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Proper health care key for successful pregnancy
By Cai Wenjun

When you and your partner are planning to have a baby, the first step is to schedule an appointment with your obstetrician for counseling prior to conception to ensure that you are in optimum health before getting pregnant, thus increasing the chances of having a healthy baby and a safe pregnancy and childbirth.

The obstetrician would do a medical history and a detailed physical examination, and several pertinent laboratory screening tests would be conducted during this consultation.

Any chronic medical illnesses like diabetes, hypertension and thyroid problems should be managed prior to getting pregnant as this could cause maternal complications during the pregnancy or congenital malformations during the baby’s development.

The immunization status would be checked and vaccinations may be given if you are not immune to organisms that could be contagious and cause several developmental abnormalities in a growing baby like rubella (German measles), hepatitis B or varicella (chicken pox).

Your reproductive and gynecological history is also very important; infertility issues are reviewed and treated. Any gynecological problems like irregular menstruation and fibroids are assessed and managed. If this is not the first pregnancy, this information is reviewed. The number of babies you may have delivered, whether full term or premature, and the type and mode of delivery, through vaginal delivery or through C-section, are reviewed. If there is any history of miscarriages, the probable cause and time interval since the miscarriage is also significant.

Your obstetrician will also enquire about your personal and occupational environment and the probability of exposure to harmful substances like heavy metals or radiation whether at work or at home. Also the nutritional status will be assessed and you are advised about food handling and food sanitation. Vitamin supplementation, particularly folic acid, is started to help prevent birth defects of the baby’s brain and spinal cord. Counseling is given regarding smoking and the effect of nicotine on the developing baby, and smoking cessation therapy is started if necessary. The risk of birth deficits and developmental disabilities caused by alcohol intake and substance abuse are also discussed.

Last but not least because both partners will contribute to the pregnancy, both of your family backgrounds would be investigated for any history of birth defects, mental retardation or any familial genetic and chromosomal abnormalities.

Prenatal check-ups

Dr Allyn Zamora, an obstetric and gynecological specialist at Shanghai East International Medical Center (SEIMC), said she received a 25-year-old woman for consultation and counseling. She and her husband wanted to have a baby but she was very anxious because of a very traumatic experience during her previous pregnancy at another hospital. She contracted German measles, putting her in the very difficult position of choosing whether to have her pregnancy terminated or continuing her pregnancy and risking having a baby with multiple congenital malformations.

“In the end she decided to have it terminated but all this emotional trauma could have been avoided if preconceptional care counseling were done prior to getting pregnant,” Zamora said.

Once the pregnancy is confirmed, prenatal check-ups should be started as early as possible. Regular visits help the obstetrician keep track of the woman’s body changes and form a long-term picture of how the body responds to her pregnancy, helping with early detection and treatment of complications.

There are several special precautions that a pregnant woman should take note of and practice especially during the first three months of pregnancy, when the baby’s organs are still developing.

First, limit caffeine intake to the equivalent or less than 300mg daily (approximately three cups of 5 ounces of percolated coffee) because intake of more than five cups a day of coffee is associated with increased risk of abortion. Completely avoid any alcoholic beverages as there is a high risk of stillbirth, miscarriage and having a baby with low birth weight and multiple congenital anomalies with alcohol intake.

Stop smoking, avoid smokers and stay away from smoking areas whenever possible because exposure to nicotine can double the risk of having a low birth-weight baby.

Avoid eating seafood and fish that contains mercury like shark, king mackerel and swordfish because mercury can cause developmental problems in the baby.

Do not eat raw or undercooked meat or eggs because it may contain harmful bacteria and can result in food poisoning and avoid unpasteurized foods like blue cheese and feta cheese because this has not undergone a thorough treatment process to remove harmful bacteria. Also it is important to practice food safety during food preparation to avoid parasitic and bacterial food contamination.

Preparation for childbirth and delivery depends on whether this is the first pregnancy or not, the mode of delivery or outcome of any previous pregnancies and whether there were any complications experienced during previous childbirth.

If this is the second pregnancy, your obstetrician and you can make plans in advance about childbirth labor and delivery plans and your obstetrician can be more prepared to manage or modify any complications the expecting mother experienced during her previous pregnancy based on the obstetrical history.

The journey through planning and preparing for a successful pregnancy, childbirth and delivery depends on the cooperation and coordinated efforts of the woman, the husband, the family and health care providers.

Nutrition during pregnancy

• Gain the proper amount of weight based on your body metabolic index. This is important because your baby’s weight is directly related to how much you gain throughout your pregnancy. A woman within the normal range BMI is expected to gain 11.5-16 kilograms for a pregnancy with one baby or 17-25kg for a pregnancy with twins. Underweight women are advised to gain 12.5-18kg while those who are overweight are advised to gain 7-11.5kg.

• Increase your calories by 100 to 300 calories a day to support body changes during pregnancy and for the baby’s proper growth and development.

• Increase your protein. You need to eat meat, milk and cheese to meet the demand of protein for the growth and development of your baby.

• Drink more water. At least eight glasses a day is recommended to keep yourself hydrated.

• Take calcium. At least 1,000 milligrams per day is recommended to ensure that your bone mass is preserved while the baby’s skeleton develops.

• Take iron. Because of the increase in your blood volume during pregnancy, you need to increase your iron intake. The recommended daily intake for pregnant women is 27mg per day.

• Take folic acid to reduce the risk of your baby having brain and spinal cord abnormalities

Common concerns in pregnancy

Pregnancy brings about a massive hormonal surge and changes in the body of the pregnant woman and because of this, most pregnant woman have to cope with the following pregnancy-related concerns.

• Nausea and vomiting: This is a common complaint and can start as early as the first or second missed menstrual period and last up to 14 to 15 weeks of pregnancy. Drinking safe herbal remedies like ginger can help, as can eating small, frequent meals and tea and crackers.

• Back ache: Seventy percent of pregnant women experience low back pain during pregnancy. The risk increases if the woman has a prior history of low back pain and if she is obese. To avoid this problem, pregnant women should squat rather than bend over when reaching down, use a back support like a pillow when sitting down and avoid wearing high-heeled shoes.

• Heartburn: This is the most common complaint of pregnant women. The increased frequency during pregnancy is most likely the result of the upward displacement and compression of the stomach by the uterus combined with relaxation of lower esophageal sphincter. Pregnant women are advised to eat small, frequent meals and avoid bending over or lying flat.

• Constipation: This is caused by hormones, vitamins and iron supplements. Pregnant women should eat lots of fruit and vegetables, and drink plenty of water.

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