Many patients ask me what is safe to eat and what is not. This is natural, we all want the best for our growing baby. A healthy balanced diet is the best plan for any pregnant woman.

A healthy diet The best way to meet you and your baby’s nutritional needs is to eat a wide variety of nutritious foods and be as healthy as possible as early as possible. These foods should include a variety of:

• Bread, cereals, rice, pasta, noodles and other grain foods—mostly wholegrain and/or high fibre
• Vegetables and legumes
• Milk, yoghurt, hard cheese and dairy alternatives with added calcium—mostly reduced fat
• Meat, fish, poultry, cooked eggs, nuts, seeds and tofu

You can read more information here – http://foodauthority.nsw.gov.au/foodsafetyandyou/life-events-and-food/pregnancy/pregnancy-and-food-safety

Whilst nausea and vomiting is an almost normal part of pregnancy, it is unpleasant and in rare cases can lead to serious complications such as dehydration. Sometimes all that is required to improve your symptoms is to make some changes to the way you eat and drink.  Sometimes medications are required, and it is important to know which ones you can safely take during pregnancy.

Hydration

The most important thing is to ensure adequate fluid intake.  You should drink at least 2000ml of fluid a day in addition to replacing fluid lost from vomiting.  Fluid tends to be best tolerated when it is cold and drunk in frequent small amounts (sips) between meals (this avoids over filling your stomach).  If you are drinking enough fluid, you will urinate normal volumes and it should be clear or yellow.

If you aren’t passing much urine or if it is becoming concentrated, this is a sign you are dehydrated.  Try to increase the amount you are drinking, or use a sports drink like Powerade (it is easier for your stomach to absorb).  If this doesn’t help, or you are unable to keep fluid down, contact either the Mercy Hospital for Women Emergency Department (8458 4000) or page Dr Lenore Ellett on 9387 1000 for advice.

Controlling Nausea

Diet

Meals should be eaten slowly and in small amounts every one to two hours.  An empty stomach should be avoided, as should an over full stomach.  A snack upon waking and before getting up may help.

It’s difficult to be sure what foods are best, however historically simple foods like toast and crackers are most tolerable when nausea is at its worst.  Everyone is different, so you might have to experiment.  Try avoiding spicy, odorous, high fat, acidic and very sweet foods first and replace with higher protein and salty foods like nuts.

Medications

Blackmore’s Morning Sickness
This contains ginger and vit B6 and should be taken regularly (4 times a day) to suppress your nausea.  If you only take it when you have severe nausea, it probably won’t work.  If you don’t like the ginger, you could instead take vitamin B6 50mg tablets 4 times a day.

If this doesn’t work by itself, take it with;

Doxylamine (Restavit)
This is an antihistamine that is sold over the counter at most pharmacies.  The dose is one tablet at night and ½-1 tablet in the morning and afternoon.  It is a very safe medication in pregnancy.  It is mildly sedating in some women, thus you may only be able to take ½ during the day.

If these tablets together don’t work, continue to take them, and add one the following medications that require a prescription

Metoclopramide (Maxolon) – Category A

• Ondansetron (Zofran) – Category B1
• Promethazine (Phenergan) – Category C
• Prochlorperazine (Stemetil) – Category C

When to seek further help

If the above measures are not working and you are still troubled by significant symptoms, you should make an appointment with Lenore in her rooms, call on 8458 4022.  You should go to hospital if you are unable to tolerate any fluids or if you are not passing enough urine.

Nausea and vomiting late in the pregnancy can be abnormal, and you should contact Lenore’s rooms if this occurs.

Prognosis

The vast majority of women’s symptoms resolve by about 13-15 weeks, and at the very least, you can expect symptoms to begin to subside by this stage.

There is no known safe level of alcohol consumption for women who are pregnant. Consuming alcohol during pregnancy increases the risk of miscarriage, low birth weight, congenital deformities and effects on the baby’s intelligence.

You can find out more information here – https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet

All women who are pregnant without complications should continue exercise as part of a healthy lifestyle during pregnancy. Carrying a baby is hard work as is labour, so remaining in good physical shape is essential. A reasonable goal should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness. It is important to stay well hydrated, wear comfortable clothing and foot wear and avoid excessive overheating.

Maintaining a healthy weight will help you return to your pre-baby weight more quickly and reduce your risk of developing diabetes of pregnancy (more common in overweight mothers).

RISKS OF EXERCISE

There are no known adverse risks to a pregnant woman who meets the recommended guidelines of at least 150 minutes of moderate to vigorous physical activity per week.

However as pregnancy progresses the body changes significantly and joints become looser. This is an important change as it allows the pelvic bones to slightly separate to allow the birth of a baby vaginally. This joint laxity can lead to pelvic and back pains. High impact running can increase the risk of pelvic instability.  A pregnant woman’s centre of gravity changes as she the pregnancy progresses, this can affect balance.

Common sense must prevail, taking up a new adventure sport is not a sensible idea in pregnancy due to altered balance. You should avoid sports that put you at risk of a blow to the abdomen eg falling whilst snow boarding, martial arts.

EXERCISE GUIDELINES

75-150 minutes of moderate physical activity per week.

Avoid overheating; don’t exercise if you are ill or feverish, take care in hot and humid weather

Stay well hydrated

Avoid contact sports or activities with a risk of falling

Avoid scuba diving whilst pregnant

AEROBIC EXERCISE SUGGESTIONS WHILST PREGNANT

• Walking
• Swimming
• Cycling (stationary bike safer)
• Low impact aerobic exercise class
• Water aerobics
• Yoga or Pilates
• Pregnancy exercise classes

WHEN NOT TO EXERCISE WHEN PREGNANT?

Stop exercising if you experience

• Abdominal pain
• Any fluid loss from the vagina
• Calf pain or swelling
• Chest pain
• Decreased baby movements
• Dizziness, light headedness, muscle weakness, blurred vision
• Shortness of breath before starting exercise
• Pelvic pain
• Excessive fatigue
• Painful uterine contractions
• Vaginal bleeding

Listen to your body!

PELVIC FLOOR EXERCISES DURING PREGNANCY

• Sit and lean slightly forward with a straight back
• Squeeze and lift the muscles as if you are trying to stop urinating
• Hold the squeeze for up to 5 seconds, relax for up to 10 seconds
• Repeat up to 10 times, 3 to 4 times a day
• Keep breathing through the exercise

You can find out more here – https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-exercise

Down Syndrome occurs if a baby has three copies of its 21st chromosome instead of two copies. A chromosome is a bundle of genetic material, and if you have too many or too few of these bundles, severe abnormalities can result. In the case of Down Syndrome, these abnormalities include intellectual, heart, thyroid and other endocrine, facial appearance and others.

It is possible to detect early in the pregnancy whether your baby might be at high risk of having Down Syndrome. This is possible through consideration of your age and additional tests.

The additional tests are Combined First Trimester Screening and Non-invasive Prenatal Testing (NIPT).

It is important to realise that both of these tests are considered to be “screening test”. This means they won’t tell you “yes, your baby has Down syndrome” or “no, it definitely does not have Down syndrome”. They will, however, say if your baby is at high risk of having Down syndrome, in which case you should have a diagnostic test. A diagnostic test is one that will tell you “yes” or “no”.

Combined First Trimester Screening requires a blood test at 10 weeks and an ultrasound between 12 and 13 weeks. Most patients choose this option. The blood test costs about $120 (no medicare rebate) and a specialised ultrasound costs about $150 after the medicare rebate, however this varies from clinic to clinic. Combined First Trimester Screening screens for Down syndrome and Trisomy 18. The detection rate for Down syndrome is 90%.

NIPT is no doubt the future of prenatal testing for Down Syndrome and other genetic abnormalities due to its incredible accuracy and lack of risk to the baby. It uses a maternal blood sample to find and test the baby’s cfDNA(cell free DNA – genetic material) in the mother’s bloodstream. Costs are constantly falling, but it is quite expensive costing about $550 and no rebate applies. This non-invasive prenatal test (NIPT) is safe and poses no risk to mother or baby. It’s recommended that expectant parents discuss with their health practitioner the limitations and advantages of cfDNA screening before having the test.

Most women would still opt for a 12 week ultrasound if doing NIPT; whilst the ultrasound has no impact on the Down Syndrome result when doing NIPT, it does provide other useful information about the development of the baby; so a saving is often not made by omitting the ultrasound.

Lenore will discuss these options with you in detail at your first pregnancy appointment.

You can find out more information here

It is now possible to check if your baby has a chance of inheriting genetic conditions. The conditions that testing is currently available for is cystic fibrosis, spinal muscular atrophy, and fragile X syndrome. It costs about $350 per person tested for all three conditions. It is usual to test the mother or the father first, then arrange testing for the partner if a copy of the gene is found, so there is potential that both parents would need the test.

Steady weight gain during pregnancy is normal and important for your health and your developing baby. However, it is also important not to gain too much weight. Pregnant women don’t need to “eat for two” in fact the calories per day that are pregnant woman needs is very similar to the caloric intake needed for a non pregnant woman.

If you are pregnant, a good approach is to eat to satisfy your appetite and continue to monitor your weight. For women who are a healthy weight, it is recommended that you gain between 11.5 and 16 kg. Underweight women may need to gain more weight (between 12.5 and 18 kg).

If you are overweight, pregnancy is not the time to start dieting or trying to lose weight. However, it is recommended for women who are overweight to gain less weight during pregnancy (between 5 and 11.5 kg).

You can find out more here – https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet

Small amounts of caffeine are safe during pregnancy but excessive volumes may
increase the risk of miscarriage and premature birth. Caffeine is in coffee, tea, chocolate
and cola (and some other soft drinks and energy drinks). Dr Lenore Ellett recommends
pregnant women limit themselves to 200mg of caffeine daily. That amount would be
obtained from about 1-2 cups of espresso style coffee, 3 cups of instant coffee, 4 cups
of medium strength tea, or 4 cups of cocoa or hot chocolate. Avoid double shots of
espresso coffee and drinks marked as sports or energy drinks that contain caffeine.

Smoking is dangerous for your baby. Smoking increases the risk of premature birth,
low birth weight, respiratory problems and SIDS. There is no safe level of smoking. For
help to quit smoking call the Quitline on 13 78 48.

There is no safe level of recreational drugs in pregnancy and you need to check any medications with your Doctor or Pharmacist to ensure they are safe during pregnancy.

Some infections can cause serious harm for both the pregnant woman and her unborn baby.

Prior to pregnancy
Rubella and Varicella (Chicken pox virus)
• Booster immunisation is advised before becoming pregnant to those with no/low immunity

During pregnancy
Influenza (Flu, Swine Flu)
• Flu is particularly serious for pregnant women and their babies- both unborn and newborn. Flu vaccination is strongly advised if you are going to be pregnant during the flu season (March –October). The seasonal flu vaccine covers both seasonal flu and swine flu. It is SAFE and EFFECTIVE.
Pertussis (Whooping cough)
• This is a serious infection that mainly affects very young babies. Adult immunity from childhood generally wanes over time. If infected, these adults usually have a mild form of the disease but may pass on the infection to young babies. As such, booster immunisation to whooping cough is recommended for all adults who are going to be in close contact with young babies.

Therefore, I highly recommend the following actions to reduce the possibility of infection in these most vulnerable young infants.
• ALL adults who will be in close contact with the newborn baby should have a Whooping cough booster (Boostrix) if they have not had one in the last 10 yrs. This can occur at ANY TIME.
• Pregnant patients should have a Whooping Cough booster between 28-34 weeks to maximise the transfer of protective antibodies to the fetus.
• Recommended in ALL pregnancies, irrespective of when last Boostrix vaccine was administered.
• Vaccinate young infants as per the National Immunisation Schedule at 2, 4 and 6 months.
• The vaccine is currently free for parent