10 steps to a healthy pregnancy
Highlights
Pregnancy is an ideal time to start taking really good care of yourself both physically and emotionally. You give yourself the best chance of having a problem-free pregnancy and a healthy baby if you follow a few simple guidelines:
1. Organise your antenatal care early
Good antenatal care is essential to your baby's health. Choosing your carer early means you'll have months to build a good relationship in preparation for the birth. Even if you are not offered a choice of carer, you may be able to develop a rapport with one particular midwife or obstetrician you have met during the course of your pregnancy care. Find out more about your antenatal care options.
2. Eat well
There's no need to "eat for two" when you're pregnant, nor to drink full-fat milk or supplements marketed as maternal milk. In fact, your energy needs don't change for the first six months of pregnancy, and only increase slightly in the last three months (by around 200 calories a day) (Nice 2010: 12).
However, it is important to eat a well-balanced and healthy diet. Many women go off certain foods, but it's always possible to substitute those with others that provide similar nutritional value.
Make sure that your diet includes plenty of fruit and vegetables (at least five portions a day). Base your meals around carbohydrates such as bread, pasta and rice (preferably wholegrain so you get plenty of fibre) (Nice 2010: 7). Include protein such as fish, meat, eggs, nuts or pulses, and some milk and dairy foods, every day (FSA n.d.). It's important, too, to eat breakfast and to keep an eye on meal portion sizes and snacks between meals (Nice 2010: 7).
However, it is important to eat a well-balanced and healthy diet. Many women go off certain foods, but it's always possible to substitute those with others that provide similar nutritional value.
Make sure that your diet includes plenty of fruit and vegetables (at least five portions a day). Base your meals around carbohydrates such as bread, pasta and rice (preferably wholegrain so you get plenty of fibre) (Nice 2010: 7). Include protein such as fish, meat, eggs, nuts or pulses, and some milk and dairy foods, every day (FSA n.d.). It's important, too, to eat breakfast and to keep an eye on meal portion sizes and snacks between meals (Nice 2010: 7).
3. Be careful about food hygiene
It is better to avoid certain foods in pregnancy because they carry a health risk for your baby.
Salmonella infections may be caused by eating undercooked poultry, and raw or soft-cooked eggs (FSA n.d). (Read more about food hygiene in pregnancy).
Listeria, which can cause miscarriage or severe illness in newborns, can be caused by mould-ripened soft cheeses, such as Brie and Camembert, and blue-veined cheeses, such as Stilton (FSA n.d.). Don't eat these while you're pregnant. Hard cheeses, such as cheddar, and soft-processed cheeses, such as cottage cheese, Philadelphia and Boursin, are safe to eat.
To avoid toxoplasmosis, which is rare, but can seriously affect an unborn baby, it is important to wear gloves when handling cat litter and garden soil, avoid eating undercooked or raw meat, and wash vegetables and salads thoroughly to remove any soil or dirt.
Salmonella infections may be caused by eating undercooked poultry, and raw or soft-cooked eggs (FSA n.d). (Read more about food hygiene in pregnancy).
Listeria, which can cause miscarriage or severe illness in newborns, can be caused by mould-ripened soft cheeses, such as Brie and Camembert, and blue-veined cheeses, such as Stilton (FSA n.d.). Don't eat these while you're pregnant. Hard cheeses, such as cheddar, and soft-processed cheeses, such as cottage cheese, Philadelphia and Boursin, are safe to eat.
To avoid toxoplasmosis, which is rare, but can seriously affect an unborn baby, it is important to wear gloves when handling cat litter and garden soil, avoid eating undercooked or raw meat, and wash vegetables and salads thoroughly to remove any soil or dirt.
4. Take folic acid supplements and eat fish
The only supplement that is considered truly vital is folic acid (also called folate), which can help prevent spina bifida and other neural tube defects in babies.
Spina bifida is a serious congenital condition. It occurs when the tube housing the central nervous system fails to close completely and may give rise to severe disabilities. All women planning a pregnancy are advised to take a daily supplement of 400mcg of folic acid starting around the time of conception through the first three months of pregnancy (DH 2004).
You can also increase your intake of natural folate through your diet. Folate is found in many different foods, particularly vegetables and fortified breakfast cereals. Other nutrients that are important to your health and your baby's are iron and calcium, which can generally be provided by your diet.
Some studies have shown that fish oils, which contain omega-3 fatty acids, may have a beneficial effect on pre-eclampsia, a baby's birth weight and on the development of a baby's brain and nerves in late pregnancy (AHRQ 2005; Makrides et al 2006; Hibbeln et al 2007).
Oily fish contain proteins, minerals, vitamin D and omega-3 fatty acids, which your baby needs as he grows and develops, but it also contains mercury and other pollutants. The current recommendation is to eat oily fish such as herring, mackerel, salmon or sardines no more than twice a week, but you can still eat other types of fish as much as you like (FSA n.d.).
If you don't like fish, fish oil supplements are available (choose a brand free of the retinol form of Vitamin A, which is not recommended in pregnancy).
Spina bifida is a serious congenital condition. It occurs when the tube housing the central nervous system fails to close completely and may give rise to severe disabilities. All women planning a pregnancy are advised to take a daily supplement of 400mcg of folic acid starting around the time of conception through the first three months of pregnancy (DH 2004).
You can also increase your intake of natural folate through your diet. Folate is found in many different foods, particularly vegetables and fortified breakfast cereals. Other nutrients that are important to your health and your baby's are iron and calcium, which can generally be provided by your diet.
Some studies have shown that fish oils, which contain omega-3 fatty acids, may have a beneficial effect on pre-eclampsia, a baby's birth weight and on the development of a baby's brain and nerves in late pregnancy (AHRQ 2005; Makrides et al 2006; Hibbeln et al 2007).
Oily fish contain proteins, minerals, vitamin D and omega-3 fatty acids, which your baby needs as he grows and develops, but it also contains mercury and other pollutants. The current recommendation is to eat oily fish such as herring, mackerel, salmon or sardines no more than twice a week, but you can still eat other types of fish as much as you like (FSA n.d.).
If you don't like fish, fish oil supplements are available (choose a brand free of the retinol form of Vitamin A, which is not recommended in pregnancy).
5. Exercise regularly
A good exercise programme can give you the strength and endurance you'll need to carry the weight you gain during pregnancy and to handle the physical stress of labour. It will also make it much easier to get back into shape after your baby is born.
Exercise can boost your spirits and help ward off depression in pregnancy (NCCMH 2007:105). Experts aren't sure exactly how, (NCCMH 2007:99-100), but there is growing evidence that it has a positive effect on brain chemicals, such as serotonin and dopamine, which help regulate your emotions and mood (Meussen 2005).
If you are used to taking exercise in the form of a sport, you can continue with this as long as it feels comfortable for you, unless your particular sport carries a risk of falls or knocks. More gentle exercise such as walking, swimming, aqua-aerobics, and yoga are also very beneficial. You may also find our animated yoga for pregnancy videos helpful.
Exercise can boost your spirits and help ward off depression in pregnancy (NCCMH 2007:105). Experts aren't sure exactly how, (NCCMH 2007:99-100), but there is growing evidence that it has a positive effect on brain chemicals, such as serotonin and dopamine, which help regulate your emotions and mood (Meussen 2005).
If you are used to taking exercise in the form of a sport, you can continue with this as long as it feels comfortable for you, unless your particular sport carries a risk of falls or knocks. More gentle exercise such as walking, swimming, aqua-aerobics, and yoga are also very beneficial. You may also find our animated yoga for pregnancy videos helpful.
6. Begin doing pelvic floor exercises
It's very common for women who are pregnant or who have had children to experience stress incontinence; when small amounts of urine leak out during activities, including sneezing, laughing and exercise (CKS 2007). You can help prevent this happening by doing pelvic floor exercises, starting before you get pregnant or during pregnancy (CKS n.d. a).
The pelvic floor muscles are the hammock of muscles at the base of your pelvis that support the bladder, vagina and rectum. They can feel weaker than usual in pregnancy because of the extra pressure upon them, and because the hormones of pregnancy cause them to slacken slightly.
Your pelvic floor can be toned and strengthened by a daily exercise pattern. Current recommendations are that you should do pelvic floor exercises three times a day, eight contractions each time (NICE 2006). Read our article on pelvic floor exercises during pregnancy for more information on how to do them properly.
The pelvic floor muscles are the hammock of muscles at the base of your pelvis that support the bladder, vagina and rectum. They can feel weaker than usual in pregnancy because of the extra pressure upon them, and because the hormones of pregnancy cause them to slacken slightly.
Your pelvic floor can be toned and strengthened by a daily exercise pattern. Current recommendations are that you should do pelvic floor exercises three times a day, eight contractions each time (NICE 2006). Read our article on pelvic floor exercises during pregnancy for more information on how to do them properly.
7. Limit your alcohol intake
Since any alcohol you drink rapidly reaches your baby via your blood stream and placenta, you may decide to cut it out completely, or at least to monitor the amount you consume.
In the UK, the Royal College of Physicians, and more recently, the Department of Health, recommend that pregnant women play it safe by steering clear of alcohol (DH 2007). The Royal College of Obstetricians and Gynaecologists and the Food Standards Agency (FSA) recommend, if you do decide to drink, a limit of one or two units of alcohol, no more than once or twice per week, and not to get drunk (RCOG 2006 a & b; FSA n.d.).
Women who drink heavily (over six units a day) on a regular basis during pregnancy are known to be at greater risk of giving birth to a baby with fetal alcohol spectrum disorders (FASD), which describes problems ranging from learning difficulties to more serious birth defects (BMA 2007:6).
In the UK, the Royal College of Physicians, and more recently, the Department of Health, recommend that pregnant women play it safe by steering clear of alcohol (DH 2007). The Royal College of Obstetricians and Gynaecologists and the Food Standards Agency (FSA) recommend, if you do decide to drink, a limit of one or two units of alcohol, no more than once or twice per week, and not to get drunk (RCOG 2006 a & b; FSA n.d.).
Women who drink heavily (over six units a day) on a regular basis during pregnancy are known to be at greater risk of giving birth to a baby with fetal alcohol spectrum disorders (FASD), which describes problems ranging from learning difficulties to more serious birth defects (BMA 2007:6).
8. Cut back on caffeine
Coffee, tea and cola-style beverages are mild stimulants, and although the research evidence is not clear, some researchers feel that too much caffeine may contribute to a risk of having a low birth weight baby, or increase your risk of miscarriage (FSA n.d; Weng et al 2008).
The current advice suggests that up to two mugs of coffee (equivalent to four cups of tea or five cans of cola) a day won't hurt your baby (FSA n.d.), although one study suggests that even low levels of caffeine can increase your risk of miscarriage (Weng et al 2007).
As with alcohol, it's best to err on the side of caution and you may prefer to cut down on caffeine significantly, or switch to decaffeinated coffee, tea, or fruit juices, instead, particularly in the first trimester. A refreshing alternative is a glass of water with a twist of lime or lemon.
The current advice suggests that up to two mugs of coffee (equivalent to four cups of tea or five cans of cola) a day won't hurt your baby (FSA n.d.), although one study suggests that even low levels of caffeine can increase your risk of miscarriage (Weng et al 2007).
As with alcohol, it's best to err on the side of caution and you may prefer to cut down on caffeine significantly, or switch to decaffeinated coffee, tea, or fruit juices, instead, particularly in the first trimester. A refreshing alternative is a glass of water with a twist of lime or lemon.
9. Stop smoking
Women who smoke increase their risk of miscarriage, premature delivery, stillbirth, and cot death (NCCWCH 2003:46-47).
Smoking in the first trimester also slightly increases the risk of having a baby with a cleft lip or palate (Wyszynski et al 1997).
While it is best to give up smoking before you even try to conceive, any reduction in the number of cigarettes you smoke per day will give your baby a better chance (NCCWCH 2003:47). (Read more advice on how to quit smoking in pregnancy.)
Smoking in the first trimester also slightly increases the risk of having a baby with a cleft lip or palate (Wyszynski et al 1997).
While it is best to give up smoking before you even try to conceive, any reduction in the number of cigarettes you smoke per day will give your baby a better chance (NCCWCH 2003:47). (Read more advice on how to quit smoking in pregnancy.)
10. Get some rest
The fatigue you feel in the first and third trimesters is your body's way of saying "slow down". A nap in the middle of the day may seem like a luxury you can't afford, but you and your baby will both benefit. If you can't sleep, at least put your feet up and relax for 30 minutes or more, in whatever way suits you best.
If backache is disturbing your sleep, try massage (tell the therapist you are pregnant or look for a bidan experienced in helping pregnant women), aquanatal classes, or exercise classes specifically for back care (NCCWCH 2003: 59-60). Exercise and relaxation can also help with sleep problems related to stress (CKS n.d.). Try relaxation techniques, which are safe in pregnancy, including yoga, stretching and deep breathing. Always tell the teacher of any exercise or relaxation class that you attend that you're pregnant or choose classes tailored for pregnant women.
If backache is disturbing your sleep, try massage (tell the therapist you are pregnant or look for a bidan experienced in helping pregnant women), aquanatal classes, or exercise classes specifically for back care (NCCWCH 2003: 59-60). Exercise and relaxation can also help with sleep problems related to stress (CKS n.d.). Try relaxation techniques, which are safe in pregnancy, including yoga, stretching and deep breathing. Always tell the teacher of any exercise or relaxation class that you attend that you're pregnant or choose classes tailored for pregnant women.
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