The Do's and Don'ts of Pregnancy

Congratulations, you're pregnant! Before long you'll be counting your newborn's fingers and toes. But for the next ten months, it's your body that's a temple (albeit one with swollen ankles). Of course, you're wise to all the commonsense taboos: no booze, no smoking, no kickboxing. But new research on maternal health emerges daily, and chances are, you could stand to brush up on the guidelines, even if this is your second (or third) trip to the maternity ward. We asked ob-gyns to share the latest thinking about what to do--and not do--while you're expecting.

Old Thinking: Get screened if you're 35 or older.

New Thinking: Age doesn't matter.

For years, 35 was considered the right age for getting an amniocentesis to rule out various birth defects. The odds of having a baby with Down Syndrome (DS) increase as you age, and by 35, the risk of having a baby with DS is about equal to losing the fetus as a result of the procedure: 1 in 400. However, in 2007, the American College of Obstetricians and Gynecologists (ACOG) began recommending that all women be offered screenings to assess a baby's DS risk. Only an amnio and chorionic villus sampling (CVS) can confirm whether a baby has DS or another chromosomal abnormality, but less invasive procedures (that don't carry a risk for pregnancy loss) can estimate the odds that a baby has DS, says Maryam Tarsa, M.D., associate clinical professor of reproductive medicine at the University of California, San Diego.

First- and second-trimester tests can analyze hormone levels in your blood, and an ultrasound can look for markers that may suggest a fetus with a chromosomal abnormality. "Technology has improved; if abnormalities exist, we can often pick them up," she says. Whether you should have an amnio or CVS may be based on a variety of factors, such as the results of less invasive screenings and a family history of birth defects. Discuss what's right for you with your doc.

Old Thinking: Eat up! You've got a little one to feed!

New Thinking: Packing on the pounds causes health complications.

"You don't need to gain a great deal of weight to have a healthy baby," says Mary Rosser, M.D., Ph.D., assistant professor of obstetrics, gynecology, and women's health at Montefiore Medical Center, in the Bronx, New York. A fetus generally requires only an extra 100 calories a day in your first trimester and 300 calories by your third trimester, according to Rakhi Dimino, M.D., an ob-gyn at the Woman's Hospital of Texas, in Houston.

Heavier moms (especially those who are overweight when they conceive and then gain a lot more) are at greater risk for gestational diabetes and hypertension, which can lead to serious problems. Their babies also tend to be larger, which can cause difficulties during delivery. Plus, gaining too much in pregnancy sets you and your baby up for weight problems later on in life.

OBs now give tailored weight-gain advice, based on new guidelines from the Institute of Medicine. Below, find out what you should put on:

• Underweight: Gain 28 to 40 pounds.
• Normal: Gain 25 to 35 pounds.
• Overweight: Gain 15 to 25 pounds.
• Obese: Gain no more than 20 pounds.

Old Thinking: Drilling could spread bacteria, which might harm your baby.

New Thinking: Routine care helps prevent serious issues like preterm labor.

Skip cosmetic procedures, such as whitening, but get regular checkups. Fluctuating hormone levels can cause expecting moms to develop pregnancy gingivitis (swollen, bleeding gums). Left untreated, gingivitis can lead to periodontal disease, which raises your risk for low birth weight and premature delivery sevenfold, according to the American Academy of Periodontology. One possible reason is that oral bacteria harbor prostaglandin, a labor-inducing hormone. "Have your teeth cleaned at least once during pregnancy," advises Amanda Calhoun, M.D., assistant director of women's health at Kaiser Permanente Northern California. "If you decrease the bacteria in the mouth, you decrease the low-level infections that could cause preterm labor."

Old Thinking: Keep your heart rate below 140 beats a minute. You don't want Baby to overheat!

New Thinking: Focus on your breathing to make sure your bambino is getting enough oxygen.

"You won't hurt the fetus by getting too hot during exercise, so many OBs no longer follow the heart rate guideline," Dr. Dimino says. Still, when you work out, blood flow shifts to send more oxygen to your muscles, lungs, and heart. Too-strenuous activity can restrict oxygen from the uterus. To make sure your baby is getting enough of it, be aware of your breathing, Dr. Dimino says. "If you can have a conversation without huffing and puffing, you're fine."

As long as your doc okays it, shoot for 30 minutes of low-impact exercise, such as walking or stationary cycling, at least five days a week. Along with keeping your weight in check, it can ease constipation, insomnia, lower back pain, and other pregnancy discomforts while building stamina for labor and delivery. Research from Kansas City University of Medicine and Biosciences in Missouri suggests that working out also strengthens your baby's heart.

Old Thinking: Wearing a seat belt can harm your baby.

New Thinking: A seat belt can save both your lives.

"Women are afraid that if they get into a minor crash, a lap belt could put pressure on the baby," says Roger Young, M.D., Ph.D., professor of obstetrics and gynecology at the University of Vermont College of Medicine, in Burlington. But when researchers at Wake Forest University, in Winston-Salem, North Carolina, analyzed crash data from the National Trauma Database, they found that seat belts decreased pregnancy-related complications after a car accident by a third. (Wearing a seat belt and having the air bags deploy decreased post-crash problems by 57 percent.) Protect yourself and your baby by positioning the lap belt under your belly and across your hips; the shoulder belt should go snugly between your breasts. "You and your baby are much more likely to be injured if you don't wear a seat belt," Dr. Young says. If you do get into a crash, even a minor fender bender, see your OB immediately.

Old Thinking: It's okay to deliver after 37 weeks.

New Thinking: If you can, wait until 39 weeks.

Babies aren't due until 40 weeks. "We used to encourage delivery at 38 weeks, but now we know that babies delivered at 39 weeks have better brain development and less respiratory distress, and they spend less time in the hospital," Dr. Young says. There are bona fide reasons to deliver early: You're having twins, the baby's in distress, or your health is at risk. But a big baby isn't always a reason to rush things; infants that are large due to Mom's blood sugar levels are especially at risk for health issues related to prematurity. And (sorry!) scheduling around an OB's vacay or when your mom is free to help doesn't qualify. Yet, the watchdog group Leapfrog recently found that as many as 40 percent of babies born in the U.S. are electively induced before 39 weeks. It may be trendy to ask your doctor to deliver early, but be patient--healthy babies are worth waiting for.

Old Thinking:Caffeine causes miscarriage and preterm birth.

New Thinking: A daily cup of regular joe is reasonably safe.

No need to decaffeinate completely during pregnancy. In moderation, caffeine doesn't appear to cause miscarriage or preterm birth, ACOG notes. But that doesn't give you the go-ahead to down a cup of java every time you yawn. To be safe, limit caffeine to less than 200 milligrams a day, which is about what you'll find in a 12-ounce cup of brewed coffee or cappuccino. Whether or not you're hooked on morning mud, it's important to keep track of your intake because you can inadvertently get caffeine from other sources: a can of soda (18 to 55 mg), a cup of brewed tea (5 to 61 mg), or even chocolate (9 to 104 mg). Having more than 200 mg of caffeine daily doubles the risk for miscarriage, according to a study from Kaiser Permanente Division of Research, in Oakland, California. If you've miscarried previously, stick to the old advice, cautions Robert Atlas, M.D., chair of obstetrics and gynecology at Mercy Medical Center, in Baltimore, Maryland: "Don't consume anything caffeinated."

IF YOU SMOKE, STOP. When you light up, your baby smokes, too, and that leads to a whole host of complications, such as low birthweight, premature delivery, miscarriage, birth defects, and still birth. Babies born to puffers also have up to three times the risk for SIDS. Call 800-QUIT-NOW for help with kicking the habit.

ABSTAIN FROM ALCOHOL. There's no safe amount of alcohol; it crosses the placenta and can cause birth defects. The risk doesn't start until six weeks after your last period, but once you know you're expecting, be sure to stick to seltzer.

HAVE SEX. As long as your doctor gives you the okay, feel free to get busy. "It's a good way for you and your partner to bond, because once you have a baby, your relationship will be uniquely challenged," Dr. Calhoun says. Hit the sheets!

BE CHOOSY ABOUT SEAFOOD. Fish is a fab source of lean protein, and many kinds, such as salmon, contain omega-3 essential fatty acids, critical for brain development. Some, though, are loaded with mercury and other contaminants. The free Fish4Health iPhone app helps you track what's safe and what to avoid, like tilefish and shark.

TELL YOUR OB-GYN WHAT MEDICATIONS YOU TAKE. Whatever you consume, your baby does too. Even over-the-counter medication may harm her. Same goes for any prescription meds, herbs, or vitamin-enriched skin creams. Can't reach your doctor to see if a product is safe? Verify its rating at SafeFetus.com. Or get counseling from the Organization of Teratology Information Specialists; visit OTISPregnancy.org for information.

TAKE PRENATAL VITAMINS. If morning sickness makes tolerating those prenatal horse pills tough, ask your OB about trying a kids' chewable vitamin, says Myra Wick, M.D., Ph.D., medical co-editor of the Mayo Clinic Guide to a Healthy Pregnancy.

BREAK UP YOUR TRAVEL. Stand up, stretch, and move around every few hours if you're going long- distance, whether by plane, train, or automobile. Sitting in one place for more than four hours at a time doubles your risk of developing a deep-vein thrombosis, a blood clot that can lead to a pulmonary embolism, Dr. Rosser says.

AVOID HOT TUBS. They can raise your body temperature as high as 102°, which may disrupt fetal development. Weekly hot tub sessions double the risk for miscarriage, according to a study from Kaiser Permanente.

SKIP RAW, UNPASTEURIZED, OR PROCESSED FOODS.
Hot dogs, deli meats, and unpasteurized juices and dairy products may contain Listeria bacteria, which can be fatal for your fetus. However, pasteurized juices and dairy items are safe.

SCHEDULE A FLU SHOT. When you're pregnant, the flu can be especially severe, even deadly. So do get the jab (preggos can't generally use the nasal-spray vaccine). Bonus: Doing this will also protect your baby from influenza for up to six months.

Originally published in the December 2011 issue of American Baby magazine.

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