Do’s and Don’ts in Pregnancy

Food, Smoking, Alcohol and Recreational Drugs in Pregnancy  

Do's

• Folic acid supplementation 
  

Folic acid is a type of vitamin B that is needed for the formation of blood cells and the development of baby’s nervous system. It has been shown to reduce the chance of a baby having brain and spinal cord defects. A simple way is to take a 5 mg folate supplement for the first 12 weeks of pregnancy. Folic acid is sold at your local pharmacy.

• Eat a variety of healthy food rich in iron, calcium and folate. For more information, read the article Nutrition during pregnancy — eating right for two . 
  

Don'ts

• Alcohol consumption
  

Alcohol consumption in pregnancy is linked to infants showing behavioral and learning difficulties. Excessive alcohol consumption is associated with Fetal Alcohol Syndrome (FAS) where the infant may have varying negative effects including congenital malformations and mental retardation.

• Caffeine
  

Safety of caffeine consumption during pregnancy is controversial. Some studies suggest that a modest caffeine intake of two cups of coffee per day presents a slight risk to the fetus, but others do not. There is some evidence that consuming larger amounts of caffeine daily during pregnancy may increase risks of miscarriage, preterm delivery and low birth weight, but these studies are non-conclusive. 

We recommend limiting any drinks containing caffeine such as coffee, tea and cola to a maximum of two cups per day for the safety of your baby.

• Diet
  

Do not focus on a weight loss regime during pregnancy.

• Recreational drugs
  

If you have been abusing recreational or “lifestyle” drugs like cocaine, heroine, amphetamine (“Ecstasy pill”), or marijuana, it is the most appropriate time for you to quit totally once you are pregnant. Continuing to consume these substances is harmful to your developing baby. They are known to cause miscarriage.

Discuss this with your doctor so that appropriate help and support can be rendered to you.

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Travel in Pregnancy

• Flying is not contraindicated in an uncomplicated pregnancy. You must be well with no abdominal pain or bleeding. Domestic travel is usually permitted until 36 weeks gestation whereas international travel may be curtailed after 32 weeks of pregnancy. This is due to the risk of preterm delivery.

• Traveling should be done mostly in the second trimester when the pregnant woman is more comfortable and the risk of miscarriage and preterm delivery are lower.

• It is important to take deep vein thrombosis (blood clots in the legs) precautions such as getting a seat with more leg room, interval walking in the aisles or toilet breaks, leg massages or wearing thrombosis deterrent stockings. Prevent dehydration by taking enough fluids orally and avoiding alcohol.

• You can consider meningococcal and rabies vaccines if these diseases are endemic in the country you are traveling to. The safety of vaccines for yellow fever, Hepatitis A and typhoid is not yet established in pregnancy.

• When traveling in a car, always wear a seat belt to protect you and your unborn baby. The seat belt should be a 3-point restraint with a lap and shoulder belts.

• Wear your seat belt correctly. The lap belt should go under your belly, across your hips and as high as possible on your thighs. The shoulder strap should go between your breasts and off to the side of your belly. Seat belt straps should fit snugly and never go directly across your tummy.  

Carrying Heavy Objects in Pregnancy

• It is common to hear that it is unsafe to lift heavy things in pregnancy. However, the risk of injury is usually directed at the mother and not the baby. The increase in the level of hormones during pregnancy causes the ligaments to soften, which leads to joints that may be less stable.

• Also, the centre of gravity of the pregnant mother has shifted which puts more stress on her back. These two factors make the mother more susceptible to injury when lifting heavy things.  
  

Clothing in Pregnancy

• The womb does not grow out of the pelvis until 12 weeks of pregnancy and most women will still get away with wearing their normal clothes until then.

• By 14–16 weeks, the belly starts protruding and you will need to wear looser or more elasticised pants or skirts. Between 18–22 weeks, the waistline thickens, and the clothes need to accommodate this to maintain comfort.

• Temperature increases during pregnancy and thus light, breathable clothing made of wool or cotton is preferred. Shorts/skirts or pants with elastic or drawstring waist made from stretchy materials that can grow with your waist is preferable.

• As long as pregnant women are comfortable in their clothing and the clothing is not too restrictive or tight, it should not impede the development of the baby.

• Exposing the belly has no known adverse effects on the developing baby.

• Normal underwear can be worn during pregnancy. However, some women prefer oversized underwear to pull up over their bump. During pregnancy, body temperature increases and vaginal discharge changes. Pregnant women are thus more prone to fungal and bacterial infections. Cotton underwear will keep the perineal area ventilated and discourage growth of these organisms.

• Avoid wearing tight socks or half leg stockings during pregnancy as these can reduce blood circulation from the feet and lower legs, thus increasing swelling, fluid retention and aggravating varicose veins. 
  

Footwear in Pregnancy 

• Your feet increase in size during pregnancy due to water retention in the legs. Also, pregnant women are prone to falling and tripping due to changes in centre of gravity and dynamics.

• Flat and low-heeled shoes are preferable. Backless shoes made of flexible material can accommodate to changes your feet. 
  

Hair-dyeing, Hair Rebonding and Perming in Pregnancy 

• The concern about exposures to hair dye and hair straightening agents is that there may be absorption of chemicals into the bloodstream at the time of use. However, most chemicals are cleared from the bloodstream fairly quickly. Unfortunately, there have been only very few studies on the use of such products during pregnancy to quantify the risk of hair dye to a developing baby.

• While no one can provide data about timing and safety, avoid dyeing or rebonding the hair once the woman has conceived.

• Perming hair during the second and third trimesters of pregnancy is a safe procedure and can make caring for hair less time consuming and easier. There are no studies that indicate perming of hair during pregnancy is detrimental to the fetus. 
  

Keeping Pets in Pregnancy 

• Pregnancy and your dog 
  

Dogs are usually safe for you and your developing baby. However, be careful of large dogs, which may jump on your tummy while you are lying down or sitting. 

• Pregnancy and your cat 
  

Cats may transmit toxoplasmosis (a parasitic infection). Toxoplasmosis can cause premature delivery, serious malformations of baby and low birth weight. 

Transmission usually occurs from contact with feline faeces. Outdoor cats are more likely to have toxoplasmosis than cats that remain strictly indoors. Since cats may use both litter boxes and outdoor sand and soil, you can become infected after changing a contaminated litter box, digging or gardening outside, or eating unwashed contaminated fruits and vegetables. 

If you are immune to toxoplasmosis by previous infection before pregnancy, then you are not likely to be infected again. Thus, if you are a cat owner and trying to get pregnant, ask your doctor for a simple blood test (antibodies level) to check if you are immune to toxoplasmosis. Unfortunately, there is no useful vaccine against toxoplasmosis. 

Eat only well-cooked meat. Avoid dried raw meats such as beef jerky. Wash the fruits and vegetables before eating them and all utensils after preparing raw meat, seafood, fruits and vegetables.

• Pregnancy and your pet bird 
  

Birds can transmit infections like campylobacter and salmonella. They can cause miscarriage in early pregnancy or stillbirth in advanced pregnancy. 

It is useful to bring your pet bird to your veterinarian to check for such infections. Inform your doctor that you have a pet bird in the house. 

Always wash your hands thoroughly with soap and hot water following any handling of the bird or its cage. Avoid changing the birdcage if possible. 

• Pregnancy and farm animals 
  

Farm animals are known to transmit listeria, campylobacter and also salmonella infections. Listeria infection can cause severe infection, miscarriage or stillbirth. 

Thus, try to avoid leisure farm visits. Always wash your hands thoroughly with soap and hot water following any contact with farm animals or their living areas. Do not feed the animals or handle the dead animals. Drink only pasteurised milk as this would eliminate the risk of food-borne listeriosis. 

Prenatal Stimulation 

Prenatal stimulation uses various stimuli such as classical music and the mother’s voice. The baby learns to recognise and respond to different stimuli, which may encourage physical, mental, and sensory development. Babies may benefit from stimulation as early as the third month of pregnancy. Once babies develop hearing in the fifth month, music is excellent for aural stimulation and to soothe the baby.

• Does it really work? 
  

Some studies have revealed that stimulated babies exhibit enhanced hearing, linguistic, and motor development. In general, they sleep better, are more alert, confident and content than infants who were not stimulated. They also show superior learning capacity and calm down more easily when they hear familiar sounds they heard while in the womb. 

Stimulated babies and their families showed more intense bonding and greater family cohesion. Prenatal stimulation provides a lasting foundation for loving communication and healthy parent-child relationships. 

• Is over-stimulation a concern? 
  

Over-stimulation may cause confusion. When babies become overwhelmed by too much stimulation, they may stop responding. Stick to moderate levels of stimulation if you desire.

Use of Computers in Pregnancy 

All electrical equipment can produce low frequency (non-ionising) radiation. Computer monitors have internal shielding that reduces non-ionising radiation to safe levels. Computer users who sit at typical distances from their monitors receive extremely low exposures. Current research suggests there are few, if any, health effects caused by non-ionising radiation among computer users. 

Many pregnant mothers are worried that the low-level electromagnetic fields (non-ionizing radiation) produced by computer monitors could cause miscarriage or harm an unborn baby. It is heartening to know that studies have shown no evidence that this is the case. 

However, avoid sitting in front of a computer for hours at a time because you may experience worsening of your backache. If you must spend extended periods in front of the computer, take frequent short breaks to walk, stretch and move to prevent blood clots in the legs (deep vein thrombosis).

X-Rays in Pregnancy 

• X-rays or Computed Tomography scans are to be avoided in pregnancy unless the benefits outweigh the risks of radiation to the fetus which can cause developmental malformations and childhood cancers.

• The amount of radiation used during a CT scan is considered minimal and therefore, the risk for radiation exposure is low.

• Inadvertent exposure to X-ray in pregnancy, even in the first trimester, may not necessarily be an indication to terminate the pregnancy.

• Avoid X-rays during pregnancy unless ordered by your doctor. You will usually be given a lead apron to shield the developing foetus if an X-ray is a must during pregnancy. 
  

Frequently Asked Questions

1. Can I go for massage and aromatherapy during pregnancy? 

Massage is a wonderful way to unwind tired muscles and pamper you. The massage table should have a cutout for your belly. Otherwise, you can position yourself with pillows so you are slightly on your side, or use a massage chair. However, massage of the tummy or breasts can cause contractions of the womb. If you notice strong contractions, stop that part of the massage. 

You may find that you are more sensitive to smells than usual. Aromatherapy is fine as long as it is pleasant for you. However, essential oils are absorbed through your skin into the bloodstream. Until more is known, avoid extensive skin contact with essential oils, especially in the first trimester while the baby’s organs are developing. 

2. Can I enter a sauna or steam room during pregnancy? 

High fever in early pregnancy is bad for the developing baby as it increases the chances of miscarriage and birth defects like spinal cord and brain malformation. Thus, all treatments that raise your body temperature should be off limits during pregnancy. These include the sauna, steam room and hot tub. Warm baths are fine as long as they are not super hot, since water cools off fairly quickly.

3. Can I begin a weight loss regime in pregnancy? 

Would being underweight cause a problem in pregnancy? Women who are severely underweight (body mass index <19 kg/m2) during pregnancy and who are not eating enough are more likely to have a baby who is small and of low birth-weight. This can have serious long-term effects on the baby’s health. Most pregnant women should expect a weight gain of 10–12 kg throughout the entire pregnancy. Take a balanced diet during pregnancy consisting of calories, carbohydrates, proteins and fibers. Dieting is a no-no in pregnancy. Your baby needs you to eat! Your baby depends on you for its nourishment. Remember that if you eat well, your baby eats well and if you starve, your baby starves.

4. With symptoms of pregnancy like shortness of breath and constant urination, are there any ways to get good night sleep? 

Pregnancy is demanding both physically and emotionally. The increasing size of your belly makes it hard to find a comfortable sleeping position. If you have always been a back or stomach sleeper, it may be difficult to get used to sleeping on your side as recommended by your doctor. Also, as the growing womb presses on your bladder, you experience more trips to the bathroom, day and night. See your doctor to exclude urinary tract infection if you experience a burning sensation when urinating. 

Try to get into the habit of sleeping on your side early in your pregnancy. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart’s job easier because it prevents the baby’s weight from applying pressure to the large vein (the inferior vena cava). Alternatively, use a pillow to keep yourself propped up on one side. Some doctors specifically recommend that pregnant women sleep on the left side. This is because your liver is on the right side and lying on your left side helps keep the womb off your liver. Ask what your doctor recommends — but in most cases, lying on either side should be fine. 

Cut out caffeinated drinks like coke, coffee and tea from your diet as much as possible especially at night. Avoid drinking a lot of fluids or eating a full meal within a few hours of going to bed at night. This might give you a better sleep with less interruptions to wake up at night to go to the bathroom. 

5. Are electronic massage chairs and foot reflexology safe during pregnancy? 

Unfortunately, there is insufficient data and research done at this moment to address the safety of massage chairs and foot reflexology during pregnancy. 

6. Can I have facial treatments during pregnancy? 

The surge of hormones in pregnancy may worsen acne on your face. Thus, facial treatments to treat acne may not be effective. Do pamper yourself with a facial treatment if you find it relaxing and reduce your stress during pregnancy. 

Avoid using facial products that contain relaxation oils as they may precipitate womb contractions. 

7. Can I have LASIK surgery to correct my eyesight during pregnancy? 

It is advisable not to have LASIK surgery during pregnancy. During pregnancy, your refraction may be different due to hormonal changes. Also there is the rare possibility that your response to the surgery might not be usual. There is no harm of the surgery to the foetus but your results may be affected. LASIK surgery can be done at least six weeks after breastfeeding. 

8. Does pregnancy affect my eyesight? 

Some women may experience worsening of myopia during pregnancy but they would return to the same level of myopia after delivery. Pushing during normal natural birth has not been shown to cause worsening of myopia and retinal detachment. 

Visual changes in pregnancy are common, and many are specifically associated with the pregnancy itself. Serious retinal detachments and blindness occur more frequently during pre-eclampsia (high blood pressure). A decreased tolerance to contact lenses is also common during pregnancy; therefore, it is advisable to wear contact lenses only after delivery. 

9. How does fear or loud noises affect my pregnancy? 

Will watching horror movies affect my baby? Fear activates your nervous system to produce adrenaline hormones. Adrenaline will increase your heart rate and your breathing becomes more shallow and faster. Your blood pressure will increase as well. 

Watching horror movies in pregnancy is more of a cultural taboo. There is no scientific proof to show its harmful effects on the baby. But fear would evoke the adrenaline gush as described. Loud noises do not usually affect your fetus as he/she is surrounded by amniotic fluid and buffered from the noises. 

As we encourage all pregnant women to be calm and relaxed and think of happy things, listening to calm music and watching nice entertainment programs will be a better alternative. 

10. Is acupuncture safe for pregnancy? 

Advocates of acupuncture treatment suggest that acupuncture during pregnancy is beneficial for both mother and baby. During the first trimester, acupuncture may reduce morning sickness and fatigue. During the second trimester, acupuncture can help maintain balance. In the third trimester, acupuncture can provide relief from backache and joint pain. Acupuncture is also used during labour for pain relief. 

However, if you are considering acupuncture during pregnancy, you should discuss it with your obstetrician.

11. Does pregnancy affect my sleeping pattern? 

Many women report daytime sleepiness during pregnancy. Try to fit in a quick nap at lunchtime if possible. Most over-the-counter and prescription sleep medications are off-limits when you are pregnant, especially during the first trimester as they may cause fetal malformations and mental retardation. Try activities such as yoga, deep breathing, a relaxing massage or taking a warm bath before bedtime, to get a better night’s sleep. 

12. Is it safe for me to paint my baby’s room during pregnancy? 

Paint toxicity depends on the chemicals and solvents found in the paint along with the amount of exposure. There are currently no studies that look into the effects of household painting on pregnancy and the developing baby. Household painting involves very low levels of exposure to toxic chemicals. However, we still recommend you to avoid painting if possible. 

Also, lead based paint was often used prior to the 1970s, so you should avoid getting involved with removing old paint in an older house because of the risk of lead exposure. 

13. Is it safe to use mobile phones during pregnancy? 

Many mothers are concerned about the possible harmful effects of cellphone radiation. Unfortunately, there is insufficient scientific research done to comment on the safety of cellphone usage at the moment. 

14. I reached an airport X-ray screener that is used to screen our carry-on items. What is the radiation exposure? 

Airport X-ray machines to screen briefcases and packages give much lower doses of radiation than X-ray machines in hospitals and medical clinics — almost immeasurable. They are designed this way because they do not have to see in such detail. 

15. Does passing through the airport security pose a risk to my baby during pregnancy? 

Passing through an airport security portal has not been shown to pose a risk to a pregnant woman or her unborn child. The metal detector is not known to pose any health risk to individuals. The devices used to scan your carry-ons are very well shielded so there is no risk passing through the airport security. 

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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