Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 2. Healthy choices during pregnancy

A new baby on the way is a great reason to take stock of your current lifestyle. Pregnancy provides many women with the motivation to eat well, exercise more and minimize risky habits. And if you make healthy habits a priority now, it’ll be that much easier to maintain them after the baby arrives, meaning you’ll lose weight faster, have more energy to devote to your new baby and get back to your old (or new and improved!) self in record time.

If you already practice a healthy lifestyle, you’re one step ahead of the game. Being pregnant may alter a few of your habits, but not that much. And even if all of your choices haven’t been spot on in the past, it’s not too late to start fresh.

This chapter will show you how to make the best choices for you and your growing baby during pregnancy. As an added bonus, your healthy choices may have a positive effect on other family members, as well. If you start eating better and exercising more, your partner may too.

PREGNANCY DIET

During your pregnancy, you’ll be eating for two (you and your baby). But don’t think of this as eating twice as much. Instead, think of it as eating twice as well.

If your diet isn’t exactly stellar — you enjoy junk food, you tend to skip meals or you eat a limited variety of foods — start making changes now. In fact, it’s a good idea to make healthy eating a part of your pregnancy planning from the start. The reason: Most of your baby’s major organs form during the first few weeks of pregnancy. Eating well helps create ideal conditions for early fetal development. Over the course of your pregnancy, there are certain nutrients you’ll want more of, too, such as iron, calcium, folic acid and other essential vitamins and nutrients.

Don’t worry! Eating right doesn’t mean taking the fun out of eating, or that you have to follow a rigid diet. To get proper nourishment, you want to enjoy a variety of foods.

Making every bite count Truth be told, there’s no magic formula for a healthy pregnancy diet. In fact, the basic principles of healthy eating recommended for everyone apply to pregnant women as well. What are those principles? Eat plenty of fruits, vegetables and whole grains. Choose lean protein and low-fat dairy products. And select a variety of foods. If you can remember these key principles, you and baby will be well on your way to a balanced diet.

Eating at least three smaller meals a day and making sure you snack on healthy foods is a good way to eat well and get the nutrients you need. For the nitty-gritty, see the chart that follows. It lists the different food groups and number of daily servings to strive for while you’re pregnant. If you’re worried that you’re not eating well, writing down what you eat every day for a week or so can help you become more aware of your food choices and where you might make some improvements.

Also pay close attention to ingredient lists and nutrition information on food labels. This information can help you keep track of sugars and fats, which add calories but little nutrition to your diet. It’s also wise not to eat too many salty foods.

If you’re pregnant with twins or other multiples, you’ll likely need more nutrients and calories. Talk to your care provider about how many calories you’ll need.

Foods to avoid During pregnancy, it’s OK to eat most foods. However, there are certain foods you should stay away from or limit because they could carry a risk of unwanted side effects. The chance of a serious complication is small, but it’s generally best to play it safe.

 Seafood high in mercury. Seafood is a good source of protein and iron, and the omega-3 fatty acids in many fish may possibly help promote fetal brain development. However, some fish and shellfish contain potentially dangerous levels of mercury, which can damage a baby’s developing nervous system. These fish include swordfish, shark, king mackerel and tile fish. According to the Food and Drug Administration (FDA) and Environmental Protection Agency (EPA), pregnant women can safely eat up to 12 ounces of seafood a week. That equates to two average-sized portions of shrimp, salmon, pollock, cod or canned light tuna. Limit albacore tuna and tuna steak to 6 ounces a week.

 Raw, undercooked or contaminated seafood. It’s best to avoid raw fish and shellfish, such as oysters and clams, and refrigerated smoked seafood, such as lox. If you eat fish from local waters, pay attention to local fish advisories — especially if water pollution is a concern. If advice isn’t available, limit the amount of fish from local waters you eat to 6 ounces a week, and don’t eat other fish that week. Most seafood should be cooked to an internal temperature of 145 F.

 Undercooked meat, poultry and eggs. Just like a woman who isn’t pregnant, if you eat undercooked foods you may experience food poisoning. But because you’re pregnant, you may get sicker than a woman who isn’t pregnant. Although rare, it’s possible your baby may get sick, too. To prevent foodborne illness, fully cook all meat and poultry before eating them. Use a meat thermometer to make sure the meat is done. If you’re having a steak, it’s OK to eat the steak “medium rare” or “medium.” Just make sure the internal temperature reaches at least 145 F. Cook eggs until the egg yolks and whites are firm, and avoid foods made with raw or partially cooked eggs. Raw eggs can be contaminated with salmonella bacteria.

 Processed meats. Meats can become contaminated during their production, especially if a lot of processing is involved. Meats such as bologna, salami or hot dogs are of most concern. They can be sources of a rare but potentially serious food-borne illness called listeriosis. Listeria grows in cold environments but cannot tolerate heat. Make sure hot dogs are fully cooked and processed meats have been thoroughly cooked and stored. There’s less risk if the meat is sliced from fully cooked roasts or turkeys, but heating the meat adds a level of safety. The other thing to remember with many processed meats, especially those that are shelf stable (they don’t need refrigeration), is that they generally contain a lot of sodium, which can lead to excessive swelling during pregnancy.

 Unpasteurized foods. Low-fat dairy products can be a healthy part of your diet, but anything containing unpasteurized milk is a no-no because the products may lead to foodborne illness. Stay away from soft cheeses — Brie, feta, Camembert, and blue cheese — unless they’re clearly labeled as being made with pasteurized milk. Also, don’t drink unpasteurized juice.

 Unwashed produce. Raw fruits and vegetables are great to eat during pregnancy, just make sure to wash them, especially if they come from a garden, farmers’ market or orchard, where they may not have been thoroughly cleaned.

 Large quantities of liver. Liver is OK to eat during pregnancy, but don’t overdo it. Liver is high in vitamin A. Eating very large amounts could lead to vitamin A toxicity and cause birth defects.

Vegetarian tips If you’re a vegetarian, you may wonder if your diet will cause any problems for your baby. Relax. If you’re in good health, there’s no reason you shouldn’t be able to follow your diet during pregnancy and have a healthy baby. The rules are the same for you as for nonvegetarians: Eat a wide variety of foods, and make sure to balance your nutrients each day.

If you normally include fish, milk and eggs in your diet, you’ll have an easier time getting the iron, calcium and protein you need. If you don’t eat any animal products at all (you’re a vegan), you may need to plan what you eat a little more carefully. Vegans sometimes have difficulty getting enough zinc, vitamin B-12, iron, calcium and folic acid in their daily diets. To help avoid this problem, try the following:

 Eat at least 4 daily servings of calcium-rich foods. Nondairy sources of calcium include broccoli, kale, dried beans, calcium-fortified juices, cereals and soy products. Vitamin D intake is also important to help you absorb calcium. If you have limited exposure to sunlight — a good source of vitamin D — consider taking a vitamin D supplement.

 Add more energy-rich foods to your diet. This is particularly important if you’re having trouble gaining enough weight. Good sources of calories include nuts, nut butters, seeds and dried fruit.

 Seek advice on supplements. Many vegans need a vitamin B-12 supplement. Supplementation with other nutrients commonly found in animal products also may be necessary, depending on your circumstances. To be sure of what’s right for you, talk with your care provider and, if recommended, see a registered dietitian.

Taking supplements The best way to get the vitamins and minerals you need is from food. Yet during pregnancy, some women find it difficult to eat enough foods to supply them with adequate folic acid, iron and calcium, especially if they’re coping with morning sickness. That’s why many care providers prescribe prenatal vitamins.

Here’s the scoop on those nutrients that are the most critical to the health of you and your baby. You’ll get some of these nutrients by taking your prenatal vitamins, but foods provide for these nutrients as well. Even if you take a prenatal vitamin or other supplements, it’s still important that you eat well. Taking supplements doesn’t make up for bad eating habits.

Folate and folic acid Folate is a B vitamin that helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. The synthetic form of folate found in supplements and fortified foods is known as folic acid.

How much you need You want 400 to 800 micrograms (mcg) of folate or folic acid before conception and the first two to three months of pregnancy. For the rest of your pregnancy, the goal is 600 mcg daily.

Good sources Fortified cereals are great sources of folic acid. Leafy green vegetables, citrus fruits, and dried beans and peas are good sources of naturally occurring folate.

Calcium You and your baby need calcium for strong bones and teeth. Calcium also helps your circulatory, muscular and nervous systems run normally. If there’s not enough calcium in your pregnancy diet, the calcium your baby needs will be taken from your bones.

How much you need Aim for 1,000 milligrams (mg) a day. Pregnant teenagers need 1,300 mg daily.

Good sources Dairy products provide the richest sources of calcium. Simply drinking 3 cups of milk every day — a cup at each meal — will go a long way toward meeting your calcium needs. You can also get your calcium from other dairy products. Many fruit juices and breakfast cereals are fortified with calcium, too.

Protein Protein is crucial for your baby’s growth, especially during the second and third trimesters.

How much you need The recommended amount is 71 grams daily.

Good sources Lean meat, poultry, fish and eggs are great sources of protein. Other options include dried beans and peas, tofu, dairy products and peanut butter.

Iron During pregnancy, your blood volume expands to accommodate changes in your body. Your body is also making extra blood to help your baby form his or her entire blood supply. As a result, your need for iron nearly doubles. Your body uses iron to produce hemoglobin, a substance in red blood cells that enables them to carry oxygen. If you don’t get enough iron, you’ll likely notice it. A common symptom of too little iron is fatigue.

How much you need The recommended amount is 27 milligrams of iron a day.

Good sources Lean red meat, poultry and fish are good sources of iron. Other options include iron-fortified breakfast cereals, nuts and dried fruit.

GETTING YOUR D

Vitamin D is important because it helps your body absorb calcium, which in turn keeps your bones strong and protects you from diseases such as osteoporosis. Sunlight is a great source of vitamin D, as are dairy products and fish.

During pregnancy adequate vitamin D intake is important. Studies suggest that vitamin D may decrease the risk of preeclampsia and improve birth weight and infant bone mineralization. It also appears that sufficient vitamin D in early life may decrease the risk of health problems later in life.

Nutrition experts recently increased the U.S. Recommended Dietary Allowance for vitamin D. Experts now recommended that pregnant women get 600 international units (IUs) of vitamin D daily. The upper limit for pregnant women is 4,000 IUs. Talk to your care provider about your need for vitamin D. Spending just 15 minutes or so in the sun or drinking an extra glass of fortified milk or orange juice every day may be just what the doctor ordered.

GAINING WEIGHT

OK. So pregnancy is the one time in your life when you can gain as much weight as you want and not worry about it. Right? Not quite. While it may seem appealing, pregnancy is not a time to pig out. Yes, weight gain is a must during pregnancy, but there’s a right way to put on the necessary pounds. Healthy weight gain — not too much or too little — is good for both you and baby. In addition, if you don’t gain too much weight, it’s easier to shed the extra pounds after your baby is born.

What’s healthy? There’s no one-size-fits-all approach to how much weight you should gain when you’re pregnant. Healthy weight gain depends on a variety of factors, including your pre-pregnancy weight and body mass index (BMI). Your health and your baby’s health also play a role.

You’ll want to work with your care provider to determine what’s right for you, but here are some general guidelines. Keep in mind that if you’re carrying twins or multiples, you’ll likely need to gain more weight.

If you’re overweight Although excess weight carries risks — such as gestational diabetes and high blood pressure — pregnancy isn’t the time to lose weight. Even if you’re overweight before pregnancy, it’s important to gain a healthy amount of weight during pregnancy.

If you’re underweight For women who are underweight, it’s essential that they gain a reasonable amount of weight during their pregnancies — especially during the second and third trimesters. Without the extra weight, your baby may be born earlier or smaller than expected. This increases the risk of complications.

Slow and steady In the first trimester of your pregnancy, don’t worry too much about gaining weight. That’s good news if you’re struggling with morning sickness. If you start out at a healthy weight, you need to gain only a few pounds in the first few months. You can do this with an extra 150 to 200 calories a day, about the amount in 8 ounces of low-fat yogurt.

Steady weight gain is more important in the second and third trimesters. This often means gaining 3 to 4 pounds a month until delivery. An extra 300 calories a day — half of a peanut butter and jelly sandwich and a glass of skim milk — is often enough to maintain healthy weight gain. If you began your pregnancy underweight, your care provider may suggest additional calories.

WHERE THE WEIGHT GOES

Let’s say your baby weighs in at 7 or 8 pounds at birth. That accounts for some of your pregnancy weight gain. But you certainly will gain more than 8 pounds during your pregnancy. Where does the rest of the weight go? Here’s a sample breakdown:

 Baby: 7 to 8 pounds

 Larger breasts: 1 to 3 pounds

 Larger uterus: 2 pounds

 Placenta: 1½ pounds

 Amniotic fluid: 2 pounds

 Increased blood volume: 3 to 4 pounds

 Increased fluid volume: 3 to 4 pounds

 Fat stores: 6 to 8 pounds

STAYING ACTIVE

Preegnancy seems like a perfect excuse to sit back and relax, doesn’t it? The fatigue, back pain and swelling sometimes associated with pregnancy all seem to be pointing you emphatically toward the couch.

But the truth is that sitting around won’t help matters. In fact, it’s quite the opposite. Exercise can help lessen common pregnancy complaints, such as back pain. It can boost your energy level and reduce your risk of gestational diabetes, pregnancy-related high blood pressure and postpartum depression. Perhaps best of all, regular exercise can help you prepare for labor and childbirth by increasing your stamina and muscle strength. If you’re in good physical condition before giving birth, you may even shorten your labor and recovery times.

Exercise is good for you, but before starting or continuing your exercise program, talk with your care provider about which type of exercise may be best.

Baby, let’s move! Try to spend at least 30 minutes each day exercising. But you don’t have to do it all at once. Even shorter or less frequent workouts can help you stay in shape and prepare for labor.

Walking is a great exercise. It provides moderate aerobic conditioning with minimal stress on your joints. Other good choices include swimming, rowing, cycling on a stationary bike, low-intensity yoga, Pilates and cross-country skiing. Strength training is OK, too, as long as you avoid lifting heavy weights.

If you haven’t exercised for a while, begin with as little as five minutes of physical activity a day and build up to 10 minutes, 15 minutes, and so on. If you exercised before pregnancy, you can probably continue to work out at the same level while you’re pregnant — as long as you’re feeling comfortable and your care provider says it’s OK. In general, you should be able to carry on a conversation while you’re exercising. If you can’t speak normally while you’re working out, you’re probably pushing yourself too hard.

Remember to stretch before and after each workout. Drink plenty of fluids to stay hydrated, and be careful to avoid overheating. No matter how dedicated you are to being in shape, don’t exercise to the point of exhaustion.

WHEN TO USE CAUTION

Although exercise during pregnancy is generally good for both mother and baby, you’ll want to proceed with caution if you have a history of preterm labor or certain medical conditions, including:

 Poorly controlled diabetes

 High blood pressure

 Heart disease

 Placenta previa, a problem with the placenta that can cause excessive bleeding before or during delivery

If you’re having multiples or you have a high risk of preterm labor, your care provider may limit your physical activity.

LISTEN TO YOUR BODY

While exercising, listen to the messages your body sends you. If your body is telling you to slow down, follow its advice, no matter how fit you are. Watch for dizziness, nausea, blurred vision, fatigue and shortness of breath. These can be signs of heat stroke, which can threaten the life of you and your baby.

Chest pain, abdominal pain and vaginal bleeding are other danger signs telling you to slow down, stop and get help if you need it. Never exercise through pain. Pain is your body’s way of telling you to slow down or stop. Discuss pain and other danger signs with your care provider.

Working in workouts Pregnancy is demanding. When do you have time to exercise? The truth is, you’re more likely to stick with an exercise plan if it involves activities you enjoy and fits into your daily schedule. Consider these simple tips:

 Start small. You don’t need to join a gym or don expensive workout clothes to get in shape. Just get moving. Try a daily walk through your neighborhood. Vary your route to keep it interesting.

 Find a partner. Exercise can be more interesting if you use the time to chat with a friend. Better yet, involve the whole family.

 Use a headset. Listen to music or a book while you exercise. Use lively songs to energize your workout.

 Try a class. Many fitness centers and hospitals offer classes designed for pregnant women. Choose one that fits your interests and schedule.

 Get creative. Don’t limit yourself to just one thing. Consider hiking, rowing or dancing.

 Give yourself permission to rest. Your tolerance for strenuous exercise will probably decrease as your pregnancy progresses.

Sports and pregnancy If you’re a regular jogger, runner or swimmer, it’s likely you’ll be able to continue these activities throughout most of your pregnancy, with your care provider’s consent. Worries such as overheating have proved largely unfounded in studies of women who exercise at a low to moderate intensity. For example, running three miles or more, four times a week, at a 10-minute-mile pace is generally safe. Concerns of preterm labor due to strenuous exercise and reduced blood flow to the baby haven’t been proved either.

Dehydration, on the other hand, can be harmful to you and your baby, and can provoke contractions. So it’s very important to replace any fluid you lose during an exercise session.

Most active women, even competitive athletes, tend to decrease the intensity of exercise especially toward the end of their pregnancies. As your weight increases, your center of gravity shifts and your ligaments become looser.

Activities to approach with care After the first trimester, it’s best to avoid floor exercises that require you to be on your back for a long period of time. The weight of the baby can cause problems with blood circulation. Standingmotionless for a long period of time also can be hard on the circulatory system.

Also be especially careful with activities that carry a high risk of falling or abdominal injury. Gymnastics, horseback riding, downhill or water skiing, and vigorous racket sports have greater risk of injury. It also may be wise to avoid high contact sports such as basketball or soccer. These sports involve the risk of falling or colliding with another person. Plus, they often require you to jump or change directions quickly. You may run a greater risk of straining the cartilage and ligaments that support your joints, which soften during pregnancy.

Underwater and high-altitude activities also can be a problem. Snorkeling is generally OK, but avoid scuba diving during pregnancy because the air decompression poses a potential risk to the fetus. Activities such as hiking at altitudes higher than 6,000 feet above sea level can put you at risk of altitude sickness, which could endanger your health and that of your baby.

Pregnancy exercises Childbirth is a wonderful experience, but the hours leading up to delivery can be a real workout. Your muscles and joints are moving and changing in all sorts of ways to make it possible for that beautiful little boy or girl to enter the world.

You can make childbirth less demanding by preparing your body for what’s to come. During pregnancy, certain exercises help limber up those joints and muscles you’ll rely on during labor and delivery. Certain exercises can also help relieve the aches and pains that often accompany pregnancy, such as back pain or leg cramps.

In Part 2 of this book, each month a pregnancy exercise is introduced — a stretching or flexibility maneuver to help keep your body limber and ease common aches and pains. The idea is to start out with one exercise and each month add another to your routine, but you don’t have to do it that way. If you would like, you can do them all at once or in whatever order you prefer. When the time comes and those contractions begin, your body will be ready!

PLAYING IT SMART

Three cups of coffee a day, or a glass of wine with dinner. You and your body may have become accustomed to certain habits you’ve developed. But things now have to change, like it or not. While it’s no fun to have restrictions placed on things you enjoy or even crave, like that midafternoon double latte jolt, during pregnancy you need to play by the rules. You likely know the key suspects — caffeine, alcohol, tobacco and illicit drugs. The good news is that becoming pregnant is a powerful motivator for many women to give up risky behaviors.

Caffeine It’s best to avoid caffeine whenever possible during pregnancy. At the very least, limit how much you consume. Research on the subject has produced mixed results, but overall, studies show that a moderate intake — 200 milligrams (mg) or less a day, about the amount found in one to two cups of coffee — generally has no harmful effects on mom or baby.

However, the same doesn’t hold true for high amounts of caffeine — 500 mg or more daily, or five or more cups of coffee. Regular intake of this much caffeine may cause a decrease in your baby’s birth weight and head circumference. Low birth weight can make it difficult for the baby to maintain a healthy body temperature and appropriate blood sugar levels, which can lead to other problems.

And remember, caffeine isn’t limited to coffee. Tea, carbonated beverages, cocoa and chocolate also contain caffeine. To reduce the amount of caffeine you consume in a day, consider switching to decaffeinated beverages. Or with hot, brewed beverages, shorten the time you brew them. For instance, brewing a tea bag for just one minute instead of several minutes can reduce caffeine content by as much as half.

Alcohol If you drink alcohol, so does your baby. It doesn’t matter if you drink beer, wine or other forms of liquor. Once in your bloodstream, alcohol passes through the placenta to your baby. Sustained drinking during pregnancy increases your risk of miscarriage and fetal death. It can also cause permanent damage to your baby.

Fetal alcohol syndrome is the most serious problem caused by excessive alcohol consumption. It can cause such birth defects as facial deformities, heart problems, low birth weight and mental retardation. Babies born with fetal alcohol syndrome may also have permanent growth problems, experience short attention spans and learning disabilities and have behavioral problems.

As soon as you know you’re pregnant, don’t drink alcohol. If you’re planning to get pregnant, it’s a good idea to stop drinking beforehand. Alcohol exposure can cause birth defects in the early weeks of your pregnancy, before you may know you’re carrying a child.

Once your child is born, small amounts of alcohol can wind up in breast milk and be passed on to your baby through your milk. Therefore, it’s best to abstain from alcohol use until you’re finished breast-feeding.

Tobacco Smoking also is dangerous for you and your baby. Smoking during pregnancy increases your risk of stillbirth, premature birth, low birth weight and sudden infant death syndrome (SIDS) after birth.

Cigarette smoke contains literally thousands of harmful chemicals. Two toxins especially — carbon monoxide and nicotine — can reduce the flow of oxygen to the developing baby. In addition, nicotine, which causes your heartbeat and blood pressure to increase and your blood vessels to constrict, can decrease your baby’s supply of nutrients.

It’s best to stop smoking before you become pregnant. This may help you give up the habit completely, even after the baby is born. It’s also wise to keep you and your baby away from the smoke of other smokers. Regular exposure to secondhand smoke appears to be capable of causing health problems for your child before and after birth.

Remember that it’s never too late to quit. Even if you stop smoking late in pregnancy, you can reduce your baby’s exposure to dangerous chemicals.

Illicit drugs Any and all illicit drug use can harm your baby. This includes everything from marijuana to cocaine, heroin, methadone, LSD, phencyclidine (PCP), methamphetamine and any other kind of recreational or street drug.

While you’re pregnant, the drugs you take can pass from you to your baby. This can affect the development of the fetus and the future of your child as he or she grows up. It can also cause the death of your fetus or withdrawal symptoms in newborns that if untreated can lead to death.

MAKING SENSE OF MEDICATIONS

Hopefully, you will enjoy a smooth and uneventful pregnancy. However, pregnancy doesn’t keep away all of the ailments of everyday life. You may still get colds and headaches and have to deal with allergies and aching joints. There are times when a pain reliever or an antihistamine could come in handy, but you don’t want to take anything that might hurt your baby.

So, what’s the deal? Do you need to avoid all medicines when you’re pregnant? Are there some medications that are safe to use? And what if you’re already taking a medication to treat an ongoing health condition? Should you stop taking it?

What’s safe? As a general rule, it’s best to use caution and avoid use of medications during pregnancy when possible. Some drugs can cause an early miscarriage or impair your baby’s development. Very few drugs have been proved to be completely safe in pregnancy, but at the same time, many have been found to be safe enough that their benefits outweigh any tiny, unknown risk. It’s best to check with your care provider before taking any medicine, be it prescription or over-the-counter. He or she can help you make the right decision based on your health history and the medication in question. A pharmacist also can provide general guidelines on medication safety.

Although some medicines should be avoided, others may be recommended because of your needs. If you have a health condition that requires regular medication — such as asthma, hypothyroidism, high blood pressure or depression — don’t stop or modify the medication until you talk with your care provider. He or she can help you evaluate what’s safe to take before, during and after pregnancy. In many cases, continuing your medication may be the best choice. In other situations, you may be advised to discontinue taking a certain medication. Or you may be advised to switch to one that poses less risk to you or your baby.

Below is a list of common over-the-counter medications that are generally considered safe to use during pregnancy, as well as those that you should use with caution or under the supervision of your care provider, and some you should avoid. Be sure to ask your care provider if you have any questions about a drug. Also make sure that any care provider who’s prescribing medication for you knows that you’re pregnant.

What’s not safe? Some medications have been shown to be extremely harmful to a developing fetus, even in the early weeks of pregnancy. Some of the most dangerous medications during pregnancy include:

 The acne medication isotretinoin (Accutane)

 The multiuse medication thalidomide (Thalomid)

 The psoriasis medication acitretin (Soriatane)

If you’re taking one of these medications, avoid becoming pregnant until you discontinue its use. Your care provider will advise you on the best way to stop taking a medication and how long you may need to wait before it’s safe to conceive. Don’t restart a drug without talking to your care provider.

QUESTION & ANSWER

I was taking birth control pills when I found out that I was pregnant. Did I hurt my baby?

Generally, taking birth control pills during early pregnancy isn’t cause for great concern. While doing so isn’t recommended, it happens fairly often among women who weren’t expecting to become pregnant.

According to the American Congress of Obstetricians and Gynecologists, taking birth control pills during pregnancy doesn’t increase the risk of birth defects. However, a 2009 study suggests a possible association between use of birth control pills at the time of conception and an increased risk of low birth weight or premature delivery.

Keep in mind that most babies are born healthy with no problems. However, if you’re concerned about having taken birth control pills during your early pregnancy, and you need more reassurance that your baby will be fine, talk to your care provider.

What about herbal products? It may be tempting to turn to herbal products to help alleviate some of your aches, pains or other symptoms during this time when traditional medications are pretty much a no-no. Perhaps some melatonin could help you sleep? Or what about echinacea to prevent a cold? But don’t be misled by the belief that just because herbal products are “natural,” they must be safe.

The fact is, herbal products need to be treated in the same manner as most medications — avoid them. Only if your care provider says it’s OK to use a certain herb, should you do so. Why? Because herbal products can be just as dangerous during pregnancy as traditional medications. They could even be more harmful because so little is known about many herbal supplements.

Unlike prescription and nonprescription drugs, herbal supplements sold in health food stores and pharmacies aren’t tested and approved by the Food and Drug Administration. And they’re not required to undergo clinical trials, in which the safety and effectiveness of the product is determined.

Pregnancy is generally a time to play it safe. If you’re pregnant — or even if you’re trying to become pregnant — it’s important that you discuss all alternative and complementary therapies, including the use of herbs, with your care provider. While some therapies may be safe to practice, your care provider may recommend that you forgo others until after baby is born.

WORKING WHILE PREGNANT

When you become pregnant, going to work can seem like agony if you’re dealing with morning sickness and fatigue. If your work situation allows it, you may want to lighten your schedule during the first three or four months of pregnancy. Once you move into your second trimester, things are likely to feel much better — the queasiness usually subsides, your energy returns and you’ve got that pregnancy glow! During the third trimester, try to take it easy if you can.

For some women, work can be a good way to occupy their minds while waiting for baby to arrive. Here are some tips to make pregnancy at work a little easier and a little more comfortable. These same tips also apply to chores you do at home.

Handling fatigue You may feel tired as your body works overtime to support your pregnancy, and resting during the workday can be tough. It may help to:

 Eat foods rich in iron and protein. Fatigue can be a symptom of iron deficiency anemia, but adjusting your diet can help. Choose foods such as red meat, poultry, seafood, leafy green vegetables, whole-grain cereal and pasta, beans, nuts, and seeds.

 Take short, frequent breaks. Getting up and moving around for a few minutes can reinvigorate you. Spending a few minutes with the lights off, your eyes closed and your feet up also can help you recharge.

 Cut back on activities. Scaling back can help you get more rest when your workday ends. Look for activities or chores you can cut back on or hand off to someone else.

 Keep up your fitness routine. Although exercise may be the last thing on your mind at the end of a long day, physical activity may help boost your energy level, especially if you sit at a desk all day. Take a walk after work or join a prenatal fitness class, as long as your care provider says it’s OK.

 Go to bed early. Aim for seven to nine hours of sleep every night. Later in your pregnancy, resting on your left side will improve blood flow to your baby and help prevent swelling. Placing pillows between your legs and under your belly may increase your comfort.

Sitting, standing, bending and lifting Carrying around a growing baby can make everyday activities like sitting, standing, bending and lifting uncomfortable. It can also cause constant pressure on your bladder, strain on your back and fluid retention in your legs and feet.

Emptying your bladder frequently can help relieve pressure. Moving around every few hours can ease muscle tension and help prevent fluid buildup. But you may need to try other strategies to make yourself comfortable throughout your workday and prevent potential health hazards. Here’s how to handle common on-the-job activities:

Sitting If you have an office job, the chair you sit in is important — and not just during pregnancy! While the weight of your body is increasing and shifting, you want a seat that you can adjust for height and tilt. Adjustable armrests, a firm seat and back cushions, and good back support can make long hours of sitting much easier and help you exit from the chair.

If a chair with these options isn’t available, take steps to improve what you do have. For instance, if you need more cushioning or back support, use a small pillow or invest in a cushion designed to support the lower back. This type of cushion can also serve as a car seat support, which might make driving easier if you have a long commute.

While sitting, it’s best to elevate your feet on a footrest or box to help take some of the strain off your back. This may also reduce your chance of developing varicose veins or clots in the veins of your legs. Using a footrest can also help reduce swelling in your feet and legs.

Standing During pregnancy, your blood vessels dilate to allow for greater blood circulation. This can cause blood to pool in your legs with too much standing, which can lead to leg pain and even dizziness. Standing for long periods of time can also put pressure on your back.

If standing is part of your job, put one foot on a box or low stool to take pressure off your back and decrease blood pooling. Switch feet every so often. It may help to wear support hose and take frequent breaks throughout the day. Wear shoes with low, wide heels rather than high heels or flats.

Bending and lifting Pregnant women typically cannot lift as much weight at a time as they did prior to becoming pregnant. Talk with your care provider about how much weight you can safely lift. To prevent or ease back pain, follow proper form when bending and lifting.

Avoiding harmful substances As long as you and the company you work for follow standard Occupational Safety and Health Administration (OSHA) practices regarding harmful substances, it’s unlikely that your job will pose a risk to your baby.

To be safe, be aware of any substances you’re exposed to at work — especially if you’re in health care or manufacturing. Industries in the United States are required by federal law to have material safety data sheets on file that report hazardous substances in the workplace and to make this information available to employees.

Substances known to be harmful to a developing fetus include lead, mercury, ionizing radiation (X-rays) and drugs used to treat cancer. Chemicals such as anesthetic gases and organic solvents such as benzene are suspected of being harmful, although results of studies are inconclusive.

Tell your care provider about any part of your job that exposes you to chemicals, drugs or radiation. Also tell your care provider about any equipment you use to minimize your exposure. This may include gowns, gloves, masks and ventilation systems.

Your care provider can use this information to determine whether a risk exists and, if so, what might be done to eliminate or reduce it. Fortunately, it appears that environmental agents cause few birth defects. Of the small percentage of birth defects that can be traced to an environmental cause, most involve alcohol, tobacco or drugs used during pregnancy — not substances in the workplace. Nevertheless, avoid exposure to known or suspected harmful substances.

TRAVELING WISELY

You may worry your pregnancy will interfere with your travel plans or your summer vacation. It doesn’t have to. Being pregnant doesn’t mean having to stay at home. It’s usually safe to travel while you’re pregnant, as long as you’re in good health and observe basic safety precautions. Generally speaking, the best time to travel is during the second trimester, when you’re likely to have less morning sickness and your body is adjusted to carrying a baby. By the third trimester, you may find it more difficult to move around.

However, if you have a medical problem, such as heart disease, or a history of problems with pregnancy, your care provider may advise you to stay close to home in case an emergency arises.

Always talk to your care provider before setting out on an extended trip, as your mode of travel and destination may have implications for your pregnancy. If you travel often, such as for business, discuss your schedule with your care provider. Together you may find ways to make your trips more comfortable.

When choosing your mode of travel, consider how long it will take you to get to your destination. Generally, the fastest way is the best, but understandably, other factors often need to be considered, including cost.

DESTINATIONS TO AVOID

When traveling, choose a suitable destination. A hot and humid climate may not be the best if you find it difficult to keep yourself cool these days. Travel to high altitudes may make breathing difficult and uncomfortable because of the decreased oxygen level. This isn’t good for you or baby. If the trip is going to require a lot of walking and standing, you may want to think twice.

You also want to consider the risks of visiting developing countries when you’re pregnant. Travel to these regions often requires that you receive a number of vaccinations and the risk of food- or waterborne illness may be greater. If you go to a developing country, make sure to get medical advice before you leave.

Airplane travel Air travel during pregnancy is generally considered safe for women who have healthy pregnancies. Still, it’s best to check with your care provider before you book that trip.

Air travel during pregnancy may increase the risk of complications associated with certain conditions in pregnancy, such as sickle cell disease and clotting disorders. In addition, your care provider may restrict travel of any type after 36 weeks of pregnancy or if you’re at risk of preterm delivery.

If you have flexibility in your travel plans, the best time to fly is usually during your second trimester — approximately weeks 14 to 28. This is when you’re likely to feel your best, and the risks of miscarriage and premature labor are the lowest. When you fly:

 Check the airline’s policy about air travel during pregnancy. Guidelines for pregnant women may vary by carrier and destination.

 Choose your seat. For the most space and comfort, request an aisle seat.

 Buckle up. During the trip, fasten the lap belt under your abdomen and across the tops of your thighs.

 Promote circulation. If possible, take occasional walks up and down the aisle. If you must remain seated, flex and extend your ankles often. Your care provider may recommend you wear support hose during the flight.

 Drink plenty of fluids. Low humidity in the cabin can lead to dehydration.

Decreased air pressure during flight may slightly reduce the amount of oxygen in your blood, but this isn’t likely to cause problems if you’re otherwise healthy. Likewise, the radiation exposure associated with air travel at high altitudes isn’t thought to be a problem for most travelers. Pilots, flight attendants and others who fly often, however, may be exposed to more radiation than is considered safe during pregnancy.

If you must fly frequently during your pregnancy, discuss it with your care provider. He or she may suggest that you limit your flight time for the duration of your pregnancy.

Sea travel Ships and cruise liners are just as safe for pregnant women as are other forms of travel, and many vessels have medical facilities onboard. Make sure that your ship has a doctor or a nurse onboard at all times. Also check to see if the locations you visit are cities with modern medical facilities, in case you should need emergency care. Most cruise liners accept women through the first 26 weeks of pregnancy.

Keep in mind that the movement of the ship may increase problems with nausea and vomiting. In addition, be careful walking on deck where floors may be slippery so that you don’t slip or lose your balance and fall.

If you’re worried about getting seasick, pack some seasickness bands. These are bands you wear on your wrist that use acupressure to help prevent an upset stomach. While the bands may be an alternative to medication for some women, others may find they’re not helpful.

Car travel When traveling by car, the main thing to remember — pregnant or not — is to always wear your seat belt. Trauma to the mother-to-be is the leading cause of fetal death, and vehicular accidents are to blame for most severe trauma to pregnant women. Wear the lap belt below your abdomen and over your upper thighs, and wear the diagonal shoulder strap between your breasts.

If you are traveling by car for a long distance, stop regularly to stretch. Spending several hours on the road is tiring, even if you’re not pregnant. If possible, avoid staying in a seated position for more than two hours at a time, and limit total car time to six hours a day. Walking around for a few minutes every couple of hours will keep blood from pooling in your legs. This reduces the risk of blood clots forming. Chances are, you also may need to take frequent bathroom breaks.

Be sure to drink plenty of water to keep well hydrated. This is true with any type of travel.

COMMON QUESTIONS

When you’re pregnant, all sorts of questions seem to pop up — things that, until now, probably never crossed your mind. Is it OK to dye your hair? What about sitting in a hot tub? Here are some answers to commonly asked questions. Visit our website MayoClinic.com to get even more answers. You can also follow the MayoClinic.com pregnancy blog written by Mayo experts.

I tripped and fell. Do I need to see a doctor? It’s easy to panic if you fall during pregnancy, but your body is designed to protect your developing baby. An injury would have to be severe enough to seriously hurt you before it would directly harm your baby.

The walls of your uterus are thick, strong muscles that help keep your baby safe. The amniotic fluid also serves as a cushion. In addition, during the early weeks of pregnancy, the uterus is tucked behind the pelvic bone, so there’s even more protection. If you do fall, you can take comfort in knowing that your baby most likely won’t be hurt.

After approximately 24 weeks, a direct blow to the abdomen can possibly cause complications and must be evaluated.

If you’re worried about the welfare of your baby after a fall, see your health care provider for reassurance. Seek medical attention immediately if:

 Your fall results in pain, bleeding or a direct blow to the abdomen

 You’re experiencing vaginal bleeding or leaking of amniotic fluid

 You feel severe pain or tenderness in your abdomen, uterus or pelvis

 You have uterine contractions

 You notice a decrease in fetal movement

In most cases, your baby will be fine. But your care provider may want to run some tests to make sure everything is OK.

Should I get an annual flu shot? Yes, it’s safe to get an influenza (flu) shot during pregnancy. In fact, the Centers for Disease Control and Prevention (CDC) recommends seasonal flu shots for anyone who will be pregnant during flu season — typically November through March — unless you have a severe allergy to eggs, or you’ve had a severe reaction to a previous flu vaccination.

Pregnancy puts extra stress on your heart and lungs. Pregnancy can also affect your immune system. These factors increase the risk not only of getting the flu but of developing serious complications of the flu, such as pneumonia and respiratory distress. A seasonal flu shot can help prevent these potential problems.

When you get your flu shot, be sure to request the flu shot and not the nasal spray vaccine. The flu shot is made from an inactivated virus, so it’s safe for both mother and baby during any stage of pregnancy. The nasal spray vaccine is made from a live virus, which makes it less appropriate during pregnancy. Both the flu shot and the nasal spray vaccine are OK before pregnancy, but conception should be avoided for four weeks after vaccination with the nasal spray.

Regarding other flu shots — such as the H1N1 (swine) flu vaccine given in 2009 — recommendations vary. But in general, these vaccines are often recommended for pregnant women as well. The risk of swine flu complications is higher during pregnancy, and mothers can potentially provide protection to infants who cannot be vaccinated. If you’re unsure about a flu vaccine, find out as much as you can about it. Go to websites you can trust, such as the Centers for Disease Control and Prevention, and ask your care provider for a recommendation.

Are other vaccinations safe? Some are and some aren’t. In addition to the seasonal flu vaccine, the CDC recommends that you get a tetanus and diphtheria (Td) booster shot if you haven’t received one in the last 10 years.

If you’re traveling abroad or you’re at increased risk of certain infections, your care provider may recommend other vaccines during pregnancy, such as hepatitis A, hepatitis B, meningococcal or pneumococcal vaccines.

Vaccines to avoid during pregnancy include the live attenuated flu vaccine, human papillomavirus (HPV), measles, mumps, German measles (rubella) and chickenpox (varicella).

What’s the best way to treat a cold? A cold can make you feel miserable. On top of that, pregnant women are advised against common cold medications, such as decongestants, cough syrups, and antihistamines. But these medications won’t cure a cold anyway, so get set to make yourself as comfortable as possible while your body fights off the virus that’s causing your discomfort. These tips may help:

 Drink lots of fluid. Water, juice, tea and warm soup are all good choices. They help replace fluids lost during mucus production or fever.

 Get plenty of rest. Being run down puts a strain on your body.

 Adjust your room’s temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.

 Soothe your throat. Gargling with warm salt water several times a day or drinking warm lemon water with honey may help soothe a sore throat and relieve a cough.

 Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops. You can buy these drops over-the-counter, and they’re effective, safe and nonirritating.

 Use acetaminophen for fever and body aches. Acetaminophen (Tylenol, others) is a pain reliever and fever reducer that’s generally considered safe to use during pregnancy.

How do I treat allergies? As a first step, try to determine what you’re allergic to and, if possible, avoid exposing yourself to those things. Many of the usual remedies for allergies — including antihistamines and decongestants — generally aren’t recommended in pregnancy. The best way to treat a runny or stuffy nose and other allergy symptoms is with these self-care measures.

 Try cromolyn. Cromolyn (NasalCrom) is a nonprescription nasal spray that reduces inflammation. It’s effective for treating mild allergies and is often a good option for pregnant women with mild allergies.

 Rinse your nasal passages. Dissolve ¼ teaspoon salt in 1 cup of warm water. Place the solution in a special bottle you can purchase at a pharmacy, or use a large rubber syringe to administer the solution. Lean over the sink with your head down and to the side. Place the bottle or syringe into your upper nostril while holding the other nostril closed with your finger. Squeeze the bottle or syringe. The solution will move through your nasal passages and into your mouth. Spit the solution out and blow your nose. Tilt your head to the other side and repeat in the other nostril. You can do nasal washes several times a day.

 Breathe in steam from a hot shower or cool-mist humidifier. Be sure to keep the humidifier clear of bacteria.

 Use your fingers to massage your sinuses. This can sometimes help relieve sinus congestion.

If your symptoms are more severe and these measures don’t work, talk to your care provider.

Can I use over-the-counter creams for acne? Pregnancy acne isn’t a special form of acne. Many women simply have trouble with acne when they’re pregnant. The likely culprit for most women is increased production of oil (sebum), which happens when your hormones go into overdrive. The best way to treat acne that occurs during pregnancy is to:

 Wash your face twice a day. Use a mild cleanser with lukewarm water.

 Shampoo daily. Be sure to keep your hair off your face.

 Use oil-free cosmetics. Look for descriptions such as water-based, noncomedogenic or nonacnegenic.

 Avoid resting your hands on your face. This can trap skin oils and sweat, which irritate acne.

Any medication that’s applied to your skin or swallowed can enter your bloodstream, so it’s important to use caution during pregnancy — even with over-the-counter products.

Erythromycin (Erygel) is often the first drug of choice for pregnancy acne. Azelaic acid (Azelex, Finacea) may be another option. Both medications are topical creams available by prescription.

Opinions about using benzoyl peroxide found in many over-the-counter products are mixed. Although problems haven’t been reported, there’s little research on the safety of benzoyl peroxide during pregnancy. The best advice is to talk with your care provider.

Certain acne medications should be avoided at all costs because they can cause birth defects. These include the prescription medications adapalene (Differin), tazarotene (Avage, Tazorac) and isotretinoin (Accutane).

I’m lactose intolerant. How do I get enough calcium? For many women, the ability to digest lactose improves during pregnancy, especially as the pregnancy progresses. So even if you’re normally lactose intolerant, you may find that while you’re pregnant you can consume milk and other dairy products without any bothersome signs and symptoms.

The Institute of Medicine recommends a daily calcium intake of 1,000 milligrams (mg) for women age 19 and older, including pregnant women, and 1,300 mg for pregnant teens under age 19. It can be hard to meet this requirement if you don’t consume milk and other dairy products, which are the best sources of calcium.

If you are experiencing lactose intolerance or dislike milk or other dairy products, consider the following suggestions:

 Most people who are lactose intolerant can drink up to a cup of milk with meals without causing symptoms. If that amount bothers you, try reducing the portion to half a cup, twice a day.

 Try using lactose-free or lactose-reduced products, including milk, cheese and yogurt.

 Yogurt and fermented products such as cheeses are often better tolerated than is regular milk. The lactose in yogurt is already partially digested by the active bacteria cultures in yogurt.

 Try using lactase enzyme tablets such as Lactaid and Lactrase, which help with lactose digestion.

 Take calcium supplements.

 Choose a variety of other calcium-rich foods, such as sardines or salmon with bones, tofu, broccoli, spinach and calcium-fortified juices and foods.

Can I color or highlight my hair? When you use hair dye, a small amount of the dye may penetrate your skin. Generally, however, the dye isn’t thought to pose harm to a developing baby.

Few studies have examined women’s use of hair dye before and during pregnancy. A 2005 study suggested a possible association between hair dye used during pregnancy and certain childhood cancers, but other studies haven’t reached the same conclusion. Most researchers say it’s unlikely that use of hair products before or during pregnancy increases the risk of childhood brain tumors.

If you decide to dye your hair during pregnancy, it doesn’t hurt to play it safe. Have someone else apply the dye and make sure to rinse your scalp thoroughly after its application. If you’re concerned about using hair dye during your pregnancy, avoid it or talk to your care provider to get more information.

Is it safe to use hot tubs and saunas during pregnancy? A bath can help you relax and relieve sore muscles without posing any health hazards. But saunas should be avoided, and pregnancy and hot tubs can be a dangerous combination. Spending 10 or more minutes in a hot tub can raise your body temperature to 102 F, causing a condition known as hyperthermia. Some studies have shown an increased risk of miscarriage and neural tube defects in the babies of pregnant women exposed to high temperatures in the first four to six weeks of pregnancy. Exposure to high heat at any time during pregnancy also can cause you to overheat and lower your blood pressure, which can harm your baby’s oxygen supply and make you lightheaded, possibly causing you to fall.

If you choose to be in a hot tub during pregnancy, follow these steps:

 Limit time in the tub to less than 10 minutes.

 Avoid sitting near the inlet that provides newly heated water.

 Get out of the hot tub if you start to sweat or feel any discomfort.

 Stay out of the tub if you already have an elevated temperature due to a fever, exercise or previous sauna use.

Is it safe to have an X-ray during pregnancy? It may surprise you, but having an X-ray during pregnancy is generally considered safe. In most cases, the benefits of the X-ray outweigh the potential risks.

When you have an abdominal X-ray during pregnancy, your developing baby is exposed to radiation. If the radiation causes changes in your baby’s rapidly growing cells, it’s possible that your baby could be at a slightly higher risk of birth defects or illnesses, such as leukemia, later in life.

Generally, however, having an X-ray during pregnancy is thought to pose only the most remote risk to a developing baby. Most X-ray exams — including those of your arms, legs, head, teeth or chest — won’t expose your reproductive organs or your baby to radiation. A leaded apron and collar also can be worn to block any scattered radiation.

If you need an X-ray, tell your care provider if you are or might be pregnant. Your care provider might be able to do an ultrasound instead of an X-ray. In addition, if you have a child who needs an X-ray exam, don’t hold your child during the exam if you are or might be pregnant. Instead, ask another person to take your place.

If you had an X-ray exam before you knew you were pregnant, don’t panic. Remember, the risk is very small. It’s highly unlikely that you received enough radiation to cause any problems. If, however, you received a radiation treatment for a medical condition — such as radiation to treat cancer — the risks may be more significant. Share any concerns about radiation exposure with your care provider.

Do I need to worry about using devices such as cell phones, computers or microwaves? Devices such as these use a form of electromagnetic energy called radiofrequency energy, which consists of waves of electric and magnetic energy moving through space. The radiation that comes from these devices is different from and much less than the radiation that comes from X-rays.

Still, researchers and environmental watchdogs have speculated that increasing exposure to these devices, such as holding a cell phone close to your head for extended periods of time, may expose you to harmful levels of radiofrequency energy. There have been reports of associations between heavy cell phone use and certain types of brain tumors, for example, but the evidence is inconclusive.

There have also been suggested links between heavy maternal cell phone use during pregnancy and impaired fetal brain development, as well as later concerns about behavior problems. Other studies have examined links between radiofrequency exposure, such as living close to a cell phone tower, and pregnancy problems. There’s no scientific evidence to support such an association.

For now, evidence indicates no cause for alarm. Still, if you’re concerned about your exposure to radiofrequency energy, you might consider making fewer cell phone calls or using a hands-free headset to make your calls.

What about the full-body scanners at airports? Are they safe for pregnant women? These scanners work in two ways. One type uses nonionizing electromagnetic radiation (millimeter waves), a form of energy similar to that used in radar images and radio signals. This type of radiation, which has been used for a century, has no known health effects.

The other type of scanner uses “back scatter” ionizing radiation, which exposes an individual to a very weak, very low-dose X-ray signal. The radiation emitted from the scanner is weak enough that the X-ray doesn’t penetrate the body.

With either type of machine, there’s no evidence of risk to the developing fetus. The risk to the mother, even with repeated exposures, would be immeasurably small.

Is it OK to use DEET to prevent mosquito bites? DEET, the active ingredient in many common insect repellents, is generally safe as long as you follow the manufacturer’s instructions. DEET provides effective protection against mosquito- and tick-transmitted diseases, such as West Nile virus and Lyme disease. The benefits of avoiding these illnesses generally exceed the risks of the small amount of DEET that might enter your bloodstream through your skin. To stay on the safe side, minimize your time outdoors, especially during the first trimester, and use the lowest concentration of DEET needed for the amount of time you’ll spend outside.

Are basic household cleaners safe to use? Regular use of normal household cleaners hasn’t been shown to harm a developing baby. Still, it’s a good idea to stay away from oven cleaners that emit strong fumes in a contained space. And — pregnant or not — don’t mix chemicals such as ammonia and bleach because the combination can produce toxic fumes.

When cleaning, avoid inhaling any strong, caustic fumes. Wear protective gloves to avoid absorbing any chemicals through your skin. You might also consider switching to cleaners such as vinegar and baking soda or other products that don’t contain any harsh, toxic chemicals.

Are paint fumes harmful? In general, avoid exposure to oil-based paints, lead and mercury, all of which may be found in old paints that you may be stripping from surfaces. Also avoid other substances that have solvents, such as paint removers. Even if you’re just painting a small room or piece of baby furniture, be careful. Work in a well-ventilated area to minimize breathing fumes, and wear protective clothing and gloves. Don’t eat or drink in the area where you’re painting. In addition, be extra careful if you use a ladder. Your changing body shape may throw off your sense of balance.

What’s the concern about kitty litter boxes? Toxoplasmosis is an infection that can threaten the health of an unborn child. It’s caused by a parasite called Toxoplasma gondii. The parasite multiplies in the intestine of cats and is shed in cat feces, mainly into litter boxes and garden soil. You can get the parasite by handling cat litter or soil where there are cat feces. You can also get the parasite from eating undercooked meat (such as rare beef) from animals infected with the parasite.

To avoid toxoplasmosis during pregnancy, have another member of the family change the litter box. If you must handle the chore, wear rubber gloves and wash your hands thoroughly afterward. Also wear gloves when you garden.

Is it true that pregnancy causes cavities? Dental health during pregnancy isn’t a glamorous topic, but it’s an important one. Misconceptions and misinformation about dental health during pregnancy are common — and often these issues aren’t discussed at prenatal appointments. Common dental health problems during pregnancy include:

 Tooth decay. During pregnancy, increased acidity in the mouth increases the risk of tooth decay. Vomiting during pregnancy can aggravate the problem by exposing the teeth to more gastric acid.

 Loose teeth. Increased levels of progesterone and estrogen can affect the ligaments and bones that support the teeth, causing teeth to loosen during pregnancy.

 Gum disease. The hormonal changes of pregnancy can lead to gingivitis, an inflammation of the superficial gum tissue. Severe gum disease left untreated may be associated with preterm birth and low birth weight.

So how do you keep your teeth and gums healthy during pregnancy? Stick to the basics. Brush and floss your teeth regularly. Rinse regularly with a fluoride mouthwash. If you have morning sickness, rinse your mouth with a solution of baking soda and water after vomiting. Mix 1 teaspoon baking soda in 1 cup of water.

I enjoy water parks and amusement rides. Do I need to avoid them during pregnancy? While there’s no consensus on avoiding water parks and amusement rides while you’re pregnant, you may want to check with your care provider before riding a roller coaster or going down a rapid water ride. Research indicates that trauma during pregnancy that produces a forceful shearing effect — such as the sudden stop experienced in a car crash — can cause the placenta to separate from the uterus (placental abruption). Placental abruption can seriously complicate your pregnancy. This type of force may be experienced to a lesser extent in an amusement ride.

Many theme park rides have restrictions for pregnant women. If you decide to go on a ride, be sure to check the restriction policy first.

Bottom line: You may want to stay on the safe side and stick with lounging in the pool rather than flying down a wild ride during the months you’re pregnant.