Obstetrician in Voorhees & Washington Twp

Your goal, before you become pregnant, is to be as healthy and prepared for pregnancy as possible.  This includes healthy eating, engaging in an exercise regimen, and taking prenatal vitamins.  It also includes optimal control of chronic medical conditions such as chronic hypertension, diabetes, autoimmune disorders, etc.  You can schedule a “pre-pregnancy planning” appointment with one of our providers if you would like to go over pre-planning.  We can discuss common topics such as tobacco cessation, pre-conception lab studies, and parental carrier screening.  If you have irregular cycles, recurrent miscarriages, or have been trying unsuccessfully to become pregnant, we can also discuss evaluation options for possible infertility and recommend specialist referrals if needed.

At Advocare Premier OBGYN of South Jersey, our goal is to help you stay healthy and have a healthy and happy pregnancy.  At your first visit we will talk about nutrition in pregnancy, recommend testing options, and generally review what to expect throughout your pregnancy with us.  You can get a good start towards a healthy pregnancy by eating well, exercising, and working with your other doctors to optimize the care of existing medical issues before becoming pregnant.  

With more than 40 years of combined OBGYN experience, the Board Certified physicians at Advocare Premier OBGYN of South Jersey have cared for pregnant women with a wide variety of high risk pregnancy problems.  “High Risk” might simply be due to Advanced Maternal Age (35 years old or older), prior history of preterm delivery, or common medical conditions.  Some conditions are more complicated than others, and our providers work closely with perinatologists (high risk pregnancy specialists) when needed to help you achieve a healthy outcome for both mom and baby. 

Our office offers pregnancy ultrasound services such as viability and dating, genetic screening, growth scans, and other necessary imaging studies.  When possible, we try to schedule your ultrasound appointment on the same day as a routine OB appointment, so we can discuss preliminary findings with you right away. 

Although an increasing number of women are becoming pregnant after the age of 35, this is still considered to be "Advanced Maternal Age" (AMA). While most AMA pregnancies are completely normal, we will discuss this "high risk" condition with you, as well as additional tests that you may wish to consider. You may wish to review ACOG's helpful patient information section on Having a Baby After Age 35.

Your pre-pregnancy BMI (Body Mass Index) is calculated based on your height and weight.  Women with elevated BMI are at higher risk of developing gestational diabetes, elevated blood pressure, postpartum bleeding, c-sections, infections, among other things.  Good nutrition and exercise are important both before and during your pregnancy to maintain a healthy BMI. 

Carrier Screening can help determine if you might pass an inherited health condition to your child. A small sample of your saliva or blood is all that is needed. Results usually take about two weeks. 

At minimum we like to screen for Cystic Fibrosis (CF), Spinal Muscular Atrophy (SMA) and Fragile X syndromes.  Many patients benefit from more expanded testing options that can include Tay Sachs, Canavan or Familial Dysautonomia, among others.  

We currently recommend a "pan ethnic" panel that screens for several hundred autosomal recessive genetic mutations.  Insurance typically covers this testing.  If you are positive, insurance often will cover screening of your partner to see if he also carries the specific genetic risk. 

We recommend cell-free DNA (cfDNA) screening for common genetic abnormalities such as trisomy 13, 18 and 21 (trisomy 21 is better known as  Down Syndrome).  

The screening test also looks at the X and Y chromosomes for errors, which is why this test can also be used to tell you the gender of your baby.  

Fortunately these screening tests are usually normal.  However, if the results show a chromosomal abnormality, we can use these results to counsel you and help manage the remainder of your pregnancy.  

Most insurance companies now cover the cost of cfDNA testing.

Older tests that are still available and sometimes needed include the "quad screen" or "sequential screen".  We can discuss these options with you only if they are more applicable.  

We typically screen for diabetes early in the pregnany.  Then, we routinely screen for gestational diabetes with the 26-28 week bloodwork.  

If you have pre-pregnancy diabetes, we will work closely with Maternal Fetal Medicine (MFM) to best manage your BG levels, medications, and a recommended fetal testing schedule.  

If you develop diabetes during pregnancy we will refer you for nutrition counseling and also MFM consultation.  The better we can help you control your diabetes, the more likely we can help you deliver a healthy, full-term  baby!

The American College of Obstetricians and Gynecologists recommends 30 minutes or more of moderate exercise per day on most, if not all, days of the week. See the following links for more information on exercise during pregnancy:

• ACOG Guidelines - Exercise During Pregnancy 
• Mayo Clinic- Pregnancy Exercises

Fish and shellfish are an important part of a healthy, well-balanced diet. However, some fish and shellfish contain high levels of mercury that can harm an unborn baby's developing nervous system. In 2004 the EPA published a consumer advisory regarding mercury in fish and shellfish. 

See "Cell Free DNA/NIPT" above.  We offer and recommend screening for all of our patients.  These are considered non-invasive (thus, Non-Invasive Perinatal Testing, or NIPT) because they require a small amount of maternal blood, but do not require invasive fetal testing. 

If the screening test is abnormal, then you may be offered a more invasive option such as amniocentesis (a needle in your belly that extracts fetal cells), which is a diagnostic test.

Fortunately, the non invasive tests are so good that fewer of our patients have needed amniocentesis over recent years.  

The American College of Obstetricians and Gynecologists and the CDC recommend screening for Group B Strep (GBS) at 36 weeks of pregnancy, even if you are planning to have a C-section. About 20% of women will test positive for GBS, and will be treated with antibiotics during their labor. 

Pregnant women need to increase their calorie intake by about 300 calories per day. You should consume a balanced diet that includes foods from the major food groups.

To ensure adequate calcium intake, pregnant women should consume at least 4-5 servings of dairy products per day.  Stay informed and read about healthy eating during pregnancy.

The doctors at Advocare Premier OB/GYN of South Jersey deliver babies at Virtua Voorhees Hospital.  Virtua provides excellent services and care to our patients. This hospital is equipped with state-of-the-art LDR (Labor/Delivery/Recovery) rooms, and offers perinatology (high risk OB doctors) and neonatology (newborn intensive care) services if needed. Virtua has 24-hour anesthesiology so you don't have to wait for an epidural! 

For our patients having trouble getting pregnant, we can discuss radiology and lab studies to help you find an answer.  Sometimes, despite extensive searching, there's no good reason for infertility - luckily we have a lot of great fertility specialists in the area and we would be happy to refer if needed for assisted reproduction options. 

Please don't hesitate to speak with us about fertility or infertility worries - we want to help you build the family of your dreams!

Many of our patients take prescription medications for various reasons that pre-date pregnancy.  You can talk to your prescribing physician to see if your medication is safe to continue, or if there is a safer alternative.  Some medications are better to transition before you become pregnant.  Many common medications, if needed, can and should be continued during pregnancy.  We can discuss specifics with you at an office appointment.

At the beginning of your pregnancy we will share a list of over the counter medications you could try, if needed, for common symptoms such as congestion or heartburn. 

We also found a neat website that reviews medications - check out www.mothertobaby.org.  

Morning sickness is nausea and vomiting that occurs during pregnancy. Despite its name, morning sickness can strike at any time of the day or night. Many pregnant women have morning sickness, especially during the first trimester. Some women have nausea and vomiting symptoms that persist, even if intermittently, throughout pregnancy.

Eating small, frequent meals can be helpful, as well as avoiding certain foods that seem to trigger the nausea. 

There are medications we can prescribe if your nausea and vomiting become unbearable.  The active ingredients of common first-line medications are doxylamine and pyridoxine. TIP: these can also be found in Unisom Sleep tabs (use 1/2 of a 25mg tablet) and vitamin B6 supplements (10mg).  We can discuss options at your appointment, as well as other prescription strength medications that have helped pregnant women over the years.  

Although you will be given a "due date," most infants are not born on this exact date.  Use The American Pregnancy Association Calculator to calculate your due date.

We will order a bunch of routine lab studies early in the pregnancy, including your blood type, blood counts, antibody tests, and tests for certain infections such as HIV, hepatitis and syphilis.  Certain tests are recommended but optional, such as carrier screening for maternal chromosomal anomalies, and fetal chromosomal screening (see above).

Later in the pregnancy we will talk to you about diabetes screening and other third trimester labs.  Also, New Jersey law requires repeat HIV and syphilis testing in the third trimester.  

Other lab studies may be discussed with you based on your medical history or based on issues that come up during the pregnancy.  

Smoking can cause multiple complications in pregnancy, including an increased risk of preterm birth, placental abruption, placenta previa, and low birth weight for your baby. To help protect your health and the health of your pregnancy, we recommend you stop smoking. Visit the following links to assist you in quitting:

• Mom's Quit Connection
• CDC Tobacco Use and Pregnancy 
• women.smokefree.gov/

We recommend flu shots for our pregnant patients.  This is consistent with recommendations by both the American College of Obstetricians and Gynecologists (ACOG) and the CDC.  We know that pregnant moms who get the flu are more likely than their non-pregnant peers to get severely ill, and this can compromise a pregnancy in different ways. 

For most (but not all) pregnant women who are 32-36 weeks pregnant between September and January, the CDC also recommends an RSV vaccine.  Studies show that vaccinating mom during this window can significantly reduce hospital admissions for their babies born during the RSV season.

We recommend Tdap vaccine (tetanus, diphtheria, pertussis) in the third trimester.  Studies show that when mom gets a Tdap booster at least a couple weeks prior to delivery, her baby has protection from Whooping Cough for a few months after delivery, until the baby is old enough to build his or her own immune system.  Whooping Cough is very contagious and can be life-threatening for newborn babies. 

Please feel free to ask us about vaccine recommendations at your next appointment!