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  • Writer's pictureAlan Frischer, MD, MPH


Pregnancy is very much on my mind these days; one of my daughters is pregnant with my first grandchild. To say that the family is overjoyed is an understatement. In the many years that have passed since I became a parent, recommendations concerning pregnancy have changed. While I’m well aware that few of you are pregnant or about to become pregnant, you may still find this interesting!

Do note that I am an internist, not an obstetrician. Also, some of these recommendations do still inspire controversy: When there is any doubt, where pregnancy is concerned, I urge you to take the more conservative path.

There are close to four million births every year in the United States, and it is the pregnant woman who has primary responsibility for creating a healthy environment. Here are some straightforward suggestions:

  • Take a prenatal multivitamin. Eating a balanced diet rich in vitamins and minerals is extremely important, but is not enough. Prenatal vitamins provide extra folic acid, calcium, and iron.

  • Get plenty of sleep. This can be difficult to manage; but pregnancy is demanding on the body and those additional hours are important. Pregnancy alters hormone levels, can increase anxiety, and is simply uncomfortable. Naps are OK. Try to achieve seven to nine hours of sleep.

  • Exercise is not only allowed but important for both the woman and the growing baby. Exercise may also help with insomnia, muscle pain, too much weight gain, and possible mood issues. If you regularly exercised before pregnancy, keep it up. Starting new or more intense exercise is often not a good idea, however, so if you did not exercise before pregnancy, speak with your doctor about a safe fitness program

  • Do practice yoga, but avoid hot yoga or Bikram yoga. Look for prenatal or gentle yoga classes that are designed for pregnancy. Again, speak with your doctor before embarking on any new exercise program.

  • Do have sex. It is safe right up until your water breaks, as long as there is no complicating factor (such as placenta previa). If it is uncomfortable, try different positions, and feel free to discuss this with your obstetrician.

  • Do get vaccinated against flu and TDAP (tetanus, diphtheria, and pertussis/whooping cough). Note that the flu vaccine is not a live virus, so it cannot cause flu.

  • Do get vaccinated against COVID-19. The CDC tells us that pregnant women are more likely to get very sick from COVID-19, and that COVID can cause an increased risk of complications that can affect the pregnancy and the baby. This vaccination during pregnancy is safe and effective, and is not associated with fertility problems, either in women or in men.

  • Eat for two. Yes, you will need to eat more than usual, and you will want to gain weight. However, this is not a license to make poor food choices, and gaining too much weight can cause problems for both mother and baby. During the first trimester, about 100 extra calories a day are needed, and by the third trimester, that increases to some 300 to 500 extra calories per day.

  • It is OK to eat seafood. It is loaded with vitamins and minerals, including the heart-healthy omega-3 fatty acids, zinc, and iron. However, avoid it when it is uncooked (such as sushi or sashimi), as it can carry harmful bacteria, viruses or parasites. Avoid fish high in mercury, like shark, tuna, swordfish, tilefish, and king mackerel.

  • Visit the dentist. For some time, there was concern that teeth cleaning might cause bacteria to spread and lead to infection. This is simply not true; please attend to your oral health while pregnant.

And, here are some things to avoid:

  • Don’t smoke. Babies born to smokers are lower in birth weight and have a greater likelihood of learning disabilities. Due to physiologic nicotine addiction, children born to smokers are more likely to become smokers at a younger age.

  • Don’t drink alcohol. Warnings were issued 40 years ago here in the United States, and finally 15 years ago in France (where wine is heavily integrated into the culture). Fetal alcohol syndrome can lead to low birth weight, learning disabilities, behavior problems, and lagging growth and development milestones. Very recent studies confirm that there is no safe level of alcohol, both in terms of the overall outcome of the pregnancy and for fetal neurodevelopment. Increased risk of miscarriage is associated with any alcohol consumption in the first trimester. (Note, however, that the bulk of research focuses on moderate to heavy drinking. We just don’t have the same level of conclusive information about very low levels of drinking in the second and third trimester. Nonetheless, my recommendation is to not drink any alcohol, until and unless we have more conclusive evidence to the contrary.)

  • Don’t eat raw or undercooked meat and eggs. Foodborne illnesses including listeriosis and toxoplasmosis, and food poisoning can lead to serious illness, birth defects, and miscarriage.

  • Don’t eat cured meats, including deli meat, hot dogs, bacon, sausages, smoked salmon. They can also cause foodborne illness, and in particular listeria.Meats that are sliced have more surface area for bacterial growth. Thoroughly cooking these processed meats reduces the risk.

  • Avoid raw dairy products, but feel free to get calcium from pasteurized milk and cheese.

  • Limit coffee consumption. Caffeine can travel through the placenta and increase the baby’s heart rate. One or two cups of coffee per day is probably OK.

  • Don’t sit in a hot tub or sauna. The high heat has been associated with a higher risk of miscarriage and birth defects.

  • Don’t clean your cat’s litter box. Pet your beautiful cat and then wash your hands well. Kitty litter contains bacteria and parasites, the worst of which, during pregnancy, is toxoplasma gondii.

Reading these “dos and don’ts” makes it seem amazing that any pregnancies go smoothly. Note that these recommendations each come with their own set of odds for causing harm. They are usually small odds…but why take chances? It is up to each one of you to make informed decisions about your own pregnancy. As always, I encourage you to discuss these choices with your physician.

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