Pregnancy can be a very exciting time for most people. It can also make some people feel anxious about what they should (or should not) be doing for their own and their baby's health. The information below will answer many frequently asked questions. There are also links to further reliable sources of information at the bottom of the leaflet.
Follow a healthy balanced diet
During pregnancy it is important to continue to eat a healthy balanced diet. You may have an increased appetite but it is not necessary to 'eat for two', even if you are having twins or triplets. Too much weight gain increases your risk of developing problems later in the pregnancy. Also, extra weight is difficult to lose after the birth. For women with a normal pre-pregnancy weight, a weight gain of 11-16 kg over the pregnancy is normal. The National Institute for Health and Care Excellence (NICE) advises that pregnant women only need an extra 200 calories per day in the last three months of pregnancy. No extra calories are needed until that point.
Aim to eat a healthy diet (which everyone should be eating, not just pregnant women). Briefly, a third of most meals should be starch-based foods (such as bread, cereals, potatoes, rice, and pasta), with fruit and vegetables. Eat plenty of fibre, which can be found in wholegrain breads as well as fruit and vegetables. Eat some protein foods such as meat, fish, pulses, chicken, etc, every day. Choose lean meat, cut the fat off red meat and the skin off chicken. Try to avoid adding fat - for example, by not frying food where possible.
Include foods with plenty of iron, calcium and folic acid - a growing baby needs these nutrients right from the start of the pregnancy:
- Iron is mainly in red meat, pulses, dried fruit, green vegetables and fortified cereals.
- Calcium is mainly in dairy products such as milk, cheese, and yoghurt. (Low-fat milk, cheeses and yoghurts usually contain just as much calcium as the full-fat varieties.)
- Folic acid is mainly in green vegetables, brown rice, and fortified cereals.
Fish - in general, fish is a good source of protein and other nutrients. Aim to eat at least two portions of fish per week, with at least one portion being oily fish (see below). However, there are some important exceptions. Some types of fish contain a high level of mercury which can damage the developing nervous system of an unborn baby. Because of this, the Food Standards Agency (FSA) advises:
- You should not eat any shark, marlin or swordfish.
- Limit tuna - eat no more than four medium-sized cans (drained weight = 140 g per can) or two fresh tuna steaks per week (weighing about 140 g cooked or 170 g raw).
Also, do not eat raw fish or uncooked shellfish which may contain germs (bacteria, viruses or parasites).
Also, some types of fish may contain a small amount of chemicals from pollution, including dioxins and polychlorinated biphenyls (PCBs). If you eat a lot of these fish, these chemicals may build up in your body over time, which may be harmful. Because of this, the FSA advises that you should have no more than two portions a week of any of the following fish:
- Oily fish, including mackerel, sardines, salmon, trout and fresh tuna. (Tinned tuna doesn't count as oily fish.)
- Sea bream, sea bass, turbot, halibut, rock salmon (also known as dogfish, flake, huss, rig or rock eel).
- Brown crabmeat.
Foods and drinks to avoid
You should not eat the following if you are pregnant:
- Anything with a lot of vitamin A. You need a small amount of vitamin A to keep healthy. However, large amounts can harm an unborn baby. So, avoid:
- Liver and liver products such as liver pâté and cod liver oil supplements.
- Vitamin tablets or supplements which contain vitamin A.
- Food which may have high levels of listeria. Listeria is a germ (bacterium) which does not usually cause problems in people who are not pregnant. However, pregnant women are more likely to become infected with listeria and it sometimes causes miscarriage, stillbirth or infections in the baby after birth. Foods which are most at risk of carrying listeria are:
- Undercooked meats and eggs. This may occur in some pre-cooked meats and pre-prepared meals. Make sure all meat foods are cooked until piping hot. Eggs should be cooked until the white and yolk are solid. Avoid foods that may contain raw eggs, such as some types of mayonnaise and mousse.
- Mould-ripened and soft cheeses such as Brie, Camembert and blue-veined cheeses. (Hard cheeses and processed cottage cheese are safe.)
- Pâtés - including vegetable pâtés.
- Raw shellfish and raw fish.
- Unpasteurised milk. Note: goat's milk is often unpasteurised, and goat's milk products such as cheeses are often made from unpasteurised milk.
- Certain fish (as described earlier).
- Limit the amount of caffeine to no more than 300 mg per day. Caffeine is a substance that occurs naturally in foods such as tea, coffee and chocolate; is added to some drinks such as cola, and some energy drinks; and is an ingredient of some cough and cold remedies, and some painkillers which you can buy at pharmacies. Having a lot of caffeine increases your risk of having a miscarriage and a baby with low birth weight. The increased risk is small. But, it is best to play safe. The main sources of caffeine are coffee, tea, chocolate, and cola. It is also added to some energy drinks and to some cough and cold remedies. As a rough guide:
- One mug of instant coffee has about 100 mg of caffeine.
- One mug of filter coffee has about 140 mg of caffeine.
- One mug of tea has about 75 mg of caffeine.
- One 50 g plain chocolate bar has about 50 mg of caffeine. Milk chocolate has about half the caffeine that plain chocolate has.
- One can of cola or half a can of an energy drink has up to 40 mg of caffeine.
A note about peanuts: at one point the FSA advised that you may wish to avoid eating peanuts when you are pregnant in certain cases. This included if you have an atopic disease such as asthma, eczema or hay fever, or if a close family member has one of these conditions. This was because there was a concern that children could develop a peanut allergy as a result of their mother eating peanuts during pregnancy. However, in the light of new evidence, this advice was changed in December 2008. The FSA now advises that there is no need for women who are pregnant or breast-feeding, or who have children aged under 3, to change their diets in order to exclude peanuts.
The effects of some prescribed medicines have been well studied and it is known that certain medicines are safe in pregnancy. For example, paracetamol at normal dose is safe and useful for headaches, backache and other aches and pains that may occur during pregnancy. However, for many medicines, we do not know for sure if they are safe or unsafe. So if you are pregnant, you should minimise your use of medication. This includes medicines that you can buy. Also, just because a medicine says it is herbal or natural, it does not necessarily mean that it is harmless or safe.
Always tell a doctor or dentist who prescribes medication for you that you are pregnant. Also, don't take medicines that you can buy over the counter (including herbal remedies) unless they are known to be safe in pregnancy. The pharmacist will advise.
- Paracetamol at normal dose is safe and useful for headaches, backache and other aches and pains that may occur during pregnancy.
- Anti-inflammatory painkillers such as ibuprofen. You should not normally take these during pregnancy. Regular use during pregnancy may affect the large blood vessels of the developing baby.
- Laxatives. Constipation is common in pregnancy and you may need a laxative. At first it is best to try increasing the fibre in your diet and increasing the amount of non-alcoholic fluids that you drink. If this fails then fibre supplements such as bran, ispaghula and sterculia are safe. Fybogel® is one such example commonly used for constipation in pregnancy. If you need something stronger then it is best to discuss this with a doctor. Some laxatives such as docusate and lactulose may be prescribed safely for a short time.
- Antihistamines. Most manufacturers advise avoiding antihistamines in pregnancy. This is because there are no trials to show they are safe. However, there is no evidence of harm either.
- Decongestants such as pseudoephedrine and xylometazoline often bought for symptoms of the common cold are best avoided in pregnancy.
If you already take regular medication, ideally you will have discussed this with a doctor before becoming pregnant. If you have an unplanned pregnancy, discuss with your doctor as early as possible any medication that you take. In some cases, the risk of taking the medicine has to be balanced against the risk of not taking the medicine, and your condition not being treated.
Vitamins and supplements
You should take folic acid tablets (supplements). Ideally, do this from at least one month before you get pregnant, and continue taking them until at least the end of the 12th week of pregnancy - even if you are healthy and have a good diet. Folic acid is a naturally occurring vitamin found in spinach, sprouts, broccoli, green beans and potatoes. Some bread and breakfast cereals are fortified with folic acid. However, you need a good supply of folic acid when you are pregnant to help with the development of the baby. If you take folic acid tablets in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida.
You can buy folic acid tablets from pharmacies. Also, the NHS Healthy Start scheme (see below) provides vitamin supplements that contain folic acid. These are free to many women who are on certain benefits.
- For most women, the dose is 400 micrograms (0.4 mg) a day.
- If you have an increased risk of having a child with a spinal cord problem then the dose is 5 mg a day. You need a prescription for this higher dose - that is, if:
- You have had a previously affected pregnancy.
- You or your partner have (or have a family with) a spinal cord defect.
- You are taking medication for epilepsy.
- You are obese - especially if your body mass index (BMI) is 30 or more.
- You have coeliac disease, diabetes, sickle cell anaemia or thalassaemia.
Ideally, start taking folic acid tablets before becoming pregnant. The common advice is to start from the time you stop using contraception. If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant.
Because of the substantial benefits of folic acid, some countries routinely fortify staple foods, such as wheat, cornflour or rice, with folic acid. Currently there is debate as to whether the UK should follow suit and fortify certain common foods with folic acid. Many foods contain folic acid, including vegetables such as spinach, sprouts, broccoli, green beans and potatoes. Some bread and breakfast cereals are fortified with folic acid. However, the intake for each individual can vary.
Vitamin D is needed for growth and supplements are recommended for all pregnant women, breast-feeding women and breast-fed babies. The dose if you are pregnant or breast-feeding is 400 units (10 micrograms) daily. Some experts think that women who get little or no sunshine on their skin need a higher dose, such as 800 units (20 micrograms) daily. This is because most of the vitamin D that we get is made in the skin with the help of sunlight. Your doctor will advise.
Some women on certain benefits can get vitamin D supplements free on the Health Start scheme. In some parts of the country they can be prescribed (and prescriptions are free for women in pregnancy). In many areas you will be advised to buy these supplements over the counter from a pharmacy.
Iodine is known to be important for the healthy development of the brain of the fetus. A woman who is pregnant needs more iodine than usual to supply the developing fetus. If they do not have enough iodine, the baby may end up less intelligent than they otherwise would. Iodine mainly comes from milk, yogurt, eggs and fish. Because iodine intake can be variable, some countries routinely fortify cereals and bread with iodine - but not the UK. Some salt contains iodine, but not all. Most people try to avoid using much salt in line with health recommendations. So there are concerns that some pregnant women may not be getting sufficient iodine in their diet. One recent study listed below suggests that all women should have iodine supplements in pregnancy. This decision has not been made for the UK but it may be worth considering whether your diet has enough iodine. You may wish to discuss this with your doctor or midwife.
If you smoke and you are pregnant, you are strongly advised to stop smoking. This is to benefit your health and the health of your baby. Tobacco smoke contains poisonous chemicals which pass into your bloodstream when you smoke and then on into the growing baby's blood. It is advised that both you and your partner do not smoke.
Smoking when you are pregnant gives a higher risk of:
- Having a miscarriage.
- Having a pregnancy which does not develop in the normal place (ectopic pregnancy.)
- Slow growth of the baby leading to a low birth weight.
- Premature labour.
- Bleeding towards the end of pregnancy, due to the placenta coming away from the wall of the womb early. This is called placental abruption. The placenta is the tissue which supplies the nutrients the baby needs, so this may harm the baby.
- Your baby having abnormalities such as a cleft lip or palate.
Even after the birth, children of smoking parents have an increased risk of:
- Chest infections.
- Glue ear.
- Cot death (sudden infant death syndrome).
- Doing less well at school.
- Behavioural problems such as attention deficit hyperactivity disorder (ADHD).
Stopping smoking reduces all these risks. See separate leaflet called Smoking - The Facts for more details.
You and your baby will get most benefit, and the risks will be most reduced, if you stop before you become pregnant. Planning to become pregnant is a good incentive to stop smoking for many women and is often a good time to persuade partners to give up too. However, your baby will still gain some benefit if you stop at any point during pregnancy.
For many people it is not easy to stop. Some tips are available in the separate leaflet called Pregnancy and Smoking.
There are also medicines available to help you quit.
Nicotine replacement therapy (NRT) can help if withdrawal symptoms are troublesome. Nicotine gum, sprays, patches, tablets, lozenges and inhalers are available to buy and on prescription. Using one of these increases your chance of stopping smoking if you really want to stop. A pharmacist, GP or practice nurse can advise about NRT.
If you are pregnant, you can consider using NRT. NRT is a medicine and may have effects on the baby. But it is believed that NRT is safer than smoking as, unlike smoking, NRT just gives you nicotine. Smoking gives you nicotine plus a lot of toxic chemicals. So, if NRT does enable you to stop smoking, it may be worthwhile to take it even if you are pregnant. However, if you can stop smoking without NRT, this is the best option. If you do use NRT patches during pregnancy, remove them before going to bed. It is not yet known what the harms are from electronic cigarettes in pregnancy. So it is best to avoid these until more is known.
There are other medicines available but these can only be used BEFORE you become pregnant. They are called bupropion and varenicline. You should not take these medicines when you are pregnant, as the risk to the unborn child is not known.
GPs, practice nurses or pharmacists can provide information, encouragement and tips on stopping smoking. Also, throughout the country there are specialist NHS Stop Smoking Clinics which have good success in helping people to stop smoking. Your doctor can refer you to one if you are keen to stop smoking. You can also call the NHS Smoking Helpline on 0300 123 1044, or visit the NHS Stop smoking website. The website link is listed at the end of this leaflet.
At your antenatal clinic appointment your carbon monoxide levels may be tested with a breath test. This is to see how much you smoke and also to check you have not been exposed to harmful carbon monoxide at home.
Women who are pregnant should not drink alcohol. The reason for this is that alcohol can cause damage to a developing baby. Alcohol gets to a baby through the placenta if a pregnant woman drinks alcohol. A baby cannot process alcohol very well. So, any alcohol in your baby stays in its body much longer than in you. This is known to be a risk for causing serious problems. At worst, babies can develop a syndrome of severe abnormalities, called fetal alcohol syndrome. In others, alcohol can cause problems for the baby such as poor growth, premature labour and physical and mental disability.
Guidelines in the UK advise that women should drink no alcohol at all for the first three months of pregnancy. This is because it increases the chance of miscarriage. After this time it is still better to drink no alcohol at all, as it is not known what amount is safe. This probably varies between different people. Getting drunk and binge drinking are harmful to the baby. It is easy to underestimate how much you drink. It is safest to avoid alcohol altogether throughout pregnancy.
For most women, it is important to do some regular physical activity during pregnancy as part of living a healthy lifestyle. In most cases, moderate physical activity during pregnancy is safe and can have benefits for both you and your baby and should not harm either of you. However, you do need to be sensible about what type of physical activity you do. You should aim to do a mixture of both aerobic physical activity and muscle-strengthening physical activity. In general, at least 30 minutes of physical activity every day is recommended. Physical activity during pregnancy is safe for most women. However, there are some pregnant women who should speak to their doctor or midwife before doing any physical activity during their pregnancy. This would include women who have other medical conditions, such as heart or breathing problems or complications in their pregnancy. It is also safer to avoid high-impact sports and contact sports where there is more risk of injury. Scuba diving should be avoided in pregnancy due to the risk to the fetus involved in pressure changes. See separate leaflet called Pregnancy and Physical Activity for more details.
Sex is safe for most couples during pregnancy. Later in pregnancy, sex and orgasm may provoke contractions known as Braxton-Hicks contractions. These make your bump feel hard. They can be uncomfortable but are quite normal. They usually pass after a few minutes.
Your doctor or midwife may advise you to avoid sex if you have had heavy bleeding in your pregnancy. This may also be the case if your waters have broken. This is because the protective barrier has gone, so having sex then may increase the risk of infection.
As the pregnancy progresses and the bump becomes bigger you may find some positions more difficult. You and your partner may need to experiment to find something that works for both of you.
Working during pregnancy
If you think that your job may pose a risk to a pregnancy then ideally you should discuss this with your employer before you become pregnant or as soon as you become pregnant.
Certain jobs and workplaces may pose a risk to a pregnancy, in particular to the early stages of pregnancy. For example:
- Raw meat is sometimes contaminated with germs (bacteria), such as listeria and toxoplasma. If these germs infect adults, they may cause listeriosis or toxoplasmosis but may cause little harm. However, these germs can cause serious problems to your unborn child if you become infected when you are pregnant.
- If you work with certain animals. For example:
- You should avoid contact with sheep and lambs at lambing time. This is because some lambs are born contaminated with germs such as listeria, toxoplasma and chlamydia which may affect you and your unborn baby.
- Cats and kittens often carry toxoplasma germs. Especially cat poo (faeces). So, cleaning out cat litters and handling cats and kittens can be a risk.
- If your job puts you at risk of contracting hepatitis B, you should be immunised against this virus. For example, if you are a healthcare worker, or work at a daycare or residential centre. (Women with hepatitis B can pass on the infection to their child at childbirth.)
- If you work with chemicals, fumes, radiation, etc. Some may be toxic to an unborn baby.
The above are just examples. In short, if you think that your occupation may pose a risk to a pregnancy then you should discuss this with your employer before becoming pregnant. A change in job, or in working practice, may be necessary.
You and your employer may wish to download information guides from the Health and Safety Executive (HSE) website (see below). They have an Information line if you have a health and safety concern at work but do not wish to discuss your pregnancy or planned pregnancy with your employer.
Recreational (illicit) drugs
The effects of all the different types of recreational drugs on pregnancy are not fully known. However, it is safe to assume that if you use recreational drugs, it is likely to pose a risk to the unborn child. You can contact the Frank website (details below) for information about individual drugs.
If you intend to become pregnant you should aim to stop taking or using recreational drugs. It is best to postpone the pregnancy until you are off drugs. If you have an unplanned pregnancy you should aim to stop the drugs as soon as possible.
Some people can stop drugs without any help but many people will require help. If you cannot come off drugs easily, see your doctor for help. Your doctor will be able to refer you to a local community drug team for help.
Most community drug teams can:
- Offer treatment plans. For example, one option for people who use heroin is to take substitute therapy with methadone in place of injecting heroin. This option is safer than injecting heroin during pregnancy.
- Provide counselling and information.
- Provide harm-reduction activities such as needle exchange schemes.
Avoid contact with sheep and lambs at lambing time. This is because some lambs are born carrying the germs that cause listeriosis, toxoplasmosis and chlamydia. These may be passed on to you and your unborn baby. Toxoplasma is also found in cat poo. You should always wash your hands after handling cats and kittens and ask someone else to wash out cat litter trays.
In general it is safe to travel during pregnancy. When in a car, wear the seat belt so that the straps go above and below your bump, not across it. Flying is not known to be harmful. Most airlines will not allow you to fly in the late stages of pregnancy. This is because planes are not the ideal place to go into labour, and they would prefer not to divert the flight to take you to the nearest hospital. It makes sense not to travel to anywhere too remote and far from medical assistance, particularly in the early or later stages of pregnancy. Also not all travel vaccinations are safe to use in pregnancy, so consider your destination carefully.
Further help & information
Dr Hayley Willacy
Dr Mary Harding
Dr John Cox