Folic acid, food, smoking, alcohol and recreational drugs
- Folic acid supplementation
Folic acid is a type of vitamin B that is needed for the formation of blood cells and the development of a 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.
- Eat a variety of healthy foods rich in iron, calcium and folate.
Smoking has adverse effects on both the pregnant mother and her foetus. It can cause an increased risk of miscarriage, premature separation of placenta, premature birth and a low birth-weight baby. There is also a long-term relationship with decreased intellectual development of the infant and increased risk of Sudden Infant Death Syndrome (cot death).
Much less is known about the consequences of exposure to passive smoke during foetal development. However, the performance of children of passive smokers was found, in most areas, to be between that of active smoking and nonsmoking mothers.
- Alcohol consumption
Alcohol consumption in pregnancy is linked to infants showing behavioral and learning difficulties. Excessive alcohol consumption is associated with Foetal Alcohol Syndrome (FAS) where the infant may suffer from congenital malformations and mental retardation among other negative effects.
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 foetus, but others do not. There is
some evidence that consuming larger amounts of caffeine daily during pregnancy may increase the risk of miscarriage, pre-term 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.
Do not focus on weight loss during pregnancy.
- Recreational drugs
If you have been abusing recreational or “lifestyle” drugs like cocaine, heroine, amphetamine (“Ecstasy pill”), or marijuana, you should quit once you are pregnant. Continuing to consume these substances will be harmful to your developing baby. They are known to cause miscarriage, bleeding in the placenta, stillbirth, low birth-weight and even mental retardation in babies. Birth defects associated with maternal cocaine use include abnormalities of the brain, skull, face, eyes, heart, limbs, intestines, genitals and urinary tract.
Discuss this with your doctor so that appropriate help and support can be rendered to you.
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 pre-term delivery.
- Traveling should be done mostly in the second trimester when the pregnant woman is more comfortable and there is a lower risk of miscarriage and pre-term delivery.
- It is important to take precautions for deep vein thrombosis (blood clots in the legs). These include 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 avoid 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 has not yet been established in pregnancy.
- 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. (Figure 15.1)
Carrying heavy objects in pregnancy
- It is commonly believed 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 in a woman's body shifts during pregnancy which puts more stress on her back. These two factors make a pregnant woman 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 your clothes need to accommodate this for your comfort.
- The body temperature increases during pregnancy and thus light, breathable clothing made of wool or cotton is the most comfortable. Shorts/skirts or pants with an elastic or drawstring waist made from stretchy materials that can grow with your waist are ideal at this time.
- 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, there is a change in vaginal discharge because of the rise in body temperature. 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.
- When traveling in a car, always wear a seat belt to protect you and your unborn baby. The seat belt should be a three-point restraint with a lap and shoulder belts.
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 the centre of gravity and dynamics. For these reasons flat and low-heeled shoes are ideal. Backless shoes made of flexible material can accommodate changes to your feet.
Hair-dyeing, hair rebonding and perming in pregnancy
- During pregnancy there is concern that using hair dyes and hair straightening agents might result in chemicals being absorbed into the bloodstream even though most chemicals are normally cleared from the bloodstreamfairly quickly. Unfortunately, there have been very few studies conducted on the use of such products during pregnancy to quantify the risk of hair dyes to a developing baby.
- While no one can provide reliable data about timing and safety, it is best to avoid dyeing or rebonding your hair once you have 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 foetus.
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 your 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 fruits and vegetables well before eating them and wash 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 take 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 your pet bird or its cage.
- Pregnancy and farm animals
Farm animals are known to transmit listeria, campylobacter and also salmonella infections. Listeria can cause severe infection, miscarriage or stillbirth.
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 dead animals. Drink only pasteurised milk as this will eliminate the risk of food-borne listeriosis.
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 are 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 show 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 receive 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 a normal distance 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 women are worried that the low-level electromagnetic fields (non-ionising radiation) produced by computer monitors could cause miscarriage or harm their 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 several 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 (CT) scans are to be avoided in pregnancy unless the benefits outweigh the risks of radiation to the foetus which can cause developmental malformations and childhood cancers.
- The amount of radiation used during a CT scan is considered minimal and therefore, the risk of radiation exposure is low.
- Inadvertent exposure to X-rays in pregnancy, even in the first trimetser, 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.
" The New Art and Science of Pregnancy and Childbirth". A Pregnancy Book written by Dr. Tan Thiam Chye, Dr. Tan Kim Teng, Dr. Tan Heng Hao, Assoc Prof John Tee Chee Seng. KK Women's and Children's Hospital.
* Available at all major book stores and Pharmacy in KK Women's and Children's Hospital.