Pregnancy Information: Do's and Don'ts

Even with all the joy and anticipation pregnancy can bring, it is not uncommon for a mother-to-be to have some questions and concerns -- not only about changes to expect throughout her pregnancy, but also concerns regarding the care of her body to ensure the health of her unborn child.

Listed below, you will find some additional information that covers not only how to care for your body while you are pregnant, but also some of the changes your body will go through in preparation of labor and delivery, for which we have provided a brief overview.

Do: Ask your healthcare provider about the role of hormones during pregnancy

Many hormone levels are affected in the body during pregnancy, with several hormones playing major roles during pregnancy, such as:

• Human chorionic gonadotropin hormone (hCG). Only produced during pregnancy—first by the ovaries and later by the placenta — HCG hormone levels found in maternal plasma and urine increase dramatically during the first trimester and may contribute to nausea and vomiting often associated with pregnancy.
• Human placental lactogen (hPL). This hormone, produced by the placenta, ensures proper fetal development and plays a role in stimulating milk glands in the breasts in anticipation of breastfeeding.
• Estrogen. Responsible for the development of the female sexual characteristics, this group of hormones is normally formed in the ovaries, and is also produced by the placenta during pregnancy to help maintain a healthy pregnancy.
• Progesterone. This hormone is produced by the ovaries and by the placenta during pregnancy, and stimulates the thickening of the uterine lining in anticipation of implantation of a fertilized egg.

Do: Plan for weight gain

Weight gain during pregnancy varies from woman to woman and depends on body type. Each woman should talk with her care provider about the appropriate amount of weight gain, as well as diet and exercise.

2009 Recommendations for Pregnancy Weight Gain by BMI (Body Mass Index) from the Institute of Medicine

Total weight gain at the end of pregnancy is, in most instances, approximated as follows, according to the March of Dimes:

Do: Maintain a balanced diet

According to the FDA, about 300 extra calories are needed daily to maintain a healthy pregnancy. These calories should come from a balanced diet of protein, fruits, vegetables, and whole grains, with sweets and fats kept to a minimum. A healthy, well-balanced diet during pregnancy can also help to minimize some pregnancy symptoms such as nausea and constipation.

The American Dietetic Association recommends the following key components of a healthy lifestyle during pregnancy: appropriate weight gain, consumption of a variety of foods in accordance with the new USDA guidelines at ChooseMyPlate.gov, and appropriate and timely vitamin and mineral supplementation.

Fluid intake is also an important part of healthy pregnancy nutrition. Women can take in enough fluids by drinking 6 to 8 glasses of water each day, in addition to the fluids in juices and soups. An expectant mother should talk with her healthcare provider or midwife about restricting her intake of caffeine and artificial sweeteners. All alcohol should be avoided in pregnancy.

Do: Talk to your healthcare provider about the importance of folic acid

The U.S. Public Health Service recommends that all women of childbearing age consume 400 micrograms (0.4 mg) of folic acid each day. Folic acid is a nutrient found in foods such as: 

• green leafy vegetables
• most berries
• nuts
• beans
• citrus fruits
• fortified breakfast cereals

Folic acid supplementation can help reduce the risk for neural tube defects - a type of birth defect affecting the brain and spinal cord. The most common neural tube defect is spina bifida, in which the vertebrae do not fuse together properly, causing the spinal cord to be exposed. This can lead to varying degrees of paralysis, incontinence, and intellectual disability.

Folic acid is most beneficial during the first 28 days after conception, when most neural tube defects form. Unfortunately, many women do not realize they are pregnant before 28 days. Therefore, folic acid intake should begin prior to conception and continue through pregnancy. Your healthcare provider or midwife will recommend the appropriate amount of folic acid to meet your individual needs.

Most healthcare providers or midwives will prescribe a prenatal supplement before conception, or shortly afterward, to ensure all of the woman's nutritional needs are met. However, a prenatal supplement does not replace a healthy diet.

Do: Exercise during pregnancy

Regular exercise during pregnancy, with the approval of your physician or midwife, can often help to minimize the daily physical discomforts and help with the recovery after the baby is born. There is evidence that physical activity may be especially beneficial for women with gestational diabetes. According to the American College of Obstetricians and Gynecologists, women who exercised and were physically fit before pregnancy can safely continue exercising throughout the pregnancy. Women who were inactive before pregnancy or who have medical or pregnancy complications should consult with their physician or midwife before beginning any exercise during pregnancy.

All women should be evaluated by their physician or midwife before beginning or continuing an exercise program while pregnant.

Exercise for pregnant women may not be safe if they have any of the following conditions:

• Preterm labor in current or past pregnancies
• Vaginal bleeding
• Cervical problems
• Leaking of amniotic fluid
• Shortness of breath
• Dizziness and/or fainting
• Decreased fetal activity or other complications
• Increased heart rate (tachycardia)
• Certain health problems, such as high blood pressure or heart disease

Types of exercise to avoid during pregnancy:

• Horseback riding
• Water skiing
• Scuba diving
• High altitude skiing
• Contact sports
• Any exercise that can cause a serious fall
• Exercising on your back after the first trimester (because of reduced blood flow to the uterus)
• Vigorous exercise in hot, humid weather, as pregnant women are less efficient at exchanging heat
• Exercise involving the Valsalva maneuver (holding one's breath during exertion), which can increase intra-abdominal pressure on the uterus

Don't: Expose yourself to unnecessary risks if you work during your pregnancy

Many women work during pregnancy without any complications. Being able to work safely, in some cases, until the day of delivery depends on the type of work performed and the mother-to-be's medical condition. However, the workplace can pose certain risks, depending upon the occupation. Knowing what these risks are and minimizing them will help increase the likelihood of a healthy pregnancy. Be sure to discuss the following job risks with your healthcare provider at your first prenatal visit:

• Exposure to metals such as mercury and lead can lead to birth defects, miscarriage, and other problems.
• Exposure to solvents such as household cleaning agents and pesticides can lead to fetal deformity and other problems.
• Exposure to pharmaceutical agents, such as chemotherapy may increase the rate of miscarriage, low birth weight, and malformations.
• Exposure to infections on the job, such as hepatitis, rubella, and other diseases can cause multiple problems during pregnancy.
• Exposure to physical agents such as radiation and radioactive waste can lead to abnormal fetal development, miscarriage, and other problems.
• Exposure to extreme heat on the job early in pregnancy may increase neural tube defects in the fetus.
• Physical job demands, such as prolonged standing or walking, heavy lifting, working varying shifts, and job stress can adversely affect a pregnancy.

Taking proper precautions to avoid these risks on the job can help keep you and your baby healthy throughout the pregnancy.

The American Medical Association recommends the following for working pregnant women:

• Take a break every few hours
• Take a longer meal break every four hours
• Drink plenty of fluids while on the job
• Vary work positions continuously, from sitting to standing and walking
• Minimize heavy lifting and bending

Proper lifting techniques during pregnancy

Weight gain during pregnancy adds strain to the back. Proper lifting can help reduce the strain and prevent injury. When lifting, a pregnant woman should keep in mind the following recommendations:

• Stand with feet shoulder-width apart
• Tuck in the buttocks
• Bend at the knees
• Lift with the arms and legs, not the back
• Limit the amount and weight of the items lifted

Computer use in pregnancy

Today, many occupations involve the use of a computer. Computers have also been associated with many complaints, such as neck, wrist, hand, shoulder, and back pain from prolonged sitting in the same position and eyestrain. To alleviate these symptoms, the following may help:

• Take frequent work breaks
• Use detachable keyboards and adjustable chairs and tables
• Use non-reflective glass on the screen, adjust the screen lighting and contrast, and install indirect lighting

Do: Discuss sex during pregnancy with your healthcare provider

In most cases, sex during pregnancy is safe. In fact, with your healthcare provider's approval, sexual relations can continue until delivery.

However, fluctuating hormone levels and certain pregnancy symptoms such as nausea and tiredness can temporarily reduce a pregnant woman's libido (sex drive). In addition, visible changes in the woman's body may affect sexual desire. Always consult your healthcare provider concerning any questions you may have about sex during pregnancy.

Sexual intercourse may have to be avoided if the following symptoms occur:

• Vaginal bleeding
• Pain
• Leaking of amniotic fluid (the fluid surrounding your baby in the womb)
• Contractions

Do: Discuss the best sleeping positions with your healthcare provider

As the fetus grows within the uterus, lying on your back is not recommended due to pressure on the inferior vena cava, a major vein that returns blood from the lower body to the heart. In addition, the increased pressure on the back and intestines can cause discomfort. Sleeping on the stomach during pregnancy also should be avoided, because of pressure on the fetus.

The best sleeping position for a pregnant woman is on her side, especially the left side, because it allows for maximum blood flow to the fetus and improves kidney function in the mother. Improved kidney flow helps to reduce any swelling. Placing a pillow between the knees can help a pregnant woman sleep more comfortably on her side.