Pregnancy is a time of growth and change. Lifestyle strategies like nutrition and exercise can have the greatest impact on pregnancy outcomes during the first 20 weeks. These strategies set the stage for what happens later in pregnancy, during labor and delivery, and the time after birth (for both mom and baby). Sifting through information online can be challenging, so this article offers some general considerations for a healthy pregnancy.
Food & Nutrition
Nutrition guidelines in pregnancy aren’t extremely different from general guidelines for good overall health. In pregnancy research, nutrition guidelines look at populations with a high risk of pregnancy complications and compare them to low-risk populations. Based on a study in 2018, these are some of the recommendations associated with lower rates of gestational diabetes, small babies, urinary tract infections, high blood pressure, and other high-risk pregnancy complications:
- Vegetables and fruits: 12 servings each per week
- Nuts and oily fish: 3 servings each per week
- Extra virgin olive oil: approximately 30 mL (2 Tbsp) per day
- Ample whole grain cereals; limit white rice, pasta, or
- white bread to less than 2 servings per week
- Plentiful legumes (beans, chickpeas, etc.)
- Skimmed dairy products: 1 serving per day
- Homemade sauces in place of conventionally processed ones
- Limit red meat consumption as well as refined flour,
- sweetened drinks, pastries, and biscuits
Even if your eating patterns are very different from this list, decreasing refined flour and white bread while increasing plant-based foods is a good place to start. Most of this data does not account for your cultural or familial eating practices, so please keep this in mind as well.
These vitamins are essentially multivitamins that offer the minimum nutrients needed for a healthy pregnancy. Ideally, a prenatal, or folic acid (400 mcg)—at the very least— should be started before you try to conceive. The WHO and most national guidelines recommend taking folic acid if you’re of childbearing age. Folic acid is needed for rapid cell division (among other things), and a deficiency can cause neural tube defects. If you haven’t been on folic acid or a prenatal, then adding one in as soon as you discover you’re pregnant is recommended by healthcare professionals. Folic acid, choline, and DHA are three nutrients that play important roles in a baby’s nervous system development and should be part of your regimen (through a prenatal, food, or separate supplementation). Choline, especially, should be supplemented (if not prenatal) for patients who do not consume eggs.
This is another supplement to consider. It helps with the development of the placenta and the immune system and supports communication between the fetus and the placenta. Testing through blood and ensuring adequate levels is recommended.
This nutrient is important to supplement, especially if your iron is deficient. Iron deficiency in pregnancy is associated with preterm delivery, low birth weight, mental health issues, and poorer school performance in offspring. It’s also extremely prevalent in menstruating populations globally, so please take your iron!
The last supplement to consider would be calcium, especially if your dietary intake is low. It’s of special consideration for those with recurrent pregnancy loss, high-risk pregnancies, malnutrition, gestational hypertension, pre-eclampsia, heartburn, heparin use, and muscle cramping (which may be experienced at around weeks 18–22). A minimum of 1000 mg of calcium is recommended during pregnancy (there should be a little bit of it in your prenatal too). Food tracking apps or working with a nutritionist/ dietitian can help you figure out if you’re getting adequate calcium.
Exercise & Movement
There’s a lot of information about exercise during pregnancy on the internet. Strength training, walking, and other forms of cardiovascular exercise all show similar levels of benefit, although there may be additional benefits to a mixture of aerobic and resistance training.
“Sometimes Healthcare Professionals Don’t Discuss The Importance Of Exercise During Pregnancy, Which Can Leave Patients Feeling Like It’s Not A Priority.”
The guidelines in Canada are to reach a minimum of 150 minutes of moderate-intensity activity per week, spread over at least three days; ideally, some form of daily exercise is best. You can also layer in some non-exercise activities, like walking or stretching. If you haven’t been active before pregnancy, then perhaps 30 minutes of walking (at once or broken up) a few times per week is a good place to start. If you’re already active, then keeping up with your routine (with minor modifications with the help of a professional) should be fine. Listen to your body to gauge if you need to change the intensity or duration, as pregnancy does alter how your body allocates resources and there are physical changes that take place too.
Sometimes healthcare professionals don’t discuss the importance of exercise during pregnancy, which can leave patients feeling like it’s not a priority. Many people reduce or even avoid exercise altogether at this time because of misinformation; in almost every scenario, choosing exercise will help support your health and your baby’s as well. Even side effects like urinary incontinence are not significantly worse in people who exercise during their pregnancy.
Exercise may be contraindicated in certain circumstances (like preeclampsia, incompetent cervix, bleeding in the second or third trimester, premature rupture of membranes, premature labor, and more). If your primary healthcare provider has advised you to not exercise, please follow their recommendations.
Rest, Sleep, & Stress
We all need rest and sleep to function well, and pregnancy is no different (although sometimes sleeping can be difficult due to the physical changes accompanying pregnancy). Heartburn, a growing belly, pelvic or back pain, body/room temperature changes, and the stresses of life can all contribute to poor sleep. Talk to your healthcare team to see what would be most helpful for you. If aches and pains are getting in the way, then using a body pillow, getting a massage, or seeing a pelvic physiotherapist and chiropractor can all be good options. Using heartburn relief support (like medication or supplements) and having small meals can also help.
Stress management and self-care need to be priorities too; a lack of these practices can lead to poor sleep, feeling overwhelmed, and low energy or mood. Connecting with loved ones or other pregnant people, carving out time to engage in activities you enjoy, exercising, spending time in nature, going for a prenatal massage (make sure to disclose you’re pregnant!), counseling and guided meditations can all be ways to support your stress and mental health. You know what’s best for you, so make sure to take care of yourself and ask for help.
If you’re feeling anxious, overwhelmed, or down, please talk to your healthcare team for support. Low iron, vitamin D, and B12 can be associated with low and anxious mood, so ensuring those are appropriately addressed is a good idea. Maternal mental health issues have an impact on pregnancy outcomes, babies’ health in infancy, and even those babies as they grow up.
Pregnancy is not a diseased state; it’s simply a different state. Real hormonal, metabolic, and immune adaptations occur during this time. It also puts different stresses on the body which can help us understand the long-term risk of certain conditions like diabetes and hypertension.
There is a lot of conflicting information, misinformation (often well-intentioned), and fearmongering online. Ultimately, it’s always best to consult with your healthcare team about your health. And if you’re looking for vetted resources, Health Canada and the Society of Obstetricians and Gynaecologists of Canada have evidence-based information.