If you're pregnant -- or even considering pregnancy -- there's a lot to think about. Below, experts suggest how to live well with pregnancy and prepare for the best possible outcomes for you and your healthy newborn.
"It's essential to optimize your health before pregnancy, including cardiovascular and mental health," says Dr. Jane van Dis, an OB-GYN and medical director of Maven Clinic, a telemedicine network of women's and family health providers. Take these preconception steps:
-- Discuss medical conditions. Hypertension, diabetes, obesity, asthma and thyroid issues are among medical conditions that can affect the growth and development of a baby, says Dr. Rakhi Dimino, an OB-GYN hospitalist in Houston and a regional medical director for Ob Hospitalist Group. See your primary care provider to have medical conditions diagnosed and well under control to minimize any possible effects on the developing baby.
-- Take prenatal vitamins. Pregnant women need at least 600 micrograms of folic acid (a type of B vitamin) daily to prevent neural tube defects during early pregnancy and embryo formation, van Dis says. Because it's difficult to get this much folic acid from food alone, you should take a daily prenatal vitamin with at least 400 micrograms starting at least one month before pregnancy and continuing during the first 12 weeks of pregnancy, according to the American College of Obstetricians and Gynecologists.
-- Make sure immunizations are up to date. Check your vaccination record with your health care provider.
-- Check that medications are safe. "Some medications for chronic conditions may not be safe in pregnancy and may need to be stopped or changed," says Dr. Maryam Tarsa, a perinatologist and clinical professor in the division of maternal fetal medicine at University of California, San Diego. Ask your doctor about any prescription and over-the-counter drugs you take.
-- Avoid alcohol and recreational drugs. Even while you're trying to get pregnant, stay away from substances that could harm early fetal development.
-- Reduce stress. "Pregnancy itself and delivery can cause a lot of anxiety and worry for many women," Dimino says. Focus on your mental health in advance by exploring stress-relievers such as journaling, exercise, social support and counseling, she suggests.
-- Consider genetic testing. For any woman who is interested, or who has family history of genetic disorders, genetic testing can be done for themselves and their partners even prior to pregnancy, Tarsa says.
-- Look into pregnancy providers. It's not too early to determine who you want for your pregnancy care provider or where you plan to deliver.
First OB-GYN Visit
Recommended time ranges for your first OB-GYN or midwife visit vary slightly by provider. In the absence of abdominal pain or bleeding, the first visit should be at around seven to nine weeks of pregnancy, Tarsa says. Here's what the visit typically encompasses:
-- Discussion. Let your provider know about your complete medical, surgical and family health history. You should also discuss genetic screening options. Ask any questions you have as you discuss your pregnancy plan.
-- Ultrasound. Your first ultrasound reveals the fluttering of the fetal heartbeat and confirms your predicted due date, Dimino says. In addition, van Dis notes, the ultrasound confirms whether you're carrying a single fetus or multiples like twins or triplets.
-- Lab tests. Blood and urine samples may be taken before or immediately after this visit.
"Exercise is amazing, especially for pregnant women," van Dis says. "As your pregnancy grows, your exercise routine may change. Women who exercise regularly have better pregnancy outcomes and shorter labors, and can avoid complications of pregnancy." Follow these tips:
-- Exercise caution. Avoiding dangerous sports, staying hydrated and not getting overheated are important pregnancy-exercise precautions, van Dis says.
-- Don't overdo. "Pregnancy is not a good time to start never-before tried strenuous routines," Tarsa notes. "In general, 30 minutes of moderate exercise most days of the week should be considered to maintain a healthy lifestyle."
-- Be safe. "All women should avoid activities where there is a high risk of falling or getting hit," Dimino says. "Therefore, many doctors will recommend against activities such as horseback riding, bike riding or high-contact sports."
-- Consider chronic conditions. If you have asthma, high blood pressure or diabetes, or you've had complicated pregnancies, consult with your doctor about exercise during pregnancy.
Keep this in mind while eating for two:
-- Follow a well-balanced diet. "Most nutritionists agree that protein, calcium and 'good' fat and carbohydrates are the backbone of a healthy diet in pregnancy," van Dis says. Calcium-rich foods can be plant-based as well as dairy.
-- "Generally, avoid 'dieting' during pregnancy," Tarsa says.
-- "If you're vegetarian or vegan, please speak to your doctor to make sure your diet includes protein, calcium and iron," Tarsa suggests. However, maintaining a vegetarian lifestyle during pregnancy is healthy and doable, van Dis notes.
-- Folic acid and iron are key nutrients to focus on, Dimino says. Whole grains are good sources of folic acid. For iron, dark chicken meat and red meat are good sources, but so are dark leafy greens.
-- "Caffeine is OK in pregnancy, though try to keep it under 200 milligrams a day," van Dis says. That equals roughly two cups of coffee.
-- Stay away from raw foods. Eating raw meat, raw shellfish or unpasteurized cheeses can introduce harmful bacteria to your body.
"Having a healthy diet -- easier said than done if you have nausea in the first trimester -- will help you and your pregnancy," van Dis says. Let your provider know if persistent nausea is preventing you from eating well.
Prenatal vitamins may not be necessary if you've been eating a healthy well-balanced diet for many months prior to and during pregnancy, Dimino says. However, some women may still be deficient in folic acid and iron. "While taking one prenatal vitamin a day is a good thing, too much of any one kind of vitamin can be harmful for your developing baby," she cautions. Bottom line: Avoid megavitamins and consult with your doctor.
[SEE: Foods High in Calcium.]
"Both significant weight gain or lack of weight gain during pregnancy can affect the health of mom and baby," Tarsa says. The ACOG website offers a summary of Institute of Medicine guidelines on pregnancy weight and gain.
These healthy habits are important to incorporate to your daily routine:
-- Wear a seat belt. You should always buckle up with a lap belt and shoulder belt combination, according to pregnancy guidelines from the National Highway Traffic Safety Administration. Secure the lap belt below -- never across -- your belly so it fits snugly across your hips and pelvic bone, NHTSA advises.
-- Get enough sleep. Fatigue is a normal side effect of pregnancy, and getting adequate sleep will help you feel better.
-- Drink plenty of water. Nausea and vomiting are common during early pregnancy and sometimes throughout pregnancy. It's important to replace lost fluid and avoid dehydration.
But there are some habits you're better off without. "If you would not give it to your 1-year-old child when they are born, do not put it into your body now that you are pregnant," Dimino says. Avoid these substances:
-- Tobacco, nicotine and smoke. Smoking, chewing tobacco and vaping deliver harmful chemicals to your developing baby.
-- Alcohol. To avoid the risk of fetal alcohol syndrome, don't drink while pregnant.
-- Marijuana and other recreational drugs. Although some women believe marijuana can help decrease vomiting and increase appetite in early pregnancy, it could be risky, Dimino says. "Research suggests that marijuana can affect the developing brain of a baby in the womb," she says. "This cost is not worth the assistance with morning sickness when there are multiple other safe options available in pregnancy."
When to Call Your Health Care Provider
It's always safer to call your health care provider if a concern arises during pregnancy. Call right away if you experience any of these symptoms:
Vaginal bleeding. "You should always call your midwife or doctor with any vaginal bleeding or leaking of fluid from the vagina," Dimino says.
Persistent pelvic pressure. Pelvic pressure can increase in the second trimester, Tarsa notes. "If this persists or is associated with bleeding or leakage of amniotic fluid, or your symptoms are worsening, you should call your doctor," she says.
Contractions. "If you are preterm, or before 37 weeks, you should call any time you have more than six contractions an hour," Dimino says.
Reduced fetal movement. "If you are over 23 weeks, you should call and go into a labor and delivery unit for evaluation if you have decreased fetal movements," Dimino says.
Preeclampsia symptoms. Persistent headache or visual changes, rapid weight gain and persistent right upper abdominal pain are signs of preeclampsia -- a dangerous high blood pressure condition that can develop in mid- or late pregnancy.
Severe pain. Call immediately if you experience severe abdominal or pelvic pain.
UTI. "Even a simple urinary tract infection, if untreated, can become a kidney infection and even a blood infection," van Dis says. "So prompt evaluation and treatment is necessary."
Other concerns. Fever, inability to keep food down, a headache that's not relieved by Tylenol, blood pressure higher than 140/90, swelling that's worse in one leg than the other, chest pain and shortness of breath are all reasons to contact your doctor or midwife, Dimino says.
"Pregnancy can be unpredictable," Tarsa says. While it's good to have certain expectations, things can change, and everyone's pregnancy is different, so keep an open mind, she advises: "Enjoy the path and roll with the punches."