Question 1

What foods should I avoid during pregnancy?

Accepted Answer

During pregnancy, avoid raw or undercooked meat and fish (risk of listeria and toxoplasma); fish that are high in mercury (shark, swordfish, king mackerel, marlin, orange roughy, bigeye tuna, and tilefish from the Gulf of Mexico); unpasteurized milk and juice, and soft cheeses made from unpasteurized milk (listeria risk); raw sprouts; and deli meats and hot dogs unless heated until steaming. For tuna, the FDA lists canned light tuna as a Best Choice (2 to 3 servings a week) and albacore or yellowfin tuna as a Good Choice (1 serving of 4 ounces a week). Limit caffeine to under 200 mg a day (about one 12-ounce cup of coffee). Avoid alcohol: no safe amount has been established during pregnancy. Refrigerate leftovers within 2 hours and use them within 3 to 4 days. (Sources: FDA and EPA, Advice About Eating Fish; ACOG Committee Opinion 462, Moderate Caffeine Consumption During Pregnancy; USDA Food Safety and Inspection Service, Leftovers and Food Safety.)

Question 2

Is it safe to exercise during pregnancy?

Accepted Answer

For most uncomplicated pregnancies, yes. ACOG recommends at least 150 minutes of moderate-intensity aerobic activity per week. Regular exercise lowers the chance of gestational diabetes and of gaining more weight than recommended, and it can ease back pain and help sleep. Safe activities include brisk walking, swimming, stationary cycling, yoga, and low-impact aerobics. Avoid contact sports and activities with a risk of falls or blows to the abdomen, scuba diving, exercise at altitude above 6,000 feet unless you are used to it, and exercise lying flat on your back beyond 20 weeks of pregnancy. Stop and call your provider for vaginal bleeding, regular painful contractions, dizziness, chest pain, or severe shortness of breath. (Source: ACOG Committee Opinion 804, Physical Activity and Exercise During Pregnancy and the Postpartum Period, 2020.)

Question 3

What are the warning signs of preeclampsia?

Accepted Answer

Preeclampsia is a serious pregnancy complication marked by new high blood pressure after 20 weeks: a top (systolic) number of 140 or higher or a bottom (diastolic) number of 90 or higher on two readings at least 4 hours apart. It often comes with protein in the urine, but protein is not required when there are signs of severe disease (such as low platelets, kidney or liver changes, fluid in the lungs, or a new headache or vision changes). A reading of 160 or higher on top or 110 or higher on the bottom is in the severe range and needs care right away. Preeclampsia affects about 2 to 8% of pregnancies. Get care right away (call your provider or go to Labor and Delivery; call 911 in an emergency) for a headache that won't go away, vision changes such as blurring or seeing spots, sudden severe swelling of the face or hands, pain in the upper right belly, or trouble breathing. Preeclampsia does not always cause symptoms, so it may be found only at a prenatal visit. Low-dose aspirin is advised for people with one high-risk factor (for example a past preeclampsia, a twin pregnancy, chronic high blood pressure, diabetes before pregnancy, or kidney disease) or more than one moderate-risk factor (for example a first pregnancy, obesity, or age 35 or older). It is started between 12 and 28 weeks, ideally before 16 weeks, and only on your provider's advice. (Sources: ACOG Practice Bulletin 222, Gestational Hypertension and Preeclampsia, 2020; ACOG Committee Opinion 743, Low-Dose Aspirin Use During Pregnancy, 2018; USPSTF, Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia, 2021.)

Question 4

How much weight should I gain during pregnancy?

Accepted Answer

Recommended total gain depends on your weight before pregnancy. With a normal BMI (18.5 to 24.9): 25 to 35 lbs. Overweight (BMI 25 to 29.9): 15 to 25 lbs. Obesity (BMI 30 or higher): 11 to 20 lbs. Underweight (BMI below 18.5): 28 to 40 lbs. For twins with a normal BMI, the provisional range is 37 to 54 lbs. The IOM assumes about 1 to 4 lbs of gain in the first trimester, then about 1 lb a week in the second and third trimesters with a normal BMI (0.8 to 1.0 lbs). Gaining much more or much less than recommended both raise pregnancy risks. Energy needs rise by only about 340 calories a day in the second trimester and 452 calories a day in the third, so the quality of what you eat matters more than the quantity. (Sources: Institute of Medicine, Weight Gain During Pregnancy, 2009; ACOG Committee Opinion 548, Weight Gain During Pregnancy, 2013; Institute of Medicine Dietary Reference Intakes for energy, 2005.)

Question 5

What prenatal vitamins do I actually need?

Accepted Answer

A prenatal vitamin should cover: folic acid 400 to 800 mcg a day, started at least 1 month before conception (it lowers the chance of neural tube defects by 50 to 70%); iron 27 mg a day (the recommended intake in pregnancy, up from 18 mg); vitamin D 600 IU a day; and iodine (the recommended intake is 220 mcg a day from food and supplements together; the American Thyroid Association advises a prenatal vitamin that contains 150 mcg). Calcium needs are 1,000 mg a day from food and supplements together for ages 19 to 50. Some prenatal vitamins also contain DHA or choline; ask your provider whether you need them. (Sources: USPSTF, Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication, 2023; CDC, Folic Acid; NIH Office of Dietary Supplements, pregnancy fact sheet; American Thyroid Association, statement on iodine.)

Question 6

When should I go to the hospital or call my OB?

Accepted Answer

Call 911 or go to the emergency room for: heavy vaginal bleeding, a seizure, loss of consciousness, trouble breathing, chest pain, or a baby who has stopped moving. Get care right away (call your OB or midwife, or go to Labor and Delivery) for: regular contractions every 10 minutes or more often before 37 weeks (possible preterm labor); a gush or trickle of fluid from the vagina; vaginal bleeding; the baby's movement stopping or slowing, or any change in your baby's usual pattern (after 28 weeks, fewer than 10 movements in 2 hours when you count); a headache that won't go away or gets worse; vision changes; severe belly pain that doesn't go away; or a fever of 100.4°F or higher. The CDC also lists dizziness or fainting, extreme swelling of the hands or face, severe nausea and vomiting, severe swelling, redness, or pain of a leg or arm, a fast-beating heart, and overwhelming tiredness. Most practices have an after-hours nurse line. When in doubt, call: your care team would rather hear from you than have you wait. (Sources: CDC, HEAR HER Urgent Maternal Warning Signs; ACOG, Preterm Labor and Birth; ACOG guidance on antepartum fetal surveillance for counting movements.)

Question 7

Is it normal to feel so exhausted in the first trimester?

Accepted Answer

Yes. Extreme tiredness in the first trimester is one of the most common pregnancy symptoms. Rising progesterone has a sedating effect, and your body is also building the placenta, increasing its blood volume, and supporting fast fetal development. For most people it improves in the second trimester. Rest when you can, protect your sleep, stay hydrated, and eat small, frequent meals if nausea is a problem. If tiredness is severe or comes with pale skin, a rapid heartbeat, or breathlessness, tell your provider so they can check for anemia. Overwhelming tiredness is also on the CDC list of urgent warning signs: if it is sudden or extreme, call your provider or go to Labor and Delivery. (Source: CDC, HEAR HER Urgent Maternal Warning Signs.)

Question 8

What is gestational diabetes and how is it treated?

Accepted Answer

Gestational diabetes (GDM) is diabetes first diagnosed during pregnancy. In the US about 8% of pregnancies are affected (CDC data: 6.0% in 2016 and 8.3% in 2021). It happens when pregnancy hormones reduce insulin sensitivity and the pancreas cannot keep up. Screening is usually done at 24 to 28 weeks with a glucose test. GDM raises the chance of a large baby, cesarean birth, and low blood sugar in the newborn, and it raises the mother's chance of developing type 2 diabetes later, so follow-up testing after delivery matters. Treatment is nutrition changes, blood sugar monitoring, and insulin or metformin if targets are not met. Most people with GDM have healthy pregnancies and babies with good management. (Sources: ACOG Practice Bulletin 190, Gestational Diabetes Mellitus, 2018; CDC National Center for Health Statistics, National Vital Statistics Reports, volume 72, number 6, 2023.)

Question 9

What should I know about postpartum depression?

Accepted Answer

Postpartum depression (PPD) is common: the CDC reports that about 1 in 8 women with a recent live birth have symptoms of postpartum depression. It is different from the baby blues, mild mood changes that begin in the first days after birth, ease within about 2 weeks, and affect many new mothers. PPD involves persistent sadness, trouble bonding with the baby, severe anxiety, trouble sleeping even when the baby sleeps, feeling like a bad parent, and thoughts of harming yourself. It can begin any time in the first year after birth. PPD is treatable with therapy, antidepressants (many are compatible with breastfeeding), or both. ACOG advises screening for depression and anxiety at least once during the perinatal period with a validated tool (such as the Edinburgh Postnatal Depression Scale), contact with your provider within 3 weeks of birth, and a full postpartum visit by 12 weeks after birth. The USPSTF recommends depression screening for all adults, including people who are pregnant or postpartum. If you have thoughts of harming yourself or your baby, call or text 988 (Suicide & Crisis Lifeline), call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), or call 911 now. (Sources: CDC, postpartum depression page (cdc.gov/reproductive-health/depression); ACOG Committee Opinion 757, Screening for Perinatal Depression, 2018; ACOG Committee Opinion 736, Optimizing Postpartum Care, 2018; USPSTF, Screening for Depression and Suicide Risk in Adults, 2023; HRSA National Maternal Mental Health Hotline.)

Question 10

How do I know if my baby is positioned correctly for delivery?

Accepted Answer

Most babies are head-down (vertex) by the end of pregnancy. Your OB or midwife checks the baby's position at third-trimester visits by feeling the abdomen and, when needed, with ultrasound. About 3 to 4% of babies are still breech (feet or buttocks first) at term. If your baby is breech near term, an external cephalic version (ECV), a procedure in which a clinician turns the baby from outside the abdomen, works in about 6 in 10 attempts overall (the ACOG average is about 58%), less often in a first pregnancy and more often after a prior birth. ECV is offered near term and lowers the chance of cesarean birth. Not every provider offers it, so ask. Positions and exercises at home, such as hands and knees, have not been shown to turn a breech baby, so ask your provider before trying anything. If ECV fails or is not attempted, a planned cesarean is usually recommended, though some providers offer vaginal breech birth in carefully selected cases. (Sources: ACOG Practice Bulletin 221, External Cephalic Version, 2020; Cochrane review of external cephalic version at term; Cochrane review, Cephalic version by postural management for breech presentation.)

Question 11

What is Group B Strep and why am I tested for it at 36 0/7 to 37 6/7 weeks?

Accepted Answer

Group B Streptococcus (GBS) is a common bacterium carried in the vagina or rectum by about 1 in 4 pregnant women (CDC). In adults it usually causes no symptoms and is not a sexually transmitted infection. If it is passed to a newborn during labor and delivery, it can cause sepsis, pneumonia, or meningitis. In 2016 to 2022, early-onset GBS disease in newborns occurred in about 0.22 per 1,000 live births (about 1 in 4,500); about 2% of term newborns with early-onset disease die, and the risk is higher in premature babies (CDC). ACOG Committee Opinion 797 advises screening with a vaginal-rectal swab culture at 36 0/7 to 37 6/7 weeks. People who test positive get intravenous penicillin (or an alternative if allergic) during labor. Given at least 4 hours before birth, it prevents about 9 in 10 early-onset cases in term babies, and much less when given for under 2 hours, so go in when labor starts. A positive GBS result does not require a cesarean; the only change is IV antibiotics during labor. GBS status can change between pregnancies, so screening is repeated each pregnancy. (Sources: ACOG Committee Opinion 797, Prevention of Group B Streptococcal Early-Onset Disease in Newborns, 2020; CDC, Group B Strep clinical overview and invasive GBS disease in infants data; Fairlie et al., Obstetrics & Gynecology, 2013, on the effectiveness of intrapartum antibiotic prophylaxis.)

Question 12

How do I know when I'm really in labor, and when should I call?

Accepted Answer

True labor differs from false (Braxton Hicks) contractions in regularity and progression. ACOG advises calling your provider when you have regular contractions every 5 to 10 minutes for an hour. Your own provider may give you different timing, so follow their instructions. Before 37 weeks, call right away for regular contractions every 10 minutes or more often. Other signs that labor is starting: bloody show (pink or blood-tinged mucus) and your water breaking (a gush or steady trickle of fluid). If your water breaks, call your provider whether or not contractions have started. Go in right away for heavy vaginal bleeding, green or brown fluid, a baby who is moving less, a severe headache or vision changes, or a feeling that something is wrong. Do not use a tampon if you think your water has broken. Braxton Hicks contractions tend to be irregular, do not grow stronger, and often stop when you change position or drink water. (Sources: ACOG, How to Tell When Labor Begins; ACOG, Preterm Labor and Birth.)

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