Self-Care During Pregnancy

To provide nutrition for the fetus, the average number of additional calories pregnant women should consume (for women who begin pregnancy with a body mass index (BMI) in the normal range) varies by trimester:

• First trimester (no additional calories)

• Second trimester (approximately 340 kcal extra daily)

• Third trimester (approximately 450 kcal extra daily)

The diet should be well-balanced and include fresh fruits, grains, and vegetables (see Eat Healthy During Pregnancy: Quick Tips). Foods that are high in fiber are a good choice. Fish contains nutrients that are important for the growth and development of the fetus. However, pregnant women should choose fish that is low in mercury. See Mercury in Seafood for more information.

Doctors recommend that pregnant women take a prenatal multivitamin containing iron and folate daily, even if their diet is adequate.

Pregnancy doubles the amount of iron needed. Most prenatal vitamins contain the recommended daily allowance of ferrous iron during pregnancy. If a woman has anemia or develops anemia during pregnancy, she may need to take a larger dose of iron than other pregnant women. Iron supplements may cause mild stomach upset and constipation.

For prevention, all pregnant women and women who are planning to or may become pregnant should take a supplement that contains 400 to 800 micrograms of folateneural tube defect), such as spina bifida. Women who have had a baby with a neural tube defect should take 4,000 micrograms of folate, starting 3 months before conception and continuing through 12 weeks of pregnancy—a much larger amount than usually recommended.

Pregnant women should handle food safely, avoid undercooked meat or fish, and avoid certain seafood with high mercury levels. They should also avoid foods with a high risk of contamination by Listeria, including

• Raw or rare fish, shellfish, meat, poultry, or eggs

• Unpasteurized juice, milk, or cheese

• Lunch or deli meats, smoked seafood, and hot dogs (unless heated to a steaming hot temperature)

• Prepared meat or seafood salads like ham salad, chicken salad, or tuna salad

• Raw sprouts, including alfalfa, clover, radish, and mung bean sprouts

How much weight a woman should gain during pregnancy depends on her body mass index (BMI) before pregnancy. BMI is weight in kilograms divided by height in meters squared and is used to determine whether weight for height is normal. Women with a high BMI should gain less weight during pregnancy than those with a BMI classified as normal or underweight. A woman of average size should gain about 25 to 35 pounds (about 11.5 to 16 kilograms) during pregnancy.

Dieting to lose weight during pregnancy is not recommended, even for women with obesity, because some weight gain is essential for the fetus to develop normally. Dieting reduces the supply of nutrients to the fetus.

Exercise during pregnancy has minimal risks and has demonstrated benefits for most pregnant women, including maintenance or improvement of physical fitness, control of weight gain during pregnancy, reduction in low back pain, and possibly a reduction in risk of developing gestational diabetes or preeclampsia. Most women can continue their usual activities and exercises throughout pregnancy. Mildly strenuous sports, such as swimming and brisk walking, are good choices. Vigorous activities, such as running and horseback riding, are also possible if done cautiously, to avoid injury, particularly to the abdomen. Contact sports should be avoided.

Sexual activity is safe throughout pregnancy unless a woman has vaginal bleeding, pelvic or vaginal pain, leakage of amniotic fluid, or uterine contractions. In such cases, sexual activity should be avoided.

Generally, avoiding medications during pregnancy is best. However, sometimes medications must be used. A pregnant woman should check with her doctor before taking any medication—including nonprescription (over-the-counter) medications, such as aspirin, or medicinal herbs—particularly during the first 3 months. Women who are taking medications for a health condition (such as diabetes or high blood pressure) and who are planning to become pregnant should talk with their doctor about whether medications are safe to continue or whether changes are needed.

Pregnant women should not use alcohol, tobacco (and should avoid exposure to secondhand smoke), cannabis, or illicit drugs. Consuming caffeine in small amounts (such as 1 cup of coffee a day) appears to pose little or no risk to the fetus. Women with substance use disorders should seek care with a multidisciplinary team, including an obstetrician, addiction specialist, and pediatrician.

Pregnant women should also avoid the following:

• Direct handling of cat litter (due to risk of toxoplasmosis, an infection that can damage the fetus’s brain)

• Being exposed to hot temperatures for a long time (for example, in a hot tub or sauna)

• Having contact with people who have rubella (German measles) or other infections that can cause birth defects

• Having contact with people who have chickenpox or shingles; during delivery, these viruses can be spread to the fetus and cause severe illness

• Being exposed to toxic chemicals or paint fumes

Exposure to toxic environmental agents during pregnancy may be associated with infertility, miscarriage, preterm birth, low birth weight, neurodevelopmental delay, and childhood cancer. The severity of the risk depends on the toxin and extent of the exposure. Pregnant women should avoid or minimize exposure to specific agents, such as lead, pesticides, solvents, and phthalates. Personal care products used during pregnancy should have no phthalates, parabens, oxybenzone, or triclosan. Cosmetic and personal care products labeled "fragrance-free" are less likely to contain toxins than those labeled "unscented."

During pregnancy, women who are planning to breastfeed and have not breastfed before should prepare by reading about breastfeeding or taking a class. Talking with women who have breastfed successfully may also be instructive and encouraging.

Travel Health Myths

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Women can obtain useful tips and information about travel from their doctor, so discussing their travel plans with the doctor is a good idea (see also Pregnancy and Travel).

When traveling in a car, airplane, or other vehicle, pregnant women should always wear a seat belt. Placing the lap belt across the hips and under the expanding abdomen and placing the shoulder belt between the breasts can help make wearing seat belts more comfortable. The belts should be snug but not uncomfortably tight.

During any kind of travel, pregnant women should stretch and straighten their legs and ankles periodically. They should get up and walk around occasionally, if possible. Travel on airplanes is allowed by most airlines until about 37 weeks of pregnancy. The primary reason for this restriction at 37 weeks is the risk of labor and delivery in an unfamiliar environment.

Pregnant women should have regular prenatal care visits with a health care professional focused on recognizing and preventing problems that can complicate pregnancy. For example, pregnant women are screened for many disorders, including

• High blood pressure

• Preeclampsia

• Diabetes

• Sexually transmitted infections

• Urinary tract infection

• Genetic mutations that could result in birth defects

• Chromosomal abnormalities in the fetus

• Rh(D) blood incompatibility (which can cause hemolytic disease of the newborn)

• Placental and fetal abnormalities (using blood tests, ultrasound, or other testing)

(See also Medical Care During Pregnancy.)