Do’s and Dont’s During Pregnancy

What Pregnant Women Should Avoid:

• Avoid oral antibiotics often prescribed for acne. If you have a severe inflammation, ask
your doctor about oral erythromycin, which is considered the safest for use during
pregnancy. Usually, this medication is reserved for those who have very painful and
inflamed lesions.

• Avoid daily use of benzoyl peroxide and salicylic acid. "If you need to dry out a pimple
now and then, dab on benzoyl peroxide," says Dr. Berson. "Just don't slather it all over
your face every day. As for salicylic acid, no studies have been done." In both cases, she
says, it's safe to use in a cleanser, which is rinsed off the skin.

• Avoid products that contain vitamin A and it's derivatives (retinals, including Retin-A,
and retinoids). A vitamin-A derivative in Accutane, which is taken by mouth, has been
shown to cause birth defects.

• Avoid alpha-hydroxy acids in creams you leave on your face.

• Avoid depilatories (cream hair removers) because the chemicals seep into the pores and
loosen hair follicles. Shave while you're pregnant.

• Avoid self-tanners. They are probably safe, but require leaving the chemicals that dye
skin cells on your skin for several hours. "Better safe than sorry," says Dr. Berson.

• Avoid hair dyes that cover your entire head as the dyes usually saturate the scalp and
could be absorbed into your system. Theoretically, these are safer towards the end of your
third trimester, but Dr. Berson cautions against hair dye because there are even safety
questions about hair dye for non-pregnant women.
8 dos and don’ts: Diet tips for pregnancy
Eating for two? Here are the top food facts you need to know
Pregnant? Now that your growing baby is absorbing everything you're eating, you’ll have to
make some dietary modifications. (Hint: Eat your veggies!) Although you should discuss your
diet with your doctor, Elizabeth Somer’s 8 dos and don’ts will help get you started.

DOS:

1. Make every bite count

It takes about 55,000 extra calories to make a healthy baby. That might seem like a lot, but it’s
only 300 extra calories a day (the equivalent of a glass of low-fat milk, a slice of bread and an
apple), and that’s only in the last two trimesters. Calorie needs don’t budge an inch in the first
trimester when your baby grows no longer than a green bean. Your vitamin and mineral needs,
however, have skyrocketed. For example, folic acid, the B vitamin that helps prevent birth
defects, is more important than ever. That means: 1) Focus on “real” foods — colorful fruits,
vegetables, whole grains, legumes and nonfat milk; 2) Little room for extra chocolate cake; and
3) Take a moderate-dose multivitamin AND mineral that contains at least 400mcg of folic acid
to cover your bases on the days when you don’t eat perfectly.

2. Consume ample calcium-rich foods

As most people know, calcium helps build bones in the baby and prevent bone loss in the mom.
Calcium also helps prevent pregnancy-induced high blood pressure and is important for normal
functioning of nerves and muscles.

The pregnant mom needs 3 or more glasses of low-fat or nonfat milk or fortified soymilk every
day before, during, and after pregnancy if she plans to nurse her little one. You can cook your
rice or oatmeal in milk instead of water to sneak more calcium into your diet. Also, look for non-
conventional sources of calcium, such as foods fortified with calcium. Aim for at least 1,000mg a
day.

3. Get enough fluid

Getting enough nourishing fluids, like water, is important during pregnancy to prevent
constipation and provide for the expanding blood volume that carries oxygen and nutrients to
both the mother and baby. So, carry a water bottle, take 8 swigs of water every time you see a
water fountain (1 swig = 1 ounce), and drink a glass of water between each meal and snack.
Also, drink nutritious beverages, such as reduced-sodium V8, orange juice, or nonfat milk to get
your fluids.
4. Focus on iron-rich foods
Protein-rich foods, like extra-lean meat, chicken without the skin, fish, or cooked dried beans and
peas, are important sources of iron. This mineral is one of the most difficult nutrients to get
enough of during pregnancy, yet is critical for maintaining normal oxygen supply to the baby, for
normal development and growth, and for preventing premature delivery. Make sure you include
several iron-rich foods in the daily diet, cook in cast iron pots, and take a multivitamin that
includes iron.

DON’TS:

1. Give up on seafood
This is one of the hottest topics in nutrition for pregnant women right now. Here’s the good stuff:
The fats in fish, called omega-3 fats, are essential for brain and vision development in the baby.
Babies whose mothers consumed ample omega-3s, in particular DHA (97% of the omega-3s in
the brain are DHA), score higher on IQ tests later in life, while low intake is associated with
developmental delays. Omega-3s also might help prevent preterm births, as well as allergies and
asthma later in life.

But, here comes the bad: All fish contains mercury, a toxic metal that can cause serious nervous
system damage. Hundreds of studies have shown that the more fish you eat, the higher the
mercury levels. As a result, pregnant women have been told to limit fish consumption to no more
than 12 ounces/week and to avoid altogether the worst offenders — shark, swordfish, mackerel
and tilefish. But many woman have taken this recommendation so seriously that they avoid fish
altogether, which explains why 75% of the population consumes no DHA on a given day.

This “Don’t” includes a very important “Do.” You absolutely do need the omega-3s, especially
DHA. Fish get their DHA by eating DHA-rich algae. If you are concerned about contaminants
like pesticides and mercury in fish, can’t afford or don’t like fish, you can get that same DHA in
foods that are fortified with algal-based DHA. Or, take a DHA supplement. Aim for about
300mg a day. Be careful, some foods are fortified with omega 3s, but it is the wrong one. The
omega-3 ALA in walnuts, flax and soy is good for your heart, but won’t give your baby the
“brain” boost that you get only from DHA.

2. Drink alcohol, coffee, colas, teas or eat soft cheeses

The information on alcohol is cut in stone: Alcohol causes irreversible birth defects. No safe
limit has been established.

Consumption of coffee and other caffeinated beverages is not quite as clear-cut. Recent studies
show no effect of caffeine on birth weight or birth defects. However, studies in the past have
found a possible link between caffeine consumption and miscarriage, low birth weight and
growth retardation.
Also, feta, Brie, Camembert, or Mexican-style cheeses such as Queso Blanco Fresco are prime
candidates for bacterial contamination (listeriosis), which causes fever, miscarriage and other
complications during pregnancy, so avoid these during pregnancy.

Soft, unpasteurized cheeses like feta, Brie, Camembert, and goat — as well as ready-to-eat meats
like hot dogs and deli meats — may contain listeria, bacteria that cause mild flu-like symptoms
in most adults but can be very dangerous for unborn babies. Listeriosis, the infection caused by
the bacteria, can cause miscarriage, premature birth, or severe illness or death of a newborn. Feta
is safe if it is made with pasteurized milk, which should be clearly identified on the label.

3. Follow fad diets, like a low-carb diet

This is not the time to experiment with unbalanced diets. You need 40+ nutrients in the proper
proportion to build a healthy baby today and in the future. The developing baby is much more
sensitive to the mother’s nutritional status than previously thought, and some health
consequences don’t show up until much later in life. So skip the low-carb or food-combining
diets and stick to tried-and-true healthy eating.

4. Gain too much weight

Excess body weight entering pregnancy or accumulated during pregnancy can affect whether a
woman conceives and also might increase the risks for pregnancy complications, such as
gestational diabetes, pre-eclampsia, stillbirth, very-preterm birth and cesarean delivery. Many
women are entering pregnancy overweight, gaining too much during pregnancy, and then not
losing the weight after the baby is born — a pattern that contributes to this country's #1 health
problem — obesity.

Optimal weight gain is an individual matter. In general, a normal-weight woman should gain
about 25 and no more than 35 pounds during her pregnancy. Women who are overweight
entering pregnancy (i.e., more than 25% of body weight is fat tissue) should gain no more than
15 to 25 pounds during their pregnancies, while underweight women should gain approximately
28 to 40 pounds depending on their height and degree of leanness prior to pregnancy.

Also, it is not just total weight gain, but the pattern of weight gain that is important — with a
slow gain in the first trimester of about 2 to 5 pounds total (more if you are thin, very active, or
tall and less if you are overweight, sedentary, or short), followed by a steady increase to
approximately three-quarters to one pound a week in the last 2 trimesters. Sudden changes in
weight should be discussed with your OBGYN.
With so many people giving their opinion on what to do and what not to do during pregnancy,
it becomes hard to determine what is fact and what is fiction. Below is a list of some of the more
important factors to consider in regards to pregnancy do's and dont's.

Food during pregnancy

Certain foods need to be avoided during pregnancy. Listeria, which is caused by uncooked
meats, some seafood, unpasterized milk and soft cheeses, can cause birth defects, miscarriages
and stillbirth.

Cat litter
Toxoplasmosis, is a disease which is contracted by contact with cat feces. It is spread by a
parasite which can lead to miscarriages, stillbirth and birth defects.

Smoking
Smoking during pregnancy is definitely a no no. It has been linked to a low birth weight,
miscarriage and premature birth in many different studies. Second hand smoke poses the same
dangers during pregnancy, and should be avoided at all costs.

Caffeine
Some studies on caffeine during pregnancy have led to the conclusion that the two do not mix
well together, as caffeine may increase the possibility of miscarriage and low birth weight. On
the other hand, other studies have shown no link between the two. Obviously an excessive
amount of caffeine is a bad idea regardless of pregnancy. An excessive amount of caffeine is
generally regarded as over 300 milligrams per day. If you stay well clear of this figure, caffeine
during pregnancy is less likely to cause problems.

Safety around the house

There are many hazards around the house for pregnant women, but almost all can be easily
avoided. If you still insist on doing all the house work yourself, try to stay clear of aerosol cans,
industrial strength cleaners and fumes from paint, solvents and strippers. All of the above have
been linked to birth defects and other pregnancy complications. It also pays to take it a little
easier around certain parts of the house such as stair cases.

Body temperature
Keeping a moderate body temperature during pregnancy (especially during first trimester) is
important as it may lead to birth defects. It is a good idea to keep an eye on your temperature
during exercise and keep your fluids up. Things such as saunas and hot baths are not
recommended during pregnancy.
Alcohol and drugs
To be safe with alcohol during pregnancy it is probably best to avoid it altogether, as there is no
safe level of consumption. It can have detrimental affects on an unborn child. In comparison to a
fully grown woman, a baby is very small, so you could imagine the potential damage to the baby
if the mother was drunk or even tipsy. Drugs during pregnancy have been shown to have a
negative effect. Drugs such as cocaine have been shown to hinder the development of a baby’s
vital oxygen and nourishment, leading to complications such as birth defects and even an
addiction in the child itself.

Exercise
Exercise during pregnancy is recommended for most women, but only at a moderate pace.
Women who participated in high impact exercise, weight lifting, contact sports, high altitude
training or scuba diving before pregnancy, will have to readjust their routines. Walking is highly
recommended for at least the first two trimesters, as it can help your body withstand the rigors of
labor and delivery more easily.

The do's and don’ts of pregnancy are different for each woman and each pregnancy. The above
information is not a medical opinion and should not substitute a professional medical opinion.
Always consult your doctor or care provider before making any major decisions before, during
and even after pregnancy.
Over-the-counter medicines in pregnancy
Written by Helen Marshall, NetDoctor pharmacist

Most women are aware that during pregnancy they need to avoid as many non-essential
medicines as possible.

Yet these same women are just as likely to suffer from minor ailments as anyone else, as well as
being more likely to suffer pregnancy-related symptoms such as constipation or heartburn.

So should you have to grin and bear those headaches, coughs and colds? Or are there over-the-
counter medicines that are actually safe to use in pregnancy?

The problem caused by medicines taken by the mother is that they can cross the placenta and
enter the baby's bloodstream. This is because the medicine particles are small enough to cross the
placental barrier along with the nutrients needed for the baby's development. The effect any
medicine has on the developing baby depends on the medicine itself and the trimester of
pregnancy the medicine is taken in.

How does a medicine affect the developing baby?

The trimester of pregnancy is often very important. Some medicines can be dangerous to take in
the first three months but safe in the second or third, or vice versa.

• The first trimester is the period of greatest risk for the baby. This is because during this stage the
baby's organs are developing. Medicines taken during this time have the potential to affect this
development, which could result in malformations or birth defects. If a defect is very severe this
could cause a miscarriage.
• During the second trimester medicines can interfere with the development of the baby's
nervous system, or with the growth of the baby, resulting in a low birth weight. However,
generally, experts believe that the second trimester is the safest period to take medicines.
• Medicines taken in the final three months of pregnancy can cause complications such as
breathing difficulties for the baby after birth. This is because the medicine remains in the baby's
body after birth, and the newborn baby may not be able to cope with the medicine in its
bloodstream the way the mother can.

Medicines taken by the mother can also indirectly affect the baby by interfering with the
environment within the womb. Some medicines can cause contractions of the womb, decreasing
the blood supply to the baby, while others may cause early, delayed or even prolonged labour, all
of which pose a threat to the baby.
How do we know which medicines are safe?
The answer is that often we don't. Pharmaceutical companies rarely perform clinical trials or
actual studies of their medicines on pregnant women. As a result, few medicines are actually
licensed for use during pregnancy.

Most information we get about safety in pregnancy often comes from practical experience with
the medicine over time. Often, when a medicine has been in wide use for many years without
causing adverse effects on pregnancies, we can conclude that it is not harmful. Information will
also come from women who have been accidentally exposed to a medicine during pregnancy and
from animal studies.

So some medicines are known to be safe while others are known to be definately harmful. But in
a large number of cases there isn't the firm evidence to conclude safety or risk. This applies to all
medicines, be they prescription only or over-the-counter.

Taking any medicine during pregnancy is all about weighing up the pros and cons. The decision
should, ideally, be made by your doctor, who will be able to weigh up the benefits of a particular
medicine to the mother against the risks of that same medicine to the baby. If the benefits
outweigh the risks, then the medicine may be given to the mother. If the risks to the baby are too
great, then alternative treatment options need to be sought. The final decision about taking a
medicine should be made in conjunction with you.

Is there anything I can take to treat minor ailments?

The best way to minimise any risks for your baby is to avoid all non-essential medicines,
especially in the first trimester. However, what follows is a general overview of what you can
and can't take safely to treat common minor illnesses. Remember: always consult your doctor
or pharmacist before taking any medicine during pregnancy.

Constipation

• Try dietary measures such as drinking more fluids and eating more fibre first. If these are not
effective, there are over-the-counter laxatives that can be taken in pregnancy.
• Bulking agents such as ispaghula (Fybogel), methylcellulose, bran and sterculia are safe.
• The stimulant laxatives senna and cascara are also safe.

Heartburn and indigestion

• Antacids are generally safe, though sodium bicarbonate is absorbed into the bloodstream and so
should be avoided in pregnancy, since your sodium intake should not be too high.
• Medicines such as Gaviscon that contain alginates are safe, and can be especially useful for
heartburn caused by the pressure of the baby on the stomach. They form a raft on the stomach
contents and prevent them passing back up the food pipe.
Pain such as headache or backache

• Try non-drug methods first. A head massage can help relieve headache, while backache can be
eased by gentle stretching to relieve tight muscles, or a soak in a warm bath.
• Paracetamol is generally regarded as safe for short-term use in all three trimesters. It is widely
used in all stages of pregnancy for pain relief and reducing fever.
• Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are not
recommended during pregnancy, as there are safer alternatives available. They should
particularly be avoided in the last trimester, because they can delay labour, increase the length
of labour and cause complications in the newborn baby. Painkilling doses of aspirin can also
increase the risk of bleeding in the mother and baby if taken in the third trimester. Evidence
suggests these medicines should also be avoided in the first trimester and by women attempting
to conceive, as they may increase the risk of miscarriage or malformations.
• Codeine and dihydrocodeine can affect the baby's breathing if taken in the last trimester, or
during labour in large amounts. Heavy use may also cause a withdrawal syndrome in the
newborn infant. However, small doses for a short period of time to treat specific pain can be
taken in the first and second trimesters, but only on the advice of a doctor. Be aware that some
over-the-counter painkillers contain codeine or dihydrocodeine. Consult your doctor or
pharmacist before taking any medicines during pregnancy.

Hay fever and allergies

• For hay fever, first try as much as possible to reduce your exposure to the allergens that trigger
it.
• If this isn't possible, you can safely use sodium cromoglicate nasal spray or eye drops in all three
trimesters.
• Alternatively, short-term use of nasal sprays containing corticosteroids such as beclometasone is
unlikely to cause any harm. With long-term use sufficient can be absorbed to impair the growth
of the baby, so these should only be used after discussing any risks with your doctor or
pharmacist.
• Products containing antihistamines, such as brompheniramine, meclozine, diphenhydramine,
doxylamine, cetirizine and loratadine should generally be avoided, as there is insufficient
information about their safety. However, chlorphenamine is generally considered safe to take
during all three trimesters, if the measures mentioned above fail. Consult your doctor or
pharmacist before taking any medicines during pregnancy.
• Antihistamine nasal sprays and eye drops should be avoided.
• Nasal decongestants, such as pseudoephedrine, phenylephrine, xylometazoline, oxymetazoline
should also be avoided as there is insufficient evidence of their safety. Steam inhalations should
provide some relief from nasal congestion.
Coughs and colds

• Cough and cold remedies often contain a combination of several ingredients, including
painkillers, antihistamines and decongestants (see above), so it is important to make sure that
each ingredient is safe before taking them. Consult your doctor or pharmacist before taking any
medicines during pregnancy.
• The cough expectorant guaifenesin to help loosen a chesty cough can be used, though drinking
lots of water is just as effective for this. You could also try using steam inhalations to help liquify
mucus and make it easier to cough up. Cough medicines containing iodine as an expectorant
should be avoided, as the iodine can impair the functioning of the baby's thyroid gland.
• The cough suppressant dextromethorphan has been in widespread use and is generally
considered safe to use during pregnancy, providing it is only taken for short periods of time and
using the smallest dose possible. However, it is probably best to avoid it in the first trimester.
Cough suppressants containing codeine should be avoided in the third trimester.
• Soothing cough mixtures such as simple linctus, or sucking lozenges containing honey or glycerol
to coat the throat, are the safest option to reduce coughing. Consult your doctor or pharmacist
before taking any medicines during pregnancy.

Diarrhoea

• Short bouts of diarrhoea won't do your baby any harm, but diarrhoea lasting longer than a few
days can cause dehydration. This can be avoided by taking rehydration salts such as Dioralyte,
which are safe to use in pregnancy.
• Kaolin mixture can also be used to increase the bulk of the stools.
• Loperamide to stop diarrhoea should be avoided, as there is insufficient information available to
decide if it is safe or not.

Vaginal thrush

• There is not a great deal of information available about antifungal medicines such as
clotrimazole (Canesten) or fluconazole (Diflucan 1). They should only be used after discussion of
the risks and benefits with your doctor.
• If you are advised to use a vaginal preparation, take care with vaginal applicators or avoid using
them altogether.

Eczema, dermatitis and skin allergies

• Moisturisers or soothing products such as calamine lotion should be your first port of call as
these are completely safe.
• Steroid creams such as hydrocortisone can be used during pregnancy, but avoid using them on
large areas of skin, for long periods of time, or under dressings, as significant amounts may be
absorbed into the bloodstream.

Folic acid
This is the only over-the-counter medicine that is really important to take, both prior to and
during pregnancy. One 400 microgram tablet should be taken every day by women planning a
pregnancy and for the first 12 weeks of pregnancy. This is to help the development of the baby's
spinal cord and nervous system and prevent neural tube defects such as spina bifida. Taking folic
acid daily also helps prevent birth defects such as cleft lip and cleft palate.

A higher daily dose (5mg) of folic acid is recommended if you or your partner has spina bifida,
or if you have had a previous child born with neural tube defects. Discuss this with your doctor.

For medicines not covered here ask the advice of either your pharmacist or doctor. The best way
to minimise risk is to minimise your intake of all unnecessary medicines. Remember that herbal
remedies are not necessarily safe in pregnancy. If in doubt ask!

Quick recap
• Are you pregnant and taking any medicines?
• Have you told your doctor or pharmacist that you are pregnant?
• If you are pregnant, are you taking your folic acid tablets?
• Generally, avoid all medicines during pregnancy if possible.
• Always consult you doctor or pharmacist if you are pregnant and starting a new medicine.
• Remember some over-the-counter medicines and medicines from the supermarket can be
harmful to your baby.
• Herbal remedies are not necessarily safe alternatives. Ask your doctor or pharmacist for advice
about taking these while pregnant too.
• If you experience any unusual effects after taking your medicine, inform your doctor or
pharmacist immediately.
• Your doctor needs to weigh up the risks versus the benefits of giving a medicine during
pregnancy.
• Everybody is different - one woman may take a harmful medicine and have a healthy baby and
another women may take a so-called safe medicine and end up having a child with a birth
defect.
• Birth defects can occur naturally, even if you do not take any medicines, and no one can really
explain why they occur.