This chapter describes some of the things you should think about to make sure you and your baby stay healthy during pregnancy.

What should you eat?

A healthy diet is an important part of a healthy lifestyle at any time, but particularly if you are pregnant or are planning a pregnancy. Eating healthily during pregnancy will help your baby develop and grow and will help keep you fit and well. You don't need to go on a special diet, but make sure that you eat a variety of different foods every day in order to get the right balance of nutrients that you and your baby need.

You should also avoid certain foods to be on the safe side.

There's no need to 'eat for two' when you are pregnant. It's the quality not the quantity that's important. With a few exceptions you can continue to eat all the foods you enjoy (see Take care with some foods). Eating healthily often means just changing the amounts of different foods that you eat rather than cutting out all your favourites. The Balance of Good Health illustrates the mixture of different foods you need in your diet and the proportions you should eat them in.

 

	Eat plenty of fruit and vegetables as these provide the vitamins and minerals, as well as fibre which helps digestion and prevents constipation. Eat them lightly cooked in a little water or raw to get the most out of them. Frozen, tinned and dried fruit and vegetables are good too
Starchy foods like bread, potatoes, rice, pasta, chapatis, yams and breakfast cereals are an important part of any diet and should, with vegetables, form the main part of any meal. They are satisfying, without containing too many calories, and are an important source of vitamins and fibre. Try eating wholemeal bread and wholegrain cereals when you can.
	Lean meat, fish, poultry, eggs, cheese, beans and pulses are all good sources of nutrients. Eat some every day.
Dairy foods like milk, cheese and yoghurt are important as they contain calcium and other nutrients needed for your baby's development. Choose low-fat varieties wherever possible. You can get seven pints of milk free per week if you are on Income Support or income-based Jobseeker's Allowance (see here)
Try to cut down on sugar and sugary foods like sweets, biscuits and cakes and sugary drinks like cola. Sugar contains calories without providing any other nutrients the body needs. It also adds to the risk of tooth decay.	Cut down on fat and fatty foods as well. Most of us eat far more fat than we need. Fat is very high in calories and too much can cause excess weight gain and increase the risk of heart disease and it can contribute to being overweight. Avoid fried foods, trim the fat off meat, use spreads sparingly and go easy on foods like pastry, chocolate and chips which contain a lot of fat. Choose low-fat varieties of dairy products, for example semi-skimmed or skimmed milk, low-fat yoghurt and half-fat hard cheese.

 

 

• Green, leafy vegetables, lean meat, dried fruit and nuts contain iron. If you are short of iron you're likely to get very tired and may suffer from anaemia.
• Citrus fruit, tomatoes, broccoli, blackcurrants and potatoes are good sources of vitamin C, which you need to help you toabsorb iron.
• Dairy products, fish with edible bones like sardines, bread, nuts and green vegetables are rich in calcium, which is vital for making bones and teeth.
• Margarine, oily fish (like sardines) and taramasalata contain vitamin D to keep your bones healthy and to provide your baby with vitamin D to last during the first few months of life. The best source of vitamin D is summer sunlight, but make sure that you wear a high protection sunblock when you are in the sunlight, and never burn. If you have dark skin, or always cover your skin, you may be particularly at risk of vitamin D deficiency. Ask your doctor if you need to take a vitamin D supplement.
• You need extra folic acid from the time you start trying to conceive until the 12th week of pregnancy. This can help prevent birth efects, which are known as neural tube defects, such as spina bifida. You can get folic acid from green, leafy vegetables, but don't overcook them as this destroys the vitamin. Some breakfast cereals and breads have had folic acid added to them, so look at the label. Regardless of what you eat, always take a 400 microgram (0.4 milligram) folic acid tablet every day.

These are available from pharmacies and supermarkets or your GP may be able to prescribe them for you. Ask your GP or pharmacist for advice if you are unsure.

 

 

Vegetarian, vegan and special diets

Providing a vegetarian diet is varied and balanced, it will provide adequate nutrients for you and your baby during pregnancy. However, iron and vitamin B12 can be hard to obtain from a vegetarian diet. Talk to your doctor or midwife about ways to increase intakes of these important nutrients. If you are vegan (i.e. you cut out all animal products from your diet), or you follow another type of restricted diet such as gluten free, for example, because of food intolerance (e.g. coeliac disease) or for religious reasons, talk to your doctor or midwife. Ask to be referred to a dietitian for advice on how to eat healthily during pregnancy.

Healthy snacks

• Sandwiches or pitta bread filled with grated cheese, lean ham, mashed tuna, salmon or sardines and salad
• Salad vegetables washed thoroughly
• Low-fat yoghurt and fromage frais
• Hummus and bread or vegetable sticks
• Ready-to-eat apricots, figs or prunes
• Vegetable and bean soups
• Unsweetened breakfast cereals or Porridge and milk
• Milky drinks or unsweetened fruit juices
• Fresh fruit
• Baked beans on toast or baked potato

Take care with some foods

Besides eating a wide variety of foods, there are certain precautions you should take in order to safeguard your baby's well-being as well as your own.

• Cook all meat and poultry thoroughly so that there is no trace of pink or blood and wash all surfaces and utensils after preparing raw meat. This will help to avoid infection with Toxoplasma, which may cause toxoplasmosis and can harm your baby (see here).
• Wash fruit, vegetables and salads to remove all traces of soil which may contain Toxoplasma.
• Make sure eggs are thoroughly cooked until the whites and yolks are solid, to prevent the risk of Salmonella food poisoning, and avoid foods containing raw and undercooked eggs like home-made mayonnaise, ice-cream, cheesecake or mousse.
• Avoid eating all types of paté and mould-ripened soft cheese, like Brie and Camembert, and similar blue-veined varieties, like Stilton or Danish blue, because of the risk of Listeria infection. You can eat hard cheeses such as cheddar and parmesan, and other cheeses made from pasteurised milk such as cottage cheese, mozzarella cheese and cheese spreads. Although Listeria is a very rare disease, it is important to take special precautions during pregnancy because even the mild form of the illness can lead to miscarriage, stillbirth or severe illness in the newborn.
• Drink only pasteurised or UHT milk which has had the harmful germs destroyed. If only raw or green-top milk is available, boil it before you drink it. Don't drink unpasteurised goat's or sheep's milk or eat their milk products.
• Don't eat liver or liver products, like liver paté or liver sausage, as they may contain a lot of vitamin A. Too much vitamin A could harm your baby.
• Avoid eating peanuts andfoods containing peanut products (e.g. peanut butter, unrefined groundnut oil, some snacks, etc.) if you or your baby's father or any previous children have a history of hayfever, asthma, eczema or other allergies. This may reduce the risk of your baby developing a potentially serious allergy to peanuts. Read food labels carefully and, if you are still in doubt about the contents, avoid these foods.

For general hygiene

• Wash your hands before and after handling any food.
• Thoroughly wash all fruit and vegetables, including ready-prepared salads, before eating. Peel and top carrots before eating them.
• Cook raw meat and poultry thoroughly and make sure that ready-to-eat poultry and cooked chilled meals are reheated thoroughly and are piping hot before they are eaten.
• Always wash your hands after handling raw meat or poultry and make sure that raw foods are stored separately from prepared foods. Otherwise there is a risk of contamination. Use a separate chopping board for raw meats.
• Wear gloves and wash them and then your hands thoroughly after gardening or handling soil.

Pregnancy and weight

Most women gain between 10 and 12.5 kg (22-28 lb). Weight gain varies a great deal and depends on your weight before pregnancy. If you're concerned, talk to your midwife or GP. They may have special advice for you if you weigh more than 100 kg or less than 50 kg.

 

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Smoking

When you smoke, carbon monoxide and nicotine pass into your lungs and bloodstream. This means that:

a) your baby gets less oxygen and cannot grow as well as it should, and
b) the nicotine makes your baby's heart beat faster. Breathing in other people's smoke makes the baby more likely to suffer from asthma attacks, chest infections, coughs and colds, and to be admitted to hospital.

If you stop smoking now:

• you're more likely to have a healthier pregnancy and a healthier baby;
• you'll cope better with the birth;
• your baby will cope better with any birth complication;
• your baby is less likely to be born too early and have to face the additional breathing, feeding and health problems which so often go with prematurity;
  oyour baby is less likely to be born underweight and have extra problems in keeping warm. Babies of mothers who smoke are, on average, 200 g (about 8 oz) lighter than other babies. These babies may have problems during and after labour and are more prone to infection;
• it will be better for your baby later too. Children whose parents smoke are more likely to suffer later on from illnesses which
  need hospital treatment (such as asthma);
• you will reduce the risk of cot death.
• The sooner you stop, the better. But stopping even in the last few weeks of pregnancy can be beneficial. If any members of your household smoke, their smoke can affect you and the baby both before and after birth. They can help you and the baby by giving up now. Perhaps you could try to stop together.

Protecting the fetus and the new baby from tobacco smoke is one of the best things you can do to give your child a healthy start in life.

 

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Alcohol

There is no evidence that light or occasional drinking in pregnancy will harm your baby. But research shows that heavy or frequent drinking can seriously harm your baby's development. To be on the safe side, stop altogether or stick to no more than one or two 'units' of alcohol once or twice a week.

If you have difficulty cutting down, talk to your doctor or midwife. Confidential help and support is available from local counselling services (look in the telephone directory or contact Alcohol Concern). See this page for national agencies who can help.

 

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Pills, medicines and other drugs

Some pills and medicines can harm your baby's health so, to be on the safe side, you should:

• assume that all medicines are dangerous until a doctor or pharmacist can tell you they are safe;
• make sure your doctor or dentist knows you're pregnant before prescribing anything or giving you treatment;
• talk to your doctor at the first possible moment if you take regular medication.

But do remember that it is safer to take some medicines, for examplethose used to treat epilepsy and diabetes, than to leave the illness untreated.

Illegal drugs (street drugs) can harm your baby. Taking cocaine or smoking crack may be especially harmful because both cause a sudden drop in blood and oxygen to the placenta. It's important to talk to your doctor or midwife straightaway so they can refer you to a maintenance reduction programme. For more information contact one of the organisations on this page, or the National Drugs Helpline on 0800 776600.

X-rays should be avoided in pregnancy if possible. Make sure your dentist knows you are pregnant.

 

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Physical activity

The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour and get back into shape after the birth.

If you feel tense after a hard day's work, physical activity is an excellent way of relaxing and it will help you to sleep soundly.

Keep up your normal daily physical activity or exercise (sport, or dancing, or just walking to the shops and back) for as long as you feel comfortable. Don't exhaust yourself and remember that you may need to slow down as your pregnancy progresses, or if your doctor advises you to. If in doubt, consult your doctor or midwife.

• If you were inactive before you were pregnant, don't suddenly take up strenuous exercise. Remember, exercise doesn't have to be strenuous to be beneficial.
• Try to keep active on a daily basis. Building in half an hour of activities like walking can help to keep you active. If you can't manage that, any amount is better than nothing.
• Avoid any strenuous exercise in hot weather.
• Drink plenty of fluids.
• If you go to exercise classes, make sure your teacher is properly qualified, and knows that you're pregnant and how far your pregnancy has progressed.
• You might like to try swimming because the water will support your increased weight. Some
  local swimming pools provide aquanatal classes with qualified instructors.

Exercises for a fitter pregnancy

Every pregnant woman should try to fit these exercises into her daily routine. They will strengthen muscles to take a bigger load, make joints stronger, improve circulation, ease backache and generally make you feel well.

Stomach strengthening exercises These strengthen abdominal muscles and ease backache, which can be a problem in pregnancy. As your baby gets bigger you may find that the hollow in your lower back increases. This can give you backache.

• Start in a box position (on all fours) with knees under hips, hands under shoulders with fingers facing forward and abdominals lifted to keep the back straight;
• pull in the abdominals and raise the back up towards the ceiling, curling the trunk and allowing the head to relax gently forward. Don't allow elbows to lock out;
• hold for a few seconds then slowly return to the box position;
• take care not to hollow the back. The back should always return to a straight/neutral position;
• do this slowly and rhythmically ten times, making your muscles work hard and moving your back carefully. Only move your back as far as you can comfortably.

Pelvic tilt exercises.

Stand with your shoulders and bottom against a wall. Keep your knees soft. Pull your belly button towards your spine, so that your back flattens against the wall. Hold for four seconds and release. Repeat up to ten times.

Pelvic floor exercises help strengthen the muscles of the pelvic floor which come under great strain in pregnancy and childbirth.

The pelvic floor consists of layers of muscles which stretch like a supportive hammock from the pubic bone (in front) to the end of the backbone. If your pelvic floor muscles are weak, you may find that you leak urine when you cough or sneeze. This is quite common and you needn't feel embarrassed.

However, you can strengthen the muscles by doing the following exercise:

• close up your back passage as if trying to prevent a bowel movement;
• at the same time, draw in your vagina as if you are gripping a tampon, and your urethra as if to stop the flow of urine;
• do this exercise quickly - tightening and releasing the muscles immediately;
• then do the exercise slowly holding the contractions for as long as you can (not more than ten seconds) before you relax;
• repeat both exercises ten times, four to six times a day.

Foot exercises can be done sitting or standing. They improve blood circulation, reduce swelling in the ankles and prevent cramp in the calf muscles.

• Bend and stretch your foot vigorously up and down 30 times.
• Rotate your foot eight times one way and eight times the other way.
• Protect your back
• Sit up straight with your bottom against the back of your chair. Tuck a small cushion behind your waist if you wish.
• When you pick something up, bend your knees, not your back.
• Try to stand tall.

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Infections

Rubella

Rubella (or German measles) can seriously affect your baby's sight and hearing and cause brain and heart defects in your baby if you catch it in the first four months of pregnancy. All children are now immunised against rubella at 12 to 15 months and again before they start school.

If you're not immune and you do come into contact with rubella, tell your doctor at once. Blood tests will show whether you have been infected, and you will then be better able to think about what action to take.

Sexually transmitted infections

Sexually transmitted infections (STIs) are very common and often there are no symptoms, so you may not know if you have one. However, many STIs can affect your baby's health during pregnancy and after birth. If you have any reason to believe that you or your partner could have an STI which was not diagnosed before pregnancy, you should go for a check-up as soon as you can. You can ask your GP or midwife or, if you prefer, go to a hospital clinic where you will also be guaranteed strict confidentiality. You can find your nearest clinic in your phone book, listed under the name of your health authority as genito-urinary medicine (GUM) clinic, or 'special' clinic, or the old name of venereal disease (VD) clinic.

Human immuno-deficiency virus (HIV) and Acquired immune deficiency syndrome (AIDS)

Current evidence suggests that an HIV positive mother in good health and without symptoms of the infection is unlikely to be adversely affected by pregnancy. However, 1 in every 6 babies born to HIV positive mothers are likely to be infected. HIV positive mothers may also pass on the virus through breast milk. If you're HIV positive, talk to your doctor about your own health and the options open to you, or contact the organisations listed on this page for advice and counselling. It is possible to substantially reduce the risk of transmitting HIV to your baby during pregnancy and after birth (look here).

You should be offered and recommended a named confidential HIV test as part of your routine antenatal care (see this page). Before the test, your doctor or midwife will discuss the test with you and counselling will be available afterwards to explain the result and the implications if it is positive. You can also go to a Genito-urinary medicine clinic for an HIV test and advice.

Hepatitis B

Hepatitis B is a virus that infects the liver. Many people with hepatitis B, even if they show no sign of illness, can be carriers and may infect others. The virus is spread by sex without a condom with an infected person and by direct contact with infected blood. If you are a carrier, or are infected during pregnancy, you can pass the infection to your baby at birth. All pregnant women are offered a blood test for hepatitis B as part of their antenatal care (see this page). Babies who are at risk can be immunised at birth to prevent infection (more here).

 

Herpes

Genital herpes infection can be dangerous for a newborn baby. It can be caught through genital contact with an infected person or from oral sex with someone who has oral herpes (cold sores). Initial infection causes very painful blisters or ulcers on the genitals. Less severe recurrent attacks usually occur for some years afterwards. If you, or your partner, are infected, use condoms or avoid sex during an attack. Avoid oral sex if you or your partner have cold sores or active genital herpes. Tell your doctor or midwife if either you or your partner have recurring herpes or develop the symptoms described above. If your first infection occurs in pregnancy there is a treatment available, although its use is controversial.

If the infection is active during labour, a Caesarean section may be recommended to reduce the risk of transmission to the baby.

Chicken pox

Around 95% of women are immune to chicken pox. If you have never had chicken pox, or are unsure, and come into contact with a child or adult who has it, speak to your GP, midwife or obstetrician at once. A blood test will establish if you are immune. Chicken pox infection in pregnancy can be dangerous for both mother and baby so seek advice early.

Toxoplasmosis

This infection can damage your baby if you catch it during pregnancy, so take precautions (more here). Most women have already had the infection before pregnancy and will be immune. If you feel you may have been at risk, discuss the matter with your GP, midwife or obstetrician. If you do catch toxoplasmosis while you are pregnant, treatment is available.

Parvovirus B19 (Slapped cheek disease)

Parvovirus B19 infection is common in children and causes a characteristic red rash on the face, so is often called 'slapped cheek disease'.

Although 60% of women are immune to this infection, since parvovirus is highly infectious and can be harmful to the baby, any pregnant woman who comes into contact with someone who is infected should seek advice from the doctor. Immunity can be checked with a blood test. In most pregnant women who are infected with parvovirus
the baby is not affected.

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Animals

Cats' faeces may contain an organism which causes toxoplasmosis - a disease which can damage your baby. Avoid emptying cat litter trays while you're pregnant or, if no one else can do it, use disposable rubber gloves. Trays should be cleaned daily and filled with boiling water for five minutes. Avoid close contact with sick cats and wear gloves when gardening - even if you don't have a cat - in case the soil is contaminated with faeces. Wash your hands and gloves after gardening. If you do come into contact with cat faeces, make sure you wash your hands thoroughly. Follow the general hygiene rules under Take care with some foods (see the section on foods). For further information on toxoplasmosis contact Tommy's Campaign (see page 144).

Lambs and sheep can be a source of an organism called Chlamydia psittaci which is known to cause miscarriage in ewes. They also carry Toxoplasma. Avoid lambing or milking ewes and all contact with newborn lambs. If you experience flu-like symptoms after coming into contact with sheep, tell your doctor.

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Inherited conditions

Some diseases or conditions, like cystic fibrosis, haemophilia, muscular dystrophy, sickle cell disease and thalassaemia, are inherited from parents or grandparents. If you, your partner or any relative has a condition which you know or suspect is inherited, or if you already have a baby with a disability, talk to your doctor about it. You may be able to have tests to check whether your baby is affected (more here). Ask your GP to refer you to a genetic counsellor for specialist advice, if necessary, preferably before you conceive or in the early weeks of pregnancy.

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Work hazards

If you work with chemicals, lead or X-rays, or in a job with a lot of lifting, you may be risking your health and the health of your baby. If you have any worries about this, you should talk to your doctor, midwife, occupational health nurse, union representative or personnel department.

If it is a known and recognised risk, it may be illegal for you to continue and your employer must offer you suitable alternative work on terms and conditions that are not substantially less favourable than your original job. If no safe alternative is available your employer should suspend you on full pay (ie give you paid leave) for as long as necessary to avoid the risk (look here).

 

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Coping at work

If you're at work during pregnancy you need to know your rights to antenatal care, leave and benefits which are set out on pages 130-140. You may get extremely tired, particularly in the first and last weeks of your pregnancy. Try to use your lunch break to eat and rest, not to do the shopping. If travelling in rush hour is exhausting, ask your employer if you can work slightly different hours for a while. Don't rush home and start another job cleaning and cooking. If possible, ask your partner to take over. If you're on your own, keep housework to a minimum, and go to bed early if you can.