Self-Care During Pregnancy
There is much a pregnant woman can do to take care of herself during pregnancy. If she has any questions about diet, the use of drugs or nutritional supplements, physical activity, and sexual intercourse during pregnancy, she can talk with her doctor.
Diet and Weight: During pregnancy, the woman's diet should be adequate and nutritious. Most women should add about 250 calories to their daily diet to provide nourishment for the developing fetus. The diet should be well balanced, including fresh fruits, grains, and vegetables. High-fiber, sugar-free cereals are a good choice. The fetus has first choice of nutrients, but the pregnant woman must make sure that the fetus has something worthwhile to choose from. In the United States, most women get enough salt in their diet, without adding salt to their food at the table. Commercially prepared foods often contain excessive amounts of salt and should be consumed sparingly. Dieting to lose weight during pregnancy is not recommended, even for obese women, because some weight gain is essential for the fetus to develop normally. Dieting reduces the supply of nutrients to the fetus.
An average-size woman should gain about 25 to 30 pounds during pregnancy. Gaining more than 30 to 35 pounds puts fat on the woman and the fetus. Because controlling weight gain is more difficult later in pregnancy, a woman should try to avoid gaining most of the weight during the first months. On the other hand, not gaining weight is an ominous sign, especially if the total weight gain is less than 10 pounds. Growth of the fetus may be slowed or inadequate.
Sometimes a pregnant woman gains weight because she is retaining fluid. Fluid may be retained because when she stands, the enlarging uterus interferes with blood flow from the legs back to the heart. Lying on one side, preferably the left side, for 30 to 45 minutes 2 or 3 times a day may relieve this problem.
Drugs and Dietary Supplements: Generally, avoiding drugs during pregnancy is best. However, drugs must sometimes be used (see Section 22, Chapter 259). A pregnant woman should check with her doctor before taking any drug--including nonprescription (over-the-counter) drugs, such as aspirin, or medicinal herbs--particularly during the first 3 months.
Pregnancy doubles the amount of iron needed. Most pregnant women need an iron supplement, because the average woman does not absorb enough iron from food to meet the requirements of pregnancy, even when iron from food is combined with iron already stored in her body. If a woman has anemia or develops anemia during pregnancy, she may need to take a larger dose of iron than other pregnant women. Iron supplements may cause mild stomach upset and constipation.
All pregnant women should take a folic acid supplement (usually included in prenatal vitamins) daily. Ideally, the folic acid supplement is begun before pregnancy. A deficiency of folic acid increases the risk of having a baby with a birth defect of the brain or spinal cord, such as spina bifida. Women who have had a baby with spina bifida should start taking a high dose of folic acid before they become pregnant. Excessive ultraviolet (UV) light exposure, particularly in fair-skinned women, can decrease folic acid levels. Women who have taken oral contraceptives are more likely to develop a folic acid deficiency, but there is no proof that they are more likely to have a baby with spina bifida.
If the diet is adequate, other vitamin supplements may not be needed, although most doctors recommend that pregnant women take a prenatal multivitamin containing iron and folic acid daily.
Physical Activity: Many pregnant women are concerned about moderating their activities. However, most women can continue their usual activities and exercises throughout pregnancy. Mildly strenuous sports, such as swimming and brisk walking, are good choices. Vigorous activities, such as running and horseback riding, are also possible if performed cautiously. But contact sports should be avoided.
Sexual Intercourse: Sexual desire may increase or decrease during pregnancy. Sexual intercourse is safe throughout pregnancy unless a woman has vaginal bleeding, pain, leakage of amniotic fluid, or uterine contractions. In such cases, sexual intercourse should be avoided.
Preparing for Breastfeeding: Women who are planning to breastfeed do not need to do anything to prepare their nipples for breastfeeding during pregnancy (see Section 23, Chapter 263). Expressing fluids from the breast manually before delivery may lead to an infection of the breast (mastitis) or even early labor. The body prepares the areola and nipple for breastfeeding by secreting a lubricant to protect the surface. This lubricant should not be rubbed off. Observing and talking with women who have breastfed successfully may be instructive and encouraging.
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