Tips for a Healthy Pregnancy

Staying healthy during your pregnancy

Now that you're pregnant, taking care of yourself has never been more important. Of course, you'll probably get advice from everyone — your doctor, family members, friends, co-workers, and even complete strangers — about what you should and shouldn't be doing.

But staying healthy during pregnancy depends on you, so it's crucial to arm yourself with information about the many ways to keep you and your baby as healthy as possible.

Prenatal Health Care

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 possible.

At this first visit, your health care provider will probably 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 (an ultrasound done sometime later in 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 tests, including blood, urine, and cervical tests, and probably at least one ultrasound.

When choosing a health care provider to counsel and treat you during your pregnancy, your options include:

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) is required.

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 you to 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, and aren't meant to 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 first 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, remember that most multivitamins contain folic acid, but not all of them have enough to meet the nutritional needs of pregnant women. So, be sure to check labels carefully before choosing one and check with your health care provider.

Fluids

It's 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.

Exercise

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 also can try yoga or Pilates classes, DVDs, videos, or exercise apps that are tailored for pregnancy. These are low-impact and they 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, scuba diving, 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 helps 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.

Some Things to Avoid

When you're pregnant, what you don't put into your body (or expose your body to) is almost as important as what you do. Here are some things to avoid:

Alcohol

Although it may seem harmless to have a glass of wine at dinner or a mug of beer out with friends, no one has determined what's a "safe amount" of alcohol to consume during pregnancy. One of the most common known causes of mental and physical birth defects, alcohol can cause severe abnormalities in a developing fetus.

Alcohol is easily passed along to the baby, who is less equipped to eliminate alcohol than the mother. That means an unborn baby tends to develop a high concentration of alcohol, which stays in the baby's system for longer periods than it would in the mother's. And moderate alcohol intake, as well as periodic binge drinking, can damage a baby's developing nervous system.

If you had a drink or two before you even knew you were pregnant (as many women do), don't worry too much about it. But your best bet is to not drink any alcohol at all for the rest of your pregnancy.

Recreational Drugs

Pregnant women who use drugs may be placing their unborn babies at risk for premature birth, poor growth, birth defects, and behavior and learning problems. And their babies could also be born addicted to those drugs themselves.

If you're pregnant and using drugs, a health clinic such as Planned Parenthood can recommend health care providers, at little or no cost, who can help you quit your habit and have a healthier pregnancy.

If you've used any drugs at any time during your pregnancy, it's important to inform your health care provider. Even if you've quit, your unborn child could still be at risk for health problems.

Nicotine

You wouldn't light a cigarette, put it in your baby's mouth, and encourage your little one to puff away. As ridiculous as that seems, pregnant women who continue to smoke are allowing their fetus to smoke, too. The smoking mother passes nicotine and carbon monoxide to her growing baby.

The risks of smoking include:

miscarriage and stillbirth
prematurity
low birth weight
sudden infant death syndrome (SIDS)
asthma and other respiratory problems

If you smoke, having a baby might be the motivation you need to quit. Talk to your health care provider about options for stopping your smoking habit.

Caffeine

High caffeine consumption has been linked to an increased risk of miscarriage, so it's probably wise to limit or even avoid caffeine altogether if you can.

If you're having a hard time cutting out coffee cold turkey, here's how you can start:

Cut your consumption down to one or two cups a day.
Gradually reduce the amount of caffeine you get by combining decaffeinated coffee with regular coffee.
Eventually try to cut out the regular coffee altogether.

And remember that caffeine is not limited to coffee. Many teas, colas, and other soft drinks contain caffeine. Try switching to decaffeinated products (which may still have some caffeine, but in much smaller amounts) or caffeine-free alternatives.

If you're wondering whether chocolate, which also contains caffeine, is a concern, the good news is that you can have it in moderation. Whereas the average chocolate bar has anywhere from 5 to 30 milligrams of caffeine, there's 95 to 135 milligrams in a cup of brewed coffee. So, small amounts of chocolate are fine.

Food Smarts & Other Precautions

Although you need to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage.

Foods you'll want to steer clear of include:

soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
unpasteurized milk, juices, and apple cider
raw eggs or foods containing raw eggs, including mousse, tiramisu, raw cookie dough, homemade ice cream, and Caesar dressing (although some store-bought brands of the dressing may not contain raw eggs)
raw or undercooked meats, fish (sushi), or shellfish
processed meats such as hot dogs and deli meats (unless they are reheated until steaming)

Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating:

shark
swordfish
king mackerel
tilefish
tuna steak

These types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus. When you choose seafood, limit the total amount to about 12 ounces per week — that's about two meals. Also, if you like canned tuna, eat no more than 6 ounces per week. Be sure to check any local advisories before eating recreationally caught fish.

Changing the Litter Box

Pregnancy is the prime time to get out of cleaning kitty's litter box. Why? Because toxoplasmosis can be spread through soiled cat litter boxes and can cause serious problems, including prematurity, poor growth, and severe eye and brain damage. A pregnant woman who becomes infected often has no symptoms but can still pass the infection on to her developing baby.

Over-the-Counter and Prescription Medications

Even common over-the-counter medications that are generally safe may be considered off-limits during pregnancy because of their potential effects on the baby. And certain prescription medications may also cause harm to the developing fetus.

To make sure you don't take anything that could be harmful to your baby:

Ask your health care provider which medicines — both over-the-counter and prescription — are safe to take during pregnancy.
Talk to your health care provider about any prescription drugs you're taking.
Let all of your health care providers know that you're pregnant so that they'll keep that in mind when recommending or prescribing any medications.
Also remember to discuss natural remedies, supplements, and vitamins.

If you were prescribed a medication before you became pregnant for an illness, disease, or condition you still have, talk with your health care provider, who can help you weigh potential benefits and risks of continuing your prescription.

If you become sick (e.g., with a cold) or have symptoms that are causing you discomfort or pain (like a headache or backache), talk to your health care provider about medications you can take and alternative ways to help you feel better without medication.

Healthy Pregnancy Habits: From Start to Finish

From the first week of your pregnancy to the fortieth, it's important to take care of yourself so you can take care of your baby. Even though you have to take some precautions and be ever-aware of how what you what you do — and don't do — may affect your baby, many women say they've never felt healthier than during pregnancy.

Folic Acid and Pregnancy

Having a healthy baby means making sure you're healthy, too. One of the most important things you can do to help prevent serious birth defects in your baby is to get enough folic acid every day — especially before conception and during early pregnancy.

What Is Folic Acid?

Folic acid, sometimes called folate, is a B vitamin (B9) found mostly in leafy green vegetables like kale and spinach, orange juice, and enriched grains.

What Are the Benefits of Folic Acid?

Many studies have shown that women who get 400 micrograms (0.4 milligrams) daily before conception and during early pregnancy reduce the risk that their baby will be born with a serious neural tube defect (a birth defect involving incomplete development of the brain and spinal cord) by up to 70%.

The most common neural tube defects are:

spina bifida, an incomplete closure of the spinal cord and spinal column
anencephaly, severe underdevelopment of the brain
encephalocele, when brain tissue protrudes out to the skin from an abnormal opening in the skull

All of these defects happen during the first 28 days of pregnancy — usually before a woman even knows she's pregnant.

That's why it's so important for all women of childbearing age to get enough folic acid — not just those who are planning to become pregnant. Only 50% of pregnancies are planned, so any woman who could become pregnant should make sure she's getting enough folic acid.

Doctors and scientists still aren't completely sure why folic acid has such a profound effect on the prevention of neural tube defects, but they do know that it's crucial in the development of DNA. As a result, folic acid plays a large role in cell growth and development, as well as tissue formation.

How Can I Get Enough 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 every day. Adequate folic acid intake is very important before conception and at least 3 months afterward to potentially reduce the risk of having a fetus with a neural tube defect.

So, how can you make sure you're getting enough folic acid? In 1998, the U.S. Food and Drug Administration (FDA) mandated that folic acid be added to enriched grain products — so you can boost your intake by looking for breakfast cereals, breads, pastas, and rice containing 100% of the recommended daily folic acid allowance.

But for most women, eating fortified foods isn't enough. To reach the recommended daily level, you'll probably need a vitamin supplement. During pregnancy, you need more of all of the essential nutrients than you did before you became pregnant.

Although prenatal vitamins shouldn't replace a well-balanced diet, taking them can give your body — and, therefore, your baby — an added boost of vitamins and minerals. Some health care providers even recommend taking a folic acid supplement in addition to your regular prenatal vitamin. Talk to your doctor about your daily folic acid intake and ask whether he or she recommends a prescription supplement, an over-the-counter brand, or both.

Also talk to your doctor if you've already had a pregnancy that was affected by a neural tube defect. He or she may recommend that you increase your daily intake of folic acid (even before getting pregnant) to lower your risk of having another occurrence.

A healthy diet

Eating well during pregnancy is more than simply increasing how much you eat. You must also consider what you eat.

Although you need about 300 extra calories a day — especially later in your pregnancy, when your baby grows quickly — those calories should come from nutritious foods so they can contribute to your baby's growth and development.

Eating Well When You're Pregnant

Do you wonder how it's reasonable to gain 25 to 35 pounds (on average) during your pregnancy when a newborn baby weighs only a fraction of that? Although it varies from woman to woman, this is how those pounds may add up:

7.5 pounds: average baby's weight
7 pounds: extra stored protein, fat, and other nutrients
4 pounds: extra blood
4 pounds: other extra body fluids
2 pounds: breast enlargement
2 pounds: enlargement of your uterus
2 pounds: amniotic fluid surrounding your baby
1.5 pounds: the placenta

Of course, patterns of weight gain during pregnancy vary. It's normal to gain less if you start out heavier and more if you're having twins or triplets — or if you were underweight before becoming pregnant. More important than how much weight you gain is what makes up those extra pounds.

When you're pregnant, what you eat and drink is the main source of nourishment for your baby. In fact, the link between what you consume and the health of your baby is much stronger than once thought. That's why doctors now say, for example, that no amount of alcohol consumption should be considered safe during pregnancy.

The extra food you eat shouldn't just be empty calories — it should provide the nutrients your growing baby needs. For example, calcium helps make and keep bones and teeth strong. While you're pregnant, you still need calcium for your body, plus extra calcium for your developing baby. Similarly, you require more of all the essential nutrients than you did before you became pregnant.

A healthy diet includes proteins, carbohydrates, fats, vitamins, minerals, and plenty of water. The U.S. government publishes dietary guidelines that can help you determine how many servings of each kind of food to eat every day. Eating a variety of foods in the proportions indicated is a good step toward staying healthy.

Food labels can tell you what kinds of nutrients are in the foods you eat. The letters RDA, which you find on food labeling, stand for recommended daily allowance, or the amount of a nutrient recommended for your daily diet. When you're pregnant, the RDAs for most nutrients are higher.

Here are some of the most common nutrients you need and the foods that contain them:

Nutrient	Needed for	Best sources
Protein	cell growth and blood production	lean meat, fish, poultry, egg whites, beans, peanut butter, tofu
Carbohydrates	daily energy production	breads, cereals, rice, potatoes, pasta, fruits, vegetables
Calcium	strong bones and teeth, muscle contraction, nerve function	milk, cheese, yogurt, sardines or salmon with bones, spinach
Iron	red blood cell production (to prevent anemia)	lean red meat, spinach, iron-fortified whole-grain breads and cereals
Vitamin A	healthy skin, good eyesight, growing bones	carrots, dark leafy greens, sweet potatoes
Vitamin C	healthy gums, teeth, and bones; assistance with iron absorption	citrus fruit, broccoli, tomatoes, fortified fruit juices
Vitamin B6	red blood cell formation; effective use of protein, fat, and carbohydrates	pork, ham, whole-grain cereals, bananas
Vitamin B12	formation of red blood cells, maintaining nervous system health	meat, fish, poultry, milk (Note: vegetarians who don't eat dairy products need supplemental B12.)
Vitamin D	healthy bones and teeth; aids absorption of calcium	fortified milk, dairy products, cereals, and breads
Folic acid	blood and protein production, effective enzyme function	green leafy vegetables, dark yellow fruits and vegetables, beans, peas, nuts
Fat	body energy stores	meat, whole-milk dairy products, nuts, peanut butter, margarine, vegetable oils (Note: limit fat intake to 30% or less of your total daily calorie intake.)

Scientists know that your diet can affect your baby's health — even before you become pregnant. For example, recent research shows that folic acid helps prevent neural tube defects (including spina bifida) from occurring during the earliest stages of fetal development — so it's important to consume plenty of it before you become pregnant and during the early weeks of your pregnancy.

Even though many foods, particularly breakfast cereals, are fortified with folic acid, doctors now encourage women to take folic acid supplements before and throughout pregnancy (especially for the first 28 days). Be sure to ask your doctor about folic acid if you're considering becoming pregnant.

Calcium is another important nutrient. 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 contain some extra calcium.

Your best food sources of calcium are milk and other dairy products. However, if you have lactose intolerance or dislike milk and milk products, ask your doctor about a calcium supplement. (Signs of lactose intolerance include diarrhea, bloating, or gas after eating milk or milk products. Taking a lactase capsule or pill or using lactose-free milk products may help.) Other calcium-rich foods include sardines or salmon with bones, tofu, broccoli, spinach, and calcium-fortified juices and foods.

Doctors don't usually recommend starting a strict vegan diet when you become pregnant. However, if you already follow a vegan or vegetarian diet, you can continue to do so during your pregnancy — but do it carefully. Be sure your doctor knows about your diet. It's challenging to get the nutrition you need if you don't eat fish and chicken, or milk, cheese, or eggs. You'll likely need supplemental protein and may also need to take vitamin B12 and D supplements.

To ensure that you and your baby receive adequate nutrition, consult a registered dietitian for help with planning meals.

You've probably known women who craved specific foods during pregnancy, or perhaps you've had such cravings yourself. Some old theories held that a hunger for a particular type of food indicated that a woman's body lacked the nutrients that food contains. Although this turned out not to be so, it's still unclear why these urges occur.

Some pregnant women crave chocolate, spicy foods, fruits, and comfort foods, such as mashed potatoes, cereals, and toasted white bread. Other women crave non-food items, such as clay and cornstarch. The craving and eating of non-food items is known as pica. Consuming things that aren't food can be dangerous to both you and your baby. If you have urges to eat non-food items, notify your doctor.

But following your cravings is fine as long as you crave foods that contribute to a healthy diet. Often, these cravings let up about 3 months into the pregnancy.

Food and Drinks to Avoid While Pregnant

No level of alcohol consumption is considered safe during pregnancy. Also, check with your doctor before you take any vitamins or herbal products. Some of these can be harmful to the developing fetus.

And although many doctors feel that one or two 6- to 8-ounce cups per day of coffee, tea, or soda with caffeine won't harm your baby, it's probably wise to avoid caffeine altogether if you can. High caffeine consumption has been linked to an increased risk of miscarriage and other problems, so limit your intake or switch to decaffeinated products.

When you're pregnant, it's also important to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life threatening to an unborn baby and may cause birth defects or miscarriage. Foods to steer clear of include:

soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
unpasteurized milk, juices, and apple cider
raw eggs or foods containing raw eggs, including mousse and tiramisu
raw or undercooked meats, fish, or shellfish
processed meats such as hot dogs and deli meats (these should be thoroughly cooked)
fish that are high in mercury, including shark, swordfish, king mackerel, or tilefish

If you've eaten these foods at some point during your pregnancy, try not to worry too much about it now; just avoid them for the remainder of the pregnancy. If you're really concerned, talk to your doctor.

Fish and shellfish can be an extremely healthy part of your pregnancy diet — they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat. But limit the types of fish you eat while pregnant because some contain high levels of mercury, which can cause damage to the developing nervous system of a fetus.

Mercury, which occurs naturally in the environment, is also released into the air through industrial pollution and can accumulate in streams and oceans, where it turns into methylmercury. The methylmercury builds up in fish, especially those that eat other fish.

Because canned albacore (or white) tuna and tuna steaks are generally considered to be higher in mercury than canned light tuna, the U.S. Food and Drug Administration (FDA) recommends that you eat no more than 6 ounces a week. A 2006 review by Consumer Reports, though, showed that some canned light tuna can contain mercury levels even higher than that of white tuna, and recommends that pregnant women eat no canned tuna. But the FDA stands by its current recommendations, saying that the levels are safe if tuna consumption is limited.

It can be confusing when recommendations from trusted sources differ. But since this analysis indicates that amounts of mercury in tuna may be higher than previously reported, some women may want to eliminate tuna from their diet while pregnant or when trying to become pregnant.

Almost all fish and shellfish contain small amounts of mercury, but you can safely eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury, such as salmon, shrimp, clams, pollock, catfish, and tilapia.

Talk with your doctor if you have any questions about how much — and which — fish you can eat.

Because the iron in prenatal vitamins and other factors may cause constipation during pregnancy, try to consume more fiber than you did before you became pregnant. Try to eat about 20 to 30 grams of fiber a day. Your best sources are fresh fruits and vegetables and whole-grain breads, cereals, or muffins.

Some people also use fiber tablets or drinks or other high-fiber products available at pharmacies and grocery stores, but check with your doctor before trying them. (Don't use laxatives while you're pregnant unless your doctor advises you to do so. And avoid the old wives' remedy — castor oil — because it can actually interfere with your body's ability to absorb nutrients.)

If constipation is a problem for you, your doctor may prescribe a stool softener. Be sure to drink plenty of fluids, especially water, when increasing fiber intake, or you can make your constipation worse. One of the best ways to avoid constipation is to get more exercise. You should also drink plenty of water between meals each day to help soften your stools and move food through your digestive system. Sometimes hot tea, soups, or broth can help. Also, keep dried fruits handy for snacking.

Some pregnant women find that broccoli, spinach, cauliflower, and fried foods give them heartburn or gas. You can plan a balanced diet to avoid these foods. Carbonated drinks also cause gas or heartburn for some women, although others find they calm the digestive system.

If you're frequently nauseated, eat small amounts of bland foods, like toast or crackers, throughout the day. If nothing else sounds good, try cereal with milk or a sweet piece of fruit. To help combat nausea, you can also:

Take your prenatal vitamin before going to bed after you've eaten a snack — not on an empty stomach.
Eat a small snack when you get up to go to the bathroom early in the morning.
Suck on hard candy.

How to Know You're Eating Well

The key is to eat foods from the different food groups in approximately the recommended proportions. If nausea or lack of appetite cause you to eat less at times, don't worry — it's unlikely to cause fetal harm because your baby gets first crack at the nutrients you consume.

And although it's generally recommended that a woman of normal weight gain about 25 to 35 pounds during pregnancy (most gain 4 to 6 pounds during the first trimester and 1 pound a week during the second and third trimesters), don't fixate on the scale. Instead, focus on eating a good variety and balance of nutritious foods to keep both you and your baby healthy.

Exercising during pregnancy

Most moms-to-be benefit greatly from exercising. During your pregnancy, though, you'll need to make a few changes to your normal exercise routine.

Discuss your exercise plans with your doctor or other health care provider early on. The level of exercise recommended will depend, in part, on your level of pre-pregnancy fitness.

What Are the Benefits of Exercising During Pregnancy?

No doubt about it, exercise is a big plus for both you and your baby (if complications don't limit your ability to exercise). It can help you:

Feel better. At a time when you wonder how this strange body can possibly be yours, exercise can increase your sense of control and boost your energy level. Not only does it make you feel better by releasing endorphins (naturally occurring chemicals in the brain), appropriate exercise can:
- relieve backaches and improve your posture by strengthening and toning muscles in your back, butt, and thighs
- reduce constipation by accelerating movement in your intestines
- prevent wear and tear on your joints (which become loosened during pregnancy due to normal hormonal changes) by activating the lubricating fluid in your joints
- help you sleep better by relieving the stress and anxiety that might make you restless at night
Look better. Exercise increases the blood flow to your skin, giving you a healthy glow.
Prepare you and your body for birth. Strong muscles and a fit heart can greatly ease labor and delivery. Gaining control over your breathing can help you manage pain. And in the event of a lengthy labor, increased endurance can be a real help.
Regain your pre-pregnancy body more quickly. You'll gain less fat weight during your pregnancy if you continue to exercise (assuming you exercised before becoming pregnant). But don't expect or try to lose weight by exercising while you're pregnant. For most women, the goal is to maintain their fitness level throughout pregnancy.

While the jury's still out on the additional benefits of exercise during pregnancy, some studies have shown that exercise may even lower a woman's risk of complications, like preeclampsia and gestational diabetes.

What's Safe During Pregnancy?

It depends on when you start and whether your pregnancy is complicated. If you exercised regularly before becoming pregnant, continue your program, with modifications as you need them.

If you weren't fit before you became pregnant, don't give up! Begin slowly and build gradually as you become stronger. The U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2½ hours) of moderate-intensity aerobic activity each week for healthy women who are not already highly active or doing vigorous-intensity activity.

If you're healthy, the risks of moderate-intensity activity during pregnancy are very low, and do not increase risk of low birth weight, pre-term delivery, or early pregnancy loss.

Before you continue your old exercise routine or begin a new one, you should talk to your doctor about exercising while you're pregnant. Discuss any concerns you have and know that you might need to limit your exercise if you have:

pregnancy-induced high blood pressure (hypertension)
early contractions
vaginal bleeding
premature rupture of your membranes, also known as your water (the fluid in the amniotic sac around the fetus) breaking early

Many women enjoy dancing, swimming, water aerobics, yoga, Pilates, biking, or walking. Swimming is especially appealing, as it gives you welcome buoyancy (floatability or the feeling of weightlessness). Try for a combination of cardio (aerobic), strength, and flexibility exercises, and avoid bouncing.

Many experts recommend walking. It's easy to vary the pace, add hills, and add distance. If you're just starting, begin with a moderately brisk pace for a mile, 3 days a week. Add a couple of minutes every week, pick up the pace a bit, and eventually add hills to your route. Whether you're a pro or a novice, go slowly for the first 5 minutes to warm up and use the last 5 minutes to cool down.

If you were a runner before you were pregnant, you might be able to continue running during your pregnancy, although you may have to modify your routine.

Whatever type of exercise you and your doctor decide on, the key is to listen to your body's warnings. Many women, for example, become dizzy early in their pregnancy, and as the baby grows, their center of gravity changes. So it may be easy for you to lose your balance, especially in the last trimester.

Your energy level might vary greatly from day to day. And as your baby grows and pushes up on your lungs, you'll notice a decreased ability to breathe in more air (and the oxygen it contains) when you exercise. If your body says, "Stop!" — stop!

Your body is signaling that it's had enough if you feel:

fatigue
dizziness
heart palpitations (your heart pounding in your chest)
shortness of breath
pain in your back or pelvis

And if you can't talk while you're exercising, you're doing it too strenuously.

It also isn't good for your baby if you become overheated because temperatures higher than 102.6°F (39°C) could cause problems with the developing fetus — especially in the first trimester — which can potentially lead to birth defects. So don't overdo exercise on hot days.

During hot weather, avoid exercising outside during the hottest part of the day (from about 10 a.m. to 3 p.m.) or exercise in an air-conditioned place. Also remember that swimming makes it more difficult for you to notice your body heating up because the water makes you feel cooler.

What Are Kegel Exercises?

Although the effects of Kegel exercises can't be seen from the outside, some women use them to reduce incontinence (the leakage of urine) caused by the weight of the baby on their bladder. Kegels help to strengthen the "pelvic floor muscles" (the muscles that aid in controlling urination).

Kegels are easy, and you can do them any time you have a few seconds — sitting in your car, at your desk, or standing in line at the store. No one will even know you're doing them!

To find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few seconds, then relax. You're using the correct muscles if you feel a pull. Or place a finger inside your vagina and feel it tighten when you squeeze. Your doctor can also help you identify the correct muscles.

A few things to keep in mind when you're doing Kegel exercises:

Don't tighten other muscles (stomach or legs, for example) at the same time. You want to focus on the muscles you're exercising.
Don't hold your breath while you do them because it's important that your body and muscles continue to receive oxygen while you do any type of exercise.
Don't regularly do Kegels by stopping and starting your flow of urine while you're actually going to the bathroom, as this can lead to incomplete emptying of your bladder, which increases the risk of urinary tract infections (UTIs).

Most doctors recommend that pregnant women avoid exercises after the first trimester that require them to lie flat on their backs.

Unless your doctor tells you otherwise, it's also wise to avoid any activities that include:

bouncing
jarring (anything that would cause a lot of up and down movement)
leaping
a sudden change of direction
a risk of abdominal injury

Typical limitations include contact sports, downhill skiing, scuba diving, and horseback riding because of the risk of injury they pose.

Although some doctors say step aerobics workouts are acceptable if you can lower the height of your step as your pregnancy progresses, others caution that a changing center of gravity makes falls much more likely. If you do choose to do aerobics, just make sure to avoid becoming extremely winded or exercising to the point of exhaustion.

And check with your doctor if you experience any of these warning signs during any type of exercise:

vaginal bleeding
unusual pain
dizziness or lightheadedness
unusual shortness of breath
racing heartbeat or chest pain
fluid leaking from your vagina
uterine contractions

How Can I Get Started?

Always talk to your doctor before beginning any exercise program. Once you're ready to get going:

Start gradually. Even 5 minutes a day is a good start if you've been inactive. Add 5 minutes each week until you reach 30 minutes.
Dress comfortably in loose-fitting clothes and wear a supportive bra to protect your breasts.
Drink plenty of water to avoid overheating and dehydration.
Skip your exercises if you're sick.
Opt for a walk in an air-conditioned mall on hot, humid days.
Above all, listen to your body.

Reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: April 2014

Taking care of your mental health during pregnancy

Pregnancy brings a mix of feelings, and not all of them are good. If you're feeling worried, you're not alone. Worry is common, especially during a woman's first pregnancy or an unplanned one. It can be even harder if you're dealing with depression or anxiety.

For your health and your baby's, take care of yourself as much as you can. Be sure to eat well, exercise, get enough sleep, and take your prenatal vitamins.

If you're feeling worried, sad, or nervous, talk to someone about it — and know when to reach out for help.

What Feelings Can Happen?

Mood swings are normal during pregnancy. But if you feel nervous or down all the time, it could be a sign of something deeper going on. Stress over being pregnant, changes in your body during the pregnancy, and everyday worries can take a toll.

Some pregnant women may have depression or anxiety:

Depression is sadness or feeling down or irritable for weeks or months at a time. Some women may have depression before getting pregnant. But it also can start during pregnancy for a number of reasons — for example, if a woman isn't happy about being pregnant or is dealing with a lot of stress at work or at home.
Anxiety is a feeling of worry or fear over things that might happen. If you worry a lot anyway, many things can stress you out during pregnancy. You might worry that you won't be a good mother or that you can't afford to raise a baby.

Pregnant women may have other mental health issues, such as:

bipolar disorder (episodes of low-energy depression and high-energy mania)
post-traumatic stress disorder (PTSD)
panic attacks (sudden, intense physical responses with a feeling of unexplained and paralyzing fear)
obsessive-compulsive disorder (OCD)
eating disorders (like bulimia or anorexia nervosa)

It's important to treat mental health concerns during pregnancy. Mothers who are depressed, anxious, or have another issue might not get the medical care they need. They might not take care of themselves, or they may use drugs and alcohol during the pregnancy. All of these things can harm a growing baby.

If you have a mental health issue, talk with your doctor so you can get the help you need during and after your pregnancy.

How Can I Get Help?

If you feel anxious or depressed, talk to a doctor, counselor, or therapist, and get help right away. The sooner treatment starts, the sooner you'll feel better.

Also talk to a doctor about your overall health and any mental health issues you've had in the past. It's best for your doctor to know your full medical history, in case anything comes up during or after your pregnancy.

How Are Problems Treated?

Treatment for mental health problems may include:

Prescription medicine. Always talk to a doctor before you start taking — or stop taking — any medicines during your pregnancy. If you take any kind of medicine for a mental health issue and are pregnant or planning to get pregnant, tell your doctor. Don't stop taking it unless your doctor tells you to. Some medicines may cause problems for a growing baby, but stopping your medicine may make things worse. Your doctor can make a treatment plan that is best for you and your baby.
Talk therapy. Talking one-on-one with a therapist can be a great way to manage stress, deal with depression, and ease anxiety during pregnancy. Finding a support group where you can share your concerns with other mothers who know what you're going through also can help. Talking with a social worker or counselor can help you deal with money issues, worries over raising a child, or other stresses in your life.
Other approaches. Many women find comfort in activities like yoga, exercise, and meditation. If you're feeling stressed or overwhelmed, talking to a friend, family member, or faith leader can help you feel better.

Many moms feel anxious or depressed at some point in their pregnancy, and some may even need treatment for it. But a mental health problem doesn't have to be a problem for you or your baby. Get the help you need to feel better, and you'll be doing the best thing for you both.

Reviewed by: Mary L. Gavin, MD

Date reviewed: February 2017

Tips for a Healthy Pregnancy

Staying healthy during your pregnancy

Prenatal Health Care

Nutrition and Supplements

Calcium

Iron

Folate (Folic Acid)

Fluids

Exercise

Sleep

Some Things to Avoid

Alcohol

Recreational Drugs

Nicotine

Caffeine

Food Smarts & Other Precautions

Changing the Litter Box

Over-the-Counter and Prescription Medications

Healthy Pregnancy Habits: From Start to Finish

Folic Acid and Pregnancy

What Is Folic Acid?

What Are the Benefits of Folic Acid?

How Can I Get Enough Folic Acid?

A healthy diet

Eating Well When You're Pregnant

Food and Drinks to Avoid While Pregnant

How to Know You're Eating Well

Exercising during pregnancy

What Are the Benefits of Exercising During Pregnancy?

What's Safe During Pregnancy?

What Are Kegel Exercises?

How Can I Get Started?

Taking care of your mental health during pregnancy

What Feelings Can Happen?

How Can I Get Help?

How Are Problems Treated?

More Questions? We've Got Answers.

Choose a location

Tips for a Healthy Pregnancy

Staying healthy during your pregnancy

Prenatal Health Care

Nutrition and Supplements

Calcium

Iron

Folate (Folic Acid)

Fluids

Exercise

Sleep

Some Things to Avoid

Alcohol

Recreational Drugs

Nicotine

Caffeine

Food Smarts & Other Precautions

Changing the Litter Box

Over-the-Counter and Prescription Medications

Healthy Pregnancy Habits: From Start to Finish

Folic Acid and Pregnancy

What Is Folic Acid?

What Are the Benefits of Folic Acid?

How Can I Get Enough Folic Acid?

A healthy diet

Eating Well When You're Pregnant

Food and Drinks to Avoid While Pregnant

How to Know You're Eating Well

Exercising during pregnancy

What Are the Benefits of Exercising During Pregnancy?

What's Safe During Pregnancy?

What Are Kegel Exercises?

How Can I Get Started?

Taking care of your mental health during pregnancy

What Feelings Can Happen?

How Can I Get Help?

How Are Problems Treated?

More Questions? We've Got Answers.

Looking for a supportive pediatrician? We've got you covered

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