As a family physician I get to see many of my patients through one of the most exciting times of their life. Pregnancy, whether you're expecting your first or tenth, is thrilling every time.
While some of the recommendations for optimal prenatal care and nutrition haven't changed - avoiding alcohol, cigarettes, and moderating caffeine intake are well known precautions - many of my patients have questions about some of the newer recommendations that may not yet be as well understood, or may have changed even in the short time since their first pregnancy.
Here are some of the most common questions I am hearing of late:
Can I keep up my usual exercise routine while pregnant?
Exercise is definitely recommended while pregnant, but don't overdo it. Now is not the time to take up a new sport. Keep up the routine that is familiar, listen to your body and make sure your rate of perceived exertion, or RPE, stays between a 5 and a 7. Five being the feeling you get when rushing out the door and 7 being the level where you can still sing while exercising.
Should I get vaccinated?
Cold and flu season is still here and we've seen in the news recently that pregnant women are more adversely affected and more likely to be hospitalized by this virus. Because your immune system is altered during pregnancy, you are more at risk for other types of infection, so the flu vaccine is especially important. Not only are flu shots recommended, pregnant women should also consider getting vaccinated for whooping cough. In fact, The Centers for Disease Control and Prevention in the U.S. recently recommended that pregnant women receive the whooping cough vaccine for adolescents and adults (called Tdap vaccine) during each pregnancy. New research shows, that getting the whooping cough vaccine while pregnant is better than getting the vaccine after you give birth because it will give your baby short-term protection as soon as he is born. Additionally, breastfeeding will pass on the antibodies you have made in response to the vaccine to your baby.
I heard multivitamins don't make a difference, should I bother taking them when I am pregnant? I eat a healthy diet
The recommendations from both Health Canada and the Society of Obstetricians and Gynecologists are clear that women who are pregnant or could become pregnant should take a prenatal vitamin with 0.4 mg of folic acid per day beginning 12 weeks before pregnancy through to the duration of breastfeeding. A recent survey from Nestle Materna showed that only 13 per cent of Canadian women were aware of this recommendation.
Taking a prenatal vitamin provides the folic acid needed for healthy brain and spinal cord development, and prevents neural tube defects such as spina bifida, which occur very early on in pregnancy, even before you've missed a period. This is why I advise my patients to start taking folic acid daily as soon as they stop using contraception.
Even after you've discovered that you're pregnant, taking a prenatal vitamin all the way through to the first six weeks post-partum, or as long as you are breastfeeding, provides the higher levels of iron, calcium and vitamin D, which are important for pregnant and breastfeeding mothers.
I've heard a lot about deli meat, cheese, and raw fish -- which of these foods do I really need to avoid?
Unripened cheese (which is legal in some parts of Canada) and deli meat can contain listeria. A listeria infection may cause only mild signs and symptoms in the pregnant mother but the consequences for the baby may be devastating through a life-threatening infection before, or within the first few days, after birth.
Bacteria from raw fish in sushi can be an issue, pregnant or not, but given that your immune system is altered during pregnancy you're more likely to get sick, so it's good idea to avoid raw fish during this time.
Can I still dye or highlight my hair or paint the baby's nursery?
A study from the Journal of the College of Family Physicians notes that evidence suggests there is minimal systemic absorption of hair products, so personal use by pregnant women 3 to 4 times throughout pregnancy is not considered to be of concern. Many expecting mothers do decide to opt for vegetable-based dyes during pregnancy.
With this in mind, you should still try to decrease your overall chemical exposure, including cleaning products and paint, as much as you can. Some chemicals can circulate in the mother's blood, pass through the placenta, and reach the developing fetus. Other harmful agents can affect the overall health of the woman and reduce the delivery of nutrients to the baby.
If painting the baby's nursery is a part of your pre-natal plans, use latex (water-based) products in a well-ventilated area. Avoid oil-based paints, paint thinners, varnish removers and substances such as lacquer. Many solvents give off volatile compounds that can put you at greater risk of pre-eclampsia (high blood pressure in pregnancy).
Lead and mercury are other toxic substances that can found in the home or workplace. Lead is found in many things such as exhaust, soil and paint so I advise my patients who work in environments where these substances are commonly found to speak to their employer or the health and safety representative at their company about how to minimize their exposure during pregnancy. Better be safe than sorry.
The most important thing to keep in mind is that pregnancy is a relatively brief period, so wherever you can minimize risk in the short term you and your baby are going to get the long term benefits.
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