- Reference Number: HEY-787/2022
- Departments: Gynaecology
- Last Updated: 1 May 2022
Introduction
This leaflet has been produced to give you general information about your pregnancy. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.
Remaining healthy in early pregnancy
Eating well during pregnancy
A healthy diet is important throughout life, but it is especially important during pregnancy. This is because your developing baby receives all the nutrients it needs from what you eat whilst you are pregnant.
You do not need to “eat for two” during your pregnancy. Be guided by your appetite, as this should give you an idea of when you may need to eat more but be sensible about the amount you are eating.
Whilst you are pregnant your immune system functions at a slightly lower level than normal, so you can be at risk from infections passed on through food.
What should I be eating?
Eat plenty of fruit and vegetables as they provide you with the vitamins and minerals as well as the fibre which helps digestion and prevents constipation. Eat them lightly cooked in a little water or raw to get the most from them. Frozen, tinned and dried fruit and vegetables are good too. You should aim to have five portions of fruit and vegetables a day.
Starchy food like bread potatoes, rice, pasta, chapattis, yams and breakfast cereal are an important part of your diet and should be the main part of your meals.
Lean meat, fish, poultry, eggs, cheese, beans and pulses are all good source of nutrients. It is important to eat some of these every day.
Dairy foods like milk, cheese and yogurts, which contain calcium, are a good source of protein which is needed for your baby’s development. When choosing, look for low fat yogurts or semi-skimmed or skimmed milk.
What foods should I cut down on?
Sugar and sugary foods. You should cut down on sweets, biscuits, cakes and sugary drinks as these only contain calories and not nutrients. This will add to tooth decay.
Fat and fatty foods. Fat is very high in calories and too much fat can increase our risk of heart disease. Most of us eat more fat than we need. It also will contribute to being overweight.
Obesity during pregnancy has implications for both mother and baby. There is an increased risk of a complications during pregnancy, delivery and after the baby is born. Especially for women whose body mass index is over 35.
What vitamins and minerals are important in early pregnancy?
Why and for how long should I take folic acid?
Even though folic acid is found in foods like leafy green vegetables and whole wheat bread, the government still recommends that all women thinking about having a baby start taking folic acid supplements three months before trying to conceive and for three months (to 12 weeks) after you fall pregnant. They are sold at most pharmacies, or your doctor may prescribe them to you. They come in 400 microgram tablets, and you should take one, once a day.
If your BMI is over 35 or you have a family history of neural tube defect you should take 5mgs of folic acid daily.
If you are taking epilepsy medication – check with your doctor to see if you need an increased dose of folic acid.
If you are diabetic – check with your doctor to see if you need an increased dose of folic acid.
Do I need extra iron?
Pregnant women can become short of iron, so make sure you choose plenty of iron rich foods. It has been shown that if you eat an iron rich meal with food or drink containing vitamin C then this will assist absorption.
Good sources of iron: red meat, pulses, bread, green leafy vegetables and dried fruit.
Is vitamin C important?
Vitamin C will help with iron absorption. Food rich in vitamin C include citrus fruits, tomatoes, broccoli, peppers, blackcurrants and potatoes. Some fruit juices are also high in vitamin C.
Is vitamin D important?
Vitamin D is important throughout pregnancy and whilst breast feeding for your health and the health of your baby. If you have dark skin or always cover your skin, you may be at risk of vitamin D deficiency. You should ask you nurse, midwife or doctor about vitamin D supplements.
What is Healthy Start?
With Healthy Start, you can get free vouchers every week which you swap for milk, fresh fruit, fresh vegetables and infant formula milk. You can also get free vitamins. Healthy Start replaces the Welfare Food Scheme. Please ask your nurse or midwife about Healthy Start to see if you qualify for this or visit www.healthystart.nhs.uk.
Are there any foods / drinks I should avoid?
While you are pregnant there are certain foods that you should take care with, in order to look after you and your baby’s well-being.
What meat can I eat?
You can eat: Meat and poultry that has been cooked thoroughly all the way through.
Avoid: Raw or under-cooked meat (ask for your steaks well-done for the next nine months and avoid parma ham) and ready-cooked poultry unless it has been thoroughly reheated.
What milk can I drink?
Milk can carry the risk of listeria, or toxoplasmosis.
You can drink: Pasteurised and UHT milk.
Avoid: Green top milk and unpasturised sheep and goat’s milk unless it has been boiled for two minutes.
What cheese can I eat?
Some cheese carries the risk of listeria, a bacteria that can cause serious problems for the mother and baby.
You can eat: Hard cheeses such as cheddar, parmesan, mozzarella, gruyere and soft processed cheeses like cottage cheese, cream cheese and cheese spreads.
Avoid: Ripened soft cheeses like brie or camembert and blue-veined cheeses such as stilton. Also avoid cheese from unpasturised sheep or goat’s milk.
What fish can I eat?
Fish can contain high levels of mercury, which can affect the development of a baby’s nervous system.
You can eat: Cod, plaice, haddock, oily fish like mackerel and cooked shellfish.
Avoid: Shark, swordfish and marlin. Limit your consumption of tuna to one fresh steak, or two cans a week, and avoid raw fish like sushi. Shellfish carries a risk of bacteria that can cause food poisoning – which can put you and your baby at risk. So avoid raw or under-cooked shellfish like oysters, mussels, cold prawns and crab.
Can I eat eggs?
You can eat: Well-cooked eggs (so that the egg-white and yolk are solid).
Avoid: Raw or runny eggs, mayonnaise made with raw egg (shop bought mayonnaise is fine, but restaurants often make homemade mayonnaise with raw egg, so always ask first) and mousses made with raw egg.
Can I eat liver or liver products?
NO do not eat liver, liver pate or liver sausages. Liver can contain high-levels of the retinol form of vitamin A, which can be harmful to your developing baby.
Can I eat peanuts or foods containing peanut products?
Peanuts can be dangerous if you or your partner’s family has a history of peanut or other allergies, asthma, eczema or hayfever.
Avoid: Eating peanuts or peanut products (e.g. satay chicken, peanut butter, peanut oils, some snacks etc) during pregnancy and breast feeding.
Do I need to cut out caffeine?
Caffeine has been associated with the risk of miscarriage and your baby runs the risk of not growing properly. The government’s advice is to limit your caffeine consumption to 300 mg a day. (This is roughly 3 mugs of coffee (3 x 100mgs), or 6 cups of tea (50mg x 6).
Avoid: Drinking too much caffeine, but a small amount is fine. Remember caffeine can also be found in energy drinks and chocolate.
Can I drink alcohol?
Many women drink a varying degree of alcohol, and it can be one of the hardest things to give up in early pregnancy. Some women cannot stand the smell or taste of alcohol once they are pregnant which makes it easier. The safest approach to alcohol in pregnancy is to avoid any alcohol intake.
Is there anything else I should be aware of?
Wash your hands before and after handling food.
Wash all fruit and vegetables and salads thoroughly to remove all traces of soil which may contain toxoplasma. Avoid: Packaged salads, unless you wash them first, ready prepared dressed salads like coleslaw or potato salad.
Cooked-chilled foods can carry the risk of listeria. You can eat: Cooked-chilled foods that have been thoroughly heated all the way through. Avoid: Unheated cooked-chilled foods. Do not reheat food more than once.
Store raw and cooked foods well away from each other in the fridge to avoid contamination (for example place raw food on the bottom shelf of your fridge).
Use separate boards for preparing meat and other foods and wash carefully after use.
Use rubber gloves and wash them and then your hands thoroughly after gardening, handling soil or after clearing out pet litter trays.
Smoking and pregnancy?
Smoking is one of the most damaging things you can do to your unborn child, and the risks can be huge. Smoking has been linked to miscarriage, stillbirths, a low birth-weight baby, damage to the placenta and a higher risk of fetal abnormalities. If your partner smokes he is compromising your baby’s health through passive smoking. When your baby is born, if any member of your household smoke, their smoke can affect you and your baby.
If you would like help to stop smoking, the nurse/doctor can refer you to a smoking cessation specialist if you would like help / support.
The NHS Smoking Helpline on 0800 1690169. A specialist adviser is available every day from 7am to 11pm.
Hull and East Riding Stop Smoking service. Free phone 0800 0915 5959.
Physical activity and exercise during pregnancy?
If you are having problems in pregnancy, it is a good idea to stop exercising until the problems settle. Your nurse/ midwife/doctor will be able to advise you.
What exercise is recommended through pregnancy?
For women who are having normal pregnancies, moderate physical exercise is seen as beneficial. Before you start however, it is essential that you ask your nurse, midwife or doctor. If you are in a high-risk category of pregnancy, you may have to avoid exercise and low impact sport is obviously going to be the safest form of exercise for any pregnant woman.
If you are already physically fit and used to exercising, it is likely that you will be able to continue a similar routine, perhaps only slightly modified. If you are new to exercise it is okay to continue with a moderate amount of exercise. It is important to consult your nurse, midwife, doctor before embarking on an exercise routine and then it is advisable to build up fitness very slowly.
You should warm up and down with gentle stretches for 10 minutes before attempting any serious exercise and in the beginning; the main activity should be limited to only 5 minutes which you can then increase as your fitness grows. Important: If at any time you experience any discomfort then stop exercising immediately and consult your doctor before recommencing.
Exercise is recommended for 30 minutes 4 times a week unless you have been told not to.
Can I go swimming?
A safe and gentle way to exercise your body during pregnancy, swimming is ideal as the water supports your body, and you can move at your own pace. Choose between swimming lengths or join an antenatal class. These classes are held at many public pools and offer women a chance to meet other mums-to-be as well as enjoy a gentle exercise routine. Especially, in later pregnancy, when backache can be a problem, water can be the ideal relief.
Can I go cycling?
A great form of aerobic exercise, similarly to swimming, walking and jogging, cycling stimulates the heart and lungs and helps to build muscle tone. It also increases your ability to process and utilise oxygen, a definite bonus for your baby. The safest way to do this is on a stationary bicycle so the risk of falling is reduced. Extreme caution should be taken on a normal bike, not only could bad weather conditions make a fall more likely but there is a greater risk of accidents. In later stages of pregnancy, it is advisable to avoid any type of cycling as the weight of your baby may affect your balance.
Walking in pregnancy
This is one of the easiest and cheapest ways to keep fit. Briskly walking for half an hour a day is an alternative to joining a class. Why not vary your routine by going to a local park or to some nearby countryside?
Yoga in pregnancy
Yoga is one of the most popular choices of exercise for pregnant women. Not only does it help to relax and unwind the body and mind, but the gentle stretches and focus on breathing exercises are key components in preparing the body for labour.
Some people believe that this type of physical training helps women to actively take control over their labour, reducing the need for pain relief through breathing exercises by helping the body to relax and accept the process rather than be fearful and tense up. Muscles are also strengthened and in antenatal yoga classes, there is often an emphasis on pelvic floor firming, reducing the likelihood of stitches and an essential ingredient for your recovery after the birth.
Do I need to slow down?
Although you may feel completely normal, your body is going through one of the biggest events it will ever have to deal with so make sure you take time to slow things down. Do not try to do extra time at work because you feel guilty about time off for maternity leave. Accept that on days where you feel tired or nauseous, it’s okay to ask for help or have a lie down. If you have a boisterous two year old to look after, ask relatives to help take care of them while you have some time-out.
Sleep
Lie in if possible and have early nights and long baths. Try to get at least eight hours sleep a night, because once your baby arrives your sleep pattern will be disrupted by broken nights and early starts. If you can, take a little nap in the afternoon and remember to lie down on your left side, if it is comfortable, to relieve the major blood vessels that supply oxygen and nutrients to your growing baby.
Should I continue to do pelvic floor exercises?
Yes, these are important that you continue to do these. If you are unsure on how to do these, please ask your nurse, midwife or doctor.
Can I have sex during my pregnancy?
If you are having problems in early pregnancy, your nurse, midwife or doctor may suggest you stop having sexual intercourse. If your problems settle and you feel happy, you can start having sexual intercourse again. If you want advice speak to your nurse, midwife or doctor.
What medication can I take in early pregnancy?
Some medications and drugs can have harmful effects on an unborn baby. If you need to take any medication during your pregnancy, always check with your doctor who is aware that you are pregnant. If you are on long term medication, please check with your doctor to make sure this is safe to continue. If it is advisable to discontinue, this can be done under the supervision of your doctor. Over the counter medications are not always safe in pregnancy, so if you are considering buying these, always let the pharmacist know you are pregnant.
Travel in pregnancy
If you are a driver a seatbelt must be worn (pregnancy does not exempt you from wearing a seatbelt). If you are travelling abroad, you should discuss considerations such as flying, vaccination and travel insurance with your nurse, midwife or doctor.
What is toxoplasmosis?
Toxoplasmosis is an infection that can be passed onto an unborn baby. The infection may lead to miscarriage, stillbirth, or survival with growth problems, blindness, water on the brain (hydrocephalus), brain damage, epilepsy, or deafness. This often develops after birth, so even normally born infants of women with known infection should be kept under observation for some time.
Toxoplasmosis may not cause any symptoms, or symptoms may vary from a mild flu type illness to severe illness. Many people who have been infected by toxoplasmosis will not be aware of the infection. It can be detected by a blood test.
Following simple guidelines can prevent toxoplasmosis:
- Never eat under-cooked meat shellfish or raw cured meats such as parma ham.
- Thoroughly cooking raw and ready prepared chilled meals.
- Wash your hands, cooking utensils and food surfaces after preparing raw meat and wash all the soil from fruit and vegetables before eating.
- Keep raw meat and cooked foods on separate plates.
- Always wash all fruit and vegetables well, even pre-washed and prepared fruit, vegetables and salad produce should be rewashed.
- Avoid all unpasturised dairy produce.
- If possible, get someone else to clean out the dirty cat litter or use gloves and wash your hands afterwards.
- Always use gloves when handling soil or gardening and thoroughly wash your hands afterwards.
- Avoid cat faeces in cat litter or in soil.
- Pregnant farmers should be aware that toxoplasmosis can be caught from sheep at lambing time.
Try not to worry excessively – if you take these precautions, your chance of infection is practically eliminated – you can still pet your cat, without fear.
Pregnancy
Pregnancy nausea / sickness
Many women feel nauseous or are sick in early pregnancy. Some feel sick in the morning, and some feel sick at different times and some feel sick all day. The cause of the sickness is not fully understood, but hormone changes in the first three months could be one cause. It usually disappears around 13-16 weeks of pregnancy.
If you are affected by nausea / sickness you may find that the following things may help you feel better:
- Eating little and often.
- Getting plenty of rest and sleep.
- Eating or drinking ginger (biscuits or tea).
- Drinking plenty of fluids – non fizzy drinks.
- Asking those close to you for extra help.
- Wearing comfortable clothes. Tight waist bands can make you feel worse.
- Eating before you get out of bed in the morning.
If you keep being sick all the time and cannot keep anything down it is advisable that you see your doctor, nurse or midwife for help.
Tiredness in early pregnancy
Some women find that they are overcome with tiredness during the early months of pregnancy. It is quite normal to feel this way, because your body directs all its energy and resources to the developing baby. Try to take extra rest if you can by going to bed early.
Anaemia will make you tired in early pregnancy. A blood test will be checked to detect any problems. If the test shows that you are anaemic, you will be given iron tablets to help the problem.
Heartburn
This is partly caused by hormonal changes. If you suffer from indigestion:
- Try eating smaller meals more often.
- Avoid particular foods which cause trouble, for example fried or highly spiced ones, but make sure you are still eating well.
- Do not take antacid remedies before checking that they are safe in pregnancy.
Constipation
You may become very constipated in early pregnancy due to the hormone changes taking place in your body. You can do a few things to help the constipation:
- Make sure you drink plenty of water.
- Eat plenty of fibre in your diet by eating fresh fruit, vegetables, wholegrain, cereals, wholemeal bread and pulses such as beans and lentils.
If these suggestions do not help, please speak to your nurse, midwife or doctor.
Be aware, iron tablets can also make you more prone to constipation.
Vaginal discharge in pregnancy
Almost all women have more vaginal discharge in pregnancy. It should be clear and white, and it should not smell unpleasant. If the discharge is coloured or smells strange, or if you feel itchy or sore, you may have a vaginal infection. Tell your doctor, nurse or midwife. The most common infection is thrush, which your doctor can treat easily. You can help prevent thrush by wearing loose cotton underwear. If vaginal discharge of any colour increases a lot in later pregnancy, tell your doctor or midwife.
Teeth and gums
Bleeding gums are caused by a build-up of plaque (bacteria) on the teeth. During pregnancy, hormonal changes in your body can cause the plaque to make the gums more inflamed. They may become swollen and bleed more easily. To keep your teeth and gums healthy, you should:
- Pay special attention to cleaning your teeth. Ask your dentist to show you a good brushing method to remove all the plaque.
- Avoid having sugary drinks and foods too often. Try to keep them only to mealtimes.
- Remember that dental treatment is free while you are pregnant and for a year after your baby’s birth, so have a check-up now.
- Discuss with your dentist whether any new or replacement fillings should be delayed until after your baby is born.
Varicose veins
Varicose veins are veins that have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually get better after delivery.
You should:
- Try to avoid standing for long periods of time.
- Try not to sit with your legs crossed.
- Try not to put on too much weight as this increases the pressure.
- Sit with your legs up as often as you can to ease the discomfort.
- Try support tights, which may also help to support the muscles of your legs. You can buy them at most pharmacies.
- Try sleeping with your legs higher than the rest of your body. Use pillows under your ankles or raise the foot of your bed.
- Do foot exercises and other antenatal exercises, such as walking, cycling and swimming, which will all help your circulation.
Haemorrhoids (or piles) are varicose veins in the rectum (back passage) and these occur more often during pregnancy. To avoid these, try to avoid becoming constipated and straining on the toilet. Drink plenty of fluids and eat a high fibre diet.
Headaches
Some pregnant women find they get a lot of headaches. A brisk walk may be all you need, as well as a little more regular rest and relaxation. Although it is wise to avoid drugs in pregnancy, paracetamol, taken according to the dosage instructions, is generally considered safe.
If you often have bad headaches, tell your nurse, midwife or doctor so that they can advise you. Severe headaches may be a sign of high blood pressure and you should seek urgent medical advice.
Mood Changes
During pregnancy your body goes through many periods of change, both physical and psychological. Hormone levels are changing, and you may be feeling anxious, frightened, excited and happy or many other emotions. You may experience rapidly changing moods. This is part of pregnancy, and it is okay to feel like this. It helps if people around you, your partner and friends are understanding. Pregnancy is as major life changing experience so it is natural that you may not feel your usual self. However, if you find that you constantly feel sad, anxious or low let your doctor, nurse or midwife know, they will be able to offer you support and advice.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the:
Early Pregnancy Assessment Unit/Emergency Gynaecology Unit – Women and Children’s Hospital (01482) 608767.
Useful information
Information on Gynaecology Services at Hull University Teaching Hospitals NHS Trust can be found at:
www.hey.nhs.uk/content/services/gynaecology
Information on Maternity Services at Hull University Teaching Hospitals NHS Trust can be found at:
https://www.hey.nhs.uk/maternity.
http://www.screening.nhs.uk/annbpublications.
