11 to 20 pounds

twins gestation –

up to 45 pounds

monitor your weight: Routine prenatal visits are an ideal way to routinely record weight gain. However, these visits are often monthly initially, and weight can quickly skyrocket out of control if you don’t take responsibility for your own weight. Use the scale as a measuring tool NOT a judgment scale of how good you are.   Take accountability for your weight and please discuss any problems or concerns that you may be having with your provider.

Here are some of the benefits for you in maintaining the proper weight:

PRE-PREGNANCY:  It will be easier to become pregnant, especially if you have Polycystic Ovarian Syndrome (PCOS).  A modest weight loss of just five to ten percent can often normalize your cycles and make it easier to become pregnant.

Achieving your target gain will ease the discomforts of pregnancy: heartburn, backache and various pains (i.e. sciatica).

It will make labor easier and decrease the chance for prolonged labor or the need for a c-section.  When you are physically fit, the uterine muscles tend to contract more efficiently and physical exercise creates mental power as well as physical strength.

Your recovery period will be shorter.  This will give you more energy to take care of what matters most…your new baby!

You will return to your pre-pregnant weight more quickly during the postpartum period.

Research has shown that women who gain too much weight during pregnancy were two to four times more likely to become overweight or obese in the future.

Gaining the appropriate amount of weight will help emotionally.  Along with the physical burden of weight comes to fatigue, discouragement, self-esteem issues, and possibly depression.  You will feel more like yourself.

benefits for baby:

Appropriate weight gain lessens the chance of delivering a baby that is too big or too small.

A normal weight gain decreases the chance that the baby will need services of the neonatal intensive care unit (NICU) because of newborn trauma or distress, thus minimizing the risk of maternal/newborn separation.

The March of Dimes suggests there may be a link between rising obesity rates and increasing birth defects.

Research has shown that very small and very large babies have a greater chance of becoming obese later in life.  Large babies have more fat cells which can increase in size as children grow and eat excess calories.  Small babies are deprived in utero and have learned to adapt to less food by holding onto calories.  They typically catch up after they are born and acquire more central fat.  This is the visceral fat that contributes to heart disease in adulthood.  Small babies are conditioned in-utero to become very efficient at storing energy as fat for future needs.

The bottom line is: gaining the appropriate amount of weight during pregnancy improves the likelihood that your child will have good health in the future.


The average woman should gain 10 pounds by mid-pregnancy to decrease the risk of having a baby that is small for gestational age (SGA) or smaller than expected.

A sudden sharp increase in weight of three to five pounds during a week in the last trimester may indicate excessive fluid retention and be a sign of preeclampsia.

Weight gain will vary with each pregnancy and among women, but if there is anything out of the ordinary, you should discuss this with your health care provider.

Since more than half of women in their reproductive years’ ages 18 to 40 are overweight (BMI of 25 or more) or obese (BMI of 30 or more), be sure to discuss the target weight gain with your provider. This should be addressed at your first prenatal visit with your pre-pregnant BMI in mind. Studies have shown a correlation between providers’ recommended weight gain and a woman’s actual weight gain during pregnancy. Hence, if you have a goal in mind and write it down, you have a better chance of achieving your target gain, and not more.


  1. know your BMI
  2. set a target gain
  3. monitor your weight

Pregnancy Is Not An Excuse To Not Exercise

Pregnancy is not an excuse to lay around and procrastinate beginning a regular exercise program.  It is true, there are some pregnant women who should not exercise because of a specific health condition but most expectant women will benefit from being active during their pregnancy.

Regular exercise during pregnancy helps in gaining the appropriate amount of weight, maximizing fetal health and making it easier to lose the extra pounds after delivery.  It frequently makes labor and delivery faster and more efficient, enabling a quicker recovery postpartum and decreases the risk of developing preeclampsia (a condition during pregnancy characterized by high blood pressure, protein in the urine, and swelling), gestational diabetes and other maternal complications.  Sometimes women are concerned that exercise may harm their baby.  Research has shown that with proper nutrition, exercise does not negatively affect the growth in the fetus.  It does, however, prevent excess fat from being laid down by the baby and may play a role in preventing very large babies, who are at increased risk for lifelong weight problems.  There has been no evidence to suggest that hyperthermia (or increased body temperature) associated with exercise poses a problem to you or the fetus.  However, proper attire to prevent overheating or constriction is recommended.   Pregnant women should be proactive in drinking plenty of water and wear appropriate shoes and a supportive bra.

If you have already established the habit of regular exercise before becoming pregnant, you may safely continue many of the activities that you are regularly participating in during the first half of pregnancy. Things like running, tennis, aerobics, kickboxing, Zumba and athletics are good to continue for most women.  Be aware, however, that as the uterus grows, your center of balance will change, and activities and sports that require agility and balance may need to be modified or postponed until after delivery.  As you (and your baby) grow, it becomes easier to lose your balance and fall and you are more likely to sustain bone or muscle injuries with activity.  Frequently, this doesn’t mean you have to stop what you are doing but you may have to move more slowly and purposefully in order to prevent injuries.  During the latter part of pregnancy, it is important to avoid activities that could cause a fall on your abdomen or cause any direct impact on your abdomen.  These types of trauma may cause injury to the fetus or placenta.  Use caution with activities requiring high altitudes, exercise that include jumping or jarring motions, or activities that have a high risk of falling (such as water skiing, downhill skiing, or in-line skating).  Scuba diving should be avoided at all times during pregnancy.


□ Begin with walking or some kind of moderate aerobic conditioning that you enjoy [low impact aerobics, swimming (but avoid breath-holding), rowing, elliptical machine, or cycling on a stationary bike].

□ Select an activity that allows for minimal stress on joints, as pregnancy naturally causes weight gain and therefore increased strain on the joints, tendons, and ligaments.  During the latter part of pregnancy, hormonal changes cause laxity in the ligaments (especially in the pelvis) to prepare the body for delivery.  These changes also increase the chance of strain or injury.

□ Remember to stretch before AND after exercise to minimize muscle soreness and strain.

□ Be diligent in keeping yourself hydrated throughout your workout sessions and keep your heart rate to less than 140 beats per minute.

□ Avoid activity that requires you to be flat on your back.  As the uterus grows, it may impede the blood flow back to the heart by physically applying pressure to the inferior vena cava (the major blood vessel that lies next to your backbone).  If there is less blood flow to the heart, there is less blood carrying oxygen and other nutrients to the brain and fetus.

□ Motionless standing causes the blood to pool in the lower extremities, potentially causing a feeling of dizziness or lightheadedness.  This will also increase the pressure on varicose veins and swelling in the feet and lower legs.


Cardiovascular or aerobic exercise should be done at least three days per week for a minimum of 20 to 30 minutes per day.  Ideally, you will work up to 45 to 60 minutes on most days of the week. Don’t exhaust yourself.  While doing cardio, aim for an intensity such that you could have a conversation but would probably choose not to. Brisk walking is a great form of cardiovascular exercise. A pedometer provides a fun and helpful way to measure your goal. Aim to get at least 10,000 steps per day.

Strength or Resistance Training should be done at least two to three days per week for 30 to 45 minutes.


For all women:  Consult your provider before commencing a new exercise program if you have heart, lung, kidney or liver disease, diabetes, chest pain, specific joint or muscle pain, problems with dizziness or balance, are over 40 or for any uncontrolled chronic condition.

For pregnant women:  Consult your provider first if you have any of the above chronic conditions or special circumstances with pregnancy that may limit your activity, such as spotting or bleeding, threatened or recurrent miscarriage, weak cervix, premature labor or preterm birth or a low-lying placenta.

More on exercise – click to see a post from March 2016

Healthy Weight Gain During Pregnancy

No one likes to gain weight. But, as a pregnant patient, you are supposed to gain weight in order for your pregnancy to be a healthy one. So, how much weight is a good weight to gain? It depends on where you start your pregnancy. This is all determined by what your Body Mass Index (BMI) is when you start your pregnancy. The BMI is figured by taking your height and your weight and running it through a special BMI calculator that gives a number to predict future health problems. You can find BMI calculators online or we can give you that number when you come in for an appointment.

Why do we even care about how much weight you gain or don’t gain? Because it makes a difference for the health of your baby and for your long-term health. When a woman doesn’t gain enough weight, a baby is born ‘small for gestational age’ which causes problems long term with body function and possibly IQ. For women that gain too much weight, babies are born with larger heads that significantly increases your risk of a C-section. It also puts the child at risk of being obese as a child and an adult. In addition, too much weight gain during pregnancy can lead to long-term obesity for the mother. This puts both mother and baby at risk for future diabetes, heart attacks, strokes and osteoarthritis of the lower extremity joints.

So, enjoy your food—when you aren’t morning sick–but watch your intake to keep your weight gain within the guidelines that follow:

  • BMI < 18.5. Desired weight gain 28-40 pounds
  • BMI 18.5 to 24.9 (Ideal BMI).   Desired weight gain 25-35 pounds
  • BMI 25 to 29.9 (Overweight) Desired weight gain 15-25 pounds
  • BMI >30 (Obese) Desired weight gain 11-20 pounds

Eating For Two

I like to eat. But, I’m not eating for two. At the same time, I like to be healthy. So, how should my eating be different than someone eating for two?

  1. American diets don’t require vitamin supplements. But, pregnancy diets do. You should be on a Pre-natal vitamin that has at least 400 micrograms of folic acid or folate (up to 1 mg) several months before becoming pregnant. If you didn’t start using supplements at the beginning of your pregnancy, start as soon as possible. It is most important during the first three months. At the same time, taking too many vitamins can be a problem. A good Pre-natal vitamin includes Vitamin D, 400 IU. So, there is not a need to take extra. But, amounts over 4,000 IU can be dangerous for your baby. Large amounts of Vitamin A, greater than 10,000 Units can cause birth defects. You don’t need more than is in the Pre-natal Vitamin. Large amounts of Vitamin E may also cause heart problems in your fetus.
  2. I love Japanese food. Should you? Is it OK to eat fish while pregnant? Like most foods, the answer is ‘Yes and No.’ You should not eat fish that could have a lot of mercury in them: shark, swordfish, king mackerel, and tilefish. Mercury can affect the baby’s brain. Other types of fish and seafood like shrimp, canned light tuna, salmon, Pollock, and catfish are OK as long as it is not more than two times per week. Sushi that has been frozen and thawed should be OK. Alcohol while pregnant is never OK. I don’t EVER recommend alcohol with your fish—or any food.
  3. I love to sleep. But, I don’t always get enough. Is it OK to have caffeine while pregnant? The answer, once again, is ‘Yes and No.’ There is some concern that caffeine may contribute to an early miscarriage. But, there is no evidence that it causes a problem with the fetus. You should limit the caffeine to only 1-2 cups of caffeine-containing fluids. Energy drinks should not be consumed.
  4. I love milk. And, I love a good burger. Should I, if I am pregnant? (Not that I ever will be.) Unpasteurized milk or raw or undercooked meat could give you an infection that could cause a miscarriage. But, pasteurized milk and well-cooked meat are good sources of calcium and protein for you and your baby.
  5. I want to be healthy. And, so should you. Lots of fresh fruits, vegetables, and whole grains and sources of protein like well-cooked meat, the fish above, eggs, dried peas or beans, and nuts are good for you.

Even though you might be eating for two, you don’t need that much extra food. Will post again with weight recommendations for pregnancy. I love food. So, should you. Happy eating during your gestational period.

Haley Pledger, PA
Women’s Care
Matthew Walton, DO
Austin Bills, DO
Family Medicine
Aaron Fausett, PA
Family Medicine
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