What lifestyle modifications are recommended for a 26-year-old primigravid woman at 14 weeks gestation with a normal pregnancy, following a vegan diet, consuming 2 cups of coffee daily, and engaging in regular running, with a prepregnancy Body Mass Index (BMI) of 22 kg/m2 and normal vital signs?

From the Guidelines

The patient can continue her running routine of 5 miles most days, but she should aim to accumulate at least 150 min of moderate-intensity physical activity each week, as recommended by the 2019 Canadian guideline for physical activity throughout pregnancy 1. Her coffee intake of 2 cups daily is acceptable. For her vegan diet, she should ensure adequate protein intake and take supplements for nutrients commonly deficient in vegan diets during pregnancy. Her normal BMI and avoidance of tobacco, alcohol, and illicit drugs are positive health behaviors that should continue. As pregnancy progresses, she may need to modify her running routine by decreasing intensity, avoiding overheating, and possibly switching to lower-impact activities like swimming if she experiences discomfort. Some key considerations for her vegan diet include:

• Ensuring adequate protein intake of about 75-100g daily
• Taking supplements for vitamin B12, iron, calcium, vitamin D, and omega-3 fatty acids
• Staying hydrated and listening to her body if she needs to reduce intensity as pregnancy progresses. These recommendations aim to support fetal development while allowing her to maintain her active lifestyle with appropriate adjustments.

From the Research

Lifestyle Modifications During Pregnancy

The patient is a 26-year-old primigravid woman at 14 weeks gestation with no chronic medical conditions, following a vegan diet, and drinking 2 cups of coffee each morning. She is an avid runner and does not use tobacco, alcohol, or illicit drugs. Considering her lifestyle, the following modifications may be recommended:

• A healthy diet rich in vegetables, essential and polyunsaturated fats, and fibre-rich carbohydrates is crucial for a successful pregnancy 2.
• Adequate intake of micronutrients such as iron, calcium, folate, vitamin D, and carotenoids is essential to support pregnancy and breastfeeding 2, 3, 4.
• Moderate physical activity throughout pregnancy, such as running, can improve muscle tone and function, and decrease the risk of preeclampsia, gestational diabetes, and postpartum overweight 2.
• The patient's vegan diet may require additional supplementation to ensure adequate intake of essential nutrients, such as vitamin B12, iron, and omega-3 fatty acids 5, 3, 4.
• Caffeine intake should be limited to 200mg per day, approximately 1-2 cups of coffee 2.

Dietary Supplementation

The patient is already taking a daily prenatal vitamin, but the following supplements may be considered:

• Iron-folic acid (IFA) supplementation to reduce the risk of maternal anaemia and low birthweight 6.
• Multiple micronutrient (MMN) supplementation to reduce the risk of low birthweight, stillbirths, and small-for-gestational age 6.
• Calcium supplementation to improve rates of pre-eclampsia/eclampsia 6, 3.
• Vitamin D supplementation to reduce the risk of preterm births 6, 4.

Physical Activity

The patient's running routine can be continued, but the following precautions should be taken:

• Moderate physical activity, such as running, should be limited to 30 minutes per day 2.
• The patient should listen to her body and rest when needed, and avoid excessive physical activity that may cause fatigue or discomfort.