The Medical Minute: Healthy pregnancy

July 29, 2004

By John Messmer
Penn State Hershey Medical Center

What comes to mind when you think about starting a family? Where to put the nursery? Financial issues, such as, will mom keep her job? Saving for college? What to name the baby? How about the amount of folic acid you'll need?

Chances are you won't make many plans until after a pregnancy is confirmed. According to current medical research, you and your baby would do better to think about your pregnancy before it happens. By the time you realize you're pregnant, you have passed a risky time in your baby's life when damage can occur.

An adequate supply of folic acid significantly reduces the risk of malformations of the brain and spinal cord, so-called neural tube defects such as spina bifida and anencephaly. Spina bifida is a failure of the lower spine to close resulting in significant nerve deficits. Anencephaly is failure of development of the brain. All women of child bearing years should get enough folic acid in case they should become pregnant. Folic acid or folate is found in enriched grains, orange juice, legumes, green leafy vegetables, nuts, broccoli and peas. The addition of at least another 400 micrograms (0.4 mg) daily as a supplement assures enough folic acid for a reduced risk for your baby. Some authorities are recommending at least one mg total daily - an amount easily obtained from the food listed above plus a multivitamin supplement.

Your body will deliver oxygen and nutrients to the baby for nine months, so don't compromise it by smoking. Smoking is bad enough for you, but it sends nicotine, one of nature's most toxic chemicals, directly to the baby and cuts down on the blood supply of the baby, increasing the risk of small size and susceptibility to health problems after birth.

Pregnancy is physically challenging. The third trimester can be physically stressful, but labor is as challenging as its name suggests. Regular exercise before conception and continued throughout pregnancy puts you in a better position to handle the physical demands of pregnancy and the challenges of caring for a newborn.

If you are significantly overweight, start before pregnancy to lose some or all of the excess pounds. Extra weight increases your chance of being diabetic before pregnancy or developing gestational (pregnancy related) diabetes. Diabetics have an increased risk of birth defects, but you may not be aware of the risk to your baby until the pregnancy is further along and the defects have occurred. Losing weight before pregnancy lowers the risk.

Pregnancy itself is not an excuse to overeat. Contrary to popular belief, you are not eating for two. In fact, in 2002 the Institute of Medicine recommended women not increase their food intake in the first trimester. By the time of delivery, a normal weight woman should have gained about 30 lbs; an overweight woman, about 20 lbs.

A variety of foods are important for proper nutrition before and during pregnancy. One exception is certain fish - tilefish, king mackerel, shark, bluefish, croaker, swordfish and salmon - may have too much mercury for the safety of a developing baby and should be avoided prior to and during pregnancy. Other fish - albacore tuna, blue fin and yellow fin tuna, lobster, mussels, grouper and oysters should be consumed no more than once a week. Go to http://www.environmentaldefense.org/seafood/fishhome.cfm for more details. Soft, unpasteurized cheeses, deli meats and uncooked hot dogs can contain Listeria bacteria and uncooked seafood can carry hepatitis and other organisms which can infect a fetus.

Toxoplasmosis is a serious infection in pregnancy that can be contracted from cat litter or the soil. Avoid handling cat litter or use disposable gloves and clean hands thoroughly after gardening or handling a cat.

If you drink alcohol and are planning a pregnancy, consider stopping altogether. The safe level of alcohol is not known and it may be that no level except zero is safe. When alcohol is absorbed, it first passes through the liver where it is detoxified. If you could consume the alcohol slowly enough that your liver detoxified it before it could get into your bloodstream, it would theoretically be safe. The complicating factor is women metabolize alcohol more slowly than men and people vary in their innate genetic ability to metabolize alcohol, so in general, women who are or could become pregnant should avoid alcohol altogether.

Generally, over the counter medications are safe although aspirin, ibuprofen (Advil and others) or naproxen (Aleve) should be avoided unless recommended by your doctor. Acetaminophen (Tylenol) is considered safe in normal doses. Some prescription medications should be avoided in pregnancy, but each situation varies. If you are planning a pregnancy and take prescription medications, ask your doctor if any precautions should be taken or if substitutes should be used. Medications for seizures, anticoagulants, some blood pressure medications (ACE inhibitors), cancer drugs, some drugs for metabolic problems, some mental-health medications, oral acne medications and some antibiotics are among those medications which must be avoided or used with caution in pregnancy depending on individual circumstances. Never stop these medications without a physician's guidance as the medical problems being treated can also be harmful to a pregnancy if uncontrolled. Avoid herbal products until approved by your doctor.

Travel is acceptable, including air travel, although flight attendants and pilots receive higher exposures than the average air traveler. It might be prudent for women in these fields to consider this although there is not enough data to say it is dangerous. Most physical activities you do prior to pregnancy can be continued after pregnancy although many doctors would agree that contact sports should be avoided. Hot tubs are out; developing babies do not tolerate high body temperatures. Hair dye, nail polish and so on are acceptable.

If a baby is in your future, discuss it with your doctor so that you can be checked for medical problems such as anemia, diabetes, high blood pressure and your immunizations can be updated. To increase the chance of a healthy baby, your child's care begins before conception.

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Last Updated March 20, 2009