Staying Healthy During Pregnancy

Now that you're pregnant, taking care of yourself has never been more important. Of course, you'll probably get advice from everyone - your doctor, family members, friends, co-workers, and even complete strangers - about what you should and shouldn't be doing. But staying healthy during pregnancy depends on you, so it's crucial to arm yourself with information about the many ways to keep you and your baby as healthy as possible.

Prenatal Health Care
Key to protecting the health of your child is to get regular prenatal care. If you think you're pregnant, call your health care provider to schedule an appointment.

You should have your first examination during the first 6 to 8 weeks of your pregnancy, which is when your menstrual period is 2 to 4 weeks late.

At this first visit, your health care provider will figure out how many weeks pregnant you are based on a physical examination and the date of your last period. He or she will also use this information to predict your delivery date (however, an ultrasound performed sometime during your pregnancy will help to verify that date).

If you're healthy and there are no complicating risk factors, you can expect to see your health care provider:

• every 4 weeks until the 28th week of pregnancy
• then every 2 weeks until 36 weeks
• then once a week until delivery

Throughout your pregnancy, your health care provider will check your weight and blood pressure while also checking the growth and development of your baby (by doing things like feeling your abdomen, listening for the fetal heartbeat starting during the second trimester, and measuring your belly). During the span of your pregnancy, you'll also have prenatal tests, including blood, urine, and cervical tests, and probably at least one ultrasound.

If you still need to choose a health care provider to counsel and treat you during your pregnancy, there are several options:

• obstetricians/gynecologists (also known as OB/GYNs - doctors who specialize in pregnancy and childbirth, as well as women's health care)
• family practitioners (doctors who provide a range of services for patients of all ages - in some cases, this includes obstetrical care)
• certified nurse-midwives (advanced practice nurses specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for "normal" pregnancies; there are also other kinds of midwives, but you should look for one with formal training who's been certified in the field)

Any of these is a good choice if you're healthy and there's no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case an unexpected problem arises or a cesarean section (C-section) has to be performed.

Nutrition and Supplements
Now that you're eating for two (or more!), this is not the time to cut calories or go on a diet. In fact, it's just the opposite - you need about 300 extra calories a day, especially later in your pregnancy when your baby grows quickly. If you're very thin or carrying twins, you'll need even more. But if you're overweight, your health care provider may advise that you consume fewer extra calories.

Healthy eating is always important, but especially when you're pregnant. So, it's important to make sure your calories come from nutritious foods so they can contribute to your baby's growth and development.

Try to maintain a well-balanced diet that incorporates the dietary guidelines including:

• lean meats
• fruits
• vegetables
• whole-grain breads
• low-fat dairy product

By eating a healthy, balanced diet you're more likely to get the nutrients you need. But you will need more of the essential nutrients (especially calcium, iron, and folic acid) than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.

But taking prenatal vitamins doesn't mean you can eat a diet that's completely lacking in nutrients. It's important to remember that you still need to eat well while pregnant. Prenatal vitamins are meant to supplement your diet not be your only source of much-needed nutrients.

Calcium
Most women 19 and older - including those who are pregnant - don't often get the daily 1,000 mg of calcium that's recommended. Because your growing baby's calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which may contain some extra calcium.

Good sources of calcium include:

• low-fat dairy products including milk, cheese, and yogurt
• calcium-fortified products, including orange juice, soy milk, and cereals
• dark green vegetables including spinach, kale, and broccoli
• tofu
• dried beans
• almonds

Iron

Pregnant women need 27 to 30 mg of iron every day. Why? Because iron is needed to make hemoglobin, the oxygen-carrying component of red blood cells. Red blood cells circulate throughout the body to deliver oxygen to all its cells.

Without enough iron, the body can't make enough red blood cells and the body's tissues and organs won't get the oxygen they need to function well. So it's especially important for pregnant women to get enough iron in their daily diets - for themselves and their growing babies.

Although the nutrient can be found in various kinds of foods, iron from meat sources is more easily absorbed by the body than iron found in plant foods. Some examples of iron-rich foods include:

• red meat
• dark poultry
• salmon
• eggs
• tofu
• enriched grains
• dried beans and peas
• dried fruits
• leafy green vegetables
• blackstrap molasses
• iron-fortified breakfast cereals

Folate (Folic Acid)
The U.S. Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age - and especially those who are planning a pregnancy - get about 400 micrograms (0.4 milligrams) of folic acid supplements every day. That can be from a multivitamin or folic acid supplement in addition to the folic acid found in food.

So, why is folic acid so important? Studies have shown that taking folic acid supplements 1 month prior to and throughout the first 3 months of pregnancy decrease the risk of neural tube defects by up to 70%.

The neural tube - formed during the first 28 days of the pregnancy, usually before a woman even knows she's pregnant - goes on to become the baby's developing brain and spinal cord. When the neural tube doesn't form properly, the result is a neural tube defect such as spina bifida.

Again, your health care provider can prescribe a prenatal vitamin that contains the right amount of folic acid. Some pregnancy health care providers even recommend taking an additional folic acid supplement, especially if a woman has previously had a child with a neural tube defect.

If you're buying an over-the-counter supplement, keep in mind that most multivitamins contain folic acid, but not all of them have enough folic acid to meet the nutritional needs of a pregnant woman. So, be sure to check labels carefully before choosing one and check with your health care provider.

Fluids
It's also important to drink plenty of fluids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy, and drinking enough water each day can help prevent common problems such as dehydration and constipation.

Exercise
The 2005 dietary guidelines recommend that healthy pregnant women get 30 minutes or more of moderate intensity physical activity every day. Exercising during pregnancy has been shown to be extremely beneficial.

Regular exercise can help:

• prevent excess weight gain
• reduce pregnancy related problems, like back pain, swelling, and constipation
• improve sleep
• increase energy
• improve outlook
• prepare for labor
• lessen recovery time

If you've been involved in an exercise program before becoming pregnant, talk to your health care provider about whether it's safe to continue. If you haven't been active and/or you have a high-risk pregnancy, ask your health care provider how you can safely start.

Low-impact, moderate intensity exercise activities (such as walking and swimming) are great choices. You can also opt for yoga or pilates classes, DVDs, or videos that are tailored for pregnancy. These are both low-impact and work on strength, flexibility, and relaxation.

But you should limit high-impact aerobics and avoid certain sports and activities that pose a risk of falling or abdominal injury. Typical limitations include contact sports, downhill skiing, and horseback riding.

It's also important to be aware of how your body changes. During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury.

So, it's easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. In addition, your center of gravity shifts as your pregnancy progresses, so you may feel off-balance and at risk of falling. Keep these in mind when you choose an activity, and don't overdo it.

Whatever type of exercise you choose, make sure to take frequent breaks and remember to drink plenty of fluids. And use common sense - slow down or stop if you get short of breath or feel uncomfortable. If you have any questions about doing a certain sport or activity during your pregnancy, talk to your health care provider for specific guidelines.

Sleep

It's important to get enough sleep during your pregnancy. Your body is working hard to accommodate a new life, so you'll probably feel more tired than usual. And as your baby gets bigger, it will be harder to find a comfortable position when you're trying to sleep.

Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart's job easier because it keeps the baby's weight from applying pressure to the large blood vessels that carry blood to and from your heart and your feet and legs. Lying on your side can also help prevent or reduce varicose veins, constipation, hemorrhoids, and swelling in your legs.

Some doctors specifically recommend that pregnant women sleep on the left side. Because your liver is on the right side of your abdomen, lying on your left side helps keep the uterus off that large organ. Lying on your left side also optimizes blood flow to the placenta and, therefore, your baby.

Ask what your health care provider recommends. In most cases, lying on either side should do the trick and help take some pressure off your back. To create a more comfortable resting position, either way, prop pillows between your legs, behind your back, and underneath your belly.

Some Things to Avoid

When you're pregnant, what you don't put into your body (or expose your body to) is almost as important as what you do. Here are some things to avoid:

Alcohol

Although it may seem harmless to have a glass of wine at dinner or a mug of beer out with friends, no one has determined what's a "safe amount" of alcohol to consume during pregnancy. One of the most common known causes of mental and physical birth defects, alcohol produces more severe abnormalities in a developing fetus than heroin, cocaine, or marijuana.

Alcohol is easily passed along to the baby, who is less equipped to eliminate alcohol than the mother. That means an unborn baby tends to develop a high concentration of alcohol, which stays in the baby's system for longer periods than it would in the mother's. And moderate alcohol intake, as well as periodic binge drinking, can damage a baby's developing nervous system.

If you had a drink or two before you even knew you were pregnant (as many women do), don't worry too much about it. But your best bet is to not drink any alcohol at all for the rest of your pregnancy.

Recreational Drugs

Pregnant women who use drugs may be placing their unborn babies at risk for premature birth, poor growth, birth defects, and behavior and learning problems. And their babies could also be born addicted to those drugs themselves.

If you're pregnant and using drugs, a health clinic such as Planned Parenthood can recommend health care providers, at little or no cost, who can help you quit your habit and have a healthier pregnancy.

If you've used any drugs at any time during your pregnancy, it's important to inform your health care provider. Even if you've quit, your unborn child could still be at risk for health problems.

Nicotine

You wouldn't light a cigarette, put it in your baby's mouth, and encourage your little one to puff away. As ridiculous as this scenario seems, pregnant women who continue to smoke are allowing their fetus to smoke, too. The smoking mother passes nicotine and carbon monoxide to her growing baby.

The risks of smoking to the fetus include:

• stillbirth
• prematurity
• low birth weight
• sudden infant death syndrome (SIDS)
• asthma and other respiratory problems

If you smoke, having a baby may be the motivation you need to quit. Talk to your health care provider about options for stopping your smoking habit.

Caffeine

High caffeine consumption has been linked to an increased risk of miscarriage, so it's probably wise to limit or avoid caffeine altogether if you can.

If you're having a hard time cutting out coffee cold turkey, here's how you can start:

• Cut your consumption down to one or two cups a day.
• Gradually reduce the amount by combining decaffeinated coffee with regular coffee.
• Eventually cut out the regular coffee altogether.

And remember that caffeine is not limited to coffee. Green and black tea, cola, and other soft drinks contain caffeine. Try switching to decaffeinated products (which may still have some caffeine, but in much smaller amounts) or caffeine-free alternatives.

If you're wondering whether chocolate, which also contains caffeine, is a concern, the good news is that you can have it in moderation. Whereas the average chocolate bar has anywhere from 5 to 30 milligrams of caffeine, there's 95 to 135 milligrams in a cup of brewed coffee. So, small amounts of chocolate are fine.

Certain Foods

Although you need to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage.

Foods you'll want to steer clear of include:

• soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
• unpasteurized milk, juices, and apple cider
• raw eggs or foods containing raw eggs, including mousse, tiramisu, raw cookie dough, homemade ice cream, and Caesar dressing (although some store-bought brands of the dressing may not contain raw eggs)
• raw or undercooked meats, fish (sushi), or shellfish
• processed meats such as hot dogs and deli meats (these should be well cooked)

Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating:

• shark
• swordfish
• king mackerel
• tilefish

These types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus. When you choose seafood, eat a variety of fish and shellfish and limit the amount to about 12 ounces per week - that's about two meals. Also, when you're eating canned tuna, you may want to choose light tuna, which has less mercury than canned white tuna. You should eat no more than 6 ounces per week of canned albacore or white tuna. Also, it's a good idea to check any local advisories before consuming any recreationally caught fish.

Changing the Litter Box

Pregnancy is the prime time to get out of cleaning kitty's litter box. Why? Because an infection called toxoplasmosis can be spread through soiled cat litter boxes and can cause serious problems, including prematurity, poor growth, and severe eye and brain damage. A pregnant woman who becomes infected often has no symptoms but can still pass the infection on to her developing baby.

Over-the-Counter and Prescription Medications

Even common over-the-counter medications that are generally safe may be considered off-limits during pregnancy because of their potential effects on the baby. And certain prescription medications may also cause harm to the developing fetus.

To make sure you don't take anything that could be harmful to your baby:

• Ask your health care provider which medicines - both over-the-counter and prescription - are safe to take during pregnancy.
• Talk to your health care provider about any prescription drugs you're taking.
• Let all of your health care providers know that you're pregnant so that they'll keep that in mind when recommending or prescribing any medications.
• Discuss any questions about natural remedies, supplements, and vitamins.

If you were prescribed a medication before you became pregnant for an illness, disease, or condition you still have, consult with your health care provider, who can help you weigh potential benefits and risks of continuing your prescription.

If you become sick (i.e., with a cold) or have symptoms that are causing you discomfort or pain (i.e., a headache or backache), talk to your health care provider about medications you can take and alternative ways to help you feel better without medication.

Healthy Pregnancy Habits: From Start to Finish

During pregnancy, from the first week to the fortieth, it's important to take care of yourself in order to take care of your baby. Even though you have to take some precautions and be ever-aware of how what you what you do - and don't do - may affect your baby, many women say they've never felt healthier than when they carried their children.

Updated and reviewed by: Mary L. Gavin, MD
Date reviewed: July 2005
Originally reviewed by: George Macones, MD, and Steven Dowshen, MD