Wednesday 23 August 2017

15 tips for a healthy pregnancy

Isabel Hayes talks to Professor Michael Turner on how women can look after both themselves and their unborn child

Women can take steps to look after themselves and their unborn during pregnancy.

Ireland is one of the safest countries in the world to give birth, but pregnancy is not without risk. Professor Michael Turner of the UCD Centre for Human Reproduction and the Coombe Women and Infants University Hospital outlines the measures women can take to protect themselves and their unborn baby.


1 Take folic acid if there's even a chance of pregnancy

Taking folic acid can help prevent a baby being born with spina bifida or other neural tube defects but despite this, just one in four Irish women take enough folic acid before getting pregnant. According to Professor Turner, women should be taking 400 micrograms of folic acid daily for at least three months before pregnancy. "If you don't have enough folic acid, it can interfere with the closure of the spinal cord and that takes place within 28 days of conception," he says. "So if you wait four weeks into the pregnancy, it's too late."

These days, half of all pregnancies are unplanned. "So now our advice is that if there's any possibility you could become pregnant in the next 12 months, you should be starting folic acid," says Turner.

2 Optimise your weight

One in six women booking antenatal care in Ireland is obese. Obesity is associated with an increase in pregnancy complications, including gestational diabetes. "Women who are obese are twice as likely to need a Caesarean section as they're more likely to get foetal distress during labour," says Turner.

It's difficult for women to lose weight when they're pregnant, as they may end up cutting back too much on vital nutrients. "I feel strongly that they should try and lose weight or optimise their weight before they become pregnant," says Turner. "Women should try and start pregnancy with a BMI of less than 30. Even if they lose some weight before they become pregnant, it helps."

3 Stop smoking

"Unfortunately, there are too many Irish women who are heavy smokers during pregnancy," says Turner. "That increases their chances of miscarriage or stillbirth and it increases the chances of the baby being too small." He recommends starting a smoking cessation programme prior to getting pregnant. "I often say to parents, 'What's the point of having a healthy child if you're not going to be around yourself to look after them?'"


4 Count nutrients rather than calories

Most women are aware of the taboo foods during pregnancy - pate, soft cheese, unpasteurised dairy products, etc. But these days there is also a greater emphasis on what they should be eating. The First 1,000 Days Movement ( advises pregnant women and mothers on nutrition from conception until their child is two-years-old - a key period when getting nutrition right has been found to have long-lasting health benefits.

"The emphasis needs to be on nutrients, not calories," says Turner. "Women don't need to eat for two, they just need to make sure they have as nutritious a diet as possible."

5 Book an early ultrasound

Professor Turner says expectant mothers should book antenatal care early and get an early ultrasound scan too,but not too early - scans are unreliable in the first six to eight weeks of pregnancy. "If your scan is normal early on in the pregnancy, there's a 95-96pc chance that you're going to take home a healthy baby," he says. "That's one of the most important reasons for having a scan, to reassure women."

6 Be alert for double trouble

An early ultrasound scan can also alert expectant parents to a surprise twist - the fact they may be expecting twins. Some sets of twins - monochorionic twins - share a placenta which can lead to one twin getting more blood and more nutrients than its sibling. "It means that one baby grows at the expense of the other," says Turner. The good news is that the last 10 years have seen vast improvements in treatment. "You can do very sophisticated laser treatment in utero where you can try and oblate or destroy the link between one twin and the other on the placenta so that they're both getting an even share," he says.

7 Know the symptoms of an ­ectopic pregnancy

An ectopic pregnancy, when the foetus develops outside of the uterus (usually in one of the fallopian tubes), is a life-threatening condition for the mother in which the foetus cannot be saved. "Ectopic pregnancy is not common but it is potentially life-threatening if the ectopic ruptures and there's a bleed into the mother's abdomen," says Turner. Symptoms include abdominal pain, bleeding and shoulder tip pain.

"The value of making the diagnosis early is that we can treat the mother with drugs, which then means there's a potential for avoiding surgery," he says.

8 Know your blood type

If a woman has a negative blood type (known as rhesus negative) and her baby is rhesus positive, this can cause complications. If there's a bleed from the baby to the mother, this can trigger an immune response in the mother. "That immune response can destroy the baby's red blood cells, causing an anaemia," says Turner. As a result, all pregnant women need to know from early pregnancy whether they are rhesus negative, which is determined by a blood test. If the woman has any bleeding, she needs to go straight to hospital where she can be given an Anti-D injection to stop the immune response. "You have to give that within 72 hours of the bleed," he warns.

9 Cut out the booze

"As a general rule, doing something that you shouldn't do is more likely to have an impact early in pregnancy, when the organs are still being formed," says Turner. This includes drinking alcohol. Women should reduce their alcohol intake and avoid binge-drinking during pregnancy, as it can be harmful to the baby.

"Some doctors take the view that pregnant women shouldn't take alcohol at all," he says. "I'm of the view that I don't think there's any harm with an occasional glass of wine, particularly with a meal."


10 Keep moving

Women were traditionally advised to rest up during pregnancy but this is no longer the case, with health professionals advocating regular exercise throughout the whole nine months. "We're very keen that women continue physical activity and continue exercise," says Turner. "I wouldn't want them doing bungee jumping or dangerous physical contact sports. But they should stay active and there's no reason why they can't keep active all the way up until labour. There's no evidence it does any harm to the baby and there's lots of evidence that it's beneficial to the mother."

11 Know the signs of infection

The incidence of premature births is low in Ireland, with a rate of 5 to 6pc. Half of premature deliveries are elective, when doctors choose to deliver because a problem has been identified with the mother or baby. In the other half it's spontaneous, with the most common cause being an infection.

Labour pains or waters breaking tend to be the first symptoms of an infection, so if a woman experiences either of these, she needs to go to a maternity hospital immediately.

12 Count the kicks

During the second trimester, expectant mothers will feel their babies kicking for the first time. Once these movements are constant, you should normally feel the baby kick at least 10 times a day. It's important to monitor these movements, as a lack of kicking could indicate a problem. "If the baby isn't kicking or if the mother thinks there's some change in the pattern of kicking, she should go in and get it checked out," advises Turner.


13 Catch up on lost sleep

As pregnancy comes to an end, nights can be hellish for expectant mothers, when baby kicks, aches and pains, heartburn and frequent trips to the bathroom can make sleeping near impossible. But lack of sleep is not going to harm you or your baby, says Turner. "Women still need to try and get seven or eight hours' sleep, but they may have to take it in parcels," he says. "It might be broken into three three hours' sleeps rather than one nine hours' sleep."

14 De-stress

As labour approaches, stress levels can skyrocket, but women should try not to worry unduly. "There are no guarantees when it comes to childbirth and it's full of surprises," says Turner. "But it's important that people see the big picture. Despite what's said in the media, Ireland remains one of the safest places in the world to have a baby, for either mother or baby."

15 Trust your instincts

As a general rule, women should trust their instincts when it comes to pregnancy, especially if they've been through it before. "If they think things are not right compared to the last time, they should go in and get it checked out," says Turner. "Often a woman's instincts are correct."

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