Eating healthy foods is more important now than ever! You need more protein, iron, calcium, and folic acid than you did before pregnancy. You also need more calories. But "eating for two" doesn't mean eating twice as much. Rather, it means that the foods you eat are the main source of nutrients for your baby. Sensible, balanced meals combined with regular physical fitness is still the best recipe for good health during your pregnancy.

The amount of weight you should gain during pregnancy depends on your body mass index (BMI) before you became pregnant. The Institute of Medicine provides these guidelines:

• If you were at a normal weight before pregnancy, you should gain about 25 to 30 pounds.
• If you were underweight before pregnancy, you should gain between 28 and 40 pounds.
• If you were overweight before pregnancy, you should gain between 15 and 25 pounds.
• If you were obese before pregnancy, you should gain between 11 and 20 pounds.

Check with your doctor to find out how much weight gain during pregnancy is healthy for you.

You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester. Generally, doctors suggest women gain weight at the following rate:

• 2 to 4 pounds total during the first trimester
• 3 to 4 pounds per month for the second and third trimesters

Recent research shows that women who gain more than the recommended amount during pregnancy and who fail to lose this weight within six months after giving birth are at much higher risk of being obese nearly 10 years later. Findings from another large study suggest that gaining more weight than the recommended amount during pregnancy may raise your child's odds of being overweight in the future. If you find that you are gaining weight too quickly, try to cut back on foods with added sugars and solid fats. If you are not gaining enough weight, you can eat a little more from each food group.

Where does the added weight go?

• Baby – 6 to 8 pounds
• Placenta – 1½ pounds
• Amniotic fluid – 2 pounds
• Uterus growth – 2 pounds
• Breast growth – 2 pounds
• Your blood and body fluids – 8 pounds
• Your body's protein and fat – 7 pounds

Your calorie needs will depend on your weight gain goals. Most women need 300 calories a day more during at least the last six months of pregnancy than they do pre-pregnancy. Keep in mind that not all calories are equal. Your baby needs healthy foods that are packed with nutrients — not "empty calories" such as those found in soft drinks, candies, and desserts.

Although you want to be careful not to eat more than you need for a healthy pregnancy, make sure not to restrict your diet during pregnancy either. If you don't get the calories you need, your baby might not get the right amounts of protein, vitamins, and minerals. Low-calorie diets can break down a pregnant woman's stored fat. This can cause your body to make substances called ketones. Ketones can be found in the mother's blood and urine and are a sign of starvation. Constant production of ketones can result in a child with mental deficiencies.

A pregnant woman needs more of many important vitamins, minerals, and nutrients than she did before pregnancy. Making healthy food choices every day will help you give your baby what he or she needs to develop. ChooseMyPlate for pregnant and breastfeeding women can show you what to eat as well as how much you need to eat from each food group based on your height, weight, and activity level.

Talk to your doctor if you have special diet needs for these reasons:

• Diabetes – Make sure you review your meal plan and insulin needs with your doctor. High blood glucose levels can be harmful to your baby.
• Lactose intolerance – Find out about low-lactose or reduced-lactose products and calcium supplements to ensure you are getting the calcium you need.
• Vegetarian – Ensure that you are eating enough protein, iron, vitamin B₁₂, and vitamin D.
• PKU – Keep good control of phenylalanine (FEN-uhl-AL-uh-NEEN) levels in your diet.

Most foods are safe for pregnant women and their babies. But you will need to use caution or avoid eating certain foods. Follow these guidelines:

Clean, handle, cook, and chill food properly to prevent foodborne illness, including listeria and toxoplasmosis.

• Wash hands with soap after touching soil or raw meat.
• Keep raw meats, poultry, and seafood from touching other foods or surfaces.
• Cook meat completely.
• Wash produce before eating.
• Wash cooking utensils with hot, soapy water.

Do not eat:

• Refrigerated smoked seafood like whitefish, salmon, and mackerel
• Hot dogs or deli meats unless steaming hot
• Refrigerated meat spreads
• Unpasteurized milk or juices
• Store-made salads, such as chicken, egg, or tuna salad
• Unpasteurized soft cheeses, such as unpasteurized feta, Brie, queso blanco, queso fresco, and blue cheeses
• Shark, swordfish, king mackerel, or tile fish (also called golden or white snapper); these fish have high levels of mercury.
• More than 6 ounces per week of white (albacore) tuna
• Herbs and plants used as medicines without your doctor's okay. The safety of herbal and plant therapies isn't always known. Some herbs and plants might be harmful during pregnancy, such as bitter melon (karela), noni juice, and unripe papaya.
• Raw sprouts of any kind (including alfalfa, clover, radish, and mung bean)

Fish and shellfish can be an important part of a healthy diet. They are a great source of protein and heart-healthy omega-3 fatty acids. What's more, some researchers believe low fish intake may be linked to depression in women during and after pregnancy. Research also suggests that omega-3 fatty acids consumed by pregnant women may aid in babies' brain and eye development.

Women who are or may become pregnant and nursing mothers need 12 ounces of fish per week to reap the health benefits. Unfortunately, some pregnant and nursing women do not eat any fish because they worry about mercury in seafood. Mercury is a metal that at high levels can harm the brain of your unborn baby — even before it is conceived. Mercury mainly gets into our bodies by eating large, predatory fish. Yet many types of seafood have little or no mercury at all. So the risk of mercury exposure depends on the amount and type of seafood you eat.

Women who are nursing, pregnant, or who may become pregnant can safely eat a variety of cooked seafood, but should steer clear of fish with high levels of mercury. Keep in mind that removing all fish from your diet will rob you of important omega-3 fatty acids. To reach 12 ounces while limiting exposure to mercury, follow these tips:

• Do not eat these fish that are high in mercury:

  • Swordfish
  • Tilefish
  • King mackerel
  • Shark
• Eat up to 6 ounces (about 1 serving) per week:
  Canned albacore or chunk white tuna (also sold as tuna steaks), which has more mercury than canned light tuna

• Eat up to 12 ounces (about 2 servings) per week of cooked* fish and shellfish with little or no mercury, such as:

  • Shrimp
  • Crab
  • Clams
  • Oysters
  • Scallops
  • Canned light tuna
  • Salmon
  • Pollock
  • Catfish
  • Cod
  • Tilapia

  * Don't eat uncooked fish or shellfish (such as clams, oysters, scallops), which includes refrigerated uncooked seafood labeled nova-style, lox, kippered, smoked, or jerky.

• Check before eating fish caught in local waters. State health departments have guidelines on fish from local waters. Or get local fish advisories at the U.S. Environmental Protection Agency. If you are unsure about the safety of a fish from local waters, only eat 6 ounces per week and don't eat any other fish that week.
• Eat a variety of cooked seafood rather than just a few types.

Foods supplemented with DHA/EPA (such as “omega-3 eggs”) and prenatal vitamins supplemented with DHA are other sources of the type of omega-3 fatty acids found in seafood.

In addition to making healthy food choices, ask your doctor about taking a prenatal vitamin and mineral supplement every day to be sure you are getting enough of the nutrients your baby needs. You also can check the label on the foods you buy to see how much of a certain nutrient the product contains. Women who are pregnant need more of these nutrients than women who are not pregnant:

Nutrients and Pregnancy

Women who are pregnant also need to be sure to get enough vitamin D. The current recommendation for all adults younger than 71 (including pregnant and breastfeeding women) is 600 international units (IU) of vitamin D each day. Talk to your doctor about how you can be sure to get enough vitamin D and other important vitamins and nutrients.

Keep in mind that taking too much of a supplement can be harmful. For example, very high levels of vitamin A can cause birth defects. For this reason, your daily prenatal vitamin should contain no more than 5,000 IU (International Units) of vitamin A. Some supplements contain much more. Only take vitamins and mineral supplements that your doctor recommends

All of your body's systems need water. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. Water also helps prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Not getting enough water can lead to premature or early labor.

Your body gets the water it needs through the fluids you drink and the foods you eat. How much fluid you need to drink each day depends on many factors, such as your activity level, the weather, and your size. Your body needs more fluids when it is hot and when you are physically active. It also needs more water if you have a fever or if you are vomiting or have diarrhea.

The Institute of Medicine recommends that pregnant women drink about 10 cups of fluids daily. Water, juices, coffee, tea, and soft drinks all count toward your fluid needs. But keep in mind that some beverages are high in sugar and "empty" calories. A good way to tell if your fluid intake is okay is if your urine is pale yellow or colorless and you rarely feel thirsty. Thirst is a sign that your body is on its way to dehydration. Don't wait until you feel thirsty to drink.

There is no known safe amount of alcohol a woman can drink while pregnant. When you are pregnant and you drink beer, wine, hard liquor, or other alcoholic beverages, alcohol gets into your blood. The alcohol in your blood gets into your baby's body through the umbilical cord. Alcohol can slow down the baby's growth, affect the baby's brain, and cause birth defects.

Moderate amounts of caffeine appear to be safe during pregnancy. Moderate means less than 200 mg of caffeine per day, which is the amount in about 12 ounces of coffee. Most caffeinated teas and soft drinks have much less caffeine. Some studies have shown a link between higher amounts of caffeine and miscarriage and preterm birth. But there is no solid proof that caffeine causes these problems. The effects of too much caffeine are unclear. Ask your doctor whether drinking a limited amount of caffeine is okay for you.

Many women have strong desires for specific foods during pregnancy. The desire for "pickles and ice cream" and other cravings might be caused by changes in nutritional needs during pregnancy. The fetus needs nourishment. And a woman's body absorbs and processes nutrients differently while pregnant. These changes help ensure normal development of the baby and fill the demands of breastfeeding once the baby is born.

Some women crave nonfood items such as clay, ice, laundry starch, or cornstarch. A desire to eat nonfood items is called pica. Eating nonfood items can be harmful to your pregnancy. Talk to your doctor if you have these urges.

Fitness goes hand in hand with eating right to maintain your physical health and well-being during pregnancy. Pregnant or not, physical fitness helps keep the heart, bones, and mind healthy. Healthy pregnant women should get at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week. It's best to spread your workouts throughout the week. If you regularly engage in vigorous-intensity aerobic activity or high amounts of activity, you can keep up your activity level as long as your health doesn't change and you talk to your doctor about your activity level throughout your pregnancy.

Special benefits of physical activity during pregnancy:

• Exercise can ease and prevent aches and pains of pregnancy including constipation, varicose veins, backaches, and exhaustion.
• Active women seem to be better prepared for labor and delivery and recover more quickly.
• Exercise may lower the risk of preeclampsia and gestational diabetes during pregnancy.
• Fit women have an easier time getting back to a healthy weight after delivery.
• Regular exercise may improve sleep during pregnancy.
• Staying active can protect your emotional health. Pregnant women who exercise seem to have better self-esteem and a lower risk of depression and anxiety.
• Results from a recent, large study suggest that women who are physically active during pregnancy may lower their chances of preterm delivery.

Should I be physically active during my pregnancy?

Almost all women can and should be physically active during pregnancy. According to current physical activity guidelines, regular physical activity may

• help you and your baby gain the appropriate amounts of weight
• reduce backaches, leg cramps, and bloating
• reduce your risk for gestational diabetes (diabetes during pregnancy)
• reduce your risk for postpartum depression

There's also some evidence that physical activity may reduce the risk of problems during pregnancy such as preeclampsia (high blood pressure during pregnancy), reduce the length of labor and postpartum recovery, and reduce the risk of having a cesarean section (or C-section).

If you were physically active before you became pregnant, you may not need to change your exercise habits. Talk with your health care professional about how to change your workouts during pregnancy.

Being physically active can be hard if you don’t have childcare for your other children, haven’t exercised before, or don’t know what to do. Keep reading for tips about how you can work around these hurdles and be physically active.

How much and what type of physical activity do I need?

According to current guidelines, most women need the same amount of physical activity as they did before becoming pregnant. Aim for at least 150 minutes a week of moderate-intensity aerobic activity. Aerobic activities—also called endurance or cardio activities—use large muscle groups (back, chest, and legs) to increase your heart rate and breathing. Brisk walking is a form of aerobic activity.

How can you tell if you’re doing moderate-intensity aerobic activity? Take the “talk test” to find out. If you’re breathing hard but can still have a conversation easily—but you can’t sing—that’s moderate intensity.

If you can only say a few words before pausing for a breath, that’s called vigorous-intensity activity. If you were in the habit of doing vigorous-intensity aerobic activity or were physically active before your pregnancy, then it’s likely okay for you to continue these activities during your pregnancy.

You can talk to your health care professional about whether to or how to adjust your physical activity while you’re pregnant. If you have health issues such as obesity, high blood pressure, diabetes, or anemia (too few healthy red blood cells), ask your health care professional about a level of activity that’s safe for you and your unborn baby.

How can I stay active while pregnant?

Even if you haven’t been active before, you can be active during your pregnancy. Here are some tips.

• Go for a walk where you live, in a local park, or in a shopping mall with a family member or friend. If you already have children, take them with you and make it a family outing.
• Get up and move around at least once an hour if you sit most of the day. When watching TV or sitting at your computer, get up and move around. Even a simple activity like walking in place can help.
• Make a plan to be active while pregnant. List the activities you’d like to do, such as walking or taking a prenatal yoga class. Think of the days and times you could do each activity on your list, such as first thing in the morning, during your lunch break from work, after dinner, or on Saturday afternoon. Look at your calendar or phone or other device to find the days and times that work best and commit to those plans.

How can I stay safe while being active?

For your health and safety, and for your baby’s, you should not do certain physical activities while pregnant. Some of these are listed below. Talk to your health care professional about other physical activities you should not do.

Safety do’s and don’ts

Follow these safety tips while being active.

For most healthy moms-to-be who do not have any pregnancy-related problems, exercise is a safe and valuable habit. Even so, talk to your doctor or midwife before exercising during pregnancy. She or he will be able to suggest a fitness plan that is safe for you. Getting a doctor's advice before starting a fitness routine is important for both inactive women and women who exercised before pregnancy.

If you have one of these conditions, your doctor will advise you not to exercise:

• Risk factors for preterm labor
• Vaginal bleeding
• Premature rupture of membranes (when your water breaks early, before labor)

Before you become pregnant, it is best to have dental checkups routinely to keep your teeth and gums healthy. If you are pregnant and have not had regular checkups, consider the following:

• Have a complete oral exam early in your pregnancy. Because you are pregnant, you might not receive routine x-rays. But if you must have x-rays for a dental problem needing treatment, the health risk to your unborn baby is small.
• Dental treatment during pregnancy is safe. The best time for treatment is between the 14th and 20th weeks. During the last months of pregnancy, you might be uncomfortable sitting in a dental chair.
• Do not avoid necessary dental treatments — you may risk your and your baby's health.
• Use good oral hygiene to control your risk of gum diseases. Pregnant women may have changes in taste and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. It can be caused by both poor oral hygiene and higher hormone levels during pregnancy. Until recently, it was thought that having gum disease could raise your risk of having a low birth weight baby. Researchers have not been able to confirm this link, but some research is still under way to learn more.

After you give birth, maintain good oral hygiene to protect your baby's oral health. Bacteria that cause cavities can transfer from you to your child by:

• A kiss on the mouth
• Letting your baby put her fingers in your mouth
• Tasting food on your baby's spoon
• Testing the temperature of a baby bottle with your mouth

You also should find a dentist for your child by age 1.

• During pregnancy, women may be more prone to gum disease and cavities.
• Pregnant women are more likely to develop gingivitis, an early stage of periodontal disease that occurs when the gums become red and swollen from inflammation that may be aggravated by changing hormones during pregnancy.
• 1 in 4 women of childbearing age have untreated cavities.
• A mother’s oral health status is a strong predictor of her child’s oral health status.
• Children of mothers who have high levels of untreated cavities or tooth loss are more than 3 times as likely to have cavities.
• Children with poor oral health status are nearly 3 times more likely to miss school because of dental pain.
• Regular and emergency dental care is safe at any stage of pregnancy.
• Women are encouraged to seek routine dental care during pregnancy.

You and your baby are connected. The medicines you use, including over-the-counter, herbal, and prescription drugs or supplements, might get into your baby's body, too. Many medicines and herbs are known to cause problems during pregnancy, including birth defects. For some medicines, we don't know that much about how they might affect pregnancy or the developing fetus. This is because medicines are rarely tested on pregnant women for fear of harming the fetus.

Mothers-to-be might wonder if it's safe to use medicines during pregnancy. There is no clear-cut answer to this question. Your doctor can help you make the choice whether to use a medicine. Labels on prescription and over-the-counter drugs have information to help you and your doctor make this choice. In the future, a new prescription drug label will make it easier for women and their doctors to weigh the benefits and risks of using prescription medicines during pregnancy.

Always speak with your doctor before you start or stop any medicine. Not using medicine that you need may be more harmful to you and your baby than using the medicine.

Weighing benefits and risks

When deciding whether to use a medicine in pregnancy, you and your doctor need to talk about the medicine's benefits and the risks.

• Benefits – what are the good things the medicine can do for me and my growing baby?
• Risks – what are the ways the medicine might harm me or my growing baby?

There may be times during pregnancy when using medicine is a choice. For example, if you get a cold, you may decide to "live with" your stuffy nose instead of using the "stuffy nose" medicine you use when you are not pregnant.

Other times during pregnancy, using medicine is not a choice — it is needed. For example, you might need to use medicine to control an existing health problem like asthma, diabetes, depression, or seizures. Or, you might need a medicine for a few days, such as an antibiotic to treat a bladder infection or strep throat. Also, some women have a pregnancy problem that needs medicine treatment. These problems include severe nausea and vomiting, earlier pregnancy losses, or preterm labor.

Using herbal or dietary supplements and other "natural" products

You might think herbs are safe because they are "natural." But, except for some vitamins, little is known about using herbal or dietary supplements while pregnant. Some herbal remedy labels claim they will help with pregnancy. But, most often there are no good studies to show if these claims are true or if the herb can cause harm to you or your baby. Also, some herbs that are safe when used in small amounts as food might be harmful when used in large amounts as medicines. So, talk with your doctor before using any herbal or dietary supplement or natural product. These products may contain things that could harm you or your growing baby.

Everyday life doesn't stop once you are pregnant. Most healthy pregnant women are able to continue with their usual routine and activity level. That means going to work, running errands, and for some, traveling away from home. To take care of yourself and help keep your baby safe, consider these points before taking a long trip or traveling far from home:

• Talk to your doctor before making any travel decisions that will take you far from home. Ask if any health conditions you might have makes travel during pregnancy unsafe. Also consider the destination. Is the food and water safe? Will you need immunizations before you go? Is there good medical care available in the event of an emergency? Will your health insurance cover medical care at your destination?
• Avoid sitting for long periods during car or air travel. Prolonged sitting can affect blood flow in your legs. Try to limit driving to no more than 5 or 6 hours each day. Take frequent breaks to stretch your legs. Stand up, and move your legs often during air travel. Wearing support pantyhose also can help blood flow.
• Occasional air travel is safe for most pregnant women, and most airlines will allow women to fly up to 36 weeks of pregnancy. Make sure to wear your seatbelt during the flight, and take steps to ease the discomforts of prolonged travel and sitting. Frequent air travel during pregnancy increases the risk of fetal exposure to cosmic radiation. If you are a pregnant pilot, aircrew member, or other frequent flier, check with your employer about flying restrictions.
• Bring a copy of your medical record and find out about medical care at your destination so you will be prepared in the event of an emergency.
• If you suspect a problem with your pregnancy during your trip, don't wait until you come home to see your doctor. Seek medical care right away.

Buckle up!

Wearing a seatbelt during car and air travel is safe while pregnant. The lap strap should go under your belly, across your hips. The shoulder strap should go between your breasts and to the side of your belly. Make sure it fits snugly.

The environment is everything around us wherever we are — at home, at work, or outdoors. Although you don't need to worry about every little thing you breathe in or eat, it's smart to avoid exposure to substances that might put your pregnancy or unborn baby's health at risk.

During pregnancy, avoid exposure to:

• Lead – found in some water and paints, mainly in homes built before 1978
• Mercury – the harmful form is found mainly in large, predatory fish.
• Arsenic – high levels can be found in some well water
• Pesticides – both household products and agricultural pesticides
• Solvents – such as degreasers and paint strippers and thinners
• Cigarette smoke

Keep in mind: We don't know how much exposure can lead to problems, such as miscarriage or birth defects. That is why it's best to avoid or limit your exposure as much as possible. Here are some simple, day-to-day precautions you can take:

• Clean in only well-ventilated spaces. Open the windows or turn on a fan.
• Check product labels for warnings for pregnant women and follow instructions for safe use.
• Do not clean the inside of an oven while pregnant.
• Leave the house if paint is being used, and don't return until the fumes are gone.

If you are exposed to chemicals in the workplace, talk to your doctor and your employer about what you can do to lower your exposure. Certain industries, such as dry cleaning, manufacturing, printing, and agriculture, involve use of toxins that could be harmful. If you are concerned about the safety of your drinking water, call your health department or water supplier to ask about the quality of your tap water or how to have your water tested. Or, call the Environmental Protection Agency's Safe Drinking Water Hotline at (800) 426-4791. Don't assume that bottled water is better or safer. Usually, bottle water offers no health benefits over tap water.

Smoking cigarettes is very harmful to your health and could also affect the health of your baby. Not only does smoking cause cancer and heart disease in people who smoke, smoking during pregnancy increases the risk of low birth weight. Low birth weight babies are at higher risk of health problems shortly after birth. Also, some studies have linked low birth weight with a higher risk of health problems later in life, such as high blood pressure and diabetes. Women who smoke during pregnancy are more likely than other women to have a miscarriage and to have a baby born with cleft lip or palate, types of birth defects. Also, mothers who smoke during or after pregnancy put their babies at greater risk of sudden infant death syndrome (SIDS).

Mothers who smoke have many reasons to quit smoking. Take care of your health and your unborn baby's health: Ask your doctor about ways to help you quit during pregnancy. Intensive counseling has been shown to increase a pregnant woman's chances of quitting success. We don't know whether the drugs used to help people quit are safe to use during pregnancy. But we do know that continuing to smoke during pregnancy threatens your and your baby's health. Quitting smoking is hard, but you can do it with help!

Using alcohol and illegal drugs during pregnancy threatens the health of your unborn baby. So does using legal drugs in an inappropriate way. When you use alcohol or drugs, the chemicals you ingest or breathe into your lungs cross the placenta and enter your baby. This puts your baby at risk for such problems as stillbirth, low birth weight, birth defects, behavioral problems, and developmental delays.

Alcohol

When you drink alcohol, so does your baby. Pregnant women should not drink alcohol to eliminate the chance of giving birth to a baby with fetal alcohol spectrum disorder (FASD). FASD involves a range of harmful effects that can occur when a fetus is exposed to alcohol. The effects can be mild to severe. Children born with a severe form of FASD can have abnormal facial features, severe learning disabilities, behavioral problems, and other problems.

You might think a drink now and then won't hurt your baby. But we don't know how much alcohol it takes to cause harm. We do know that the risk of FASD, and the likely severity, goes up with the amount of alcohol consumed during pregnancy. Also, damage from alcohol can occur in the earliest stages of pregnancy — often before a woman knows she is pregnant. For this reason, women who may become pregnant also should not drink.

Illegal drugs

Many women who use illegal drugs also use tobacco and alcohol. So, it's not always easy to tell the effects of one drug from that of alcohol, tobacco, or other drugs. We do know that using illegal drugs during pregnancy is very dangerous. Babies born to women who use drugs such as cocaine, heroine, and methamphetamine are likely to be born addicted and must go through withdrawal. Mothers who inject drugs are at higher risk of getting HIV, which can be passed to an unborn baby. Some studies suggest that the effects of drug use during pregnancy might not be seen until later in childhood.

Getting help for alcohol or drug use

If you drink alcohol or use drugs and cannot quit, talk to your doctor right away. Treatment programs can help pregnant women with addiction and abuse. You can quit using and give your baby a good start to life.

It's hard to be excited about the new life growing inside of you if you're afraid of your partner. Abuse from a partner can begin or increase during pregnancy and can harm you and your unborn baby. Women who are abused often don't get the prenatal care their babies need. Abuse from a partner also can lead to preterm birth and low birth weight babies, stillbirth and newborn death, and homicide. If you are abused, you might turn to alcohol, cigarettes, or drugs to help you cope. This can be even more harmful to you and your baby.

You may think that a new baby will change your situation for the better. But the cycle of abuse is complex, and a baby introduces new stress to people and relationships. Now is a good time to think about your safety and the safety and wellbeing of your baby. About 50 percent of men who abuse their wives also abuse their children. Think about the home environment you want for your baby. Studies show that children who witness or experience violence at home may have long-term physical, emotional, and social problems. They are also more likely to experience or commit violence themselves in the future.

Prenatal exams offer a good chance to reach out for help. It's possible to take control and leave an abusive partner. But for your and your baby's safety, talk to your doctor first. Let motherhood prompt you to take action now.

If you're a victim of abuse or violence at the hands of someone you know or love, or you are recovering from an assault by a stranger, you and your baby can get immediate help and support.

• The National Domestic Violence Hotline can be reached 24 hours a day, 7 days a week at 800-799-SAFE (7233) and 800-787-3224 (TTY). Spanish speakers are available. When you call, you will first hear a recording and may have to hold. Hotline staff offer crisis intervention and referrals. If requested, they connect women to shelters and can send out written information.
• The National Sexual Assault Hotline can be reached 24 hours a day, 7 days a week at 800-656-4673. When you call, you will hear a menu and can choose #1 to talk to a counselor. You will then be connected to a counselor in your area who can help you. You can also visit the National Sexual Assault Online Hotline.

When you are pregnant, do not hesitate to call your doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem.

Call your doctor or midwife as soon as you can if you:

• Are bleeding or leaking fluid from the vagina
• Have sudden or severe swelling in the face, hands, or fingers
• Get severe or long-lasting headaches
• Have discomfort, pain, or cramping in the lower abdomen
• Have a fever or chills
• Are vomiting or have persistent nausea
• Feel discomfort, pain, or burning with urination
• Have problems seeing or blurred vision
• Feel dizzy
• Suspect your baby is moving less than normal after 28 weeks of pregnancy (if you count less than 10 movements within 2 hours.
• Have thoughts of harming yourself or your baby

Pregnancy is a time of great joy, but even under the best circumstances, it is also a time of considerable stress and challenge, both physically and emotionally. Expectant mothers understandably want to know, “What can I do to make sure my baby is as healthy as possible? And what can I do to make sure I stay healthy—and happy—during my pregnancy?”

There are countless guides to pregnancy that offer expectant moms very similar, if not identical, suggestions, and for good reason: the tried-and-true guidelines concerning nutritious eating, healthy habits, regular exercise, and social and emotional support are now verities because they are firmly grounded in medical science, experience, and common sense. Regular prenatal visits, of course, are the best way for women to monitor their own health and the progress of their pregnancy. Health professionals can also recommend sources of useful information and other types of resources.

In recent years, relaxation resources available to expectant mothers have steadily expanded and now include yoga, meditation, massage, and other techniques. Dietary advice is better and more detailed than ever, including information on vitamins and caffeine. The evidence that shows that smoking, alcohol, and addictive drugs can seriously harm your baby is more convincing than ever. Doctors today also have a better idea of which prescription drugs and over-the-counter medicines might pose dangers to a developing fetus (a growing concern, considering that a survey of 14,000 pregnant women in 22 countries found that 86% of these women took medication during pregnancy, with an average woman taking 2.9 medications).

Stress, Blues, and Impact on Moms

Scientists today are also gaining insights into the impact of stress on pregnancy. The results confirm the commonsense hunch that women under terrible stress give birth to babies who are likely to suffer some effects of this stress. The results are not so clear when it comes to pregnant women under moderate stress, which includes a great many expectant mothers. And do happier moms have happier babies? That’s actually the trickiest question of all to answer, or to even experimentally evaluate. One thing that can safely be said, however, is that the happier the mom—well, the happier the mom! And that, everyone can agree, is a good thing in itself, and can only help a mother better cope with pregnancy, birth, and the arrival of her baby.

Not everything goes as smoothly or as happily as every mom would like, of course. Roughly half of all new mothers experience some degree of “postpartum blues” a few days after birth. A smaller percentage, between 10-15%, go on to experience more serious depression several weeks after birth. The most commonly cited symptoms include anxiety, sleep disturbances, concern for the baby, depression, irritability, and hostility. Perhaps not surprisingly, studies have shown that mothers suffering from depression also seem to have more pessimistic opinions about their babies’ dispositions.

Why does this happen? One formerly popular interpretation was that mothers became depressed following birth due to their “sense of loss” at no longer being pregnant. As Sarah Blaffer Hrdy observes, however, “few contemporary psychiatrists, and even fewer mothers, are persuaded that women are anything other than relieved when pregnancy ends.”

What seems more certain is that there are a number of risk factors that seem to correlate with postpartum depression, including a history of depression, high levels of stress and anxiety, and little or no social support. A mother’s depression doesn’t just affect her, of course. There is growing research evidence, according to researcher Jacqueline McGrath and colleagues, that “postpartum depression has the potential for long-lasting effects for both the mother and the infant.”

Impact of Stress on Baby

But just how much stress is too much? First of all, stress is not definable as just “one” thing, and it isn’t even always a bad thing. There is actually positive stress that is a part of life’s daily challenges. For a developing infant, this could involve dealing with routine frustration and mastering separation. Being able to manage this type of stress is important for growth and development. There is negative, but tolerable stress, which can have an adverse impact over the long run. What usually makes stress tolerable for babies and children is the support of caregivers. But there is also very serious and chronic stress. In the absence of strong caregiver support, this sort of “toxic” stress can take a terrible toll on a child.

One of the ways that stress is mediated in the body is through the hormone cortisol, which is secreted by adrenal glands in response to physical and emotional stress or high states of arousal. Studies have shown that a rise in cortisol levels can be adaptive—up to a point. If cortisol levels are too high or elevated for too long, “there appear to be negative effects on health, behavior, and learning and memory processes,” according to researchers Laura Thompson and Wenda Trevathan.

Most research on the impact of elevated cortisol has been done on adult populations. A growing number of studies, however, are trying to correlate stress in pregnant women with cortisol levels in their babies. Other studies track the effects of high cortisol levels in infants and children when they are temporarily separated from the mother. Still other studies explore how cortisol levels affect learning and memory in infants.

Studies such as these have shown that elevated cortisol levels can have adverse effects, but they have also shown that the support of a caregiver can often mitigate this impact. The study of stress and its impact is an important and promising area of research, but the complete picture of how stress affects an expectant mother, developing fetus, or growing baby is complex and subject to a whole range of social, environmental, and genetic factors.

Meanwhile, dwelling on stress can, well, add to stress! Instead, expectant moms have plenty of reasons to focus on activities and attitudes that celebrate the joyous experience of motherhood and the bonds of love between parents and children. It is often easier, in experimental terms, for researchers to isolate the impact of the negative. But research into the impact of stress doesn’t have to translate into anxiety. Increasingly, there are researchers who are exploring the many ways that positive experiences, wellness, safe and secure environments help babies grow into strong, sensitive and resilient individuals. Mothers will always play a pivotal role in enhancing the lives of their children, and deeper insights will help mothers even more fully embrace these opportunities.