Important precautions for a healthy pregnancy

The waitress glances at your baby bump, raising an eyebrow as she hands you your coffee. “Good grief, it’s not a martini,” you think.

When you’re expecting, everyone from your mom to your subway seatmate feels free to offer an opinion about what’s safe for your baby and what’s not, and separating fact from fiction isn’t always easy. So which health precautions are prudent during pregnancy? Here’s what you need to know:

Food

Pregnancy partially suppresses your immune system, making you more vulnerable to food-borne illnesses like listeriosis and salmonella. While it’s relatively uncommon for such illnesses to lead to complications like miscarriage and premature labour, the resulting vomiting or diarrhea can make it harder to get the nutrients your baby needs. So it’s more important than ever to strictly follow the usual food-safety measures, like using a separate cutting board for raw chicken and meat, and washing fruits and vegetables. In addition, experts recommend avoiding foods that could harbour the bacteria that cause such infections, or taking special precautions during preparation.

In a few other cases, the concern isn’t infection, but an ingredient or possible contaminant that might increase the chances of certain complications or abnormalities.

Eggs Raw or undercooked eggs, which may be hidden in homemade eggnog and from-scratch Caesar dressing, are a potential source of salmonella bacteria. If you’d like to indulge in the garlicky greens while eating out, check with the chef. Some restaurants use a safe alternative: a commercial, pasteurized Caesar base.

Fish and seafood Experts suggest skipping sashimi and other raw seafood, as well as refrigerated smoked salmon, due to the possibility of picking up parasites or food-borne infections.

What about cooked fish? Not only is it a good source of lean protein, studies suggest the omega-3 oils in fatty varieties, such as salmon, may modestly boost baby’s IQ. The caveat? During pregnancy, Health Canada recommends curbing your intake of large predator species that feast on smaller fish — they contain higher levels of mercury, which, in sufficient amounts, may have subtle effects on baby’s brain development. Limit these (which include swordfish, orange roughy and fresh or frozen tuna) to two 75 gram servings a month. There’s some dispute over how much canned albacore tuna is safe: According to Health Canada, four weekly servings is fine, while the US Environmental Working Group advises avoiding it entirely.

Lower in mercury and high in omega-3s, the following fish are excellent choices during pregnancy: tinned light tuna, salmon, rainbow trout, herring and sardines.

Meats Scratch medium-rare burgers and refrigerated (versus tinned) pâtés from your menu. All meats, including cold cuts, should be heated until the internal temperature reaches 71ºC — for instance, by microwaving those smoked turkey or ham slices before assembling your sandwich. Popping the whole sandwich under the broiler may not do the trick, cautions Jo-Anne Hammond, an associate professor of obstetrics and gynaecology at the Schulich School of Medicine and Dentistry, University of Western Ontario in London. If the mere thought of steaming cold cuts makes you gag, that may mean temporarily forgoing your favorite sandwiches, or coming up with combos that are more appealing served hot — such as ham with spicy mustard and a side of coleslaw.

If fast food is a staple in your diet, here’s a reason to consider cutting down: In a recent study, one serving a day of fried foods appeared to quadruple the odds of gaining too much weight during pregnancy, which has been linked to an increased risk of problems like birth complications and pre-eclampsia.

Cheeses While most soft and semi-soft cheeses (which include ricotta, brie and blue-veined beauties like Stilton) sold in Canada aren’t a concern, certain brands are made from unpasteurized milk, making them more apt to allow bacteria to flourish. Eyeball labels carefully: If they don’t explicitly say “pasteurized,” take a pass. (Hard cheeses, such as cheddar and Parmesan, are fine.)

Beverages

Juices and sodas Pass on unpasteurized juice, like some apple ciders (check labels). Many caregivers also recommend limiting sweet beverages, including natural sodas and 100 percent fruit juice. “Fruit juice contains sugar, which can predispose to weight gain and could contribute to changes in blood sugar,” Davis notes. This can cause the baby to grow too large too quickly, increasing the odds of a difficult delivery.

Caffeinated drinks While the evidence is conflicting, some research suggests that drinking 300 milligrams of caffeine per day — and perhaps even as little as 100 milligrams (roughly the amount in a 250 millilitre cup of coffee) per day — may increase an expectant mom’s chances of having a slightly smaller-than-average baby. The bottom line? “One cup of coffee or tea during the day is certainly reasonable,” reassures Don Davis, a Medicine Hat, Alta., obstetrician and gynaecologist, and spokesperson for the Society of Obstetricians and Gynaecologists of Canada.

Alcohol Drinking during pregnancy has the potential to cause a wide range of learning and behaviour problems (known as fetal alcohol spectrum disorder) in babies. While you don’t need to worry if you had a drink or two before you knew you were pregnant, it’s best to abstain entirely, since no amount of alcohol has been proven to be safe.

Drugs

Too many expectant moms still swallow the myth that all drugs are dangerous during pregnancy, according to Gideon Koren, director of the Motherisk program at Toronto’s Hospital for Sick Children. “We find a lot of women not taking medications, even for life-threatening conditions,” he observes. In general, the risks of not treating conditions like asthma, depression and severe morning sickness far outweigh any potential harm from appropriate medications, says Koren, who is also the Ivey Chair in Molecular Toxicology at the University of Western Ontario in London. So, if you were taking prescription meds for a serious condition before getting pregnant, don’t dump your pills or puffer — check with your caregiver, or call Motherisk.

Sometimes it is necessary to switch from one medication to another. For example, since widely used blood pressure drugs called ACE inhibitors (like enalapril) raise the risk of kidney damage and other problems in the baby, these are usually replaced with a medication called methyl-dopa. Other drugs to avoid: powerful acne treatments like Accutane (which is linked with birth defects) and the antibiotic tetracycline (which can damage baby’s teeth).

Herbs For most herbal products, “there is little or no information about…safety during pregnancy,” Koren writes in The Complete Guide to Everyday Risks in Pregnancy & Breastfeeding. That said, Koren lists the following as definite don’ts: black cohosh, burdock, calendula (orally), camomile, feverfew, goldenseal, juniper, ma huang, passion flower, peppermint and slippery elm. (Most of these are thought to stimulate uterine contractions.) Check with your caregiver before taking any herbal remedies.

Over-the-counter meds Looking for relief from everyday nuisances like constipation, headaches, heartburn and cold and allergy symptoms? The go-to remedies for constipation are fibre supplements like Metamucil. For pain and fever, acetaminophen is the best option. (Aspirin and ibuprofen — which are a component of many cold remedies — can cause a fetal heart defect if taken in the third trimester.) The safest bets for heartburn: products containing calcium carbonate (like Tums), aluminum hydroxide or magnesium hydroxide (Maalox, for instance) or alginic compounds (such as Gaviscon). If you’re stuffed up, Koren says decongestants containing ephedrine and noradrenalin are “probably safe” in small, infrequent amounts; ditto for cough suppressants like dextromethorphan, and phlegm expellers like guaifenesin. (On the other hand, non-drug alternatives, such as warm water and honey for cough and saltwater nasal rinses for stuffiness, probably work equally well.) For easing allergy sneezing and itching, old-style “sedating” antihistamines like Benadryl are definitely safe, says Koren, while their newer, non-drowsy counterparts are “probably safe.”

Nicotine Smoking increases the risk of low birth weight and SIDS. If your attempts to quit haven’t yet been successful, talk to your doctor or midwife about nicotine replacement therapy. “The nicotine patch is far safer than smoking in pregnancy,” says Koren, because it eliminates exposure to the other 1,400 toxins found in cigarette smoke.

Activities

Exercise If you have a normal, uncomplicated pregnancy, exercise is not only safe but recommended. Just check with your caregiver first to rule out any medical concerns. If you were inactive before becoming pregnant, Michelle Mottola, director of the R. Samuel McLaughlin Foundation Exercise and Pregnancy Laboratory at the University of Western Ontario in London, recommends waiting until your second trimester to begin, then starting with a 15-minute walk three to four times a week, gradually lengthening your workout to 30 minutes. “However, if you have medical approval, you can begin sooner and start slower,” says Mottola.

Once you reach week 28, either continue at the same pace or back off a bit, according to how you feel.

Gardening/changing the litterbox Touching sand, soil or used kitty litter poses a small chance of picking up toxoplasmosis, a parasitic infection that can cause serious health problems in babies. Sensible precautions include wearing gardening gloves, handwashing, and having your partner assume poop-scoop duty.

Saunas and hot tubs Raising your core temperature by more than 1ºC in your first trimester may increase the odds of abnormal organ development, notes Hammond, so it’s best to avoid steamy saunas or hot tubs at least until your fourth month.

Five tips for a healthier pregnancy

1. Take folic acid Not only does a daily 0.4 to 1.0 milligram dose of this nutrient (if you’re overweight, consult your caregiver as you may need more) substantially reduce the risk of birth defects affecting the spinal cord, brain and skull, it may also protect against heart and urinary tract abnormalities and sharply cut the odds of premature birth and pre-eclampsia. Pregnancy multivitamins containing folic acid may have an edge over a plain folic acid supplement, and a recent study suggests they also decrease the likelihood of low birth weight.

2. Exercise regularly Regular physical activity helps prevent excessive weight gain (which ups the odds of problems like pre-eclampsia) and keeps mom’s blood sugar levels from skyrocketing (which causes some babies to grow too big, increasing the chances of a difficult birth). What’s more, walking a half-hour three to four times weekly seems to decrease the chances of developing gestational diabetes, says Jo-Anne Hammond, an associate professor of family medicine and obstetrics and gynaecology at the Schulich School of Medicine and Dentistry, University of Western Ontario in London.

3. Eat a healthy diet A healthy diet goes hand in hand with exercise for curbing excess weight gain and preventing gestational diabetes.

4. Take a jab at flu Pregnancy substantially increases the odds of having flu symptoms severe enough to require hospitalization, so Canada’s National Advisory Committee on Immunization now recommends all expectant moms get a flu shot.

5. Go easy at work It may be worthwhile to temporarily ease back on your workload: A recent study suggests that high job stress and working more than 32 hours per week may increase the risk of low birth weight.

Read more: 10 things you get to rock during mat leave> Healthy pregnancy: Essential vitamins and supplements> Pregnancy power foods>

Originally published in December 2009.