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The Do's And Don'ts of Maintaining a Healthy Pregnancy

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Estimated read time: 11-12 minutes

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Let's see, there are pesticides, insecticides, X-rays, UV rays, microwaves, air pollution, noise pollution, asbestos, stress, hot tubs, hair dyes, sushi and SARS.

What more can we add to the list of worries pregnant women deal with these days? The dangers seem never-ending. But before you break out the Michael Jackson surgical face mask and quarantine yourself in an air bubble, take solace in the fact that the majority of pregnancies will end with a healthy mother and baby. And while many of the threats mentioned above are out of our control (some are myth and some still up for debate), there are many things you can do to increase your odds of maintaining a healthy pregnancy.

In this section, you'll find a list of pregnancy do's and don'ts. Also, two doctors address 10 safety questions, ranging from the pressing to the paranoid. And a physical therapist offers suggestions for working out during pregnancy.

Keep in mind that the following information is geared to the average, uncomplicated pregnancy. Be sure to talk to your doctor before initiating any new workout plan or diet.

The experts:

-Dr. Timothy C. Philpott, obstetrician-gynecologist at Missouri Baptist Medical Center

-Dr. Octavio R. Chirino, chairman, department of OB/GYN at St. John's Mercy Medical Center in St. Louis

-Debbie Monje, registered dietitian at Missouri Baptist Medical Center

-Kathy Sommers, physical therapist and Lamaze-certified childbirth educator at St. John's Mercy Medical Center



-Eat a balanced diet that includes fiber, protein, calcium and iron.

-Drink plenty of noncaffeinated fluids-up to 8 cups per day (water is a good choice). Limit caffeinated beverages to one per day.

-Take your prenatal vitamin containing folic acid and iron daily as prescribed by your doctor. Tip: Check to see if a generic version exists. It may be much less expensive.

-Eat a healthy meal or snack every few hours.

-Exercise at a mild to moderate intensity level at least three times a week (walking and swimming are good).

-Eat some form of carbohydrate about one hour before exercising to prevent dizziness and fatigue.

-Maintain a consistent deep-breathing pattern while exercising.

-Take rest periods daily, with your legs elevated, and get plenty of sleep.

-Find an obstetrician who answers your questions and makes you feel comfortable.

-Find a good pregnancy reference book ("Planning Your Pregnancy and Birth," by the American College of Obstetricians and Gynecologists, is a good one).


- "Eat for two." For a single birth, only 300 extra calories are needed per day, beginning with the second trimester.

-Try to lose weight or diet. Most women need to gain 25 to 35 pounds in a healthy pregnancy.

-Rely on a vitamin and mineral supplement to replace a good diet. The best way to absorb these nutrients is through the diet.

-Assume that all herbs and vitamins are safe. Some can be toxic or cause problems at high doses.

-Skip meals (even if you experience nausea).

-Take any medications without first checking with your doctor. (Of course, don't use drugs, alcohol or tobacco).

-Eat raw fish. Be careful with fish in general; swordfish, shark, king mackerel and tilefish, also known as golden bass and golden snapper, are off-limits. Tuna should be limited to one serving a week.

-Lift heavy weights that might cause strain or injure your back.

-Engage in any contact sports or any sport that may cause serious falls or trauma to the abdomen (skiing, for example).

-Expose yourself to X-rays or toxic chemicals such as lead or mercury.

(This list was compiled from interviews with our experts.)


We asked Dr. Timothy Philpott and Dr. Octavio Chirino to address 10 questions of safety during pregnancy.

... To maintain a vegetarian diet while pregnant?

PHILPOTT: YES. Most vegetarians eat a very well-balanced and healthy diet. The typical vegetarian diet lacks only a few essential nutrients that are important in pregnancy. First, vitamin B-12 is needed to make red blood cells and for the normal function of the nervous system in mom and baby. B-12 is found only in animal products including meat and milk. Most vegetarians need to take a supplement that includes this vitamin. Protein is also critical to fetal development. Vegetarians will find protein in tofu, eggs and whole-grain cereals. All pregnant women need to include adequate iron (30 mg per day), folic acid (800 mg per day) and calcium (1,000 mg per day) in their diet. Vegetarian women are advised to increase their consumption of dark green leafy vegetables (iron and folic acid) and dairy products fortified with vitamin D (for calcium). A daily prenatal vitamin is important for all pregnant women.

... To sleep on my back while pregnant?

PHILPOTT: NO. Halfway through pregnancy (at 20 weeks) it is no longer safe for a woman to sleep flat on her back. At this point, her uterus can begin to compress large blood vessels, primarily the vena cava. The vena cava is responsible for returning blood to the heart to be pumped again to the rest of the body. If the uterus compresses the vena cava for too long, the amount of blood available for the heart to pump drops and the total oxygen flow to the baby and the mother decreases. We recommend that pregnant patients train themselves as early as possible to sleep on their sides. Patients sometimes complain that their shoulders hurt when sleeping fully to the side, but simply having one hip higher than the other is enough. Some books suggest that the left side is the safest because the vena cava travels on the right side of the body. Practically speaking, there is no real difference. If a pregnant patient awakens to find herself flat on her back, we tell her not to worry. Just roll to the side as soon as possible.

... To keep cats in the house while pregnant?

PHILPOTT: YES. But there is one important stipulation: The pregnant woman doesn't change the cat box litter. Toxoplasmosis is a microbe that infects the feces of a large number of cats. This infection can harm a fetus, especially if the mother is infected in the first trimester. Simply petting or holding the cat is safe. But be sure to wash your hands afterward. Changing the litter box is not safe due to the high concentration of toxoplasmosis that can infect humans through the lungs or digestive system. "Toxo" can also be found in soil, so we recommend careful hand washing after working in the garden.

... To sit in the hot tub while pregnant?

PHILPOTT: NO. Raising the body temperature above 102 degrees can be harmful. The concern is that high temperatures in the uterus, especially in the first three months, can lead to birth defects. Hot tubs and saunas set at lower temperatures may avoid this problem but need to be set and maintained carefully. Bacteria grow well in warmer water, so hot-tub water can also pose infectious risks to mom and baby. We recommend that soaking for 10 to 15 minutes in a warm bath is safe as long as the water doesn't turn the skin red. It is probably safest to avoid even this, though, in the first trimester.

... To have sex while pregnant?

PHILPOTT: YES. Sex is considered generally safe but does carry a few risks in pregnancy. It can cause spotting, which is rarely dangerous but causes patients to worry. Patients being monitored for preterm labor are advised to avoid sex, which can increase uterine contractions. Of course, sex with multiple partners can increase the risk of acquiring infections such as gonorrhea or HIV. We recommend condoms to protect against these sexually transmitted infections.

... To get my hair dyed while pregnant?

CHIRINO: YES. But whether you are going to a hairstylist or doing it yourself, make sure the products are nontoxic and safe for use during pregnancy. Check the label for warnings. When you are dying your hair, be sure there is good ventilation so you don't get dizzy or nauseated (as pregnant women often do). Checking with your doctor first is always the best policy.

... To give blood during pregnancy?

CHIRINO: NO. This is not a good idea. Your baby depends on the oxygen-carrying capacity of your blood to stay healthy, and that is directly related to how many red blood cells you have circulating. As a blood donor, you give a portion of those away and this can be a potential problem for your baby's needs. Wait until you're not pregnant and then give generously.

... To work around computers while pregnant?

CHIRINO: YES. Working with and around computers is not dangerous, despite the rumors you might have heard. Of course, you should sit at a comfortable distance from the screen and avoid straining your eyes by looking away from time to time and taking a break when you feel tired.

... To be on my feet all day while pregnant?

CHIRINO: NO. Unfortunately, in today's busy world it's often hard to avoid this. Being on your feet all day can make you feel fatigued and increase swelling in your legs. What you can do is wear soft-soled, comfortable walking shoes. High heels only serve to increase the strain and pain in your calves. Be smart, and take several 10-minute breaks during the day with your legs elevated above your hips to improve the blood flow and reduce the swelling. Support hose can be quite helpful, but they must be put on when you first get up for maximum results.

... To drink herbal tea while pregnant?

CHIRINO: YES. Drinking herbal tea is a common alternative to coffee. But while most herbal teas are caffeine-free, some do contain caffeine. No need to panic, though-the amounts per cup are usually quite small, and drinking these in small quantities is not a problem. The important thing to remember is moderation. Keeping your intake to 2 to 4 cups per day makes the most sense.


Physical therapist Kathy Sommers has these suggestions:

By focusing on strengthening neglected muscles, such as your abdominals, pelvic floor and upper back, and stretching tight muscles, such as your hamstrings and neck, you will have a more comfortable pregnancy.

Stretching and strengthening should be incorporated into your daily workout routine. For example, tighten your abdominals while sitting, rotate your ankles while you elevate your feet or pull your shoulders back and down while standing.

Start with the essential exercises (below) and then add cardiovascular fitness such as walking, swimming and bicycling three times a week for 30 to 45 minutes.

If you were sedentary before becoming pregnant, it is best to stick with low-impact exercises that are not weight bearing in order to avoid injuries. If you were very active prior to your pregnancy, you can safely continue your workouts, modifying your intensity level as you are limited by your growing abdomen. Runners can continue to run, but should monitor the intensity level.

The same exercise program can be continued throughout all three trimesters. Simply modify the number of repetitions, duration, intensity and pace as you feel necessary. Listen to how your body feels. The intensity should feel mild to moderate. You should be able to breathe comfortably and not experience pain.

Look for exercise classes geared toward pregnant women. Prenatal water aerobics, yoga and other fitness classes are available in hospitals and fitness centers.


Women should avoid exercising on their backs after the fourth month of pregnancy since the growing uterus could put excessive weight on major blood vessels. A simple way to modify these exercises is to do them in a standing or sitting position. Consult your doctor before beginning any exercise program.

Pelvic tilts: Lie on your back with knees bent. Tighten your abdominal muscles and visualize pushing your low back into the floor. Hold the position for a few counts as you exhale. Keep your buttocks and shoulders on the floor. Pelvic tilts can be done on your back, on your side or sitting on a large gymnastic ball. Do 2 to 3 sets, 10 to 15 repetitions each. Try to do these at least three times a week; every day if possible.

Abdominal wall tightening: Lie on your back or side with knees bent. Take deep breaths in through your nose and allow your abdominal wall to expand upward. Blow air out through your mouth, slowly and forcibly, pulling in your abdominal muscles. Again, do 2 to 3 sets of 10 to 15 repetitions each, every day if possible.

Kegel exercises: Tighten the pelvic floor, pulling upward as if stopping urine flow. Hold for 10 seconds (try to build up to 30 seconds), then relax. Repeat a few times. Do these exercises throughout the day. They can be done in any position-standing, sitting, lying down or on your side. Although lying down is probably the easiest position when just learning, any position is effective.

Shoulder-blade squeezes: With your arms resting at your sides, squeeze shoulder blades back and down. Hold for 2 to 3 counts. Do 2 to 3 sets, 10 to 15 repetitions each, every day if you can.

Hamstring and calf stretches: Lie on your back. Pull one knee into the your chest and straighten that leg until a stretch is felt in the back of the thigh. Flex your foot to feel the stretch in the calf, and hold for 15 to 20 seconds. Do these once a day.


In addition to the standard pregnancy guide, "What to Expect When You're Expecting" (Workman, $13.95), here are a few more resources:

BOOK: "Eating Expectantly" by dietitian Bridget Swinney (Meadowbrook, $12)

WEB SITE: If you can put up with occasional pop-up advertisements, check out for a reader-friendly look at all things pregnancy. A more highbrow choice (although still very readable) would be (the American College of Obstetricians and Gynecologists).


(c) 2003, St. Louis Post-Dispatch. Distributed by Knight Ridder/Tribune News Service.

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