Some things to avoid during pregnancy

When you're pregnant, what you don't put into your body (or expose your body to) is almost as important as what you do.

Here are some things to avoid:

Alcohol

Although it may seem harmless to have a glass of wine at dinner or a mug of beer out with friends, no one has determined what's a "safe amount" of alcohol to consume during pregnancy. One of the most common known causes of mental and physical birth defects, alcohol can cause severe abnormalities in a developing fetus.

Alcohol is easily passed along to the baby, who is less equipped to eliminate alcohol than the mother. That means an unborn baby tends to develop a high concentration of alcohol, which stays in the baby's system for longer periods than it would in the mother's. And moderate alcohol intake, as well as periodic binge drinking, can damage a baby's developing nervous system.

If you had a drink or two before you even knew you were pregnant (as many women do), don't worry too much about it. But your best bet is to not drink any alcohol at all for the rest of your pregnancy.

Recreational Drugs

Pregnant women who use drugs may be placing their unborn babies at risk for premature birth, poor growth, birth defects, and behavior and learning problems. And their babies could also be born addicted to those drugs themselves.

If you're pregnant and using drugs, a health clinic such as Planned Parenthood can recommend health care providers, at little or no cost, who can help you quit your habit and have a healthier pregnancy.

If you've used any drugs at any time during your pregnancy, it's important to inform your health care provider. Even if you've quit, your unborn child could still be at risk for health problems.

Nicotine

You wouldn't light a cigarette, put it in your baby's mouth, and encourage your little one to puff away. As ridiculous as this scenario seems, pregnant women who continue to smoke are allowing their fetus to smoke, too. The smoking mother passes nicotine and carbon monoxide to her growing baby.

The risks of smoking to the fetus include:

• stillbirth
• prematurity
• low birth weight
• sudden infant death syndrome (SIDS)
  
• asthma and other respiratory problems

If you smoke, having a baby may be the motivation you need to quit. Talk to your health care provider about options for stopping your smoking habit.

Caffeine

High caffeine consumption has been linked to an increased risk of miscarriage, so it's probably wise to limit or even avoid caffeine altogether if you can.

If you're having a hard time cutting out coffee cold turkey, here's how you can start:

• Cut your consumption down to one or two cups a day.
• Gradually reduce the amount by combining decaffeinated coffee with regular coffee.
• Eventually try to cut out the regular coffee altogether.

And remember that caffeine is not limited to coffee. Many teas, colas, and other soft drinks contain caffeine. Try switching to decaffeinated products (which may still have some caffeine, but in much smaller amounts) or caffeine-free alternatives.

If you're wondering whether chocolate, which also contains caffeine, is a concern, the good news is that you can have it in moderation. Whereas the average chocolate bar has anywhere from 5 to 30 milligrams of caffeine, there's 95 to 135 milligrams in a cup of brewed coffee. So, small amounts of chocolate are fine.

Certain Foods

Although you need to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage.

Foods you'll want to steer clear of include:

• soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
  
• unpasteurized milk, juices, and apple cider
  
• raw eggs or foods containing raw eggs, including mousse, tiramisu, raw cookie dough, homemade ice cream, and Caesar dressing (although some store-bought brands of the dressing may not contain raw eggs)
  
• raw or undercooked meats, fish (sushi), or shellfish
  
• processed meats such as hot dogs and deli meats (unless they are reheated until steaming)

Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating:

• shark
• swordfish
• king mackerel
• tilefish
• tuna steak
  

These types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus. When you choose seafood, limit the total amount to about 12 ounces per week — that's about two meals. Also, if you eat canned tuna, limit consumption to no more than 6 ounces per week. Also, check any local advisories before consuming recreationally caught fish.

Changing the Litter Box

Pregnancy is the prime time to get out of cleaning kitty's litter box. Why? Because toxoplasmosis can be spread through soiled cat litter boxes and can cause serious problems, including prematurity, poor growth, and severe eye and brain damage. A pregnant woman who becomes infected often has no symptoms but can still pass the infection on to her developing baby.

Over-the-Counter and Prescription Medications

Even common over-the-counter medications that are generally safe may be considered off-limits during pregnancy because of their potential effects on the baby. And certain prescription medications may also cause harm to the developing fetus.

To make sure you don't take anything that could be harmful to your baby:

• Ask your health care provider which medicines — both over-the-counter and prescription — are safe to take during pregnancy.
  
• Talk to your health care provider about any prescription drugs you're taking.
  
• Let all of your health care providers know that you're pregnant so that they'll keep that in mind when recommending or prescribing any medications.
  
• Also remember to discuss natural remedies, supplements, and vitamins.

If you were prescribed a medication before you became pregnant for an illness, disease, or condition you still have, consult with your health care provider, who can help you weigh potential benefits and risks of continuing your prescription.

If you become sick (e.g., with a cold) or have symptoms that are causing you discomfort or pain (like a headache or backache), talk to your health care provider about medications you can take and alternative ways to help you feel better without medication.

Healthy pregnancy

Staying healthy during pregnancy depends on the mother. Key to protecting the health of your child is to get regular prenatal care. If you think you're pregnant, call your health care provider to schedule an appointment. You should schedule your first examination as soon as you think that you are pregnant.

At this first visit, your health care provider likely do a pregnancy test, and will figure out how many weeks pregnant you are based on a physical examination and the date of your last period. He or she will also use this information to predict your delivery date (however, an ultrasound performed sometime during your pregnancy will help to verify that date).

If you're healthy and there are no complicating risk factors, most health care providers will want to see you:

• every 4 weeks until the 28th week of pregnancy
• then every 2 weeks until 36 weeks
• then once a week until delivery

Throughout your pregnancy, your health care provider will check your weight and blood pressure while also checking the growth and development of your baby (by doing things like feeling your abdomen, listening for the fetal heartbeat starting during the second trimester, and measuring your belly). During the span of your pregnancy, you'll also have prenatal test, including blood, urine, and cervical tests, and probably at least one ultrasound.

If you still need to choose a health care provider to counsel and treat you during your pregnancy, there are several options:

• obstetricians/gynecologists (also known as OB/GYNs — doctors who specialize in pregnancy and childbirth, as well as women's health care)
  
• family practitioners (doctors who provide a range of services for patients of all ages — in some cases, this includes obstetrical care)
  
• certified nurse-midwives (advanced practice nurses specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for uncomplicated pregnancies; there are also other kinds of midwives, but you should look for one with formal training who's been certified in the field)

Any of these is a good choice if you're healthy and there's no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case an unexpected problem arises or a cesarean section (C-section) has to be performed.

Nutrition and Supplements
Now that you're eating for two (or more!), this is not the time to cut calories or go on a diet. In fact, it's just the opposite — you need about 300 extra calories a day, especially later in your pregnancy when your baby grows quickly. If you're very thin, very active, or carrying multiples, you'll need even more. But if you're overweight, your health care provider may advise that you consume fewer extra calories.

Healthy eating is always important, but especially when you're pregnant. So, make sure your calories come from nutritious foods that will contribute to your baby's growth and development.

Try to maintain a well-balanced diet that incorporates the dietary guidelines including:

• lean meats
• fruits
• vegetables
• whole-grain breads
• low-fat dairy product

By eating a healthy, balanced diet you're more likely to get the nutrients you need. But you will need more of the essential nutrients (especially calcium, iron, and folic acid) than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.

But taking prenatal vitamins doesn't mean you can eat a diet that's lacking in nutrients. It's important to remember that you still need to eat well while pregnant. Prenatal vitamins are meant to supplement your diet not be your only source of much-needed nutrients.

Calcium

Most women 19 and older — including those who are pregnant — don't often get the daily 1,000 mg of calcium that's recommended. Because your growing baby's calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which may contain some extra calcium.

Good sources of calcium include:

• low-fat dairy products including milk, pasteurized cheese, and yogurt
• calcium-fortified products, including orange juice, soy milk, and cereals
• dark green vegetables including spinach, kale, and broccoli
• tofu
• dried beans
• almonds

Iron

Pregnant women need about 30 mg of iron every day. Why? Because iron is needed to make hemoglobin, the oxygen-carrying component of red blood cells. Red blood cells circulate throughout the body to deliver oxygen to all its cells.

Without enough iron, the body can't make enough red blood cells and the body's tissues and organs won't get the oxygen they need to function well. So it's especially important for pregnant women to get enough iron in their daily diets — for themselves and their growing babies.

Although the nutrient can be found in various kinds of foods, iron from meat sources is more easily absorbed by the body than iron found in plant foods. Iron-rich foods include:

• red meat
• dark poultry
• salmon
• eggs
• tofu
• enriched grains
• dried beans and peas
• dried fruits
• dark leafy green vegetables
• blackstrap molasses
• iron-fortified breakfast cereals

Folate (Folic Acid)

The Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age — and especially those who are planning a pregnancy — get about 400 micrograms (0.4 milligrams) of folic acid supplements every day. That can be from a multivitamin or folic acid supplement in addition to the folic acid found in food.

So, why is folic acid so important? Studies have shown that taking folic acid supplements 1 month prior to and throughout the first 3 months of pregnancy decrease the risk of neural tube defects by up to 70%.

The neural tube — formed during the several weeks of the pregnancy, possibly before a woman even knows she's pregnant — goes on to become the baby's developing brain and spinal cord. When the neural tube doesn't form properly, the result is a neural tube defect such as spina bifida.

Again, your health care provider can prescribe a prenatal vitamin that contains the right amount of folic acid. Some pregnancy health care providers even recommend taking an additional folic acid supplement, especially if a woman has previously had a child with a neural tube defect.

If you're buying an over-the-counter supplement, keep in mind that most multivitamins contain folic acid, but not all of them have enough folic acid to meet the nutritional needs of a pregnant woman. So, be sure to check labels carefully before choosing one and check with your health care provider.

Fluids

It's also important to drink plenty of fluids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy, and drinking enough water each day can help prevent common problems such as dehydration and constipation.

Exercise

The U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2 hours and 30 minutes) of moderate-intensity aerobic activity each week if you're not already highly active or doing vigorous-intensity activity. If you are very active or did intense aerobic activities before becoming pregnant, you may be able to keep up your workouts, as long as your doctor says it's safe. Before beginning — or continuing — any exercise regimen talk to your doctor first.

Exercising during pregnancy has been shown to be extremely beneficial. Regular exercise can help:

• prevent excess weight gain
• reduce pregnancy related problems, like back pain, swelling, and constipation
• improve sleep
• increase energy
• improve outlook
• prepare for labor
• lessen recovery time

Low-impact, moderate-intensity exercise activities (such as walking and swimming) are great choices. You can also opt for yoga or Pilates classes, DVDs, or videos that are tailored for pregnancy. These are both low-impact and work on strength, flexibility, and relaxation.

But you should limit high-impact aerobics and avoid certain sports and activities that pose a risk of falling or abdominal injury. Typical limitations include contact sports, downhill skiing, and horseback riding.

It's also important to be aware of how your body changes. During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury.

So, it's easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. In addition, your center of gravity shifts as your pregnancy progresses, so you may feel off-balance and at risk of falling. Keep these in mind when you choose an activity and don't overdo it.

Whatever type of exercise you choose, make sure to take frequent breaks and remember to drink plenty of fluids. And use common sense — slow down or stop if you get short of breath or feel uncomfortable. If you have any questions about doing a certain sport or activity during your pregnancy, talk to your health care provider for specific guidelines.

Sleep

It's important to get enough sleep during your pregnancy. Your body is working hard to accommodate a new life, so you'll probably feel more tired than usual. And as your baby gets bigger, it will be harder to find a comfortable position when you're trying to sleep.

Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart's job easier because it keeps the baby's weight from applying pressure to the large blood vessels that carry blood to and from your heart and your feet and legs. Lying on your side can also help prevent or reduce varicose veins, hemorrhoids, and swelling in your legs.

Some doctors specifically recommend that pregnant women sleep on the left side. Because one of those big blood vessels is on the right side of your abdomen, lying on your left side helps keep the uterus off of it. Lying on your left side optimizes blood flow to the placenta and, therefore, your baby.

Ask what your health care provider recommends. In most cases, lying on either side should do the trick and help take some pressure off your back. To create a more comfortable resting position either way, prop pillows between your legs, behind your back, and underneath your belly.

strategies to avoid breast cancer

1. Limit alcohol

A strong link exists between alcohol consumption and breast cancer. The type of alcohol consumed — wine, beer or mixed drinks — seems to make no difference. To help protect against breast cancer, limit alcohol to less than one drink a day or avoid alcohol completely.

2. Eat fruit

You can't go wrong with this – almost all dietary advice comes down to the single instruction to eat more fruit and veg. Diet is thought to be a key factor in one in four cancer deaths – and animal fat in the diet is the suspect ingredient in breast cancer. The Japanese, who eat a diet of fish, rice and vegetables that is extremely low in animal fat, also have low rates of breast cancer.

A high-fat diet increases the levels of the female hormone estrogen in the blood, which encourages the growth of cancer cells. In populations with a high-fat diet, women tend to start their periods earlier and reach menopause later so they are exposed to high levels of estrogen for longer, increasing their risk of breast cancer.

Studies into what effect eating fruit and vegetables has on breast cancer have produced mixed results. One study found that, when combined with taking exercise, the results were dramatic. Published in the Journal of Clinical Oncology last June, it showed that women who ate their five portions a day and walked briskly for at least 30 minutes halved their risk of breast cancer.

3. Walk

It is enjoyable, simple and requires no equipment. Walking is good for all aspects of physical and mental health – and cancer is no exception. Brisk walking (or other exercise) for 30 minutes a day, five times a week, is all that's needed. Currently only one in four women manages this. If all women did, Cancer Research UK estimates it would prevent 1,400 cases a year.

Three large studies in Italy and the US showed that inactivity caused 11 per cent of cases of breast cancer. Exercise works best before the menopause, but it is effective afterwards, too. It is thought to alter estrogen metabolism, resulting in a weaker version being made.

4. Avoid HRT

Hormone replacement therapy is seen as the principal avoidable risk for breast cancer. At the height of its popularity, in 2002, an estimated two million women were taking HRT in the UK, and millions more worldwide. Tens of thousands of women will have developed breast cancer, ovarian cancer and endometrial cancer (of the lining of the womb) as a result. Overall, women currently taking HRT are 63 per cent more likely to develop these three cancers than those who are not. Earlier hopes that these risks would be counterbalanced by a reduction in heart disease have not been borne out. Gynecologists recommend that women who wish to use it to ease the symptoms of the menopause do so for as short a time as possible.

5. Get screened

Women diagnosed with breast cancer at the earliest possible stage have a nine in 10 chance of a successful recovery. This is the rationale for screening – to detect a tumour by mammography when it is still too small to feel. Women aged 50 to 70 are invited for screening every three years – shortly to be extended to ages 47 to 73. It is estimated that the scheme saves 1,400 lives a years in England – one life for every 500 women screened.

However, there is a downside in the shape of false alarms. Screening picks up abnormalities in the breast that look like cancer but turn out not to be. Several thousand women each year suffer the anxiety and discomfort of being recalled for further tests and undergoing biopsies of the breast to check for cancer – before being given the all-clear. Screening is now more accurate, since two views of the breast are taken, reducing the chances of cancers being missed.

6. Give birth

Having children, especially before the age of 30, helps protect against breast cancer. It is down to those hormones, again. Over the last century, economic progress has led to delayed childbirth and smaller families as women with their own careers have sought to balance the demands of work and home. But researchers estimate that delaying childbearing increases the risk of breast cancer by 3 per cent for each year of delay.

7. Breast-feed

Breast-feeding protects against breast cancer, as well as being best for the baby. But smaller families and the rise in the number of working mothers has meant the time spent breast-feeding has reduced. Breast-feeding for six months reduces the risk, experts say. Yet many women never get that far. In England, 77 per cent of mothers start breast-feeding but more than a third switch to bottle-feeding in the first six weeks.

8. Lose weight

Obesity increases the risk of breast cancer – but only after the menopause. A large European study called Epic found post menopausal women who were obese had a 31 per cent higher risk of breast cancer than women with a healthy weight. Reducing obesity could save 1,800 cases of breast cancer a year.

Obesity increases the risk of other cancers including those of the bowel, womb, kidney and esophagus. Overall it is estimated that 5 per cent of cancers in women and 3 per cent in men are due to being obese or overweight. In the UK, 12,000 people might avoid getting cancer each year if they maintained a healthy body weight.

9. Sleep Safely

Shut out all light: Sleeping in a dark room aids production of neurotransmitter serotonin, which is crucial in making melatonin.

Get nine hours' sleep: A Finnish study found that women who slept nine hours were one-third as likely to get breast cancer as those who slept seven-eight.

Get a red light bulb: Place a red light bulb in one fixture. If you get up in the night, only use this one.

Get outside in the morning: Just 10-15 minutes of morning light will send a strong time-keeping signal to the brain's clock, leaving it less likely to be confused.

10. Live somewhere clean

It has long been claimed that exposure to pollutants used in the manufacture of products from plastics to cosmetics has an "endocrine disrupting" effect. The chemicals are said to mimic the action of oestrogen and have been blamed for feminised fish and frogs and declining sperm counts in men. A report from the World Wide Fund for Nature last year claimed their role in breast cancer had been neglected. It pointed out that less than half of new breast cancer cases can be explained by genetic and lifestyle factors and chemicals in the environment could be the missing link. Other studies have contradicted this suggestion and experts point out that compared with the natural levels of oestrogen in a woman's blood, the level of the chemicals is too small to have significant impact.