Healthy pregnancy

Staying healthy during pregnancy depends on the mother. Key to protecting the health of your child is to get regular prenatal care. If you think you're pregnant, call your health care provider to schedule an appointment. You should schedule your first examination as soon as you think that you are pregnant.

At this first visit, your health care provider likely do a pregnancy test, and will figure out how many weeks pregnant you are based on a physical examination and the date of your last period. He or she will also use this information to predict your delivery date (however, an ultrasound performed sometime during your pregnancy will help to verify that date).
If you're healthy and there are no complicating risk factors, most health care providers will want to see you:

• every 4 weeks until the 28th week of pregnancy
• then every 2 weeks until 36 weeks
• then once a week until delivery

Throughout your pregnancy, your health care provider will check your weight and blood pressure while also checking the growth and development of your baby (by doing things like feeling your abdomen, listening for the fetal heartbeat starting during the second trimester, and measuring your belly). During the span of your pregnancy, you'll also have prenatal test, including blood, urine, and cervical tests, and probably at least one ultrasound.

If you still need to choose a health care provider to counsel and treat you during your pregnancy, there are several options:

• obstetricians/gynecologists (also known as OB/GYNs — doctors who specialize in pregnancy and childbirth, as well as women's health care)
  
• family practitioners (doctors who provide a range of services for patients of all ages — in some cases, this includes obstetrical care)
  
• certified nurse-midwives (advanced practice nurses specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for uncomplicated pregnancies; there are also other kinds of midwives, but you should look for one with formal training who's been certified in the field)

Any of these is a good choice if you're healthy and there's no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case an unexpected problem arises or a cesarean section (C-section) has to be performed.

Nutrition and Supplements

Now that you're eating for two (or more!), this is not the time to cut calories or go on a diet. In fact, it's just the opposite — you need about 300 extra calories a day, especially later in your pregnancy when your baby grows quickly. If you're very thin, very active, or carrying multiples, you'll need even more. But if you're overweight, your health care provider may advise that you consume fewer extra calories.

Healthy eating is always important, but especially when you're pregnant. So, make sure your calories come from nutritious foods that will contribute to your baby's growth and development.

Try to maintain a well-balanced diet that incorporates the dietary guidelines including:

• lean meats
• fruits
• vegetables
• whole-grain breads
• low-fat dairy product

By eating a healthy, balanced diet you're more likely to get the nutrients you need. But you will need more of the essential nutrients (especially calcium, iron, and folic acid) than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.

But taking prenatal vitamins doesn't mean you can eat a diet that's lacking in nutrients. It's important to remember that you still need to eat well while pregnant. Prenatal vitamins are meant to supplement your diet not be your only source of much-needed nutrients.

Calcium

Most women 19 and older — including those who are pregnant — don't often get the daily 1,000 mg of calcium that's recommended. Because your growing baby's calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which may contain some extra calcium.

Good sources of calcium include:

• low-fat dairy products including milk, pasteurized cheese, and yogurt
• calcium-fortified products, including orange juice, soy milk, and cereals
• dark green vegetables including spinach, kale, and broccoli
• tofu
• dried beans
• almonds

Iron

Pregnant women need about 30 mg of iron every day. Why? Because iron is needed to make hemoglobin, the oxygen-carrying component of red blood cells. Red blood cells circulate throughout the body to deliver oxygen to all its cells.

Without enough iron, the body can't make enough red blood cells and the body's tissues and organs won't get the oxygen they need to function well. So it's especially important for pregnant women to get enough iron in their daily diets — for themselves and their growing babies.

Although the nutrient can be found in various kinds of foods, iron from meat sources is more easily absorbed by the body than iron found in plant foods. Iron-rich foods include:

• red meat
• dark poultry
• salmon
• eggs
• tofu
• enriched grains
• dried beans and peas
• dried fruits
• dark leafy green vegetables
• blackstrap molasses
• iron-fortified breakfast cereals

Folate (Folic Acid)

The Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age — and especially those who are planning a pregnancy — get about 400 micrograms (0.4 milligrams) of folic acid supplements every day. That can be from a multivitamin or folic acid supplement in addition to the folic acid found in food.

So, why is folic acid so important? Studies have shown that taking folic acid supplements 1 month prior to and throughout the first 3 months of pregnancy decrease the risk of neural tube defects by up to 70%.

The neural tube — formed during the several weeks of the pregnancy, possibly before a woman even knows she's pregnant — goes on to become the baby's developing brain and spinal cord. When the neural tube doesn't form properly, the result is a neural tube defect such as spina bifida.

Again, your health care provider can prescribe a prenatal vitamin that contains the right amount of folic acid. Some pregnancy health care providers even recommend taking an additional folic acid supplement, especially if a woman has previously had a child with a neural tube defect.

If you're buying an over-the-counter supplement, keep in mind that most multivitamins contain folic acid, but not all of them have enough folic acid to meet the nutritional needs of a pregnant woman. So, be sure to check labels carefully before choosing one and check with your health care provider.

Fluids

It's also important to drink plenty of fluids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy, and drinking enough water each day can help prevent common problems such as dehydration and constipation.

Exercises

The U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2 hours and 30 minutes) of moderate-intensity aerobic activity each week if you're not already highly active or doing vigorous-intensity activity. If you are very active or did intense aerobic activities before becoming pregnant, you may be able to keep up your workouts, as long as your doctor says it's safe. Before beginning — or continuing — any exercise regimen talk to your doctor first.

Exercising during pregnancy has been shown to be extremely beneficial. Regular exercise can help:

• prevent excess weight gain
• reduce pregnancy related problems, like back pain, swelling, and constipation
• improve sleep
• increase energy
• improve outlook
• prepare for labor
• lessen recovery time

Low-impact, moderate-intensity exercise activities (such as walking and swimming) are great choices. You can also opt for yoga or Pilates classes, DVDs, or videos that are tailored for pregnancy. These are both low-impact and work on strength, flexibility, and relaxation.

But you should limit high-impact aerobics and avoid certain sports and activities that pose a risk of falling or abdominal injury. Typical limitations include contact sports, downhill skiing, and horseback riding.

It's also important to be aware of how your body changes. During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury.

So, it's easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. In addition, your center of gravity shifts as your pregnancy progresses, so you may feel off-balance and at risk of falling. Keep these in mind when you choose an activity and don't overdo it.

Whatever type of exercise you choose, make sure to take frequent breaks and remember to drink plenty of fluids. And use common sense — slow down or stop if you get short of breath or feel uncomfortable. If you have any questions about doing a certain sport or activity during your pregnancy, talk to your health care provider for specific guidelines.

Sleep

It's important to get enough sleep during your pregnancy. Your body is working hard to accommodate a new life, so you'll probably feel more tired than usual. And as your baby gets bigger, it will be harder to find a comfortable position when you're trying to sleep.

Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart's job easier because it keeps the baby's weight from applying pressure to the large blood vessels that carry blood to and from your heart and your feet and legs. Lying on your side can also help prevent or reduce varicose veins, hemorrhoids, and swelling in your legs.

Some doctors specifically recommend that pregnant women sleep on the left side. Because one of those big blood vessels is on the right side of your abdomen, lying on your left side helps keep the uterus off of it. Lying on your left side optimizes blood flow to the placenta and, therefore, your baby.

Ask what your health care provider recommends. In most cases, lying on either side should do the trick and help take some pressure off your back. To create a more comfortable resting position either way, prop pillows between your legs, behind your back, and underneath your belly.