General Recommendations for a Healthy Pregnancy
All pregnant women should follow evidence-based guidelines for physical activity, nutrition, supplementation, and lifestyle modifications to optimize maternal and fetal health outcomes and reduce pregnancy complications. 1, 2
Physical Activity Recommendations
All women without contraindications should accumulate at least 150 minutes of moderate-intensity physical activity each week throughout pregnancy to achieve clinically meaningful health benefits and reduce pregnancy complications. 3
Physical activity during pregnancy is associated with decreased risk of pre-eclampsia, gestational hypertension, gestational diabetes, caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression. 3
Previously inactive women, women with gestational diabetes, and women categorized as overweight or obese should all be encouraged to engage in regular physical activity with appropriate modifications as needed. 3
Prenatal physical activity should be considered a front-line therapy for reducing pregnancy complications and enhancing maternal physical and mental health. 3
Nutrition and Weight Management
Weight gain during pregnancy should be guided by preconception BMI: underweight women should gain 28-40 lbs, normal weight women 25-35 lbs, overweight women 15-25 lbs, and obese women 11-20 lbs. 4
A well-balanced diet including omega-3 fatty acids from sources like oily fish (at least one weekly portion) is recommended for optimal fetal development. 4, 5
Unpasteurized foods should be avoided due to risk of listeriosis, and raw animal foods, soft cheeses, and packed fresh salads should be avoided to reduce risk of listeriosis and toxoplasmosis. 4, 5
Fresh fruits, vegetables, and salads should be washed thoroughly and consumed promptly. 5
Supplementation
Folic acid supplementation (400-800 mcg daily) should be started before pregnancy and continued for at least the first trimester to reduce neural tube defect risk. 1, 2, 4
A daily prenatal vitamin containing at least 30 mg of elemental iron is recommended to promote neurologic and musculoskeletal fetal development. 4
Iodine-rich foods and an iodine supplement (100-150 μg/day) are recommended during pregnancy. 5
Calcium supplementation of at least 1g per day is beneficial during pregnancy and can reduce the risk of pre-eclampsia by nearly half, particularly in high-risk women. 6
Vitamin D supplementation is advisable unless there is regular exposure to sunlight. 5
Screening and Monitoring
All pregnant women should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella. 2
Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection. 2
Screening for gestational diabetes between 24 and 28 weeks is recommended for all pregnant women. 2
People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks. 2
Universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy due to the impact of social determinants of health on outcomes. 2
Lifestyle Modifications
Complete abstinence from alcohol is recommended during pregnancy as there is insufficient evidence regarding fetal safety at low levels of alcohol consumption. 7
Caffeine intake should be limited to 200 mg per day (approximately two small cups of coffee), and energy drinks should be avoided. 4, 5
Both active and passive smoking should be avoided during pregnancy. 5
Artificial sweeteners should be avoided during pregnancy. 4
Sexual activity can be continued throughout an uncomplicated pregnancy. 4
Immunizations
- All pregnant women should receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines. 2
Chronic Disease Management
Chronic hypertension should be treated to maintain blood pressure below 140/90 mm Hg. 2
When using medications for chronic conditions during pregnancy, be aware of potential interactions. For example, methyldopa (used for hypertension) should not be coadministered with ferrous sulfate or ferrous gluconate as this may decrease methyldopa's bioavailability and adversely affect blood pressure control. 8
Women with diabetes should achieve optimal glycemic control before and during pregnancy to reduce congenital anomaly risk. 9
Treatment of iron deficiency anemia decreases the risk of preterm delivery, intrauterine growth restriction, and perinatal depression. 2