10 steps to a healthy pregnancy

Pregnancy is an ideal time to start taking really good care of yourself both physically and emotionally. If you follow the few simple guidelines below, you should give yourself the best chance of having a problem-free pregnancy and a healthy baby.

1. See your doctor or midwife as soon as possible

As soon as you find out you're pregnant, get in touch with your GP or a midwife to organise your antenatal care. Organising your care early means you'll get good advice for a healthy pregnancy right from the start. You'll also have plenty of time to organise any ultrasound scans and tests that you may need (NHS 2011a).

2. Eat well

Aim to eat a healthy, balanced diet whenever you can. Try to have:

• At least five portions of fruit and vegetables daily.
• Plenty of carbohydrates, such as bread, pasta and rice, as the basis of your meals. Choose wholegrain carbohydrates rather than white, so you get plenty of fibre (Nice 2010: 7).
• Daily servings of protein, such as fish, lean meat, eggs, nuts or pulses, and some milk and dairy foods (NHS 2010).
• Two portions of fish a week, at least one of which should be oily. Fish is packed with protein, vitamin D, minerals and omega-3 fatty acids. Omega-3 fatty acids are important for the development of your baby's nervous system.
  
  

You don't need to eat for two when you're pregnant. You don't need extra calories for the first six months of pregnancy. In the last three months you'll need about an extra 200 calories a day (Nice 2010: 12). You can keep up your energy levels with healthy snacks.

3. Take a supplement

Pregnancy vitamin supplements aren't a substitute for a balanced diet. But they can help if you're worried you're not eating well, or you're too sick to eat much (Maggini et al 2007, Brough et al 2010).

Make sure your supplement contains 400 micrograms (mcg) of folic acid. You need this while you're trying for a baby and for the first three months of pregnancy(NCCWCH 2008: 15). Taking folic acid reduces the risk of your baby developing a neural tube defect such as spina bifida (Blencowe et al 2010).

Also, check that your supplement contains 10mcg of vitamin D. Vitamin D is important for your baby's future bone health.

Talk to your GP or a pharmacist before taking an antenatal supplement. If you don't take a multivitamin for pregnant women, you can buy folic acid and vitamin D supplements separately.

If you're on a low income, you might be able to get pregnancy vitamin supplements free of charge under the government's healthy start scheme.

If you don't eat fish, fish oil supplements may be helpful (Williamson 2006). Choose a supplement made from the body of the fish, not the liver. This is because fish liver oils (such as cod liver oil) may contain the retinol form of vitamin A, which isn't recommended in pregnancy.

4. Be careful about food hygiene

There are some foods it's safest not to eat in pregnancy. This is because they can carry a health risk for your baby.

Listeriosis is an infection caused by listeria bacteria (NCCWCH 2008: 16, NHS 2011, RCOG 2010). It's rare and doesn't usually pose a threat to your health. However, it can cause pregnancy or birth complications. Listeriosis can even lead to miscarriage.

The following foods may harbour listeria and so are best avoided:

• pate of any type
• unpasteurised milk
• undercooked ready meals
• soft, mould-ripened cheeses, such as brie
• blue-veined cheeses, such as roquefort
  
  

As listeria bacteria are destroyed by heat, make sure you heat ready meals thoroughly (Williamson 2006).

Salmonella bacteria can cause food poisoning (NCCWCH 2008: 16). You can catch it from eating:

• raw or undercooked meat
• raw shellfish
• 
  
(FSA 2016, NHS 2015, BDA 2013)

Not all eggs contain salmonella bacteria. British Lion eggs, which have a red lion stamped on the shell, have a very low risk of carrying salmonella (ACMSF 2016 cited BEIC 2016). If you buy unmarked eggs, cook them until the white and yolk are solid. Food products made from raw eggs, such as mayonnaise, are fine to eat if you know for sure that the eggs have been pasteurised or have the British Lion mark (ACMSF 2016 cited BEIC 2016).

Thoroughly wash utensils, boards and your hands after handling raw poultry (Williamson 2006). Food hygiene is especially important now you're pregnant.

Toxoplasmosis is an infection caused by a parasite. It's also rare, but it can affect your unborn baby. You can cut down your risk of catching it by:

• cooking meat and ready meals thoroughly
• washing fruit and vegetables well to remove soil or dirt
• wearing gloves when handling cat litter and garden soil
(NCCWCH 2008: 22, RCOG 2010, Williamson 2006)

5. Exercise regularly

Regular exercise has many benefits for mums-to-be. It can:

• Build your strength and endurance. This may help you to cope better with the extra weight of pregnancy and the hard work of labour (RCOG 2006c).
• Make it easier for you to get back into shape after your baby is born.
• Boost your spirits and even help to ward off depression.
(Mead et al 2009, NCCMH 2007:105, RCOG 2006c)

Good exercise choices for pregnancy include:

• brisk walking
• swimming
• aquanatal classes
• yoga
• pilates
  
  

If you play sport, you can continue as long as it feels comfortable for you. However, if your particular sport carries a risk of falls or knocks, or extra stress on your joints (NCCWCH 2008: 36, RCOG 2006c), it's best to stop. Talk to your GP if you're unsure.

6. Begin doing pelvic floor exercises

Your pelvic floor comprises a hammock of muscles at the base of your pelvis. These muscles support your bladder, vagina and back passage. They can feel weaker than usual in pregnancy because of the extra pressure upon them. Pregnancy hormones can also cause your pelvic floor to slacken slightly.

Weak pelvic floor muscles put you at risk of developing stress incontinence. This is when small amounts of urine leak out when you sneeze, laugh or exercise (Hay-Smith et al 2008).

Strengthening your muscles by doing pelvic floor exercises regularly throughout your pregnancy (Hay-Smith et al 2008, Lemos et al 2008, NCCWCH 2006: 12) can help. Having a toned pelvic floor may help your baby's birth go more smoothly too. You'll feel the benefit if do eight pelvic floor squeezes, three times a day (NCCWCH 2006: 20).

7. Cut out alcohol

Any alcohol you drink rapidly reaches your baby via your blood stream and placenta.

There is no way to know for sure how much alcohol is safe during pregnancy. That's why many experts advise you to cut out alcohol completely while you're expecting (DH 2016, RCOG 2015).

It's particularly important to avoid alcohol during the first trimester, as drinking during this stage can increase your risk of miscarriage (NICE 2008). If you do decide to drink after your first trimester, stick to no more than one or two units of alcohol, no more than once or twice a week (NICE 2008, RCOG 2015).

Drinking heavily or binge drinking during pregnancy is especially dangerous for your baby. Mums-to-be who drink heavily on a regular basis are more likely to give birth to a baby with fetal alcohol spectrum disorders (FASD). These are problems ranging from learning difficulties to more serious birth defects (BMA 2007:6).

8. Cut back on caffeine

Coffee, tea, cola and energy drinks are mild stimulants. There are concerns that too much caffeine may increase your risk of miscarriage (CARE study group 2008, FSA 2008, Weng et al 2008). It's also thought possible (Jahanfar and Sharifah 2009) that too much caffeine may contribute to your risk of having a low-birth-weight baby.

Current guidelines state that up to 200mg of caffeine a day won't hurt your baby (FSA 2008. Maslova et al 2010, OTIS 2011, RCOG 2010). That's the equivalent of two mugs of instant coffee.

As with alcohol, you may prefer to cut out caffeine altogether, particularly in the first trimester. Decaffeinated tea and coffee, fruit teas and fruit juices are all safe alternatives.

9. Stop smoking

Smoking during pregnancy can cause serious health problems, for you and your baby. These risks include an increased risk of:

• miscarriage
• premature birth
• low birth weight
• cot death (SIDS)
(NCCWCH 2008: 99-100, NICE 2010: 22)

Smoking may even be associated with the loss of a baby at birth.

Smoking makes the following pregnancy complications more likely:

• Nausea and vomiting (morning sickness).
• Ectopic pregnancy.
• Placental abruption, where the placenta comes away from the uterus wall before your baby is born.
(NCCWCH 2008: 99, NHS 2010)

If you smoke, it's best to stop, for your own health and that of your baby. The sooner you stop smoking, the better, but it's never too late. Even stopping in the last few weeks of your pregnancy can benefit you both (NHS 2010b). Watch a video about how smoke reaches your unborn baby.

10. Get some rest

The fatigue you feel in the first few months is due to high levels of pregnancy hormones circulating in your body (Murray and Hassall 2009). Later on, it's your body's way of telling you to slow down.

If you can't sleep at night, try to take a quick nap in the middle of the day to catch up. If that's impossible, at least put your feet up and try to relax for 30 minutes.

If backache is disturbing your sleep, try lying on your left-hand side with your knees bent. Placing a wedge-shaped pillow under your bump may help ease the strain on your back (Stuge et al 2003).

Exercise may also give you some relief from backache (Pennick and Young 2007). It can help with sleep problems, too, as long as you don't exercise too close to bedtime (PRODIGY 2009).

To wind down ready for bed, try relaxation techniques, which are safe in pregnancy, such as:

• yoga
• stretching
• deep breathing
• visualisation
• massage

Always let your exercise teacher know that you're pregnant or, ideally, choose classes tailored to pregnant women.