Next ... exercise
. This may be difficult while you are pregnant - but it does need addressing, as after the baby is born, your time is going to be less than now and the danger is that Sara could become secondary, causing more problems. She certainly isn't getting out enough. Even as a small dog, she needs walking every day, ideally twice a day, but one 20-30 minute walk is okay if that's all that can be managed. Who do you live with, if anyone?