Pregnancy Tips and Tricks

We’ve put together the answers to the most common questions we get asked by pregnant women. We hope you find this information useful!

What vitamins do I need?

Folate (0.5mg/day) should be taken from before conception, until 12 weeks of pregnancy. This is to reduce the risk of neural tube defects. Some women need to take MegaFol (5mg of folate). These women have a personal or family history of Neural Tube Defects (NTD), have had a previous pregnancy affected by NTD, have Type 1 Diabetes, or are on medication for epilepsy.

Iodine (150 mcg/day) is recommended from before conception and throughout pregnancy. Iodine is important for thyroid function.

Omega 3 (500mg of DHA) from 12 weeks of pregnancy has been shown to reduce the risk of preterm delivery. We recommend that everyone considers this.

Aspirin 150mg taken at night, started in the first trimester or early second trimester, is recommended in some cases. Examples include: previous pre-eclampsia, pre-existing hypertension, a low Papp-A at first trimester screening, Type 1 or 2 diabetes, twins or higher-order pregnancies, pre-existing kidney disease, or autoimmune diseases such as lupus and antiphospholipid syndrome. If multiple of the following moderate-level risk factors are present, aspirin is also recommended. These include a BMI over 30, age over 35, first baby, or a family history of pre-eclampsia.

What dietary changes do I need to make?

Pregnant women need to be aware of foods that are high risk for listeria, salmonella, mercury and vitamin A, and avoid these foods during their pregnancy. Examples include: soft cheeses, deli meats, unwashed fruits/vegetables, smoked salmon, sushi, uncooked egg (including real mayonnaise), fish high in mercury such as swordfish, soft serve icecream, pate and offal. The NSW Food Authority has good information on this.

An increase in nutrients is ideal in pregnancy. This means eating a well-balanced diet with plenty of different coloured vegetables; food rich in iron; calcium; protein and whole grains. You do not need to eat for two, nor increase your daily calorie intake. Just focus on eating a variety of nutritious foods.

Alcohol and smoking should be avoided at all stages in pregnancy. Please discuss with us if you are struggling to reduce or quit. We can support you.

Caffeine: small amounts are fine (1-2 caffeinated drinks per day), but excessive amounts can risk miscarriage and premature delivery.

Can I exercise during pregnancy?

Exercise is generally safe during pregnancy, particularly if you have been doing the same activity before you were pregnant. Always listen to your body and stop or rest if you experience any pain. It is important to not overheat, so exercise in a well-ventilated area and keep hydrated.

Pregnancy pilates or yoga classes are a firm favourite with many women. They help improve core and pelvic floor strength and can help with many musculoskeletal issues in pregnancy.

I have cats – I’ve heard this is an issue?

The problem with cats and pregnancy is due to the risk of getting toxoplasmosis from their faeces. If you’re going to change their kitty litter, wear gloves, wash hands, or better still, delegate to someone else!

Toxoplasmosis is also present in soil, so be careful when gardening too. The symptoms of toxoplasmosis are very similar to the flu.

Can I have sex?

Generally, there is no issue with having sex while pregnant. Towards the later stages of pregnancy you may have to be creative with positions that are comfortable.

There are a few obstetric conditions where sex is best avoided. This is in the case of placenta praevia (where the placenta is low lying and covers the cervix); with recurrent threatened preterm labour; a short cervix; or ruptured membranes/amniotic fluid leak.

What medications should I avoid?

Your doctor should inform you if any prescribed medications you are on are unsafe in pregnancy. The vast majority are acceptable to continue.

The main over-the-counter medication that is best avoided while pregnant is ibuprofen and other anti-inflammatories.

The Women’s and Children’s Pharmacists are the best resource for what is safe to take during pregnancy and breastfeeding. You can contact them Monday to Friday 9am-5pm on (08) 8161 7555.

How do I manage the common pregnancy symptoms?

Reflux

This is a very common problem in pregnancy. You can try eating small meals, avoiding caffeine and chocolate, or trying over-the-counter options like Mylanta, Gaviscon and Quick-eze. Zantac (or ranitidine) is a tablet that is also very effective and is available without prescription. Stronger acid-suppression tablets are available on script and are safe in pregnancy.

Constipation

This can hit early and it’s because of the high progesterone in pregnancy slowing down gut transit time. Later in pregnancy, it is because of the large uterus further slowing things down. It is important to drink lots of water, try and stay active, and increase fibre in the diet. If this doesn’t work, try adding 2 Coloxyl tablets at night and increasing to twice a day. Coloxyl is a softener and won’t make the bowel lazy. The next step is adding Movicol sachets. If this isn’t working, touch base with your doctor to discuss other options.

Nausea and Vomiting

Experienced by the vast majority of women in early pregnancy, luckily most cases are mild and transient. For those that are suffering you can try things like: eating small amounts often; eating before getting out of bed; drinking semi-flat fizzy drinks; ginger ale/biscuits/tablets; eat plain and easy to prepare meals; and B6 tablets. The next step is Restavit (a sedating antihistamine, available over the counter). Try ¼-½tab at night initially. Beyond this, prescriptions are needed. Options include Maxolon, Stemetil and Ondansetron, or a combination of these. Ondansetron can cause significant constipation, so you will have to watch your bowels.

Fatigue

This is usually worse in the first trimester and abates over time. If it is persistent, getting your iron levels checked is a must. Unfortunately it is also common to experience insomnia while pregnant, which doesn’t help the situation!

Leg Cramps

These seem to be more common in pregnancy and the cause is poorly understood. Low iron levels can sometimes be to blame – so make sure yours are checked. Magnesium tablets can be helpful. As can keeping hydrated, stretching before bed, and Epsom salt baths.

Ankle Swelling

As long as it is mild, this is usually just a common pregnancy complaint. Try keeping your legs moving, not standing for long periods and wearing compression socks/tights. If your swelling suddenly increases, involves your fingers or face, it is important you see your doctor or midwife ASAP to get your blood pressure and urine protein levels checked. This can be a sign of pre-eclampsia.

Fainting

For some women, the physiological drop in blood pressure can cause all sorts of trouble with fainting or dizzy spells. Simple measures include: staying hydrated, eating plenty of snacks, standing up slowly, not standing for prolonged periods, wearing TEDs stockings or other compression tights, and lying on your side rather than your back.

Back Pain

A very common pregnancy complaint! Some will just get the odd niggle while others will be plagued with continuous discomfort and/or symptoms of pelvic instability or pubic symphysis pain (SPD). A physio is the best person to manage this for you. Supporting your belly with a tubi-grip can be useful, as well as maintaining fitness and flexibility. Pelvic instability and SPD can be managed with a brace if needed.

Sleeping Positions

From 20 weeks of pregnancy, your uterus is usually up to your belly button. This is where the inferior vena cava (the main vein bringing blood back to your heart) starts. If you lie on your back when you are over 20 weeks, there is a chance this vein will get compressed, causing a decrease in cardiac output. This can result in feeling faint, breathless, and also reduce blood flow to the placenta which can stress your baby. It is advised to sleep on your left side. At a minimum, placing a pillow or wedge under your right hip should displace the uterus off your vena cava.

Stretch Marks

Despite what is often claimed, not much can be done to prevent stretch marks. It is usually up to your genetic predisposition as to how your skin will tolerate the stretch during pregnancy. Keeping the skin well moisturised is your best defence, as well as not gaining excessive weight.

Is it safe to travel in pregnancy?

Most airlines will let you travel up to, and even beyond, 36 weeks within Australia if you have a singleton pregnancy. International travel has earlier restrictions. The airlines will need a letter from your doctor once you are past 28 weeks confirming you have an uncomplicated pregnancy. Letters generally need to be completed no more than 10 days before travel. All airlines publish their requirements for travelling when pregnant on their website. It is best to check with your specific airline before booking.

The safest time to travel is in your second trimester. It is best to avoid developing countries during your pregnancy due to the increased risk of infections and poor food and water quality. The most important aspect of travelling while pregnant is travel insurance. It can be very hard to find insurance for yourself, and even harder for a baby if it happens to come early while overseas. The costs of a hospital stay and NICU bed for your baby can be enormously expensive, especially in the USA where bills over AUD$500,000 are not unheard of.

Prevention of DVT (deep vein thrombosis) is important when travelling long distances by plane or car. Make sure you move your ankles and pump your calf muscles often during the journey. Keeping hydrated is also important (although may increase the swelling in your ankles). Avoid alcohol and caffeine. You can consider using travel socks or TED stockings. And most importantly – take your Pregnancy Hand Held Record with you!

For a printable PDF version of this information, click here.

By Dr Briony Andrew and Dr Rhiannon Smith

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