A 28-Year-Old Primigravida at 16 Weeks Gestation Comes to the Office

A 28-year-old primigravida at 16 weeks gestation comes to the office for a routine prenatal visit.  The patient has had muscle aches for the past 3 months.  She did not think much of her soreness early in the pregnancy, but her symptoms have become more bothersome.  The patient reports feeling fatigued and sleeping restlessly even before becoming pregnant and takes short naps most days.  Throughout the past year, she has spent much of her time thinking about whether she can tolerate the pain of labor and if her marriage and health will be affected by having a baby.  The patient usually feels comforted after talking to her mother but becomes overwhelmed again soon after.  She has no chronic medical conditions and takes a prenatal vitamin.  Vital signs are within normal limits.  Physical examination shows no abnormalities, and fetal heart tones are normal.  Complete blood count, comprehensive metabolic panel, and TSH are normal.  Which of the following is the most appropriate statement in response to this patient's condition?

A) "It's natural to be worried when it's your first pregnancy; I encourage you to keep talking with your mother who can be an important source of support for you."
B) "There are lots of physical and emotional changes that occur in pregnancy; scheduled acetaminophen and relaxation techniques may help decrease your symptoms."
C) "Your symptoms and sleep difficulty may be due to restless legs syndrome, which is very common in pregnancy.  Are you experiencing an urge to move your legs at night?"
D) "Your symptoms may be due to a treatable anxiety disorder; psychotherapy can help relieve the physical symptoms and worries you are experiencing."

Correct Answer:

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