The Dos and Don’ts in Pregnancy: An evidence-based review

Every Pregnant woman receives tons of advice regarding precautions she needs to take to optimize the pregnancy outcome. In this digital age, she is constantly exposed to ideas and suggestions about the dos and don’ts in pregnancy, a lot of which is confusing and conflicting, as a result, the woman is often unsure of what is correct for her and the baby. She often turns to her healthcare provider to direct her regarding her daily routine in pregnancy, but the healthcare provider is also exposed to myriads of opinion on this topic.

This recent article published ahead of print as a part of clinical expert series in the Journal of Obstetrics and Gynecology provides an evidence-based review on things routinely advised or avoided during pregnancy.

The author has looked upon Cochrane systematic reviews, guidelines from the American College of Obstetricians and Gynecologists(ACOG) and other international organizations to formulate the recommendations that can be used to direct a pregnant woman on this confusing and much-advised topic.

Prenatal Vitamins

The necessity of taking or not taking a prenatal vitamin for women has not yet been proven, especially in women taking a balanced diet. But, they are not harmful and may be consumed during pregnancy. Any simple multivitamin will suffice and there is no ideal formulation for a prenatal vitamin. A woman needs to take:

• Folic acid 400–800 micrograms (until the end of the first trimester)
• Iron 30 mg (or be screened for anemia)
• Vitamin D 600 international units
• Calcium 1,000 mg

Nutrition and weight gain

According to the National Academy of Medicine, weight gain in pregnancy is determined by pre-pregnancy BMI. A woman should consume an additional 350–450 calories per day in the second and third trimesters but it also depends upon her activity levels, height and weight and her metabolism rate.

So, the exact calories required should be individualized.

Alcohol consumption

The safe threshold for alcohol intake is not known and higher alcohol consumption is known to cause fetal alcohol syndrome. It is best avoided in pregnancy.

Artificial sweeteners

Artificial sweeteners are safe in pregnancy as no evidence exists to link them with an increase in birth defects, but it is advisable to keep the intake at the lowest possible level.

Caffeine

Low to moderate caffeine intake is presumed to be safe during pregnancy based on most human studies. It is advisable to limit the intake to less than 300 mg/day. An 8-ounce cup of brewed coffee has about 130 mg of caffeine while a cup of tea or soda has about 50 mg of caffeine.

Eating Fish

Fish intake during pregnancy is associated with improved neurodevelopment in children and is also linked to decreased risk of preterm birth. But, because of increased mercury content, the fetus may suffer neurological damage.

Women should try to eat 2-3 servings of fish/week that is low in mercury and high in omega-3 long-chain polyunsaturated fatty acids and docosahexaenoic acid (DHS).

Raw fish should be avoided during pregnancy.

Other Food choices

Food restrictions are mainly put in place to avoid toxoplasmosis and listeria infection.

To prevent toxoplasmosis, pregnant women should avoid eating raw and undercooked meat, and should wash all fruits and vegetables before consumption.

To avoid Listeria, pregnant women should avoid unpasteurized dairy products, raw sprouts, unwashed vegetables, and unheated deli meats. However, Listeria outbreaks can happen from many other food sources and are difficult to compile a list of foods to be avoided. Pregnant women are in general asked to be aware of local outbreaks of food poisoning and listeriosis and avoid those specific foods.

Smoking, Nicotine patch and vaping

Women are advised against smoking in pregnancy but the use of nicotine patch or gum to help quit smoking is acceptable while pregnant.

Marijuana

No long-term data about fetal neurodevelopmental outcomes after Marijuana consumption is currently available, hence women are advised against Marijuana use in pregnancy.

Physical activity and bedrest

Women with uncomplicated pregnancies are advised to have regular aerobic and strength conditioning exercise during pregnancy. They should aim at average 20–30 minutes of moderate-intensity exercise four to five times per week.

Bed rest or activity restriction has no role in pregnancy and has not shown to prevent preterm birth or pregnancy loss nor does it benefit women with hypertensive disorders of pregnancy, premature rupture of membranes, fetal growth restriction, or placenta previa.

Precautions while driving

Women are advised to continue using three-point seat-belts while pregnant, the belt should be placed low in lap, below the uterus. ACOG recommends against disabling the airbags, but the benefits or harm of airbag is unclear in pregnancy.

Oral Health

The importance of maintaining good dental hygiene should be emphasized during prenatal visits. Routine preventive dentistry should be practiced while pregnant and procedures like cleanings, extraction, scaling, root canal, radiographs and restoration and fillings should be carried out while taking appropriate precautions for exposure to X-rays.

Swimming and Hot-tub baths

Hot-tub baths are not advisable in pregnancy because they raise the risk of miscarriage and birth defects as they increase the maternal temperature.  On the other hand, a woman can continue to enjoy swimming while pregnant.

Travel

Air travel is safe during pregnancy as the cosmic and screening radiation exposures are below the threshold for any sort of fetal risk. Women should be aware of their travel destination and the necessary information on potential infections prevalent in those areas.

But, as the pregnancy progresses, it is difficult to adjust to the demands of traveling. There is no specific cut-off for gestational age after which travel is not advisable. Each woman should take her decision keeping in mind the benefits and harms of the proposed travel.

Intimacy

Sexual intimacy and orgasm are not associated with increased risk of pregnancy complications. In women with placenta previa, intercourse is avoided after 20weeks of pregnancy, although no data exists. In cases of vaginal bleeding or PROM, it is not known whether intimacy increases the risk of bleeding or infection.

Sleeping position

Currently, no data exists to advice a pregnant woman about exact gestational age at which she should start sleeping on her side.

Hair-dye and insect repellents

Hair-dye results in minimum systematic absorption and hence presumed to be safe during pregnancy. Topical insect repellents can be safely used in pregnancy, especially in areas where mosquito-borne illnesses, including West Nile and Zika virus, are rife.

All these are general guidelines and can be appropriate for a broad class of pregnant women, but still, each case needs to be evaluated at an individual level and the advice should be tailored to the specific circumstances.

Abstract

Media courtesy: http://www.webfeed360.com/health-fitness/pregnancy-tips/