The essential facts about pregnancy health

Are you really eating for two? Can stress affect your baby? Dr Nick Walker highlights the essential facts about pregnancy health and wellbeing.

Soon after conception, the tiny group of living cells destined to become your baby begins to move. It travels through your Fallopian tubes – two narrow tunnels about the width of an udon noodle – and into the womb, which at this stage is about the size of a small pear. Those cells then multiply and attach to the inner lining of your womb, and start drawing nutrients from the rich blood supply there. As this happens, a special hormone known as HCG is released into your bloodstream. This hormone causes the symptoms of pregnancy and triggers the ‘positive’ indicator on a home pregnancy test: yes, you’re actually pregnant!

If this is your first pregnancy, this early stage evidence can be especially exciting, but perhaps also nerve-wracking as you consider how best to monitor and maintain your health as an expectant mother. I’d like to guide you through some of the more common facts – and myths – of pregnancy health and wellbeing.

A LITTLE SOMETHING EXTRA
Many women use dietary supplements while planning a pregnancy and while they’re waiting to conceive. However, just one micronutrient has been found to significantly benefit your baby’s health: folate, in the form of folic acid. This important vitamin is directly involved in reducing the likelihood of a group of birth defects known collectively as ‘neural tube defects’, or ‘spina bifida’. Many countries require staple foods to be fortified with this vitamin. This policy accounts for the fact that most women get pregnant without planning beforehand, and – because folic acid is best taken during such an early stage of pregnancy – that many women would miss the opportunity to use it effectively. New Zealand has so far resisted this policy, but the matter is being debated again. Regardless, you should ideally take folate supplements just prior to conception, and continue taking them for the first 12 weeks of your pregnancy.

The New Zealand Ministry of Health has recommended universal supplementation of iodine during pregnancy and lactation, recognising that our soils, and therefore food sources, are low in that mineral, and that fewer people are regularly using iodised salt. Iodine is vital to your thyroid hormone system, and is responsible for regulating your metabolism and brain development. During pregnancy and breastfeeding, your iodine needs increase markedly. Because the consequences of iodine deficiency can be so severe, it is recommended you take this supplement from your first trimester onward. It doesn’t matter if you already use iodised salt because any excess iodine will be flushed out in your urine.

Another common supplement used nowadays is a probiotic capsule. These contain colonies of various bacteria thought to be beneficial to your health. In their recent Probiotics in Pregnancy Study, researchers from the Universities of Auckland and Otago were surprised to find that probiotic use was also associated with a lower risk of postnatal depression, although this result would only apply to the specific probiotics used in the study. 

Unless you have a range of specific dietary needs, or a handful of rare medical conditions, you’ll find a well-balanced diet should provide all the necessary ingredients for a healthy pregnancy. While you may feel like only eating plain foods during your first trimester, as long as you were nutritionally sound going into your pregnancy, there’s no cause for concern about your dietary needs in the early stages. A baby is very efficient at taking its requirements directly from the mother’s bloodstream. It’s been calculated that a woman’s overall energy requirements rise only by around ten percent during pregnancy, so the old adage about pregnant women ‘eating for two’ should really be corrected to ‘eating for one-point-one’!

LET'S GET PHYSICAL
General exercise during pregnancy is beneficial and recommended – for both your physical and your mental wellbeing. Many people are concerned that exercise will reduce a woman’s energy available to her baby, but this is not the case. Pregnancy will limit your ability to exercise to your full capacity though, because the demands on your heart and lungs mean you’ll get tired and out-of-breath more quickly than when you weren’t pregnant, even in the early stages. Steady walking and light jogging is acceptable, but the latter usually becomes difficult in the last trimester due to the bulk of your uterus. Yoga and Pilates are very popular and completely safe, and many instructors offer pregnancy-specific classes. I wouldn’t recommend dangerous or extreme sports such as rock-climbing, parachuting or water-skiing, as the risk of an impact injury far outweighs any health benefit. I wouldn’t encourage long-distance marathon or triathlon events either, as these activities are likely to deplete all your energy reserves and, consequently, negatively affect foetal growth.

FEELING THE PRESSURE
During your first pregnancy, your life is likely to undergo some profound changes, especially in relation to employment or work, which in turn may lead to stress or conflict. Many of my patients become confronted at one point or another by stress, and the presence of pregnancy certainly seems to amplify the stress levels in any given situation! While I’m not a counsellor, I can advise that staying as calm as possible is important for your overall wellbeing. Recognising stress and removing yourself from stressful situations are the best ways to counteract stressful events, as is maintaining good social support from friends and family, where possible. Short periods of stress are unlikely to have a negative impact on your pregnancy, but chronic and long-term stress may. If you are experiencing a stressful situation, do tell your LMC so they are aware of your circumstances.

The opposite of stress is, of course, relaxation, and you should definitely put aside time for this. The ultimate form of relaxation is sleep, and it’s as important now as at any other time in your life. Unfortunately, sleep disturbance is really common during the third trimester, due to a range of issues such as foetal activity, frequent visits to the toilet and musculoskeletal discomfort as well. You can try to improve your sleep quality by not drinking excessive fluid in the evenings, and maintaining physical comfort by using lots of pillows for body support. Night-time leg muscle cramps bother some people, and magnesium supplements may help with these. Your sleep position is important too; the current recommendation is to go to sleep on your side, preferably the left, so your heavy uterus doesn’t compress the large blood vessels in your abdomen (though this advice is mainly relevant during the third trimester). After an initial period of deep sleep, you subconsciously begin to shift about, so if you wake up lying on your back, don’t be alarmed. Simply roll on to your side again before you go back to sleep.

SOUND ADVICE
No article on staying healthy during pregnancy would be complete without a reminder to avoid tobacco, alcohol and drugs. The main problem with smoking is that it produces carbon monoxide in your blood, which competes for space with oxygen, effectively lowering the oxygen levels available to your baby. This usually means your baby will not grow properly and attain his or her expected healthy birthweight. Less likely but far more seriously, smoking very much increases the chance of bleeding behind the placenta (placental abruption), which can cause a catastrophic disconnection between mother and baby, leading to either or both becoming very unwell. Alcohol should be avoided by anybody wishing to be as healthy as possible, because it’s now a recognised carcinogen (a substance proven to increase cancer risk). During pregnancy, the developing baby is thought to be particularly sensitive to alcohol exposure, as evidenced by the most extreme example known as ‘foetal alcohol syndrome’. There’s no known safe limit for alcohol in pregnancy, so an absolute teetotal approach is the only recommendable option.

At some point in your pregnancy, work and employment matters will usually clash with your new priorities. While it’s impossible to give general advice about this, there’s no medical reason to stop working at any particular gestational age. Much depends on the type of work you do and your financial considerations around income loss. What I do observe in practice is that, psychologically, if not physically, many women find the balance of their energy becoming more devoted to themselves and their baby, whether one week or one month before their due date. And remember, any sudden and unexpected complication of pregnancy will usually render you unable to work, regardless of what you may have planned!

WINGING IT
Lastly, I often field questions around travel during pregnancy. It’s not unhealthy or unsafe to travel while you’re pregnant, but insurance limits usually mean that by 30 weeks gestation it’s unlikely that you’ll be able to travel to countries where you cannot receive free health care. Domestic travel in New Zealand is permissible right until your due date, a fact that acknowledges our excellent maternity hospitals. If you plan to travel further afield, check with both your intended airline and your destination.

Now that you have some guidelines for your pregnancy, the most important thing to do is to choose a Lead Maternity Carer (LMC), and book your pregnancy with them. They’ll be full of useful information, and will be with you every step of the way.

Dr Nick Walker is a specialist obstetrician working in both public practice at National Women’s Hospital, and private practice in Mt Eden, Auckland. He divides his time between these roles and helping his wife in caring for their four young children.