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Self-Care During Pregnancy
There is much a pregnant woman can do to take care of herself during pregnancy. If she has any questions about diet, the use of drugs or nutritional supplements, physical activity, and sexual intercourse during pregnancy, she can talk with her doctor or other health care practitioner.
During pregnancy, the woman’s diet should be adequate and nutritious. If she does not consume enough nutrients for herself and the fetus, nutrients first go to nourish the fetus. However, adding about 250 calories to the daily diet is usually enough to provide nourishment for both. Most of the extra calories should be protein. The diet should be well-balanced and include fresh fruits, grains, and vegetables. Cereals that are high in fiber and low in sugar are a good choice.
In the United States, most women get enough salt in their diet, without adding salt to their food at the table. Commercially prepared foods often contain excessive amounts of salt and should be consumed sparingly.
Dieting to lose weight during pregnancy is not recommended, even for obese women, because some weight gain is essential for the fetus to develop normally. Dieting reduces the supply of nutrients to the fetus.
How much weight a woman should gain during pregnancy depends on her body mass index (BMI) before pregnancy. BMI is weight in kilograms divided by height in meters squared (see Table: Who Is Overweight?) and is used to determine whether weight for height is normal. Women with a high BMI should gain less weight during pregnancy than those with a BMI classified as normal or underweight. An average-size woman should gain about 25 to 30 pounds during pregnancy. Gaining more than 35 pounds puts fat on the woman and the fetus. Because controlling weight gain is more difficult later in pregnancy, a woman should try to avoid gaining too much weight during the first months. However, during early pregnancy, woman should try to gain between 2 and 3 pounds each month because not gaining weight can hinder the growth and development of the fetus.
Sometimes a pregnant woman gains weight because she is retaining fluid. Fluid may be retained later in pregnancy because when she lies flat, the enlarging uterus interferes with blood flow from the legs back to the heart. Lying on one side, preferably the left side, for 30 to 45 minutes 2 or 3 times a day may relieve this problem. Wearing elastic support stockings may also help.
Generally, avoiding drugs during pregnancy is best. However, drugs must sometimes be used (see Drug Use During Pregnancy). A pregnant woman should check with her doctor before taking any drug—including nonprescription (over-the-counter) drugs, such as aspirin, or medicinal herbs—particularly during the first 3 months.
Pregnancy doubles the amount of iron needed. Most pregnant women need an iron supplement because the average woman does not absorb enough iron from food to meet the requirements of pregnancy. If a woman has anemia or develops anemia during pregnancy, she may need to take a larger dose of iron than other pregnant women. Iron supplements may cause mild stomach upset and constipation.
All pregnant women should take a supplement that contains 400 micrograms of folate (folic acid) each day, although some experts recommend slightly higher amounts, such as 600 or 800 micrograms. Such doses are often available in over-the counter products, such as multivitamins. Ideally, the folate supplement is begun before pregnancy. A deficiency of folate increases the risk of having a baby with a birth defect of the brain or spinal cord (neural tube defect), such as spina bifida. Women who have had a baby with a neural tube defect should take 4,000 micrograms of folate—a much larger amount than usually recommended. Doses of 1,000 micrograms or higher require a prescription. For most other women, even those with a folate deficiency, the amount of folate in a standard prenatal vitamin is sufficient.
Most doctors recommend that pregnant women take a prenatal multivitamin containing iron and folate daily, even if their diet is adequate.
Many pregnant women are concerned about moderating their activities. However, most women can continue their usual activities and exercises throughout pregnancy. Mildly strenuous sports, such as swimming and brisk walking, are good choices. Vigorous activities, such as running and horseback riding, are also possible if done cautiously, to avoid injury, particularly to the abdomen. Contact sports should be avoided.
During pregnancy, women who are planning to breastfeed do not need to do anything to prepare their nipples for breastfeeding (see Feeding of Newborns and Infants : Breastfeeding). Expressing fluids from the breast manually before delivery may lead to an infection of the breast (mastitis) or even early labor. The body prepares the areola and nipple for breastfeeding by secreting a lubricant to protect the surface. This lubricant should not be rubbed off. Observing and talking with women who have breastfed successfully may be instructive and encouraging.
The safest time to travel during pregnancy is between 14 and 28 weeks. Travel time should not exceed 6 hours a day. Women can obtain useful tips and information about travel from their doctor, so discussing their travel plans with the doctor is a good idea.
When traveling in a car, airplane, or other vehicle, pregnant women should always wear a seat belt. Placing the lap belt across the hips and under the expanding abdomen and placing the shoulder belt between the breasts can help make wearing seat belts more comfortable. The belts should be snug but not uncomfortably tight.
During any kind of travel, pregnant women should stretch and straighten their legs and ankles periodically. Travel on airplanes is safe until about 36 weeks. The primary reason for this restriction at 36 weeks is the risk of labor and delivery in an unfamiliar environment.
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