During pregnancy, a woman must eat

adequately to supply enough nutrients to

the fetus, so it can grow, as well as to
support her own nutrition.

Adequate protein intake is vital because so

much is needed by a fetus to build a body
framework. Adequate protein may also help
prevent complications of pregnancy such as
pregnancy-induced hypertension or preterm
birth.
Either deficiencies or overuse of vitamins may
contribute to birth anomalies.

Most women should gain somewhere between 25 and 35

pounds during pregnancy. Most will gain 2 to 4 pounds
during the first trimester, and then 1 pound a week for the
rest of the pregnancy. The amount of weight gain depends
on your situation:
Women who are underweight coming into pregnancy should
gain slightly more weight than the average woman (0.5 kg
per month or week).
An obese woman might be advised to gain less than average
(0.3 kg).

Recommended rates of weight gain per week during the second

and third trimesters are 1.1 pound, 0.9 pound, and 0.66 pound
for pregnant women who are underweight, normal weight, and
overweight, respectively.

Inadequate weight gain has been associated with low birth

weight, whereas excessive weight gain has been associated with
fetal macrosomia and maternal obesity Women should avoid
fasting (>13 hours without food) They should have five feedings
per day (breakfast, lunch, afternoon snack, dinner, and bedtime
snack). Pregnant women should never skip breakfast. Weight gain
is an important consideration during pregnancy, and the clinician
should emphasize the right amount of nutrition over the right
amount of weight gain. Normal pregnancy requires an increase in
daily caloric intake of 300 kcal.

Calorie needs increase during pregnancy

to help support a woman's maternal body changes
and the baby's proper growth and development. The
RDA for energy intake during pregnancy is an
additional 300 calories per day for the second
and third trimester, in addition to maintenance
needs.
All the calories you consume during pregnancy
should be healthy calories that contain plenty
of protein, complex carbohydrates, fiber,
vitamins, and minerals. Complex carbohydrates
such as fruit, whole-grain starches, cereal,
pasta, rice, potatoes, corn, and legumes should
be the main source of energy.

Good nutrition is important during pregnancy and

breastfeeding, as there is an increased need for
calories and for most nutrients.
a) Folate (B vitamin)
A particularly important nutrient during pregnancy is folic
acid,

folic acid, before conception and throughout the first 12 weeks,

reduces the risk of having a baby with a neural tube defect

(for example, anencephaly or spina bifida).

The recommended dose is 400 micrograms per day.

b) Calcium
--keep bones healthy and strong.
Adequate calcium intake during both
pregnancy and breastfeeding is also
important, since calcium is drawn
from the mother.

is essential in the maintenance of skeletal

growth and bone health
vitamin D regulates calcium and phosphate
absorption and metabolism.

needs
increase
during
pregnancy to help develop the body cells of
the growing baby. Other changes that are taking
place in your body during pregnancy also
require protein, such as the building of the
placenta.
Protein

Most women do not have a problem

meeting their protein requirements. Consuming
plenty of lean meats, fish, tuna, eggs, and
legumes, as well as increasing your dairy
servings, will ensure you meet your protein
needs. If you are a vegetarian, consume a
variety of legumes, grain products, eggs,
low-fat
or
fat-free
dairy
products,
vegetables, fruits, and soy foods to ensure
proper protein intake.

Also be aware of increased fluid needs. Water is an

important nutrient and is essential for the nourishment
that passes through the placenta to the baby.
.
ALERT!Raw foods can increase your risk for bacterial
infection. Avoid anything raw, including sushi and other
raw seafood, undercooked meat or poultry, beef tartar,
raw or unpasteurized milk, soft-cooked or poached eggs,
and raw eggs (possibly found in eggnog).

c) Omega 3
--development of the central nervous system,
brain growth and eye development in your baby
before and after he or she is born
--oily fish like salmon, trout, herring, anchovies
and sardines, chicken, eggs, canned tuna and
flaxseed oil
d) Iodine
--required for healthy thyroid function in both the
mother and unborn baby
--insufficient iodine can lead to brain development
and neurological issues problems in the baby

e) Zinc
--rapid cell growth that occurs during pregnancy
--found in lean meat, wholegrain cereals, milk,
seafood, legumes and nuts
f) Vitamin C
--increased in pregnancy due to larger blood
volume in the mother and the growth of the
unborn baby
--fruit and vegetables

g) Fiber
--high fiber intake combined with plenty of fluid is
encouraged to help prevent constipation
--wholegrain breads and cereal products, legumes,
nuts, vegetables and fruit
h) Water
--drink eight to twelve glasses of fluid a day

Iron supplementation should not be offered

routinely to all pregnant women.
It does not benefit the mother's or the
baby's health and may have unpleasant
maternal side effects.
Iron supplements are particularly important
for pregnant women who have anemia.

Vitamin A supplementation during pregnancy as part of routine antenatal

is not recommended.

vitamin A supplementation (intake above 700 micrograms) might be

teratogenic and should therefore be avoided.

In settings where there is a severe public health problem (prevalence of

night blindness is 5% or higher in pregnant women or 5% or higher in
children 2459 months of age), related to vitamin A deficiency vitamin A
supplementation during pregnancy is recommended for the prevention of
night blindness.

Pregnant women should be informed that vitamin A supplementation

(intake above 700 micrograms) might be teratogenic and should therefore
be avoided.

Pregnant women should be informed that liver and liver products may
also contain high levels of vitamin A, and therefore consumption of these
products should also be avoided.

Avoid undercooked meat, poultry and eggs During

pregnancy, you're at increased risk of bacterial food
poisoning. Your reaction might be more severe than if you
weren't pregnant.

Avoid eating ripened soft cheese, there is no risk with hard

cheeses.

Avoid eating pt (of any sort, including vegetable)

caffeine to 300 milligrams a day

Seafood can be a great source of protein,

and the omega-3 fatty acids in many fish can
promote your baby's brain and eye
development.
However, some fish and shellfish contain
potentially dangerous levels of mercury. Too
much mercury could harm your baby's
developing nervous system.
The bigger and older the fish, the more
mercury it's likely to contain.

Breastfeeding

has been shown to significantly reduce morbidity and improve

cognitive development during infancy and childhood.
The

benefits of breastfeeding include:

for

the newborn,

excellent

for

nutrition and provision of immunologic protection

the mother,

more

rapid uterine involution, economy, maternalchild bonding, to some

extent natural contraception, , more rapid weight loss associated with extra
calorie expenditure.
Contraindications

to breastfeeding include certain maternal infections and

use of medications.

Sexual Activity

Sexual intercourse is not restricted during a normal

pregnancy, although advice about more comfortable
positions in later pregnancy may be appreciated.

in later pregnancy may be appreciated Sexual activity

may be restricted or prohibited under certain high-risk
circumstances, such as known placenta previa, premature
rupture of membranes, or actual or history of preterm
labor.

Travel is acceptable under most circumstances. Prolonged sitting

increases the risk for thrombus formation and thromboembolism.

should be informed about the correct use of seatbelts (that is,

three-point seatbelts 'above and below the bump, not over it').

International travel that places the patient at a high risk for

infectious disease (such as travel to areas with a high rate of
transmission of malaria or typhoid fever) should be avoided,
whenever possible. When such travel cannot be avoided,
appropriate vaccinations should be administered

Exercise;
In the absence of either medical or obstetric
complications, up to 30 minutes of moderate
exercise per day on most if not all days of
the week is acceptable strenuous exercise
,activities with a high risk for falling or for
abdominal trauma and Supine exercises after
the first trimester should be avoided.

regarding work A woman with an

uncomplicated pregnancy can usually
continue to work until the onset of labor

Strenuous work is best avoided

A teratogen is any agent or factor that can

cause abnormalities of form or function
(birth defects) in an exposed fetus.
The most important determinants of the
developmental toxicity of an agent are
timing, dose, and fetal susceptibility.
Many agents have teratogenic effects only if
taken while the susceptible fetal organ
system is forming.

Teratogens may be assigned to three broad

categories:
(1) drugs and chemical agents, (2) infectious
agents, and (3) radiation.

ALCOHOL

Alcohol is the most common teratogen to which a fetus is exposed, and alcohol
consumption during pregnancy is a leading preventable cause of mental
retardation, developmental delay, and birth defects in the fetus. There is no
established safe level of alcohol use during pregnancy.

avoid drinking alcohol in the first 3 months of pregnancy if possible because it may
be associated with an increased risk of miscarriage.

Fetal Alcohol Syndrome

a pattern of mental and physical defects that can develop in a fetus when
a woman drinks alcohol during pregnancy

Tobacco Use

TOBACCO SMOKING. Maternal tobacco smoking interferes with prenatal growth,

including birth weight, birth length, and head circumference. Pregnant women
should be strongly encouraged to avoid smoking

it is important to educate patients about the risks of smoking for both themselves
and their newborns and to coordinate appropriate resources to help patients quit.

Substance Abuse The use of illicit substances by women of childbearing age has led to an increased
number of neonates having had in utero exposure and subsequent risk of adverse effects from a variety of
drugs. Fetal drug exposure often is unrecognized because of the lack of overt symptoms or structural
anomaly following birth. Illicit drugs may reach the fetus via placental transfer or may reach the newborn
through breast milk. The specific effect on the fetus and newborn varies with the respective substances.
An opiate-exposed fetus may experience withdrawal symptoms in utero if the woman stops or when the
woman goes through withdrawal, either voluntarily or under supervision, or after birth when the delivery
by way of the placenta ceases. Universal screening, using biologic specimens, of women and newborns for
substance abuse is not recommended. However, all pregnant women should be asked at their first prenatal
visit about past and present use of alcohol, nicotine, and other drugs, including recreational use of
prescription and over-the-counter medications. Use of specific screening questionnaires may improve
detection rates. A woman who acknowledges use of these substances should be counseled about the
perinatal implications of their use during pregnancy, and offered referral to an appropriate drug-treatment
program if chemical dependence is suspected. Careful follow-up during the postpartum period is also
recommended.

MEDICATIONS METHYL MERCURY Industrial pollution is the major source of mercury entry in our ecosystem.
Large fish, such as tuna, shark, and king mackerel, retain higher levels of mercury from the smaller fish
and organisms they consume. Hence, women who eat these fish are storing high levels of mercury. HERBAL
REMEDIES Herbal remedies are not regulated as prescription or over-the-counter drugs, the identity and
quantity of their ingredients are unknown, and there are virtually no studies of their teratogenic potential.
Because it is not possible to assess their safety, pregnant women should be counseled to avoid these
substances. Remedies containing substances with pharmaceutical properties that could theoretically have
adverse fetal affects include the following:

radiation

exposure has the potential to cause gene mutations, growth

impairment, chromosome damage and malignancy, or fetal death, large
doses are required to produce discernible fetal Effects. RADIATION. Prenatal
ionizing radiation exposure occurs frequently as a result of therapeutic or
diagnostic medical and dental procedures.

Nausea and vomiting in early pregnancy

Nausea and vomiting complicate up to 70% of pregnancies.

Most mild cases of nausea and vomiting can be resolved with lifestyle and
dietary changes, including consuming more protein, vitamin B6 , or
vitamin B6 with doxylamine.

Usually, nausea and vomiting improve significantly by the end of the first
trimester.

When medication is deemed necessary, antihistamines appear to be the

drug of choice,

Heartburn (gastric reflux) is common,

especially postprandially, and is often
associated with eating large meals or spicy
or fatty foods.

Avoiding lying down immediately after meals

and elevating the head of the bed may help
reduce heartburn.

When these simple measures fail, antacids,

such as calcium carbonate, should be used.

Constipation

is physiologic in pregnancy, associated with increased transit time,

increased water absorption, and often decreased bulk.
Dietary modification, including increased fiber and water intake, can help lessen this
problem.

Stool

softeners may be used in combination with bulking agents. Irritant laxatives

should be reserved for short-term use in refractory cases.

Increased rest, with elevation of the legs,

and avoidance of constipation are
recommended.

Backaches

are common during pregnancy and

are lessened by avoiding excessive weight gain.
Additionally, exercise, sensible shoes, and
specially shaped pillows can offer relief. In
cases of muscle spasm or strain, analgesics
(such as acetaminophen), rest, and heat may
lessen the symptoms.

Leg cramps Leg cramps, usually affecting

the calves, are common during pregnancy.

Massage and stretching may afford some

relief during an attack. Both calcium and
sodium chloride appear to help reduce leg
cramps in pregnancy.

Pregnant women should be informed that

few over-the-counter medicines have been
established as being safe to take in
pregnancy.

Over-the-counter medicines should be used

as little as possible during pregnancy.

Prescribing during pregnancy involves the

balance between benefit to the mother and
potential harm to the fetus.

Few medicines have been established as safe

to use in pregnancy. Prescription medicines
should be used as little as possible during
pregnancy and should be limited to
circumstances where the benefit outweighs
the risk