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The Time Is Now

10 Tips to Keep Healthy During Your Pregnancy
By Jennifer Lacey

Pregnancy takes every mother-to-be on an emotional and physical journey filled with ups and downs, so it is of the utmost importance to stay healthy. Here are a few tips to stay on the road to a healthy delivery.

Nine Months of Healthy Eating
Pregnancy is not an excuse to overeat. According to the March of Dimes, an expectant woman needs only 300 extra calories per day in order to support her unborn baby's growth and development.

"A well-balanced diet and a daily prenatal vitamin are usually sufficient to supply the extra nutrients required for pregnancy," says Dr. Marguerite Lisa Bartholomew, maternal-fetal medicine specialist at Cedars Sinai Medical Center in Los Angeles, Calif. "The Food and Drug Administration (FDA) recommends between 6 and 11 servings of complex carbohydrates (bread, non sugar cereal, pasta); three to five servings of vegetables; two to four servings of fruit; three servings of dairy; and two to three servings of proteins per day. Fats, oils and sugars should be used sparingly."

Sensible Weight Gain
Dr. Marjorie Greenfield, associate professor of obstetrics and gynecology at University Hospitals of Cleveland and Case School of Medicine, director of obstetrics and gynecology for the Dr. Spock Company and author of Dr. Spock's Pregnancy Guide (Pocket, 2003), says that the, "ideal weight gain is 25 to 35 pounds during the pregnancy, with 7 to 10 pounds in the first half of the pregnancy, and a half pound a week after that. Many women tend to gain more than that, and women who start off their pregnancy being overweight can probably gain slightly less and still do well."

One of the biggest obstacles that a pregnant woman faces with an excess amount of weight gain is risk for serious medical conditions. "Excess weight gain can lead to excessively large babies, with some increase in the risk of complications of childbirth," says Dr. Greenfield, who adds that a mom-to-be may also experience a struggle in losing the weight after she has given birth.

Time to Take Your Vitamins
Right now, you are growing a baby, and you need to take in the right kinds of nutrients, vitamins and minerals to assist in keeping you and your little one healthy. The March of Dimes and the United States Public Health Service both recommend that a pregnant woman consume approximately 400 micrograms of folic acid every day prior to and during their pregnancy.

Folic acid supplements have been shown to significantly decrease the incidence of neural tube defects (such as spina bifida). Some examples of natural sources of folic acid include orange juice, peas and green leafy vegetables.

"Folic acid is a water-soluble vitamin and does not build up in tissues or cause birth defects in high doses like vitamin A," says Dr. Bartholomew. She also says women should learn that folic acid must, "be in the woman's system prior to, at conception and during the first three to four weeks of gestation."

Time to Break the Caffeine Addiction
Caffeinated beverages traditionally offer no nutritional value to anyone, especially a mom-to-be. Caffeine contains a stimulant that can increase heart rate and metabolism, which may cause stress to a developing baby.

"Ideally, a mom should try to decaffeinate before she gets pregnant, since many caffeine drinkers get withdrawal headaches if they stop cold turkey," says Dr. Greenfield. She suggests it may be "best to avoid caffeine in the first trimester and to use it sparingly after that."

Dr. Bartholomew agrees, saying that moderation is the key. "A woman does not have to give up her morning coffee during pregnancy," she says. “One or two cups of coffee per day does not pose a problem during pregnancy. The recommendation is to limit caffeine intake to less than 300 milligrams a day."

Up Your Water Intake
Most expectant women need approximately eight 8-ounce glasses of fluid per day during the course of their pregnancy. "We do our best to encourage that pregnant women try to meet that recommendation for many reasons, since dehydration can cause water retention, pre-term contractions, constipation, headaches, irritability and urinary tract infections," says Dr. Bartholomew.

Drinking water may also ease constipation in many pregnant women. "Hydration is important in softening the stool, which eases constipation," says Dr. Ashi Daftary, assistant professor of obstetrics and gynecology at the University of Pittsburgh Medical Center in Pennsylvania.

Make Sure You Get Your Flu Shot
Most prenatal care specialists will recommend that a woman should have all of her vaccinations up-to-date prior to conception.

"Live or live attenuated vaccines are usually avoided in pregnancy because of a theoretical risk of transmitting the virus to the fetus," says Dr. Bartholomew.

Unfortunately, an expectant woman cannot always avoid becoming sick at least once during her pregnancy. "Pregnant women have slightly impaired immune systems, and this makes them more susceptible to getting very sick if they get infected with a cold," says Dr. Greenfield. “It is always an issue about how to treat symptoms of a cold or flu, since we don't like to have pregnant women exposing their babies to a lot of medications. Non-medical treatments like using a vaporizer are preferred whenever possible."

The American College of Obstetrics and Gynecologists (ACOG) recommends that all pregnant women receive a flu vaccination after they have completed their first trimester if they are going to be pregnant during the flu season (which runs from October to March).

"Pregnant women who get the flu have an increased risk of developing serious complications," warns Dr. Bartholomew, who says that the vaccine is, "inactivated and is considered safe for both pregnant women and their fetuses." However, since the influenza vaccination contains components of eggs, Dr. Bartholomew also says that "women with egg allergies should not receive the flu shot because of cross reactivity with components of the vaccine."

Get Up and Start Moving
Unless a mother-to-be has specific medical conditions or reasons that advise against it, she should try to exercise moderately during pregnancy. In January 2003, the ACOG released new guidelines that, barring any preexisting medical conditions or concerns, pregnant women should try to exercise moderately for at least 30 minutes on most, if not all, days.

"Although the best time to begin an exercise program is before pregnancy, moderate exercise during pregnancy is important," says Dr. Bartholomew. Not only can exercise help relieve stress, it also can assist in building up the strength and stamina that an expectant mom needs for delivery. According to the March of Dimes, there has been evidence that suggests exercise may help to prevent a diagnosis of gestational diabetes (a form of diabetes that can develop during pregnancy).

Be cautious of the type of exercise routine that you choose to implement. Pregnant women should avoid activities such as horseback riding, skiing, ice hockey, kickboxing and/or soccer.

Always be on the lookout for telltale signs that suggest that you may be overdoing it. "Notify your physician if you experience any type of injury, vaginal bleeding or leaking, shortness of breath, dizziness, chest pain, muscle weakness and regular contractions during exercise or at any time," says Dr. Bartholomew.

Keep Up With Your Self Breast Exams
Self-breast exams are recommended monthly by most specialists for all women. Self breast exams are usually best performed right after your monthly period has ended. However, in the case of women who are pregnant, it can be more confusing.

"Due to the rapid changes in the tissue during pregnancy, it can be more confusing and uncomfortable," says Dr. Bartholomew, who recommends that pregnant women notify their provider about any findings that may be of a concern. "Breast discharge can be normal during pregnancy, but you should always be evaluated by a care provider. A breast exam is usually performed by your care provider during the first prenatal visit and may be repeated at your postpartum visit. Mammograms, breast ultrasound, MRI and breast biopsy can be safely performed in pregnancy, if needed."

Be an Active Participant in Your Care
It is vital that an expectant mom find the right kind of health care provider that will make her feel comfortable and will listen to her concerns during this special time in her life. "The importance of getting involved in your own pregnancy cannot be stressed enough," says Dr. Bartholomew. Every expectant mom-to-be, "owes it to herself to be her own advocate," she says. “Be honest about your history, learn the names of your medications and ask questions if you don't understand something."

Most specialists concur that they, too, want to make sure that you are an informed and satisfied patient during these precious months of your pregnancy. "I appreciate a patient with an interest in her health and who kindly tells me what is on her mind, even if she is unhappy with what is going on," says Dr. Bartholomew. “Doctors are people, too, and we want you to be informed. You must have a sense of trust in your physician and be comfortable with the care plan."

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