Diet and Exercise
I recommended that you take a pregnancy specific supplement during your pregnancy, which includes Iron and Folic Acid, such as Elevit, InNatal with iron, Eagle Brand, or Blackmore’s Pregnancy and Breastfeeding Gold. Elevit has more iron, but is larger and harder to swallow in the first trimester.
Iron deficiency is very common in pregnancy. The symptoms include tiredness and lack of energy. Iron deficiency may affect your recovery from birth and your milk supply. I shall check your iron stores at times during the pregnancy and will recommend a supplement if you are deficient. The highest dose supplement is Ferro Grad C, however it can be quite constipating, in which case Maltofer may be better, or the liquid Spatone may be a better option, although it gives you a much lower dose of iron. Do not take Iron at the same time as tea, coffee, Calcium or dairy, which inhibit iron absorption.
If you are severely iron deficient or do not tolerate or respond to oral supplements then I can arrange an iron injection, known as Ferinject. It is given intravenously, and takes about an hour. It has recently been PBS listed, so it costs only $40 with Medicare, unless you have to pay a hospital excess fee. Iron infusions can also be performed in the infusion clinic, or in some GP surgeries.
Vitamin D deficiency is common. I recommend you have 15 minutes of sunlight every day, preferably early morning or late afternoon, and you may need a Vitamin D supplement, such as Ostelin. Iodine deficiency is also surprisingly common in Australia and there are usually no symptoms. It is recommended that all women who are currently pregnant or planning a pregnancy take a supplement, containing 150mg iodine, throughout pregnancy and while breastfeeding.
I shall provide you with a booklet that gives you details about foods to choose and foods to avoid in pregnancy. And although you are eating for two during pregnancy, this does not mean twice as much! On average you should expect to gain 10-15 kg in weight during the pregnancy. In pregnancy you have increased insulin resistance, so it is preferable to choose low glycaemic index (GI) foods, and reduce your intake of saturated fats, processed foods and white sugar, white flour and white rice.
You should aim to have three meals per day, each with some lean protein, starchy carbohydrate and green vegetables. You should also have three snacks per day in between meals. All meat and seafood should be cooked through. Soft cheeses, patés, and smoked or cured meats should be avoided, unless they are then cooked, in which case they are fine. All dairy should be pasteurised. Caffeine should be restricted during pregnancy. One coffee per day, however, is reasonable.
The current recommendation on alcohol is to avoid it entirely during pregnancy. That is because heavy or frequent alcohol consumption in pregnancy has been associated with a range of problems with babies including birth defects and a risk of alcohol dependence in later life. The official advice used to be only one alcoholic drink per day, but this has been reduced to none, because we do not have good evidence on what the safe threshold is. If you are going to drink alcohol during pregnancy then my advice is to limit it to a single standard drink, no more than one or two times per week.
Cigarette smoking during pregnancy has been shown to cause a variety of problems for both you and your baby. For that reason I urge you to cut down or, preferably, quit smoking as soon as you find out that you are pregnant, even if you need to use Nicotine patches to help you through the pregnancy. You should encourage your partner not to smoke, as it is then easier for you not to smoke, and smoking in the home increases the risk of SIDS and childhood respiratory diseases, including asthma.
You should try to remain active during the pregnancy. Most exercises are fine, including brisk walking or even light running and upper body exercises. Swimming and aquarobics, in particular, are great. Core strength and breathing exercises, such as pregnancy yoga and Pilates are also excellent, as are classes that develop your breathing and stretching techniques.
You should avoid sit-ups, crunches and exercises that increase abdominal pressure or separation of the abdominal muscles. And it is important you keep your heart rate under 140-160, depending on your level of fitness, and, above all, not to over-heat. Remember the baby takes up a lot of your heart and lung reserve, so please do not to push yourself too hard in pregnancy. Please make sure that you drink plenty of water before, during and after exercise, especially in summer.
Good Bowel and Bladder Habits
These are important for long-term bladder and bowel function, and include:
- Drink 1.5 to 2.5 litres of fluid each day, preferably water
- Empty your bladder up to eight times per day
- Take your time — don’t hurry or strain to empty bladder or bowel
- Sit properly on the toilet with feet flat on the floor — don’t hover or dangle legs,
- Maintain bladder capacity — no ‘just in case’ visits to the toilet
- Do at least three pelvic floor exercise sessions each day, and ideally four or five
- Brace by squeezing your pelvic floor before lifting anything, eg a toddler, baby, washing or pram, or before coughing & sneezing.
Keeping Fit and Healthy
It is important to maintain your fitness with regular, gentle exercise throughout your pregnancy. Exercise programs that include walking or aqua-aerobics are ideal. Utilise the pelvic floor “bracing” technique to protect your body throughout each exercise session.
You are free to continue with your regular non-contact sports for as long as you are comfortable doing so. However, if you experience any pain or discomfort during any exercise activity, be sure to stop the activity and seek professional advice. Starting new sports or participating in vigorous exercise should be avoided while you are pregnant. Contact sports especially should be avoided, particularly after you are 13 weeks (4 months) pregnant.
Preparing Guidelines for Exercising Safely
- Exercise in specially designed classes
- Avoid exercising in the heat or for prolonged periods
- Avoid eating in the hour immediately prior to exercising
- Drink plenty of water before, during and after exercising
- Go to the toilet before beginning exercising
- Begin with warm-up—large, free body movement and stretches, and finish with a slow cool-down, including stretches
- Always get up slowly when rising from the floor. Lie fully on your side before you get out of bed
- Don’t push through any pain or discomfort — use alternative exercise
- Exercise at your own pace — rest if tired or short of breath
- You should be able to maintain a conversation as you exercise i.e. NOT short of breath
- Never exceed heart rate of 160 beats per minute, or less if you have a slow exercising heart rate
- Wear cool, comfortable, supportive clothes that allow freedom of movement. Bike pants or tights, a good bra and sports shoes to support the arches of the feet are recommended
- spending any time lying flat on your back
- any “sit-ups” or abdominal “crunches” exercise while pregnant
- rapid, alternating movements
- any high-impact activities
Seek further help if you experience any of the following:
- Pelvic Joint Pain — Pubic Symphysis, Sacro-Iliac Joint (SIJ) or “Sciatica”: Grinding/grating, severe aching, sudden stabbing pain, unable to take weight, limping, muscle spasm, pain on movement including walking, pain on lifting one foot up, such as putting shoes or underwear on.
- Rectus Diastasis — Separation of the abdominal muscles: A bulge appears in the central line of the abdomen as you get up, change position, lift, or cough.
- Back pain: Lumbar (low back) pain, thoracic (mid back) or neck pain
- Bladder control problems — accidental loss of urine with cough, sneeze
- Problems with constipation and/or straining to empty the bowels
- Carpal Tunnel Syndrome — Numbness, pins and needles, tingling or pain in the fingers and hand or wrist, often worst in the mornings, and sometimes settling with a wrist splint
- De Quervain’s tenosynovitis – painful inflammation of the tendon in the wrist, near the thumb
- Localised muscle tension or cramps