Staying Healthy

Having a Healthy Pregnancy

Pregnant Woman

Good Nutrition

Your diet is your baby’s diet so it is important for you to eat well. Your diet should be well balanced and include a variety of different foods. In general, the least processed foods are the most healthy (exceptions include raw or undercooked meat, poultry, seafood, eggs, unpasteurized dairy products and juices, raw sprouts).

Most women consume 1800-2200 calories per day. When you become pregnant you will need about 300 more calories per day.

The servings below reflect the new government guidelines for non pregnant women:

Fruit: 4 servings per day
1 serving = 1 medium fruit (size of a baseball), cup fresh, frozen or canned fruit, or cup fruit juice.
Vegetables: 5 servings per day
1 serving = cup of raw or cooked vegetables (size of a baseball), 1 cup raw leafy vegetable,
or 1 cup vegetable juice
Grains: 6 1oz equivalents per day, with at least 3oz. being 100% whole grain.
1oz equivalent = 1 slice of bread, 1 cup dry cereal, or cup cooked rice (size of a baseball)
Meat and beans: 5 1oz. equivalents per day
1oz. equivalent = 1oz. cooked lean meat, poultry or fish, 1 egg, or cup cooked dry beans or tofu
Milk: 3 cups per day
1 cup = 1 cup low fat or fat free milk or yogurt, or 1oz. low fat natural cheese (size of 4 dice)
Oils: 6 teaspoons (tsp) per day
1 tsp = 1 tsp vegetable oil, 1 tablespoon (tbsp) low fat mayo, 2 tbsp light salad dressing

Vitamins and Minerals

A nutritious diet will go a long way towards supplying these important vitamins and minerals. Most doctors recommend a prenatal vitamin which helps supply extra amounts needed in pregnancy. Check with your doctor before taking any vitamin supplement during pregnancy.

Critically important vitamins and minerals during pregnancy include:

Folic Acid (one of the B vitamins): This vitamin helps make blood, make enzymes function, and helps prevent neural tube defects (spina bifida and other disorders).
Iron: This mineral helps form red blood cells, prevents anemia and fatigue, and helps the body resist infection.
Zinc: Helps produce insulin and certain enzymes.
Iodine: Helps produce hormones that control energy use.
Vitamin A: Prevents eye disease, aids vision, and helps bones and teeth grow.
Vitamin D: Helps body use calcium and phosphorus, promotes strong bones and teeth.
Calcium: Builds strong bones and teeth, helps blood clot, and helps muscles and nerves function.

Foods to Avoid

Fish with high levels of mercury: swordfish, shark, king mackeral, tile fish.
Limit tuna to no more than 6 oz. of albacore (white) per week. You can eat up to 12 oz. of shrimp, canned light tuna, salmon, pollock, or catfish.
Raw or undercooked meats, poultry, eggs, seafood.
Hot dogs or deli meats.
Unpasteurized soft cheeses, milk, or juices.
Raw sprouts, especially alfalfa.
Herbal supplements or teas.
Caffeine
Research suggests that low to moderate caffeine consumption probably does not increase your risk of miscarriage and is probably okay in pregnancy. Moderate means = 300 milligrams of caffeine per day (2-8 oz. cups per day). Remember that strong coffee will have more caffeine, and there is also caffeine in chocolate, tea, cola, coffee ice cream, some other beverages and some non-prescription medications. It is better to drink water, milk and fruit juice during pregnancy.

Weight Gain (ACOG)

Women who are underweight should gain 28-40 lbs.
Women at normal weight should gain 25-35 lbs.
Women who are overweight should gain 15-25 lbs.
Women who are severely overweight should gain 15 lbs.
Women who have twins should gain 35-45 lbs.

Where does the weight go?

For a normal weight woman who gains 30 lbs here is a breakdown of where the weight will go:

Baby 7.5 lbs
Amniotic Fluid 2 lbs
Placenta 1 lb
Uterus 2 lbs
Breasts 2 lbs
Body Fluids 4 lbs
Blood 4 lbs
Maternal Stores (fat, protein, other nutrients) 7 lbs

After delivery, women with normal weight gain will only be about 4 lbs more than their pre-pregnancy weight.

Exercise

It is advisable for the pregnant woman to get at least 30 minutes of moderate exercise per day. This reduces her stress and actually gives her energy, as well as helping avoid excess weight gain. It also helps avoid gestational diabetes, which can complicate pregnancy. Women who do a reasonable amount of exercise such as walking, dancing, swimming, biking, aerobics, or yoga can build strength and stamina needed during labor and delivery and thereafter.

Avoid:

High risk activities such as horseback riding, scuba diving, or downhill skiing.
Laying flat on your back while exercising after the first trimester.
Dehydration. Drink water before, during, and after exercising.
Strenuous sports or exercise you are not used to doing.

Your health and fitness level will determine what exercise is safe for you during pregnancy. Check with your doctor if you have any questions.

Prenatal Care

Prenatal care should begin early in pregnancy and be regular throughout. Your doctor, midwife, or nurse practitioner will keep monitoring your health and the health of your baby. It is not simply a question of being checked for problems but also of maintaining optimal health and pregnancy outcome. A typical prenatal schedule in a normal, low risk pregnancy is as follows:

One visit per month weeks 4-28, two visits per month weeks 28-36, and one visit per week from 36-40 weeks. If you have medical conditions, are carrying twins, or have any other higher risk situation you may be seen more frequently.

Good prenatal care is linked to good pregnancy outcomes.

Other Concerns:

Alcohol

Drinking alcohol while pregnant can cause mental and physical defects called Fetal Alcohol Syndrome (FAS). FAS is the leading preventable cause of mental retardation. No one knows how much alcohol will cause fetal alcohol syndrome so it is best not to drink at all while pregnant. However, do not panic if you have had a few alcoholic drinks before you realized you were pregnant. This is probably not enough to cause a problem. If you cannot stop drinking seek help. For referral to resources call us or contact the National Council on Alcoholism and Drug Dependence (NCADD) 1-800-622-2255 or ncadd.org.

If you have an alcohol habit or problem this is a good time to quit.
Contact The National Council on Alcoholism and Drug Dependence (NCADD) 1-800-622-2255 for help, resources, and referrals in your area.

Smoking

Smoking during pregnancy has been shown to reduce oxygen to your baby, and may cause complications like low birth weight, preterm labor, and even sudden infant death syndrome (SIDS). If you are smoking, STOP. If you can’t stop get help to stop!

The American Legacy Foundation (866) 667-8278
The National Partnership to help Pregnant Smokers Quit (919) 843-7663
Smokefree.gov (877) 448-7848) Smoking Quitline of National Cancer Institute

Drug Use & Medications

Illegal drugs, over the counter drugs, prescription drugs and even some herbal teas and medications harm your baby because they cross the placenta and enter your baby’s bloodstream. Check with your health care provider before taking any medications or remedies, for example, aspirin or Ginko Biloba or other vitamin supplements.
Before taking medication OR before stopping medication that you are currently taking for a serious health problem or condition, talk to your doctor.

Chemical Hazards

Some chemicals and substances can harm your child. Chemicals such as paint thinners, paint, and insect repellents should be avoided as they can cause birth defects or increase risk of miscarriage. Other things to avoid are lead, mold, carbon monoxide, nitrates, mercury, kerosene, benzene, formaldehyde and second hand cigarette smoke. If you work around hazardous chemicals you need to find a way to minimize exposure and talk to your doctor.

Infections

There are some infections that can cause harm to your child during pregnancy and or labor and delivery.

Listeriosis

This is a bacterial illness that is food borne. Symptoms can be flu-like or none at all. It can cause miscarriage or other problems for the baby. To prevent it, wash hands and food preparation surfaces with hot soapy water, and reheat luncheon meats, cold cuts, or any deli style meats or poultry to very hot. Do not eat any unpasteurized milk or soft cheeses or refrigerated smoked seafood.

Toxoplasmosis

This is a parasite found in animals that live outdoors. It can be contracted by eating raw or undercooked meat, unwashed vegetables, or most often by working in the garden without gloves. It can also be contracted, although rarely, by changing a cat’s litter box.

Rubella and chickenpox

A blood test can tell you if you are immune. If not, it is not advisable to be vaccinated during pregnancy because vaccinations are live viruses.

HIV and other STDs

STDs affect women of every socioeconomic and educational level, age, race, ethnicity, and religion. The CDC 2002 Guidelines for Treatment of Sexually Transmitted Diseases recommend that pregnant women be screened on their first prenatal visit for STDs which may include:

Chlamydia
Gonorrhea
Hepatitis B
Hepatitis C
HIV
Syphilis

Ask your doctor about getting tested for these STDs, since some doctors do not routinely perform them. New and increasingly accurate tests continue to become available. Even if you have been tested in the past, we recommend that you be tested again when you become pregnant.

Travel During Pregnancy

Early in pregnancy morning sickness can be aggravated by travel. The best time is mid pregnancy or 14-28 weeks. After that it is harder to move around or sit for long periods. Many airlines have restrictions on travel for pregnant women who are close to their due dates.

Sex During Pregnancy

Unless you are bleeding or having a gush of fluid from the vagina, or a doctor has advised you otherwise, it is safe to have sex during pregnancy. At times during pregnancy sexual desire may increase or decrease. Physical awkwardness can become a problem but there are various positions that will avoid the problem of the belly becoming large such as side-lying or man-behind.

Domestic Violence

It is never all right for anyone to inflict emotional or physical abuse on you. If someone is hitting, kicking, pushing, yelling, calling you names, or scaring you, it can be harmful to you and your baby. If it has gone on before it often gets worse during pregnancy. For help call the National Domestic Violence Hotline (1-800-799-7233) or talk to your health care provider or another trusted person. Staying in such a situation can cause physical injury, miscarriage, preterm labor, and even death.

Stress

When you do things to stay healthy you will also be reducing your stress:

Eat well and regularly.
Drink lots of water.
Get enough sleep and rest.
Exercise moderately and regularly.
Stay away from drugs, alcohol and cigarettes.
Stay away from people and situations that upset you.
Seek out and talk to caring and supportive people.
Get regular prenatal care.
Find activities that you enjoy and that calm you (prayer, meditation, listen to music, write in a journal, knit, read a good book.)

Help for common problems

Nausea and vomiting: This is common early in pregnancy. It usually goes away after 14 weeks. Eating dry toast or crackers before you get out of bed in the morning, avoiding strong odors, and drinking lots of fluid throughout the day are a few things you can do. If vomiting is severe and persistent consult your doctor.
Constipation: Drink lots of water, eat a high fiber diet (fresh fruits, vegetables, and whole grain carbohydrates).
Heartburn: Eat small meals throughout the day, eat slowly, drink fluids between rather than with meals, and stay away from spicy, greasy. and highly fatty foods. Do not lie down immediately after eating and try raising the head of your bed or using pillows.
Cravings: Pregnant women often have food cravings and usually they are not harmful as long as you maintain a balanced diet and do not eat the same thing all the time.
Fatigue: This is normal especially during early pregnancy due to the increased demands on your body. Get a good night sleep and rest when you can. This usually gets less severe in mid pregnancy and returns later in pregnancy.
Headaches: Headaches are common in pregnancy, but should be discussed with your doctor if they are frequent and/or severe. For minor headaches, a cold washcloth to the forehead can help, as can a massage. Resting in a quiet dark room may also help.

Remember that pregnancy is a natural process and not an illness, but definitely seek care for:

Vaginal bleeding
Abdominal pain
Continuous vomiting
Chills & Fever
Severe persistent headache
Decreased or blurred vision
Marked decrease of frequency or intensity of movement of baby
Gush of fluid from the vagina
Persistent burning on urination
Marked swelling of the legs, face, or fingers

Compiled using information from the following sources:

Your Pregnancy & Birth, Fourth Edition, The American College of Obsbstretricians and Gynecologists. (2005)

“Eat Your Way to a Healthy Pregnancy”, Mama Your Guide to a Healthy Pregnancy, AMA March of Dimes. (2005)

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(no. RR-6).

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