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/

Artificial sweeteners are now linked to increased cardio-metabolic risk and gain in weight -Not weight loss.

Artificial sweeteners are now linked to significantly higher risks of diabetes, heart disease and increased weight gain according to results of a systematic review and meta-analysis published today in Canadian Medical Association Journal.

Artificial sweeteners are synthetic food additives that we all are familiar with, they provide a sweet taste to the food without adding significant calories to it.

They are found in many common products we consume in our daily life Diet Soda, cough syrup, salad dressings, yoghurts and many more.

It is frequently added to tea, coffee and other sweet dishes to reduce the daily calorie consumption.

The present review was conducted by researchers from the University of Manitoba, Canada and reviewed data from 37 randomized control trials (RCTs) and prospective cohort studies which analyzed more than 406,000 people for an average period of 10 years.

Seven studies were RCTs, considered a gold trials in research arena.

The primary outcome that the researchers were interested was BMI, while secondary outcomes included weight, obesity and other cardiometabolic end points.

The data analysis of included RCTs shows that artificial sweeteners had no significant effect on BMI, whereas the analysis of cohort study showed a moderate increase in BMI over the course of years.

Further analysis of data from RCTs showed no further effect on other parameters of body composition or risk of cardiometabolic diseases. However, the data from cohort studies was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events.

Because the data from RCTs does not resulted in increased weight gain and higher risk of cardiometabolic events, the systematic review does not prove causation.  

Meghan Azad, lead study researcher and an assistant professor in the department of pediatrics and child health at the University of Manitoba in Canada said, “I think there’s an assumption that when there are zero calories, there is zero harm. This research has made me appreciate that there’s more to it than calories alone.”

Susan Swithers, a professor in the department of psychological studies at Purdue University said, “Unfortunately, the quality of evidence that would support using sweeteners is not really strong. I think we are at a place where we can say that they don’t help.”

The current USDA guidelines allows for 10 teaspoons of sugar a day for average person, that equals to just one 16-ounce bottle of regular soda.

There are just five sweeteners approved by the Food and Drug Administration for use in the United States: acesulfame potassium (sold as Sunett and Sweet One), aspartame (sold as Equal, Nutrasweet and Sugar Twin), neotame (sold as Newtame), saccharin (sold as Sweet'N Low, Sweet Twin and Necta Sweet) and sucralose (sold as Splenda).

“More research is definitely needed,” says Azad. “You need a long-term study.” But, lack of proven benefits does make people pause and think, before choosing an artificial sweetener.

In the meantime, researcher’s advice that reducing your taste for sweet altogether rather than choosing between a sugar-sweetened or artificially sweetened drink or food is the best choice at present.

The FDA strongly believes that  use of these sweetener in moderation will not do much harm, till results of more studies proving the harms and benefits are available.  

Stevia, a natural sweetener derived from plants, was not included in the study.