Looking after your body in pregnancy

Growing another human can take its toll. Dr Michelle Wise reiterates the importance of looking after your own body, as well as your baby on board.

The most helpful step you can take towards enjoying a safe and healthy pregnancy is engaging early with a lead maternity carer, usually a midwife. It seems most women will find out quite early on that they are pregnant, but many delay actually booking in with a midwife until after the first trimester. Midwives are an excellent source of information and advice. To find the right midwife for you, either contact your local maternity hospital services or find a midwife in your area by going to findyourmidwife.co.nz.

Most of the following pregnancy symptoms are very common and they are related to your rapidly changing hormones during pregnancy. Knowing they are common, and mostly not harmful, may help you to cope with these symptoms. However, pregnancy-related ailments can still cause significant distress.

Treating these symptoms appropriately may improve your sense of wellbeing, so you can get on with growing your baby.

Feeling queasy
The most common symptom of pregnancy is feeling sick or nauseous, even to the point of vomiting. Three out of four women will experience nausea in their pregnancy – you are not alone! For some women, it occurs only on waking (hence the reference to ‘morning sickness’) while for others it lasts all day. Nausea usually disappears by the end of the first trimester, but could last until 20 weeks or longer. Nausea can affect your general wellbeing and relationships and it may be difficult to work or to look after children. The cause is not well understood, and different treatments will work for different women.

Getting more rest will help, but isn’t always easy! Get as much support as possible –call in favours from friends, family members and neighbours. Don’t say ‘no’ if they offer to make you a meal, look after a child, or hang out a load of laundry. Also, ask your GP or midwife for a medical note if you need time off work.

Dietary changes may help ease your nausea, such as eating smaller nutritious snacks more frequently, separating solids from liquids (drinking fluids 20 minutes before or after you eat), and avoiding certain foods that trigger your nausea. Eat and drink things that you like and that stay down. My obstetrician told me that she ate nothing but mashed potatoes for three months while she was pregnant! It's important that you make sure you stay well hydrated as well, especially in the summer months.

Products containing ginger, such as ginger ale, ginger tea, ginger biscuits, or ginger supplements (up to 1000 mg per day, from a health food store) can help. Vitamin B6 tablets (up to 200 mg per day) can also help. These are available with or without a prescription from your doctor or midwife. Acupressure bands (pressing on the P6 point on the inner wrist) can be useful as well. These interventions have been shown to greatly improve symptoms of nausea and they are all perfectly safe options to use while you are pregnant.

You may find that prenatal vitamins containing iron can make your nausea (and constipation) worse, so consider switching to one with less or no iron, or stop taking them altogether and re-start when you're feeling better.

Your GP or midwife can prescribe other medications to help with nausea and vomiting that are also safe to use in pregnancy, so don’t wait until your symptoms get really severe. The most commonly prescribed medication is called metoclopramide. Other choices on prescription include prochlorperazine, promethazine and diphenhydramine. Talk to your midwife or doctor about trying one of these options so that you can get back to feeling better as quickly as possible. If you are prescribed one of these types of medications, the most important thing is to remember to take them routinely in order for them to work –don't hold off using them until you really need them.

Regular challenges
Symptoms of heartburn, acid reflux, indigestion and constipation are also common in pregnancy. Three out of every four women will experience gastrointestinal symptoms and these often go along with nausea. Treating these symptoms could also improve nausea, which is a bonus. Similar dietary and lifestyle changes to those listed for morning sickness can also help to alleviate heartburn. Other things to try include propping your upper body on extra pillows while you're lying down, and remaining upright after eating. It might even be good to get some fresh air –head out for a walk outside after a meal –to help with digestion.

Your doctor or midwife can prescribe medications to help heartburn that are safe during pregnancy.

First choice would be an antacid containing aluminium, calcium or magnesium, but be careful that you don't take too many in one day, or for too long. The second choice would be an H2 blocker such as ranitidine. You will find that improving these symptoms of nausea and reflux can really improve your quality of life.

A word about constipation – infrequent bowel motions or difficulty passing bowel motions are caused by slowed gut movement, a result of rising progesterone. Vitamin supplements such as iron and calcium, can also contribute to this issue. First choice treatments include drinking lots of fluids to stay well hydrated, as well as exercising regularly and adding some fibre to your diet (high fibre cereals, bread and snacks, and lots of fruits and vegetables). These simple lifestyle changes will help most women. However, if these treatments don’t help, speak to your midwife or doctor about trying some laxatives. All laxatives are generally thought to be safe in pregnancy, especially if they are only used for a short amount of time. Bulk-forming laxatives, like psyllium husk (Metamucil), or stool softeners like docusate sodium, can both be safely used long term.

Not so sweet
Diabetes is a medical condition that can occur in pregnancy. All women in New Zealand are offered screening for this during their pregnancy. The first testing point is at your booking visit with your GP or midwife. Blood tests are ordered, including one called glycated haemoglobin, which looks at blood sugar levels. If this is high, you may have undiagnosed or pre-diabetes and will be referred to secondary services.

The second point of testing is at six months. You'll have a test in the form of an hour-long glucose challenge (called a polycose). If your midwife considers you to be at high risk of gestational diabetes, you'll have to do a diagnostic test instead. In this two-hour glucose tolerance test, you have to fast from midnight and skip breakfast. Make sure you book in for this test fi rst thing in the morning, so you don’t have to starve all day! If you are found to have gestational diabetes, you'll be given lifestyle advice and offered ongoing care by specialists in this area. For most women, gestational diabetes resolves following the birth of their baby.

Your body will change during pregnancy, leading to new feelings and discomforts.

Rest assured that your hormones are doing their thing to help you grow a healthy baby and preparing your body for birth. Congratulations –you are amazing!

TIP THE SCALES
All women should strive for a healthy lifestyle when they are pregnant. This means healthy eating, exercising and managing to stay within the recommended weight gain range for your pregnancy. Regular exercise, meaning at least 30 minutes of moderate exercise per day, five days per week or more, is safe and well tolerated in pregnancy. Regular exercise helps improve your physical and mental health, and that can only be good for your growing baby.

Gaining some weight in pregnancy is perfectly normal (think: baby, placenta, amniotic fluid and growing womb), but gaining too much weight is associated with gestational diabetes, high blood pressure, having a large baby and increasing the need for a caesarean delivery. If you gain more than the recommended weight during pregnancy, it will also be harder to lose weight after you have given birth.

Talk to your doctor or midwife about how you can monitor your weight and for advice about healthy eating during your pregnancy. Ask about getting a Green Prescription – free advice on keeping active throughout your pregnancy. 

Dr Michelle Wise, BSc MD FRCSC MSc FRANZCOG, is an obstetrician at Auckland District Health Board and a senior lecturer in the Department of Obstetrics and Gynaecology at the University of Auckland.