This leaflet offers advice if you are planning to become pregnant, or have just become pregnant. The aim is to reduce the risk of harm to the baby, and to reduce the risk of pregnancy complications. There is a summary checklist at the end of the leaflet.
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 vitamin which occurs naturally in certain foods 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. When you are pregnant, you need a good supply of folic acid 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. There is evidence that folic acid also reduces the risk of having a baby born with a cleft lip and palate, a heart defect (congenital heart disease), and the risk of a premature ('prem', preterm, or early) labour.
Folic acid is a naturally occurring vitamin which your body needs. It is not a drug (medicine). By taking these supplements you are just making sure that you get a good, regular amount of folic acid which you need especially during pregnancy. You can buy folic acid tablets from pharmacies. Also, the NHS Healthy Start scheme provides vitamin supplements that contain folic acid. These are free to many women who are on certain benefits - see: www.healthystart.nhs.uk.
Ideally, start taking folic acid tablets before becoming pregnant. The common advice is to start from the time you plan to become pregnant. If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant. However, a recent study looked at the effect of taking folic acid for a year prior to becoming pregnant. This study looked at the effect folic acid had on reducing preterm labour and delivery of the baby (that is, of having a 'prem' baby). The study found a significant decrease in the rate of preterm delivery for women who took folic acid for one year prior to becoming pregnant. So, you may wish to consider taking folic acid tablets well before you plan to become 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. (See 'Further reading & references' at the end for details of this debate.)
Vitamin D is needed for growth. Vitamin D supplements are recommended for all pregnant women, breast-feeding women and breast-fed babies.
Advice from the Department of Health states that pregnant women or women trying to conceive should not drink alcohol at all. If you do choose to drink then, in order to minimise the risk to your baby, you should not drink more than 1-2 units of alcohol once or twice a week, should not get drunk and should avoid binge drinking (drinking more than 6 units of alcohol in a day). This is because 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 their body much longer than in you. This is known to be a risk for causing serious problems. For example, studies have shown that:
NB: one unit of alcohol is in about half a pint of beer, or two thirds of a small glass of wine, or one small pub measure of spirits. See separate leaflet called Alcohol and Sensible Drinking for details.
The National Institute for Health and Clinical Excellence (NICE) advises pregnant women to avoid alcohol particularly in the first three months of pregnancy, because of an increased risk of miscarriage. However, there has been debate over the years as to whether small amounts of alcohol are safe to drink during pregnancy; also, if there is a time of pregnancy when alcohol is most likely to cause harm. But, recent research supports the advice of not drinking any alcohol whilst pregnant.
For example, a study by Feldman et all (cited below) looked at the relationship between drinking alcohol during pregnancy and it causing facial defects in the baby. This study showed that the more alcohol a woman drank, the more likely there was to be a facial defect in the baby. BUT, there was no safe amount of alcohol to drink during pregnancy, as there was still some risk with small amounts of alcohol. The study also found that drinking alcohol has risks throughout pregnancy, but it may be most likely to cause facial defects during weeks 6-12 of pregnancy. The authors of the study concluded that ... "Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy."
If you are already dependent on alcohol you should be open and honest about the amount you drink, for the sake of your baby's health. If you are planning a pregnancy, go to see your doctor before you become pregnant so that professional help can be arranged. Once you are pregnant, many different people may offer you support, including doctors, midwives, social workers and counsellors. This can become confusing but, if you regularly keep in touch with one healthcare professional (usually your midwife or GP), they should be able to make sure that you are not bombarded with too many unnecessary appointments.
If you smoke, you are strongly advised to stop before getting pregnant. Tobacco smoke contains poisonous chemicals which pass into the baby's blood and can slow the baby's growth. The risk of having a miscarriage, premature birth, or stillbirth are higher if you smoke. Babies born to mothers who smoked when pregnant also have an increased risk of developing behavioural problems and attention deficit hyperactivity disorder (ADHD) when they are older. Also, after the birth, children of smoking parents have an increased risk of having chest infections, asthma, glue ear, and cot death (sudden infant death syndrome).
Of course, there are many other risks with smoking, such as the increased risk of developing chest and heart disorders. See separate leaflet called Smoking - The Facts for details. For many women who smoke, planning to become pregnant is a good incentive to stop smoking. It is often a good time to persuade partners to give up too. If you find it difficult to stop smoking then seek advice and help from your practice nurse, GP, or pharmacist.
For many people it is not easy to stop. Below are some tips which may help:
There are also medications that can help you quit.
Nicotine replacement therapy (NRT): this 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 not yet pregnant, but are planning a pregnancy, an option is to try a course of NRT before becoming pregnant.
Medicines called bupropion (trade name Zyban®) and varenicline (trade name Champix®) can also help. These are available on prescription. One of these may be useful before you become pregnant. These medicines roughly double your chance of stopping smoking if you really want to stop. They help to reduce the symptoms of nicotine withdrawal. But note:
If you take or inject street drugs, you are strongly advised to stop before getting pregnant. Their effects on pregnancy are not fully known. However, there is an increasing amount of evidence to suggest that they are likely to pose a risk of damage to the baby. A couple of examples of what is known include:
But the above are just two examples. There are many street drugs and it is beyond the scope of this leaflet to discuss each drug in turn. But, you can contact FRANK (details below) for information about individual drugs.
If you intend to become pregnant you should aim to stop taking or using street 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:
If you are obese or overweight, try to lose some weight before becoming pregnant. Women who are overweight or obese have a greater risk of pregnancy complications such as pre-eclampsia, stillbirth and the need for a caesarean section compared with women who are not overweight. Basically, the more obese you are, the greater the risk.
Aim to eat a healthy diet (which everyone should be eating, not just pregnant women). Briefly, the bulk of most meals should be starch-based foods (such as bread, cereals, potatoes, rice, and pasta), with fruit and vegetables. Eat protein foods such as meat, fish, pulses, chicken, etc, in moderation. Include foods with plenty of iron, calcium and folic acid. A growing baby needs these nutrients right from the start of the pregnancy:
As mentioned, folic acid and vitamin D supplements are recommended for all pregnant women. Otherwise, apart from possibly iodine (see below), no other supplements are routinely advised if you have a normal diet. However, some women have low iron stores which puts them at risk of becoming anaemic during pregnancy. The routine blood tests that are done during pregnancy will detect anaemia and the need for iron supplements.
Iodine - a research study published in 2011 concluded that it is likely that many young women in the UK do not get enough iodine in their diet and are lacking in iodine. 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. Iodine is essential for the brain development of a baby in the womb. The research author's concern is that many pregnant women will be lacking in iodine. This may cause their baby to have reduced brain development and be less intelligent than they would otherwise have been. Further research is needed in this area. But, in the meantime, you may wish to consider whether your diet has enough iodine. And, if it doesn't, perhaps talk to your doctor about taking an iodine supplement. A link to the NHS analysis on this study is given at the end.
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:
Also, do not eat raw fish or uncooked shellfish (which may contain 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:
However, the advice above (from the FSA) is controversial. Some experts think the advice to eat no more than two portions of oily fish per week during pregnancy is too restrictive, and may even be harmful to a developing baby. For example, one study found that children of mothers who had eaten a reasonable amount of oily fish during pregnancy had, on average, better communication and social skills at age 7. Oily fish are rich in nutrients called omega-3 fatty acids. It is thought that omega-3 fatty acids are important to aid brain development and may be the reason for the results of this study.
Therefore, some experts argue that the concern over toxic chemicals in fish is over-cautious and that the benefits of eating three or more portions of oily fish per week outweigh other risks. Further research may help to clarify this.
You should not eat the following if you are pregnant or trying to become pregnant:
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 (faeces). Always wash your hands after handling cats and ask someone else to wash out cat litter trays.
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, some medicines are not safe, and may be harmful to a developing baby - in particular, if you take them in the early weeks of pregnancy. Therefore, always tell a doctor or dentist who prescribes medication for you that you intend to become 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 you about this.
Always tell a doctor or dentist who prescribes your medication that you intend to become pregnant.
If you already take regular medication (for example, for epilepsy or diabetes), it is important that you discuss 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.
If you plan to become pregnant for the first time, you should check that you are immune to rubella (German measles) before becoming pregnant. See your practice nurse for a pre-pregnancy blood test. Most women are immune to rubella, as they have been immunised as a child. However, childhood immunisation does not work in every child and you may not be immune. If you are not immune, you can be immunised.
Note: you should not become pregnant for one month after the injection, and ideally until your immunity has been confirmed by a further blood test.
The rubella virus causes a mild illness but can seriously damage an unborn baby, especially in the early stages of growth. So, until you know that you are immune (from the result of the blood test), you should avoid anyone who has rubella, especially in the first 16 weeks of pregnancy.
This germ is commonly found in raw meat, and sheep, lamb and cat poo (faeces). It can sometimes cause serious harm to an unborn baby. To avoid it:
Various germs (bacteria, viruses or similar) can cause food poisoning. Food poisoning causes tummy (abdominal) pain, diarrhoea and vomiting. Two germs that are of particular importance to avoid during pregnancy have already been mentioned - listeria and toxoplasma. It is possible that other food poisoning bacteria may also cause complications during pregnancy. For example, gut infection with bacteria called salmonella and campylobacter may be associated with an increased risk of pregnancy complications. So, it is wise to be extra vigilant about avoiding food poisoning.
Therefore, be strict about food hygiene; always cook eggs, and meat, including poultry, thoroughly; wash fruit and vegetables, and wash hands after going to the toilet, before handling food, before eating, and after handling raw meat or animals.
Having chickenpox when pregnant can be a nasty illness, and there is some risk to the developing baby. A vaccine is offered to healthcare workers (doctors, nurses, etc) who have not previously had chickenpox and so are not immune and may catch chickenpox. (About 1 adult in 10 has not had chickenpox as a child.) Therefore, non-immune healthcare workers should consider having this vaccination before getting pregnant. If you are not sure if you have had chickenpox, a blood test can check if you have previously had it.
A mother who is infected with hepatitis B has a high risk of passing it on to her newborn baby. If you are at high risk of catching hepatitis B, you should be immunised against this virus before becoming pregnant. People at increased risk and who should be immunised include:
Ideally, you should have a blood test before you become pregnant, to screen for hepatitis B, syphilis, and HIV. Ask your practice nurse for a pre-pregnancy blood test.
Less likely to develop swelling of your feet, ankles or hands.
Less likely to develop back pain.
Less likely to have problems with high blood pressure during your pregnancy.
Sleep better and feel less tired.
If you already have diabetes, regular physical activity may help to improve the control.
Have a reduced chance of becoming anxious or depressed.
Have a reduced chance of developing varicose veins.
More likely to have a shorter labour and be less likely to have problems or complications during the delivery of your baby.
More likely to keep a healthy weight during and after your pregnancy.
Now you have read 9 benefits of physical activity during pregnancy, why not look at some of our other slideshows.
Less likely to develop swelling of your feet, ankles or hands.
If you think that your job may pose a risk to a pregnancy then ideally you should discuss this with your employer before becoming pregnant. Certain jobs and workplaces may pose a risk to a pregnancy, in particular to the early stages of pregnancy. For example:
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 working practice, may be necessary.
You and your employer may wish to download information guides from the Health and Safety Executive (HSE) website at www.hse.gov.uk.
You may not wish to discuss with your employer your intention to become pregnant, but have a health and safety concern at work. One option then is to contact the HSE for advice on their Infoline - Tel: 0845 345 0055.
Women with certain medical conditions may benefit from advice before becoming pregnant. See your doctor if you have concerns about a medical condition which may affect pregnancy. For example:
If in doubt about any medical condition that you have or treatment that you take with regard to their effect on pregnancy then see your doctor. Ideally, do this before you become pregnant; or, if the pregnancy is unplanned, as soon as possible.
Since October 2008, all pregnant women in England have been offered a screening test for sickle cell disease and thalassaemia. Some women may wish to have the screening test before becoming pregnant, especially if their family origins make these diseases more likely. See your doctor to discuss this. Genetic testing is a rapidly developing area of medicine. It may be possible that more tests will become available to detect carriers of various diseases. When they become available, these may be tests to consider before becoming pregnant.
See separate leaflet called Pregnancy - Screening Tests.
Most pregnancies go well and without any major problems. But, it is wise to reduce any risks as much as possible. So, a reminder of things to consider before becoming pregnant, and as soon as you realise you are pregnant ...