Prenatal Care

Table of Contents

Have you been warned about periodontal disease?

The oral health connection to prenatal care

What causes periodontal disease?

Treatment is easy

Eating myths

The truth about exercising

Stay healthy throughout your pregnancy and throughout flu season

Have You Been Warned About Periodontal Disease?

If you are planning to conceive or are already pregnant, you can lower your chances of having your baby too early by maintaining good oral hygiene and by getting a dental exam and cleaning.

The oral health connection to prenatal care.

Research has linked periodontal disease to higher risks of pre-term low weight births in pregnant women. In one study, pregnant women with periodontal disease were seven times more at risk for having babies too early and too small.

Periodontal disease inflames gums, allowing bacteria to enter the blood system. Because pregnant women and their fetus are especially vulnerable to bacteria, it becomes extremely important to lower their exposure to potentially dangerous bacteria.

What causes periodontal disease?

There are several factors that can cause periodontal disease: an increase in hormones during pregnancy, genetics, and the build up of plaque on teeth and gums.

Symptoms include bad breath, sore or swollen gums, bleeding gums, and tooth pain or sensitivity. If you have any of these symptoms, or have been diagnosed with gingivitis (which can lead to periodontal disease), make an appointment with your dentist and get treated.

Treatment is easy.

Getting treatment for periodontal disease can have a huge impact. According to one study, just by treating a woman's periodontal disease decreased her chances of having her baby early by almost 50%!

Treatment can vary from a shot of antibiotics (may not be available for pregnant women), to brushing and flossing more often, and/or to increasing the number of your dental office visits. After an evaluation, your dentist will be able to determine the type of treatment that is right for you and your baby.

Eating Myths

You may have heard that now you are pregnant, you can eat anything you want. However, what you eat has a great impact on the development of your unborn child. To help you make the right eating choices, here is the truth to some commonly told myths:

Pregnant women can eat as much as they want. False. The March of Dimes recommends an additional 300 calories is all that is needed to have a healthy pregnancy.

Eating more can cause unneeded weight gain, which can be dangerous to both mother and baby. Extra weight gain can increase the risk of developing gestational diabetes, high blood pressure, the need for a Caesarean delivery and postpartum infection. It also raises the risk to the baby of neural tube defects, birth trauma and even fetal death near term.

How much you should gain depends on how much you weighed before becoming pregnant. Your health care professional will advise you on appropriate weight gain.

Pregnant women can eat "anything" they want. Also false. While it may be okay to splurge on that bowl of ice cream once in awhile, it is important for pregnant mothers to maintain a nutritious diet. Your baby will need all the vitamins and minerals he or she can get to develop a strong and healthy body.

Follow these basics for a healthy diet:

1. Whole grains, 6 to 11 daily servings
2. Low-fat dairy products, 3 to 4 daily servings
3. Lean protein, 3 to 4 daily servings
4. Vegetables, 3 to 5 daily servings
5. Fruits, 2 to 4 daily servings

Sushi should be avoided. True. Not only can fish be high in mercury, but consuming raw fish, raw eggs, raw sprouts, and unpasteurized juices and dairy products can increase the likelihood of food poisoning from bacteria like listeriosis. Because a pregnant woman's immune system is vulnerable at this time, food-poisoning bacteria can cause pregnancy complications, including miscarriage and pre-term child birth.

Here is a list of foods you'd want to avoid:

1. Hot dogs, lunch meats, bologna, deli meats, unless reheated until steaming hot
2. Refrigerated pâté, meat spreads, smoked seafood
3. Raw or unpasteurized milk, or food containing unpasteurized milk
4. Salads made in the store, such as ham salad, chicken salad, egg salad
5. Soft cheeses like feta, queo blanco, questo fresco, brie, camembert, blue-veined cheeses, and Panela, unless it is made with pasteurized milk
6. Fish high in mercury, such as shark, swordfish, king mackerel,and tilefish; some commonly eaten fish like salmon and chilean sea bass may also contain high amounts of mercury.

For more information on food safety, visit the USDA website.

Eating a diet low in carbohydrates or fat is okay during pregnancy. False. Once again, the quality of food you consume while you're pregnant is important for your baby's development. Diets that limit any type of food may be limiting the nutrients your baby needs.

Carbohydrates are good for your baby. Complex carbohydrates, such as fruit, vegetables, beans and whole grains, are rich in vitamins, minerals and fiber. In addition, the sugar that is released when your body breaks down the carbohydrates help to develop your baby's nervous system.

If you are concerned about consuming too many carbohydrates, select the most nutritious ones and limit your intake of those that are fried, made of white, refined flour, or high in sugar content.

Not all fats are bad! Omega-3 fatty acids are required for your baby's brain and eye development. This becomes even more important in the third trimester.

Omega-3 is a type of polyunsaturated fat found in fish, seeds and leafy green vegetables. Healthy choices include fortified foods (like eggs, bread and juice), dark green vegetables, canola, sunflower and flaxseed oils and walnuts.

While it is fine to consume dairy products low in fat, and lean cuts of meat, make sure you don't overdo it by keeping your fat intake up to 30% of your overall diet.

You will always have time to diet after the baby is born.

The Truth About Exercising

Pregnant women can actually benefit from exercising. Some of the benefits include preventing the development of gestational diabetes, relieving stress, building more stamina (which will be useful for labor and delivery), and a quicker postpartum recovery.

The American College of Obstetrics and Gynecology recommends 30 minutes or more of moderate exercise per day. However, you should always check with your health care professional first before starting an exercise routine. You may be advised against exercising if there are any pregnancy complications or health complications that existed before the pregnancy.

If your health care professional says it is okay for you to exercise, follow these basic guidelines:

1. If just starting, start slowly and do not over exert yourself
2. Listen to your body, it will let you know when to slow down
3. Never exercise to the point of exhaustion or breathlessness, it can affect the amount of oxygen you and your baby receive
4. Take frequent breaks and drink plenty of fluids during exercise
5. Wear comfortable exercise footwear for strong ankle and arch support
6. Avoid exercising in extremely hot weather
7. Avoid rocky terrain or unstable ground when running or cycling
8. Avoid contact sports
9. Weight training to improve tone in the upper body and abdominal area is especially beneficial (though avoid lifting weights above your head and using weights that strain the lower back muscles)
10. During the second and third trimesters, avoid exercise that involve lying flat on your back, as this decreases blood flow to your womb
11. Include relaxation and stretching before and after your exercise program
12. Do not let your heart rate exceed 140 beats per minute

Stay Healthy throughout Your Pregnancy and throughout Flu Season

from the Flu-Free and a Mom-to-Be Health Center

Never thought of yourself as high-risk, health wise? If you're pregnant during flu season, consider yourself on the list. And, if it's been years since you've had the flu—that classic seasonal illness that brings on the "I-feel-like-I've-been-hit-by-a-truck-how-can-anything-hurt-this-much" symptoms of fever, aching muscles and extraordinary fatigue—the time is now to take action to keep you and your baby healthy.

Here's why: About one in five people—adults and children—get the flu each year. You might tough it out at home or you might find yourself one of the more than 200,000 people hospitalized each year with flu-related complications, such as dehydration, bacterial or viral pneumonia, infections of the brain and spinal cord, Reye syndrome and heart conditions, as well as seizures in children. If you have a chronic health condition like congestive heart failure, asthma or other lung diseases, or diabetes, you're particularly susceptible to complications.

Then there's the simple—but scary—fact that every year about 36,000 people in the United States die from the flu.

A Little Prevention Goes a Long Way

Like most viral diseases, the flu is highly contagious. Unlike the common cold, however, there's a relatively simple, easy, safe way to prevent the flu: an annual vaccine.

Maybe you think you don't need a vaccine because you're young and healthy and don't work in day-care centers or nursing homes. Or maybe you think you shouldn't get a vaccine because you're pregnant.

Unless you're severely allergic to eggs, had a severe reaction to the flu vaccine in the past or currently have a fever, you should get vaccinated. Even if you're young and healthy, a flu vaccine is important. One study found that healthy working adults receiving the vaccine had 43 percent fewer sick days from work. Since many companies are cutting back on sick days, that's a good benefit!

When you're pregnant (or soon plan to be) during flu season, you should get vaccinated. Here's a fact you might not have learned from your pregnancy planning books: if you get the flu during pregnancy, you are more likely to be sicker and to develop flu-related complications like pneumonia than if you weren't pregnant. Your risk of dying is higher if you have the flu while you're pregnant. Blame pregnancy-related changes in your respiratory and immune systems.

But here's the kicker—if you get the flu, it could affect your baby. After major worldwide flu outbreaks like the one in 1918, infected women had higher rates of miscarriage and premature births, especially those who developed pneumonia. During the Asian influenza pandemic of 1957, it appeared that babies of women who developed the flu were more likely to have birth defects. Even normal flu years may increase the risk of cleft lip or palate, neural tube defects such as spina bifida (in which the spinal column doesn't completely close) and heart defects. Some studies also suggest higher rates of leukemia, schizophrenia and Parkinson disease in people whose mothers had the flu during pregnancy.

That's why the U.S. Centers for Disease Control and Prevention recommend flu vaccines for all pregnant women, no matter where they are in their pregnancy. In fact, the American College of Obstetricians and Gynecologists say that getting the flu shot is an essential part of prenatal care. And, it's safe to get the vaccine while breastfeeding.

Yet a 2004 survey that included responses from roughly 500 obstetricians and gynecologists found that just 52 percent would recommend a flu vaccine for a healthy woman in the first trimester of pregnancy, although 95 percent would recommend the vaccine for a healthy pregnant woman beyond the first trimester, and 63 percent would recommend vaccination for a woman with a medical condition in the first trimester. Importantly, a third of the doctors who said they would recommend the vaccine did not offer it in their offices.

Flu Vaccine Is Safe and Effective for Pregnant and Breastfeeding Women

The good news is that the injectable flu vaccine, made with an inactive form of the virus, is perfectly safe for pregnant women and usually is widely available from multiple sources in our communities, if it's not offered by your obstetrics practice. You also can consider new flu vaccines that are thimerosal free. Plus, no matter what you've heard, you cannot get the flu from the flu vaccine. However, you should not get the nasal version of the vaccine, called FluMist, which contains attenuated, or partially live, viruses.

Here's some more good news: getting vaccinated while pregnant or breastfeeding is not only perfectly safe for your baby, but may help protect your newborn against the flu. Recall that babies less than 6 months old shouldn't get the flu vaccine. But a recently published study found that the risk of flu in infants dropped 63 percent when the mothers were vaccinated during pregnancy; plus, the risk of other respiratory illnesses also dropped nearly a third.

OK, so what if you forgot to get vaccinated and now it is flu season? What can you do? Get a flu vaccine! It only takes two weeks for the vaccine to rev up your immune system to better resist the virus.

Guarding Against Flu during Pregnancy in Other Ways

That's not the only thing you should do, however. You also need to practice preventive protection. That means washing your hands several times a day with alcohol-based sanitizers and/or lots of soap and hot water. Also, stay away from people who might be sick, and avoid crowded, closed rooms if possible.

Plus, continue all the things you're already doing to ensure a healthy pregnancy—eating right, getting moderate exercise, getting enough sleep and managing stress. All will help strengthen your immune system so be better prepared to fight off any viruses that do come calling.

And if you get the flu, see your health care professional as soon as possible. While antiviral medications—those medications that can help minimize the effects of the flu when they are taken within 48 hours of your first symptoms—are not recommended for pregnant women, it's important that your health care professional keep a close watch on you to make sure you don't get dehydrated, that your fever doesn't get too high and that you don't develop complications.

© 2007 National Women's Health Resource Center, Inc. (NWHRC) All rights reserved.
Reprinted with permission from the NWHRC. 1- 877-986-9472 (toll-free). On the Web at: www.healthywomen.org.