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Healthy beginnings

Wondering what to eat - and what not to eat - during pregnancy? How much exercise should you be doing, anyway? And what's the deal with supplements? Specialist obstetrician and gynaecologist Dr Anil Sharma talks about the most important things you can do to give your baby the best start in life - while he or she is still inside you!

Are you pregnant, or planning to be? Preparing for pregnancy and during the three trimesters of pregnancy are ideal times to take stock of your health - not only for the sake of a healthy pregnancy and baby, but to lay the foundation for successful parenthood and your own good health. Adjustments to your diet, exercise and lifestyle practices may be necessary.

Getting started
For women on medications, or those who have any medical problems, a visit to your family doctor is important for a check-up. Sometimes, changes to ingested prescription and over-the-counter medications are needed. A pre-pregnancy visit is also good time to check your immunity to rubella (German measles), and a vaccine can be discussed with those who are non-immune. Rubella can cause harm to the developing baby if infection occurs during pregnancy.
You should also enquire about how up-to-date your cervical smear is, as many women are reluctant to have these done during pregnancy. If you are due for, or nearly due for, a smear test, you should have one done.
Take care of your teeth, too - a visit to the dentist for a check-up prior to conception would also be worthwhile.

While thinking about physical health for you and your baby, don't forget how important your mental wellbeing is. Avoid unnecessary stress, ask for support from your friends and family, and accept help when it is offered.

Look at what you're eating
The old adage "you are what you eat" really is true, as the building blocks of your body and that of your baby are ingested through food and drink.

Foods to enjoy
Your diet should ideally ensure that you include all four major groups below:
• Vegetables and fruits: Around seven servings a day.
• Cereals, pasta, rice, or bread (brown or wholegrain is best): Around six servings a day.
• Dairy foods (milk, yoghurt, hard cheeses): Two servings per day. The lower-fat versions are best.
• Protein (fish, chicken without skin, eggs, trimmed meat, nuts and pulses): At least one to two servings a day. Vegetarians should supplement with iron and possibly vitamin B12. In general, a serving of meat should be of a size that fits in the palm of your hand, and a portion of carbohydrate should fit in your cupped palm.

Foods to avoid
Listeria is a flu-like illness with vague, unpleasant symptoms due to a bacterium and can occur after eating cold or raw fish or seafood products (including sushi). It can cause significant harm to your pregnancy and these foods should be avoided. Similarly, you should stay away from pâté, precooked chicken, ham, all precooked meat products, soft cheeses such as brie and camembert, stored salads, coleslaws, unpasteurised milk products and any food prepared and stored in the fridge for more than 12 hours. Good food hygiene is important, and all fresh foods should be washed before eating. Let your partner eat any reheated leftovers, not you - but if you must eat reheated food, it should be piping hot. High-calorie foods and foods containing excessive salt (such as potato chips) need to be avoided. This means that carbonated drinks, some fruit juices, fatty foods and desserts are only suitable as occasional treats.

Eating for two?
For women in the ideal BMI (body mass index) range before pregnancy (20-25 and calculated as weight in kilograms divided by height in metres squared), the recommended average daily increase in calories is none in the first trimester of pregnancy, 350 in the second trimester and 450 in the last trimester. 350 calories is the equivalent of two slices of wholemeal bread with light butter, a 150g carton of yoghurt and an apple.
Pregnancy is not a time to try to lose weight, but unfortunately is a time where a lot of weight can be put on if you are not careful. The average gain in pregnancy is said to be around 12kg, and although many women will lose this extra weight during the postnatal period (particularly if breastfeeding), "eating for two" is not necessary and will only make it more difficult to get back to your pre-pregnancy weight and figure. Healthy snacks such as yoghurt, fruit, washed carrots and other vegetable sticks, nuts, dried fruit, or drinks such as fruit smoothies, are ideal.

Obesity
Obesity affects reproductive health and pregnancy in many ways, including increased difficulty achieving a pregnancy, possible spina bifida in the baby, increased risk of gestational diabetes, raised blood pressure, and clots in the legs that can break off and enter the lungs (deep-vein thrombosis).
Birthing outcomes are also affected, with increased risks of difficult labour, admission of the newborn to the neonatal unit, instrumental delivery, and Caesarean section. In an ideal world, women (and their partners for different reasons) would be encouraged to bring their weight down into the normal range for their height before getting pregnant, although reality has a way of preventing this. Nevertheless, dieting during pregnancy is not a good idea.

Morning sickness "Morning sickness" is a misnomer, as it actually occurs at any time of the day, and affects around one in three pregnant women. In most cases, it resolves by around 13-14 weeks, but can linger on. Healthy, non-fatty and frequent smaller meals and fluids are the order of the day. Ginger (such as in ginger tea) and vitamin B6 can help reduce nausea and vomiting in some women. Some women will need to see their doctor if they become dehydrated, and, although hospital admission is sometimes necessary for an intravenous drip, many women can stay at home after anti-nausea drugs are prescribed.

Drink up! Drinking around 2 to 2.5 litres a day (six to eight glasses of water) helps prevent bladder infections. It is generally considered sensible to stick to a maximum of two caffeinated drinks (tea, coffee, or cola) per day.

Dietary supplements
• Folate (Folic acid): Ideally, all women planning a baby should take at least one 0.8mg tablet of folate a day from four weeks prior to conception to around 12 weeks of pregnancy. This is to significantly reduce the risk of spina bifida, which can be a very serious condition affecting the baby's spinal cord and health. Women who have a history of these conditions in their own or their partner's family should take 5mg tablets. Also ideally, women should eat a diet rich in folate (green leafy vegetables, fruits and cereals).
• Iron: Severe lack of iron can cause low birth weight, premature birth and poor childhood development. Iron is plentiful in red meat, fish, eggs, chicken and wholegrain foods. While foods such as tomatoes and oranges can help you absorb iron, you should not drink tea during a meal as it can decrease the amount of iron absorbed. Depending on the routine blood tests that your lead maternity carer undertakes in your pregnancy, the need for iron tablets can be detected.
• Calcium: During pregnancy and breastfeeding, four servings of calcium-rich foods are needed daily. Calcium is found mainly in dairy products, but is also in nuts, well-cooked fish and dried fruit. It is important for the baby's developing bones and teeth, nervous system, heart and blood clotting. To keep your own bones healthy, adequate dietary intake is important - you need around 1000mg of calcium per day, mainly through dairy products.
• Iodine: Iodine is vital for normal thyroid gland function and normal brain development in the baby. Foods rich in iodine include seafood (ensure it is well-cooked), eggs, milk and seaweed. While it may be trendy to use rock salt in your meals and cooking, in pregnancy, bog-standard iodised cooking salt should be used.
• Fish oil: Fatty acids contained in fish oil are important for the development of the brain and eyes. If taking a fish-oil supplement, check that it has been tested and is certified as mercury-free.

Get some exercise If you have any medical conditions or concerns, please see your doctor before starting any exercise programme. If there are no problems with your pregnancy, swimming, walking, light aerobics and exercycle machines are all beneficial as long as you are comfortable. Regular exercise is to be encouraged as the positive benefits, including lower blood pressure and improved self-esteem, outweigh the theoretical disadvantages and studies have backed up this general advice.

What kind of exercise should I do?
As your ligaments (the tough bands of tissue which link bones together) relax during pregnancy, you are especially vulnerable to injury. Sports which use rapid directional changes (such as squash or netball) or hard, repetitious movements (like some types of aerobics) should be undertaken with care. Use common sense and avoid extreme sports like galloping and show-jumping on horseback, bungy jumping, and water-skiing. Scuba diving, body contact sports and high-altitude climbing should also be avoided.
Swimming is an excellent form of resistance exercise in pregnancy. The weightlessness which is experienced during swimming is relaxing as well as energising. Some pools also offer aqua-aerobic classes, which are low-impact and can be quite fun. Yoga is also a pleasant way to exercise when pregnant, as long as you avoid high-impact or "hot" yoga. As well as providing a gentle workout, pregnancy yoga teaches you how to control your breathing and to relax, useful tools for coping with labour.
However, pregnancy is not a time to exercise to exhaustion. Furthermore, it is important not to become overheated, and in later pregnancy, to avoid exercise that involves lying on your back. If you have been running on a regular basis when you become pregnant, it is generally fine to continue until it starts to become uncomfortable. If you have not been a regular runner, pregnancy is not a good time to take it up!
If you have not been doing any regular exercise before pregnancy and want to begin, walking is the cheapest, safest and most beneficial option. Walk for at least half-an-hour four times a week. Start off slowly, building up your speed and distance as you get more fit. Another benefit of walking is that it is easy to continue once the baby is born. Most babies enjoy being walked (and sleeping!) in a stroller and you may find it is a good way to keep both of you content, and your partner fit, as well. Don't forget your pelvic floor Pelvic floor exercises strengthen your pelvic floor muscles. This may help stop them becoming weakened during pregnancy and childbirth. Strengthening them involves squeezing the same muscles that you would squeeze if you needed to stop passing urine suddenly. Once you've learned these exercises, you will need to do 20 repetitions, three times a day. Start off by squeezing for one second, but gradually building up to a four-second squeeze. Pelvic floor exercises can and should become part of your daily routine, as they can be done in around a total of five minutes a day, they reduce the chances of vaginal prolapse (laxity), and they improve your sex life. If you find it difficult to learn the correct muscle squeezes, a session with a physiotherapist can be most beneficial.

Other things to think about
• Tobacco poisons affect your baby: Smoking significantly increases the risks of restricting the growth of your baby, stillbirth, cot death and placental abruption (where the placenta separates from the uterine wall before birth). It has been estimated that if all pregnant women who smoke stopped smoking, around 10% of all stillbirths and 5% of newborn deaths could be prevented, although some researchers feel these figures underestimate the truth. Visit www.quit.org.nz or www.smokefree.co.nz for resources on stopping smoking.
• Alcohol consumption: The moderation of alcohol is advised, but since there is no known "safe" amount, giving up alcohol during pregnancy is sensible.
• Sex during pregnancy: Having sex while pregnant will not harm the baby, although if bleeding has occurred during pregnancy, many women feel more reassured by avoiding intercourse. Other issues, such as a recent procedure (chorionic villus sampling or amniocentesis) or a low-lying placenta, can mean that avoiding sex is important. If there is any doubt, please ask your lead maternity carer.
• Heating things up: Using hot tubs, steam rooms, saunas or spas during pregnancy is generally not advised.
• Dental care: When visiting the dentist or any healthcare or treatment provider, to be safe, let them know you are pregnant.

Parting advice
As many women are postponing starting a family until later in their lives due to work and lifestyle issues, for some, disappointment is bound to occur. In general terms, if pregnancy hasn't occurred by 12 months of trying, preliminary blood tests and a semen test should be undertaken and referral made to a gynaecologist. In women over 35 years of age, this is probably best done sooner, around six to eight months. One thing that we are all short of when newborns arrive in our lives is energy. Dietary and lifestyle modifications can significantly give you extra "oomph" and, therefore, increase your physical and mental strength to cope with the changes.

I wish you the best of luck for a safe and healthy pregnancy.

by Dr Anil Sharma

Dr Anil Sharma is a Specialist Obstetrician and Gynaecologist from the UK with practices across Auckland and the North Shore. His expertise is in women's health and pregnancy care, and he is a parent to three daughters. Visit www.dranilsharma.co.nz for more information.

As seen in OHbaby! magazine Issue 1: 2008