Recommendations for a Healthy Pregnancy
All women without contraindications should engage in at least 150 minutes of moderate-intensity physical activity weekly throughout pregnancy, take 400-800 mcg of folic acid daily starting at least 3 months before conception, maintain a healthy prepregnancy BMI of 19.8-26.0 kg/m², receive appropriate prenatal screening and immunizations, and avoid alcohol, tobacco, and teratogenic exposures. 1, 2
Physical Activity During Pregnancy
Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week, spread over a minimum of 3 days, though daily activity is encouraged. 1
- Incorporate a variety of aerobic and resistance training activities, with yoga and gentle stretching as beneficial additions 1
- Use the "talk test" to gauge intensity—you should be able to maintain a conversation during exercise 1
- For women under 29 years, moderate intensity corresponds to heart rates of 125-146 beats/min; for women 30+, it's 121-141 beats/min 1
- Pelvic floor muscle training (Kegel exercises) should be performed daily to reduce urinary incontinence risk by 50% prenatally and 35% postnatally 1
- Avoid the supine position during exercise if experiencing light-headedness, nausea, or feeling unwell 1
Activities to Avoid
- Never scuba dive during pregnancy due to fetal risk of decompression sickness and gas embolism 1
- Avoid activities with physical contact or fall risk: horseback riding, downhill skiing, ice hockey, gymnastics, Olympic lifts, and non-stationary cycling 1
- Avoid physical activity in excessive heat with high humidity 1
- Lowlanders should avoid physical activity above 2,500 meters altitude 1
Warning Signs to Stop Exercise Immediately
Stop physical activity and consult a healthcare provider if experiencing: 1
- Persistent excessive shortness of breath not resolving with rest
- Severe chest pain
- Regular, painful uterine contractions
- Vaginal bleeding
- Persistent fluid loss from vagina (possible membrane rupture)
- Persistent dizziness or faintness not resolving with rest
Preconception and Early Pregnancy Nutrition
Folic acid supplementation of 400-800 mcg daily should begin at least 3 months before conception and continue through the first trimester to reduce neural tube defect risk by nearly 75%. 1, 2, 3, 4
- Women with obesity (BMI >35), diabetes, epilepsy, or family history of neural tube defects require higher doses of 4-5 mg daily 1, 2, 3
- Achieve and maintain a healthy prepregnancy BMI of 19.8-26.0 kg/m² through balanced nutrition and exercise 1, 2
- Consume "five-a-day": two servings of fruit and three servings of vegetables 1, 2
- Take a daily multivitamin containing folic acid 1
- Maintain adequate hydration—drink water before, during, and after physical activity 1
Essential Preconception Screening and Assessment
Medical History Review
- Assess for chronic conditions affecting pregnancy: rheumatic heart disease, thromboembolism, autoimmune diseases, hypertension, diabetes, and thyroid disease 1, 2, 3
- Review all current medications and discontinue FDA pregnancy category X medications; evaluate category D medications for risk-benefit ratio 1, 2, 5
- Document reproductive history, including previous adverse outcomes (infant death, fetal loss, birth defects, low birth weight, preterm birth) 1, 2
Laboratory Testing
Complete the following tests: 1, 2, 5
- Complete blood count to screen for anemia
- Urinalysis and urine culture for asymptomatic bacteriuria
- Blood type and Rh screen
- Rubella immunity status
- Syphilis screening
- Hepatitis B surface antigen
- HIV testing
- Thyroid function tests (TSH and free T4) if indicated
Genetic Screening
- Assess risk based on maternal age (≥35 years increases chromosomal anomaly risk), ethnic background, and family history 1, 2, 3
- Offer carrier screening for cystic fibrosis and other conditions as indicated by ethnicity and family history 1, 2, 3
- Evaluate for consanguinity and review pedigree 2
Immunizations
Update all indicated immunizations before pregnancy, as some vaccines cannot be given during pregnancy. 1, 2, 5, 3
- Hepatitis B vaccine series if not immune 1, 2
- Rubella vaccine if no evidence of immunity (must wait one month before conceiving) 1, 2, 3
- Varicella vaccine if not immune (must wait one month before conceiving) 1, 2, 3
- Tdap vaccine 1, 2, 5
- Influenza vaccine 1, 2, 5
- HPV vaccine if age-appropriate 1, 2
Infection Prevention
- Screen for and treat periodontal, urogenital, and sexually transmitted infections as indicated 1, 2, 3
- Counsel on preventing TORCH infections (Toxoplasmosis, Other viruses, Rubella, Cytomegalovirus, Herpes simplex) 1, 2, 6
- Avoid raw or undercooked meat, unpasteurized dairy, and contact with cat litter to prevent toxoplasmosis 6
Lifestyle Modifications and Risk Avoidance
Substance Use
Complete abstinence from alcohol is mandatory when trying to conceive and throughout pregnancy. 1, 2, 3
- Implement smoking cessation using the five A's approach (Ask, Advise, Assess, Assist, Arrange) 1, 2, 3
- Screen for alcohol and substance abuse using CAGE or T-ACE questionnaires 1, 5
- Avoid all street drugs 6
Environmental and Occupational Exposures
- Avoid exposure to heavy metals, solvents, pesticides, endocrine disruptors, and allergens at home and workplace 1, 2, 3
- Review Material Safety Data Sheets for workplace chemicals and consult teratology information specialists as needed 1, 2
- Limit consumption of large fish to avoid mercury exposure 3
- Avoid insecticides 7
Safety Practices
- Always wear seatbelts throughout pregnancy 1, 2
- Most cosmetics and hair care products, including permanent wave solutions, are safe in limited exposures 7
- Allergy medications and common food additives like caffeine (in moderation) and aspartame are generally safe 7
Psychosocial Assessment and Support
- Screen for depression, anxiety, domestic violence, and major psychosocial stressors using validated instruments 1, 2, 5, 3
- Evaluate for intimate partner violence and provide appropriate referrals 2, 3
- Discuss mental health support, as pregnancies complicated by fetal anomalies have higher rates of anxiety and depression 2
Chronic Disease Optimization
Diabetes Management
- Achieve optimal glycemic control before conception through intensive management to reduce congenital anomaly risk 1, 2, 3, 6
- Monitor HbA1c every 3 months during pregnancy 1
Hypertension Control
- Ensure blood pressure is well-controlled using pregnancy-safe medications before conception 1, 2, 3, 6
- Continue monitoring throughout pregnancy 5
Thyroid Disease
- Manage hypothyroidism with appropriate levothyroxine dosage adjustments, as requirements increase during early pregnancy 2, 3, 6
Reproductive Life Planning
- Discuss optimal pregnancy spacing of 18-24 months between deliveries 3
- Develop a reproductive life plan based on values and resources 1
- For women not planning pregnancy, promote effective contraceptive use and discuss emergency contraception 1
Physical Examination Focus
Conduct a focused examination emphasizing: 1, 2, 5
- Periodontal health
- Thyroid examination
- Cardiac assessment
- Breast examination
- Pelvic examination
Special Populations
Women with Previous Bariatric Surgery
- Monitor nutritional status closely with serum indices every trimester, including ferritin, iron studies, folate, and vitamin B12 1
- Adjust gastric band as needed based on gestational weight gain and fetal growth 1
Women Over Age 35
- Provide comprehensive genetic counseling regarding age-related chromosomal abnormality risk 2, 3
- Offer appropriate aneuploidy screening options 2, 5, 3