Healthy Pregnancy

A healthy pregnancy starts before conception. If you are thinking about having a baby, now is the time to prepare your body. You could be pregnant for weeks before you realize it. The first few weeks are a time when it's especially easy for the fetus to be impacted by drugs, alcohol, smoking and lack of nutrients. That's why good health is so important. You can read more below to learn about having a healthy pregnancy. You can also visit our Pregnancy Resource Center.

Prenatal care

The March of Dimes suggests the following to get off on the right foot:

• Early prenatal care is essential. (Read about "Prenatal Care") Ideally, you should see a healthcare practitioner even before you get pregnant. This gives you a chance to get your body in the healthiest shape possible. For example, you may need to reach your ideal weight first, before the pregnancy. That's because, while it's important to gain enough weight during pregnancy to ensure your baby's proper development, starting out with excess weight before you conceive can put you at a higher risk of developing diabetes or high blood pressure during pregnancy. (Read about "Losing Weight") If you have chronic health problems, a visit to a doctor or healthcare provider prior to conceiving provides a chance to get those health problems under control such as diabetes, epilepsy and high blood pressure. (Read about "Diabetes" "Epilepsy" "Hypertension: High Blood Pressure") Talk with your doctor or healthcare provider early about keeping conditions such as these in check throughout your pregnancy as well. You should also find out about any immunizations you may need before getting pregnant, for example vaccinations for rubella or chicken pox. (Read about "Childhood Illnesses") In addition, ask your doctor or healthcare provider about screening for the herpes virus. The National Institute of Allergy and Infectious Diseases says a pregnant woman with genital herpes can pass the virus to her baby during vaginal delivery. HSV infection in newborns can result in mental retardation and death. (Read about "Herpes" "STD's") However, with proper care, this risk can be reduced.
• Prenatal visits: Early and often is the best advice when it comes to prenatal visits. Again, try to see your healthcare practitioner if you're even thinking about becoming pregnant. In the beginning, expect to be seen at least once a month. Later on, near delivery, you may be seen once a week. (Read about "Due Date") Seek medical help right away if you have any signs of an infection or other problems such as bleeding or leaking of fluid from the vagina, unusual cramps or other unusual changes. If you are older or are carrying multiple fetuses (Read about "Later Age Pregnancy" "Multiple Birth Pregnancies"), your healthcare provider may have extra concerns.
• Nutrition is important throughout each of the trimesters. (Read about "Stages of Pregnancy") Eat a well balanced and nutritious diet with all the food groups, once again consulting with your doctor or healthcare provider on supplements such as folic acid. The U.S. Department of Health and Human Services says pregnant women or women who are thinking of getting pregnant should consume at least 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet. Multiple birth pregnancies can require more folic acid. Folic acid is a B vitamin and is found in green leafy vegetables, nuts, beans and citrus fruits. (Read about "Vitamins & Minerals") Folic acid reduces the chances of neural tube birth defects (Read about "Neural Tube Defects") according to the March of Dimes. Calcium is also important. (Read about "Calcium") For pregnant women, the Institute of Medicine (IOM) recommends, depending on your age and other health issues, between 1000 and 1300 milligrams per day of calcium. You should discuss with your healthcare provider what your needs are. IOM also says the upper intake level for calcium is between 2000 and 3000 milligrams per day. Once again, it depends on your age and other health factors how much calcium you should be getting. Upper intake levels represent the upper safe boundary and should not be misunderstood as amounts people need or should strive to consume, according to IOM. Since most women don't get enough calcium even when they're not pregnant, it's important to pay attention to this need in your diet. Calcium-rich foods include dairy products, leafy green vegetables, tofu and salmon. The Food and Drug Administration says getting enough calcium can help prevent a new mother from losing her own bone calcium as the fetus uses the mineral for bone growth. Depending on your diet, your doctor or healthcare provider may recommend a calcium supplement, which should also include vitamin D. Vitamin D helps the body absorb the calcium. For pregnant women, IOM recommends, depending on your age and other health issues, 600 international units (IUs) of vitamin D per day to maintain health. Once again, you should discuss with your healthcare provider what your needs are. IOM also says the upper intake level for vitamin D is between 2500 and 4000 IUs per day, depending on your age and other health factors. (Read about other important nutrients in "Pregnancy and Nutrition")
• Exercise: Get the facts about getting regular exercise, and about how much is appropriate at different times throughout your pregnancy. The American College of Obstetricians and Gynecologists (ACOG) says regular activity can not only help you stay fit; it may also improve your ability to cope with the pain of labor and make it easier to get back in shape after the baby is born. ACOG says you should not, however, exercise to lose weight while you are pregnant.

You may also want to start thinking ahead to issues you will face later on in pregnancy, such as where you will give birth, (Read about "Childbirth") and other concerns such as purchasing a car safety seat to bring your baby home from the hospital. (Read about "Car Safety")

Pregnancy dangers

While there are many things that you should do to help insure a healthy pregnancy there are also things that you need to avoid. From alcohol to drugs, to even a soak in a hot tub, your developing baby can be at risk. The March of Dimes warns about the following:

• Alcohol, drugs and smoking: Avoid alcohol, cigarettes and illegal drugs. (Read about "Addiction") Consult carefully with your doctor or healthcare provider about prescription medication if you are taking any. Don't decide to stop taking your regular medication without the advice of your doctor or healthcare provider, you could wind up doing more harm by stopping treatment for problems you are having. For example, the American College of Obstetricians and Gynecologists (ACOG) has concerns about selective serotonin reuptake inhibitors (SSRIs) and other related antidepressants (Read about "Depressive Illnesses") for pregnant women. The group advises that women and their doctors should carefully consider all the ramifications of being on the drugs or not while pregnant. The concern is the higher risk of birth defects (Read about "Birth Defects") in babies whose mothers took the drugs. Also, speak to your physician before taking any over-the-counter medications.
• Hot tubs or saunas can cause a dangerous rise in body temperature and are best avoided.
• X-rays: In general, pregnant women are also advised to avoid x-rays, owing to concerns about potential harm to the fetus. (Read about "X-rays") If x-rays are absolutely necessary, the abdomen should be shielded.
• Infections: Take extra precautions to avoid infections. (Read about "Microorganisms") If you get a urinary tract infection (Read about "Urinary Tract Infections") or a sexually transmitted disease (Read about "STD's"), it needs to be treated immediately. Also have someone else change the cat litter, and don't eat raw or under cooked meat. Cat litter and undercooked meat both can contain a parasite that could cause toxoplasmosis that can harm a fetus. (Read about "Toxoplasmosis") Pregnant women and their babies are also at a higher risk from certain bacterial infections such as listeria. If you develop a fever or gastrointestinal problems during pregnancy, see your doctor or healthcare provider. (Read about "Listeriosis") To avoid listeriosis, the Centers for Disease Control and Prevention (CDC) say pregnant women should avoid soft cheeses and raw milk, and not eat hot dogs, luncheon meats, or deli meats unless they are reheated until steaming hot. There are other infections that pregnant women should be aware of, such as group B strep. Around 25 percent of women may carry the bacteria at any time. This doesn't mean that they have group B strep disease, but it does mean that they are at higher risk for giving their baby a group B strep infection during birth. CDC guidelines recommend that a pregnant woman be tested for group B strep in her vagina and rectum when she is 35 to 37 weeks pregnant. (Read about "Group B Strep") In addition, CDC says pregnant women should consider postponing travel to any country where infectious diseases such as Zika virus are present (Read about "Travel and Health" "Zika Virus")
• Tooth & gum disease: Pregnant women also need to take extra care of oral hygiene. The Academy of General Dentistry (AGD) says that elevated hormones during pregnancy causes the bacteria in plaque to react differently with the gums. It can result in a condition called pregnancy gingivitis. AGD says that research is showing a link between gingivitis and early labor and low birth weight. (Read about "Preterm Labor") The connection, according to AGD, is the bacteria in gingivitis are suspected of causing premature labor. The gums can also swell due to the pregnancy hormones and bleed during chewing and brushing. (Read about "Oral Health")
• Anemia: There are various types of anemia (Read about "Anemia") that can occur during pregnancy. Pregnancy can cause iron deficiency anemia if a woman's diet does not have enough iron for both the mother and fetus. Folate deficiency anemia can occur when the mother's diet is lacking in folate or there are problems absorbing vitamins. (Read about "Vitamins & Minerals") Folate, also called folic acid, is needed to make red blood cells. It also may occur during the third trimester of pregnancy, when your body needs extra folate. A third type of anemia is called anemia of pregnancy. It can occur because a women's blood volume increase by as much as 50 percent during pregnancy. This can lead to a dilution of the red blood cells in circulation. It becomes a problem if the levels fall too low.

Tests

The American Academy of Family Physicians says there are many tests that a doctor or midwife can run on you during your pregnancy to help determine if your fetus has a problem. These include:

• Ultrasound is becoming more and more common. The sonogram pictures are sometimes used by parents to announce their upcoming addition to the family. Ultrasounds do more then just supply a picture and the sex of the fetus; they can also help a doctor diagnose causes of bleeding, and help check on the overall health of the baby. (Read about "Ultrasound Imaging")
• Blood tests: A simple blood test called alpha-fetoprotein (AFP or AFT) can check for a number of problems (Read about "Laboratory Testing") including spinal cord defects and the possibility of Down syndrome. (Read about "Down Syndrome") AFP is not definitive however and other tests may be needed. Blood tests for beta human chorionic gonadotropin (ß-hCG) and plasma protein-A (PAPP-A) combined with an ultrasound, called nuchal translucency that measures the thickness at the back of the neck of the fetus, can indicate an increased risk of Down syndrome and the need for additional diagnostic testing. (Read about "Birth Defects")
• Amniocentesis is used to check for a number of genetic (Read about "Genetics") and metabolic diseases and for fetal lung maturity. The test involves inserting a needle into the womb to extract fluid. It is often done with the assistance of ultrasound (Read about "Ultrasound Imaging") to see the baby's position and the structures inside the womb. That fluid is then tested. There are some concerns about side effects from this test.

(Read about "Pregnancy Testing")

Morning sickness

Morning sickness and nausea are common to about 70 percent of pregnant women. Most nausea occurs during the early part of pregnancy and, in most cases, will subside or go away entirely once you enter the second trimester, according to AAFP. The hormonal changes in your body are a suspected cause, according to ACOG. They might cause you to become nauseous or sick when you smell or eat certain things, when you are tired or stressed (Read about "Stress"), or for no apparent reason at all. Sometimes iron supplements (Read about "Iron Supplements") can play a role, if they upset your stomach. Discuss the issues with your healthcare provider. For some women, it might last longer than the early stages of pregnancy or even throughout the entire nine months.

Nausea in early pregnancy is a condition that often can be managed nutritionally. Here are some tips from the National Women's Health Information Center:

• eat small meals
• avoid going long periods without food
• drink fluids between, but not with, meals
• avoid foods that are greasy, fried or highly spiced
• avoid foul and unpleasant odors
• eat crackers and other bland foods when you feel nauseous
• rest when you are tired

Severe nausea and vomiting in pregnancy (known as hyperemesis gravidarum) is rare, but if it occurs, it may cause you to become dehydrated or it can be a symptom of other conditions. Your healthcare provider should be informed if this occurs. (Read about "Dehydration") If you feel that your nausea or vomiting is keeping you from eating right or gaining enough weight, consult your doctor or healthcare provider. Severe cases of nausea and vomiting in pregnancy, known as hyperemesis gravidarum, can result in serious complications. (Read about "Morning Sickness")

Pregnancy weight gain

Although it's a good idea to reach a healthy weight before becoming pregnant, it is definitely not a good idea to lose weight once you do become pregnant. All women, even those who are overweight, need to gain weight during pregnancy, in order to ensure the health of their baby. For those over the age of one, the Institute of Medicine (IOM) suggests that women should gain:

• 28 to 40 lbs if they are underweight
• 25 to 35 lbs if they are normal weigh
• 15 to 25 lbs if they are overweight
• 11 to 20 lbs if they are obese

Although people may talk about "eating for two," you shouldn't double your calorie intake. IOM says on average, women need an extra 200-300 calories a day. You should talk about this issue with your doctor or midwife.

Possible complications

You should also discuss possible complications in advance with your healthcare practitioner. Your body is undergoing major changes as it grows a baby. Those changes can have an impact on other systems in your body.

• Gestational diabetes - Gestational diabetes is a condition that can develop during pregnancy. It results in elevated blood sugar levels, and may be managed by dietary changes and/or medication and/or insulin. This condition requires careful monitoring throughout the pregnancy and can put a woman at higher risk of developing diabetes later in life. The American Diabetes Association says about four percent of pregnant women develop gestational diabetes during pregnancy, and women who were overweight (Read about "Obesity") before becoming pregnant are at a higher risk. Your healthcare provider should routinely screen you for this at 28 weeks gestation. (Read about "Diabetes")
• Incontinence - Another concern for many women is incontinence, which is the accidental loss of urine or the inability to hold your urine. The National Institutes of Health (NIH) say pregnancy and childbirth, along with the structure of the female urinary tract (Read about "The Urinary System"), help account for the fact that women suffer from incontinence twice as often as men. Kegel's or pelvic muscle tightening exercises can help to decrease urinary leakage. (Read about "Incontinence")
• Constipation - One of the most common complaints of pregnant women is constipation. Your doctor may recommend adding fiber to your diet and increasing your fluid intake. (Read about "Constipation")
• Hemorrhoids - Many women also suffer from hemorrhoids during pregnancy, the result of the extra weight and other factors. After birth, the hemorrhoids often go away. (Read about "Hemorrhoids")
• Postpartum thyroiditis - According to the National Women's Health Information Center, postpartum thyroiditis is something else women should be aware of. This is a swelling of the thyroid that occurs in 5-7 percent of women who give birth, and can cause temporarily high levels of thyroid hormone. (Read about "Thyroid")
• Back pain - Many pregnant women develop back pain, because of the extra weight and changes that pregnancy can cause in their posture and center of gravity. You can help to minimize problems if you avoid standing for extended periods of time, pay attention to posture and use proper lifting techniques. (Read about "Back Pain")
• Deep vein thrombosis - During pregnancy, women have a fivefold increased risk of deep vein thrombosis (DVT) according to ACOG. DVT is the development of blood clots in veins, usually in the leg. With that comes an increased risk of a blood clot breaking loose and traveling to another part of the body, such as the heart, brain or lungs. When it lodges in the lung, it is called a pulmonary embolism (Read about "Pulmonary Embolism"). The American Heart Association says pulmonary embolism is the most frequent cause of death associated with childbirth.
• Preeclampsia - One in twenty women will develop a condition during their first pregnancy called preeclampsia. (Read about "Preeclampsia") It results in high blood pressure and protein in the urine. It is potentially fatal to the woman and the fetus. NIH calls it the leading cause of maternal death. This is why frequent prenatal visits are essential to help prevent these serious complications. (Read about "Deep Vein Thrombosis")
• Depression - Women should also be aware of mental changes that can occur, both during pregnancy and after delivery. The American Academy of Family Physicians (AAFP) says symptoms of what is commonly called the "baby blues" can start three to four days after delivery, and include mood swings, crying spells and problems concentrating. The symptoms usually go away within ten days of delivery. But if they last or become increasingly intense, it's called post-partum depression and medical help may be needed. Do not be ashamed to discuss your feelings with your healthcare provider. (Read about "Depressive Illnesses")
• Melasma or chloasma - Another complication is melasma, which is also called chloasma, according to the American Academy of Dermatology (AAD). It is a benign skin condition that is fairly common. (Read about "Skin") When it occurs, the skin takes on a darker appearance compared to the surrounding skin. It is most often found on the face and other portions of the body exposed to the sun. AAD says that hormonal changes brought about by pregnancy, hormonal treatments during menopause (Read about "Menopause") or any other type of hormonal drugs are common causes. Up to 70 percent of pregnant women will experience melasma, which is sometimes referred to as the "mask of pregnancy." AAD adds, most cases will clear up after pregnancy or when hormones are brought back into balance. Sun exposure is also a risk factor and women who avoid the sun during pregnancy or while they are taking hormone drugs are less likely to experience melasma. AAD also recommends sunscreen (Read about "Sunscreen") to help in this area. Treatments can include various topical applications. There are, however, many concerns about these medications and pregnancy. You should discuss the issue with your healthcare provider before any kind of treatment if you are pregnant or even of childbearing age. (Read about "Melasma/Chloasma")
• Thrombophilias - Thrombophilias are a group of conditions and disorders that cause the blood to clot too easily. If a woman has an acquired or congenital thrombophilia, she may have an increased risk of problems during pregnancy. They can include poor fetal growth, separation of the placenta from the uterine wall and stillbirth. (Read about "Thrombophilia")
• Vaginal yeast infections - Vaginal yeast infections are common during pregnancy and can cause itching or a burning sensation in the vagina. However, the signs of a yeast infection are similar to those of some sexually transmitted diseases. So, it's important to contact your doctor if you suspect you have a yeast infection. (Read about "Vaginal Yeast Infections")
• Rh disease - Rh disease occurs when the mother's blood type is Rh-negative and the baby's blood is Rh-positive. It is usually not a problem with first pregnancies but can cause serious complications for the baby in subsequent pregnancies. (Read about "Rh Disease")

There are many other issues that can develop during a pregnancy. A woman may have a weakened cervix that can open before a pregnancy reaches full term. (Read about "Cervical Insufficiency / Incompetent Cervix") There may be other issues such as too much amniotic fluid or problems with the placenta, which is the organ that nourishes the developing fetus and removes its waste products. (Read about "Polyhydramnios / Hydramnios" "Placental Complications") One of the big concerns with many of these complications is that they can lead to early delivery. (Read about "Preterm Labor") Premature birth can be very dangerous, so it is essential to talk with your doctor or healthcare provider about any concerns you may have.

Although it may seem overwhelming, it's important to consider all the important precautions you need to take as early as possible. By starting to plan early, you have the best chance of warding off potential problems later on and giving your child a great start on life.

Related Information:

    Microorganisms

    Baby and Young Child Care

    Anemia

    Food Labels

    Pregnancy Terms Glossary

    Genital Health - Female

    Woman's Health Terms Glossary