Pregnancy Dos and Don'ts

Pregnancy can be a scary time for many women. The advice changes frequently, and whilst well-meaning, the advice given by women of older generations might not be thought of as current practice today. It is therefore imperative that women know what current guidelines and research recommends they do or do not do throughout pregnancy

Pre-pregnancy

Before a woman becomes pregnant, she should ensure she and her body are well prepared to cope with the changes she will experience over the next nine months. However, over half the babies born in the UK are not planned pregnancies and therefore women may not have prepared their body for the demands of pregnancy. Folic acid is an important B vitamin which can significantly reduce the risk of a woman having a baby with a neural tube defect, such as spina bifida. Ideally, women should start taking 400mcg per day at least twelve weeks before she plans to become pregnant, and until she is twelve weeks pregnant. The neural tube develops very early in pregnancy. Some women (such as diabetics, epileptics who those who have a family history of neural tube defects) may require higher doses of folic acid, which need to be obtained on prescription. Folic acid, at 400mcg, is available over the counter. Women should also ensure that they are as healthy as possible before they become pregnant.

Weight is an important issue, with women at either end of the spectrum at increased risk of pregnancy complications. Whilst this does not mean women who are underweight or who are obese will have these pregnancy complications, it does increase the risk that they will happen. These complications include pre-term labour, intra-uterine growth restriction (a baby which hasn't grown well and is much smaller than it should be - this increases the risk of stillbirth and complications for the baby following delivery), microsomal baby (a baby much larger than it should be), maternal health complications, such as gestation hypertension (raised blood pressure not associated with the other symptoms of pre-eclampsia, pre-eclampsia and gestational hypertension, and stillbirth.

Women should also give up smoking in the pre-conception period. smoking throughout pregnancy increases the risk of intra-uterine growth restriction, pre-term labour and stillbirth.

Pregnancy
No specific additional calories are required until the third trimester, and even then, it is only an additional 200 calories per day which are required. Dietary advice has changed considerably over the last generation. It also varies widely throughout the world, often with advice from the USA different to over here in the UK. This advice is based on UK recommendations. Once encouraged, liver is now something women are advised to avoid due to the high levels of Vitamin A found within it. The quantity of Vitamin A varies widely within liver, and the safe level of Vitamin A consumption during pregnancy has been greatly debated. The safety of consuming liver during pregnancy is, therefore, not known. All other meat should be thoroughly cooked to prevent infection with toxoplasmosis. Pre-packed meat, such as ham, is considered safe to eat in the UK.

Eggs are something pregnant women worry about. In the UK, women should buy eggs which display the Lion mark. To avoid the risk of salmonella, eggs should be well cooked, and homemade products which use raw eggs should be avoided. Factory produced products which contain raw eggs, such as mayonnaise, are pasteurised. If they are pasteurised, they are safe to eat.

Consuming certain cheese can cause an infection called listeriosis, which can be fatal to an unborn baby. Soft cheeses with white rinds and mouldy cheeses should only be eaten if they have been thoroughly cooked. All other cheese are safe to eat. Likewise, pasteurised milk, or boiled unpasteurised cow's milk is safe to consume. Yogurts and ice cream are also safe, including soft ice cream which has been pasteurised.

Certain types of fish are high in mercury, which can be damaging to an unborn baby. Fresh tuna should be limited to two portions per week or a maximum of four medium sized tins of tuna. Shark, marlin and swordfish are also high in mercury and should be avoided. Up to two portions of oily fish (and fresh tuna counts as oily fish) may be eaten per week. Smoked fish, such as smoked salmon, is considered safe to eat, and sushi may be eaten providing it has been frozen. Shellfish should be thoroughly cooked prior to eating.

Unless the woman has an allergy to peanuts, peanuts are safe to eat in pregnancy. Pate of all kinds, including vegetarian pate, should be avoided. Food hygiene is important during pregnancy. Fruit and vegetables should be washed thoroughly, and all soil removed to reduced the risk of toxoplasmosis.

No safe limit for alcohol consumption on pregnancy has been established. Therefore, the current advice is to avoid alcohol completely. One to two units once or twice a week are possibly safe although there is no conclusive research, and it is therefore best to avoid it.

Caffeine may be consumed up to 200mg per day. Whilst coffee provides high sources of caffeine, it is also present in tea, coke and chocolate.

Smoking has been linked to a number of complications of pregnancy, including preterm labour, low birth weight and an increased risk of stillbirth. Women should be offered the option of a referral to smoking cessation services, and, if needed, certain nicotine replacement therapies can be used, and are available on prescription.

Exercise during pregnancy should be encouraged. Women should continue their normal exercise regime as long as they want to and feel comfortable doing so. However, they need to be aware of changes to their body which could affect balance and the risk of injuries. They should not try and reach peak fitness levels during pregnancy. There is some research which suggests that babies of mums who exercise during pregnancy are better able to cope with labour. Pelvic floor exercises should be commenced and continued during pregnancy. The pelvic floor cannot be too tough, and a strong pelvic floor will help with labour and will recover better after labour.

Perineal massage can also be beneficial. This involves using sweet almond oil and gently massing and stretching the perineum (the area between the vagina and anus). This will reduce the risk of tears during labour. It can be quite uncomfortable at first, but many women find it more acceptable than a tear or an episiotomy (cut).

During pregnancy, sex is generally safe, although at the end of pregnancy, it may cause Brakton Hick's (false contractions). However, some women may be advised to avoid sex, including women who have had heavy bleeding during pregnancy and women whose membranes (waters) have gone. Women's sex drive may change during pregnancy, or they might wish to try new positions.

Flying is safe, but may require a doctor or midwife's note in the final trimester. Remember, however, that women are at increased risk of DVTs and PEs (blood clots) when pregnant anyway, and flying, due to the enforced period of reduced mobility, further increases the risk. Women should keep hydrated and mobilise as much as possible. Women should check with the airline before booking a flight, particularly in the third trimester, as different airlines have different rules concerning the latest gestation they will allow women to fly and from what gestation they require a doctor or midwife's note.

Pregnant or newly delivered livestock can carry infections, particularly sheep. These infections include chlamydiosis, Q fever, toxoplasmosis and listeriosis. These all may cause infection in the mother and miscarriage or stillbirth of the baby. Women are therefore advised to avoid lambing, calving or kidding and to not have any contact with aborted lambs. Clothing should be washed separately to normal clothing. A primary infection with toxoplasmosis during pregnancy, or immediately before, can have an impact on the pregnancy and the baby. Cats are one source of toxoplasmosis, and so women are advised to avoid changing cat litter, or should wear gloves when doing so. Women should also wear gloves when gardening during pregnancy due to the risk of the soil having been contaminated with cat faeces. Tests are available for most infections to confirm whether the woman has already been infected. However, these are not routinely offered to women in the UK. Women in high risk groups, such as those who keep sheep, may wish to discuss the possibility of screening early in pregnancy with their midwife.

Whilst pregnancy may appear to come with a long list of dos and don'ts, and it can at first appear a little overwhelming with conflicting advice coming from all directions, women should talk to their midwife or doctor if they have any concerns. There will usually be information available in their handheld records. Advice should be obtained from reputable sources, such as the NHS website to ensure the advice is current, up-to-date and evidence based.