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Preterm Delivery Due to Overweight Women

Preterm Delivery Due to Overweight Women

Just in case you’re looking for another reason to lose weight, here it is

If you’re overweight, you run a higher risk of preterm delivery, and as a result, of endangering the life and health of your baby. According to a study shared on MedPage Today, obese and severely obese women had a two to three times greater chance of delivering a baby early at 22 to 27 weeks after conception than women with healthy weights at conception.

In fact, extra weight causes more than just premature births; it can result in severe health issues concerning the mother and the baby.

"There are a whole slew of problems associated with patients who are obese when pregnant — everything from preterm labor to gestational diabetes to preeclampsia to macrosomia and large babies," says Eugene Scioscia, MD, of West Penn Allegheny Health System in Pittsburgh.

Obesity has replaced smoking as the number one complication associated with pregnancy, according to Scioscia.


Gestational Diabetes and Premature Birth

Donna Murray, RN, BSN has a Bachelor of Science in Nursing from Rutgers University and is a current member of Sigma Theta Tau, the Nursing Honor Society.

Meredith Shur, MD, FACOG, is board-certified in obstetrics and gynecology, as well as a certified medical examiner.

Pregnant women with diabetes can have healthy pregnancies and healthy babies. The key is to keep diabetes under control to minimize or prevent complications. The more complicated diabetes is, the more problems it can cause.

While gestational diabetes needs to be followed closely, if it is controlled well with diet, exercise, and medications if necessary, it is not usually as serious as having pregestational diabetes (having type 2 or type 1 diabetes before becoming pregnant). Of course, there are still risks. Gestational diabetes, just like other types of diabetes, can lead to premature birth as well as other complications, especially if it goes untreated.


Make it to Forty Weeks

All the right moves now will help you avoid preterm labor -- and deliver the healthiest possible baby.

Sure, those last preggo weeks can be plenty uncomfortable, but keeping your little bun in the oven all the way to 40 weeks may make a whopping difference in your child&aposs health. The latest studies indicate that babies born at 37 and 38 weeks, once considered full term, are more likely to have breathing problems, low blood sugar, and other issues that could send them to the neonatal intensive care unit.

The research was so compelling that it spurred the American Congress of Obstetricians and Gynecologists (ACOG) last year to revise its definition of full term to those infants who are born after 39 weeks. "We&aposre recognizing that the last few weeks matter," explains Michael Gravett, M.D., scientific director of the Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children&aposs Hospital. "Babies born at 39 weeks have fewer immediate problems versus those born at 37 and 38 weeks. And down the road, they do better on tests of intelligence and gross motor skills."

The exact cause of preterm labor remains a mystery, but these smart strategies will increase your chances of making it to that magical date.

Eat real food Put down that bag of chips! Your craving for junk food may be intense, but evidence continues to mount that eating a balanced diet of real foods may reduce your risk of preterm labor. A recent study of 66,000 pregnant Scandinavian women found that those who consumed a diet of fresh and raw veggies, whole-grain cereals, fruit and berries, lean poultry and fish, and lots of water were significantly less likely to have a premature delivery than moms-to-be on a Western diet that included more processed foods.

Although the study didn&apost directly prove that unhealthy eating habits cause preterm births, it added to the evidence linking the two, notes Edward McCabe, M.D., Ph.D., chief medical officer of the March of Dimes. "It&aposs one more reason to avoid fast food, junk food, processed food, and sugary drinks," Dr. McCabe says.

Nosh often Your baby doesn&apost just need nutrients -- he needs them delivered frequently. Researchers have found that skipping meals and going for long periods without food increases your chance of early labor. Your best course of action: Eat at least five times a day. (Aim for three meals and two or three healthy snacks.) Eating frequent smaller meals may also reduce nausea and heartburn.

Do a smell check You may love the scent of your shampoo, but many beauty products with "fragrance" listed on the label contain phthalates, a class of hormone-mimicking chemicals that have been linked to preterm labor. A study in JAMA Pediatrics found that pregnant women with higher levels of phthalates in their urine were two to five times more likely to deliver preterm than those with lower levels. The study makes a case for using products that are phthalate free, says principal investigator John Meeker, Sc.D., of the University of Michigan in Ann Arbor.

Six types of phthalates, also called plasticizers, are banned from toys, but they&aposre still found in building materials like pipes, vinyl flooring and wallpaper, food packaging, and personal-care products. Avoid plastics with recycling code No. 3. Perfume and toiletries are a trickier issue because manufacturers aren&apost required to list phthalates on the label. Dr. Meeker recommends looking for products that say "fragrance free," "no synthetic fragrance," or "phthalate free" to lower your risk of exposure. Or download the free Skin Deep app from the Environmental Working Group and use it to scan bar codes for ingredients and a safety rating before you buy.

Be good to your gums Chronic gum disease is a serious risk factor for preterm birth, though doctors aren&apost sure why, says Louis Muglia, M.D., director of the Center for Prevention of Preterm Birth at Cincinnati Children&aposs Hospital. Pregnant women should brush and floss after meals and visit the dentist for regular cleaning. And don&apost forget mouthwash. Another study found that using an alcohol-free antimicrobial mouth rinse could cut women&aposs risk of early labor by about three-quarters.

Go when you gotta go You&aposre running to the bathroom constantly, so you may be tempted to sometimes hold it. Don&apost. You may trigger a urinary tract infection (UTI), a bacterial infection that can spread to your kidneys and jump-start labor. (Ward off UTIs by drinking plenty of fluids, wiping front to back, and fully emptying your bladder.) What&aposs more, pregnant women may not experience the burning pain during urination that&aposs a typical UTI symptom, so watch for foul-smelling, cloudy, or bloody urine. Your care provider will also test your urine during checkups. If bacteria turn up, a course of antibiotics usually clears up the problem and reduces your risk.

Measure up A short cervix is probably the most powerful predictor of preterm birth among first-time moms. Your cervix, which is like a doorway from the uterus to the vagina, gets shorter as your due date approaches. But if it shortens too soon, you&aposre five or six times more likely to have a premature birth. A transvaginal ultrasound between 18 and 24 weeks is the best way to measure your cervix.

ACOG says it&aposs reasonable for doctors to have all their patients measured, but some ob-gyns evaluate cervical length only in women whom they consider to be high risk, so ask your doctor about it. If your cervix does come up short, your doctor can prescribe progesterone treatments, which can reduce the likelihood of preterm labor by about 40 percent.

Steer clear of all smoke You may already know that smoking doubles your risk of preterm birth, but exposure to secondhand smoke can also up your chance of having a preemie. And you&aposd be wise to avoid the fumes from third-hand smoke too. "Third-hand smoke is when you enter a room or a car and you can tell someone was smoking in there," says Dr. McCabe. "The smoke leaves a residue that contains lead, arsenic, and other toxins." The same goes for e-cigs. Manufacturers claim they are healthier, but e-cigs still contain nicotine, which can be dangerous to a fetus, he notes. "We also know that preterm births go down after smoke-free legislation is enacted." Studies in the U.S. and Europe show that when a community makes this change, hospitalization for preterm births, on average, can drop by as much as 10 percent in just one year.

Fight off infections Your immune system is weaker when you&aposre pregnant because your body is focused on growing a baby, and infections have been known to kick-start labor, so it&aposs important to do everything you can to stay healthy. Wash your hands frequently, avoid people who are sick, and call your doctor right away if you run a fever.

Be sure to get a flu shot, too, says Siobhan Dolan, M.D., medical advisor for the March of Dimes and coauthor of Healthy Mom, Healthy Baby. It&aposs safe and effective, and studies have found that your baby will be bigger and less likely to be born prematurely than the babies of moms who weren&apost vaccinated. Plus, your baby will be less likely to catch the virus after he&aposs born, because you&aposll pass on your protective antibodies to him.

Get the right dose of D There&aposs new evidence that women who don&apost get enough vitamin D are significantly more likely to develop preeclampsia and to go into early labor. Scientists believe the nutrient, which your body naturally makes in response to sunlight, helps fight infections that lead to prematurity.

Most prenatal vitamins contain 400 IU per tablet, but that may not be enough for many women. Dr. Gravett recommends asking your doctor to test your vitamin D level, especially if you&aposre a vegetarian, have limited exposure to the sun, or have dark skin. If the test shows your level is low, he recommends an additional vitamin D supplement. ACOG says that 1,000 to 2,000 IU a day is safe for pregnant women, but the latest research has persuaded some doctors, including Dr. Gravett, to recommend even higher daily doses. One large study found that pregnant woman who took 4,000 IU of vitamin D per day significantly reduced their risk of giving birth prematurely.

Don&apost skimp on DHA Another nutrient that may prolong your pregnancy is DHA, an omega-3 fatty acid that helps your baby&aposs brain and eyes develop. Studies have found that DHA supplements can increase the average length of gestation by three to six days and significantly reduce your risk of delivering before 34 weeks. The best way to get DHA is from fish. Eat at least 8 but no more than 12 ounces per week of low-mercury fish like salmon, herring, freshwater trout, and sardines, or up to 6 ounces per week of chunk light canned tuna. (Avoid higher-mercury albacore, also called chunk white.) You can also find DHA in walnuts, some vegetable oils (canola, soybean, olive), and foods labeled DHA-fortified. If you don&apost eat a lot of these foods, ask your doctor about a daily supplement of at least 200 milligrams of DHA.

Originally published in the March 2015 issue of American Baby magazine.

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.


Obesity and Pregnancy

Being overweight is defined as having a body mass index (BMI) of 25&ndash29.9. Obesity is defined as having a BMI of 30 or greater. Within the general category of obesity, there are three levels that reflect the increasing health risks that go along with increasing BMI:

Lowest risk is a BMI of 30&ndash34.9.

Medium risk is a BMI of 35.0&ndash39.9.

Highest risk is a BMI of 40 or greater.

You can find out your BMI by using an online BMI calculator on a web site such as http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.

Obesity during pregnancy puts you at risk of several serious health problems:

Gestational diabetes is diabetes that is first diagnosed during pregnancy. This condition can increase the risk of having a cesarean delivery. Women who have had gestational diabetes also have a higher risk of having diabetes in the future, as do their children. Obese women are screened for gestational diabetes early in pregnancy and also may be screened later in pregnancy as well.

Preeclampsia is a high blood pressure disorder that can occur during pregnancy or after pregnancy. It is a serious illness that affects a woman&rsquos entire body. The kidneys and liver may fail. Preeclampsia can lead to seizures, a condition called eclampsia. In rare cases, stroke can occur. Severe cases need emergency treatment to avoid these complications. The baby may need to be delivered early. Sleep apnea is a condition in which a person stops breathing for short periods during sleep.

Sleep apnea is associated with obesity. During pregnancy, sleep apnea not only can cause fatigue but also increases the risk of high blood pressure, preeclampsia, eclampsia, and heart and lung disorders.

Obesity increases the risk of the following problems during pregnancy:

Pregnancy loss&mdashObese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight.

Birth defects&mdashBabies born to obese women have an increased risk of having birth defects, such as heart defects and neural tube defects.

Problems with diagnostic tests&mdashHaving too much body fat can make it difficult to see certain problems with the baby&rsquos anatomy on an ultrasound exam. Checking the baby&rsquos heart rate during labor also may be more difficult if you are obese.

Macrosomia&mdashIn this condition, the baby is larger than normal. This can increase the risk of the baby being injured during birth. For example, the baby&rsquos shoulder can become stuck during delivery. Macrosomia also increases the risk of cesarean delivery. Infants born with too much body fat have a greater chance of being obese later in life.

Preterm birth&mdashProblems associated with a woman&rsquos obesity, such as preeclampsia, may lead to a medically indicated preterm birth. This means that the baby is delivered early for a medical reason. Preterm babies are not as fully developed as babies who are born after 39 weeks of pregnancy. As a result, they have an increased risk of short-term and long-term health problems.

Stillbirth&mdashThe higher the woman&rsquos BMI, the greater the risk of stillbirth.

Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5&ndash7% of your current weight, or about 10&ndash20 pounds) can improve your overall health and pave the way for a healthier pregnancy.

If you have never exercised before, pregnancy is a great time to start. Discuss your exercise plan with your obstetrician to make sure it is safe. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes on most&mdashpreferably all&mdashdays of the week. Walking is a good choice if you are new to exercise. Swimming is another good exercise for pregnant women. The water supports your weight so you can avoid injury and muscle strain. It also helps you stay cool.

To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise and eating healthy foods. Your obstetrician may refer you to a nutritionist to help you plan a healthy diet. You also can use the Choose My Plate web site at www.choosemyplate.gov. Increasing your physical activity is important if you want to lose weight. Aim to be moderately active (for example, biking, brisk walking, and general gardening) for 60 minutes or vigorously active (jogging, swimming laps, or doing heavy yard work) for 30 minutes on most days of the week. You do not have to do this amount all at once. For instance, you can exercise for 20 minutes three times a day.

If you have tried to lose weight through diet changes and exercise and you still have a BMI of 30 or greater or a BMI of at least 27 with certain medical conditions, such as diabetes or heart disease, weight-loss medications may be suggested. These medications should not be taken if you are trying to become pregnant or are already pregnant.

Bariatric surgery may be an option for people who are very obese or who have major health problems caused by obesity. If you have weight loss surgery, you should delay getting pregnant for 12&ndash24 months after surgery, when you will have the most rapid weight loss. If you have had fertility problems, they may resolve on their own as you rapidly lose the excess weight. It is important to be aware of this because the increase in fertility can lead to an unplanned pregnancy. Some types of bariatric surgery may affect how the body absorbs medications taken by mouth, including birth control pills. You may need to switch to another form of birth control.

Despite the risks, you can have a healthy pregnancy if you are obese. It takes careful management of your weight, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for your labor and delivery.

Finding a balance between eating healthy foods and staying at a healthy weight is important for your health as well as your baby&rsquos health. In the second and third trimesters, a pregnant woman needs an average of 300 extra calories a day&mdashabout the amount of calories in a glass of skim milk and half of a sandwich. You can get help with planning a healthy diet by talking to a nutrition counselor. Help also can be found at the Choose My Plate web site, which has a special section for women who are pregnant or breastfeeding.

If you have never exercised before, pregnancy is a great time to start. Discuss your exercise plan with your obstetrician to make sure it is safe. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes on most&mdashpreferably all&mdashdays of the week. Walking is a good choice if you are new to exercise. Swimming is another good exercise for pregnant women. The water supports your weight so you can avoid injury and muscle strain. It also helps you stay cool.

Your weight will be tracked at each prenatal visit. The growth of your baby also will be checked. If you are gaining less than the recommended guidelines, and if your baby is growing well, you do not have to increase your weight gain to catch up to the guidelines. If your baby is not growing well, changes may need to be made to your diet and exercise plan.

Overweight and obese women have longer labors than women of normal weight. It can be harder to monitor the baby during labor. For these reasons, obesity during pregnancy increases the likelihood of having a cesarean delivery. If a cesarean delivery is needed, the risks of infection, bleeding, and other complications are greater for an obese woman than for a woman of normal weight.

Once you are home with your new baby, stick to your healthy eating and exercise habits to reach a normal weight. Breastfeeding is recommended for the first year of a baby&rsquos life. Not only is breastfeeding the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who breastfeed their babies for at least a few months tend to lose pregnancy weight faster than women who do not breastfeed.

Bariatric Surgery: Surgical procedures that cause weight loss for the treatment of obesity.

Body Mass Index (BMI): A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Calories: Units of heat used to express the fuel or energy value of food.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the woman&rsquos abdomen and uterus.

Eclampsia: Seizures occurring in pregnancy or after pregnancy and linked to high blood pressure.

Gestational Diabetes: Diabetes that arises during pregnancy.

Macrosomia: A condition in which a fetus has an estimated weight of 4,500 grams (9 pounds 15 ounces) or greater.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Obesity: A condition characterized by excessive body fat.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Sleep Apnea: A disorder characterized by interruptions of breathing during sleep that can lead to other health problems.

Stillbirth: Delivery of a dead baby.

Stroke: A sudden interruption of blood flow to all or part of the brain, caused by blockage or bursting of a blood vessel in the brain and often resulting in loss of consciousness and temporary or permanent paralysis.

Trimesters: The three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.


Prevention of premature births

While the cause of most preterm births is unknown, there are life decisions that play a role in helping prevent early labor before and during pregnancy.

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Chronic condition recommendations

If mothers have any of the chronic conditions listed above or suffer from a different one, they should speak to their doctor about how it can potentially impact their pregnancy.

They need to learn if there are any changes that need to be made to medications or other treatment they may be receiving. For example, women with diabetes will want to optimize blood sugar control and overweight/obese type two diabetics should be encouraged to lose weight. Women on chronic medications should review all of them for safety during pregnancy. This includes any over-the-counter medications or supplements that they might be taking.

  • The doctor might have the following recommendations to reduce the risk and/or complications related to premature birth, including:
  • Although bed rest, at home or in the hospital, is sometimes recommended, there is no evidence to show that it is effective in treating preterm labor or preventing preterm birth
  • Your doctor may prescribe antibiotics if PPROM occurs. This may prevent you and your baby from getting a serious infection.
  • According to a 2017 study, progesterone therapy is applicable to only a small percentage of pregnant women (primarily those with a shortened cervix and those with a history of previous preterm birth). The benefits to the general population appear to be limited. However, several studies have shown that conducting population-based cervical screening programs combined with progesterone therapy is promising.
  • Steroids prior to delivery have helped decrease some of the long-term complications of prematurity. Steroids can help the baby’s lungs grow faster in the womb so they will be less likely to have breathing trouble on their own once they are born.
  • A meta-analysis of randomized controlled trials published in the American Journal of Pediatrics demonstrated that antenatal (prior to birth) exposure to magnesium sulfate reduces the risk of cerebellar hemorrhage in premature babies. This may explain the observed neuroprotective effect that leads to a reduced risk of cerebral palsy.

Eating healthy during pregnancy

Healthy eating during pregnancy includes getting enough nutrients for you and your baby as well as knowing how much to eat.

Eat food from different groups like grains, proteins, vegetables, fruits and dairy. Some foods from these groups are good sources for nutrients like folic acid, iron, calcium and Vitamin D, which are helpful for you and your baby.

If you're pregnant, thinking about getting pregnant or breastfeeding, eat 8 to 12 ounces each week of fish that are low in mercury.

Talk to your health care provider about nutrients, eating a healthy amount of food and when you have any concerns about your diet.

You may have heard that your eating habits may change during pregnancy. That’s OK! You will find foods that you like and that are healthy for both you and your baby. Eating nutritious foods will help you support your pregnancy and the new changes in your body.

Healthy eating during pregnancy includes knowing how much to eat and what foods are healthy. It’s also finding a balance between getting enough nutrients for your baby’s growth and keeping a healthy weight for you and your baby’s health. Nutrients are the building blocks of the body like protein, carbohydrates and fat. Talk to your provider about how you can get the nutrients you need in your diet.

What nutrients do I need during pregnancy to keep my baby and me healthy?

During pregnancy, you can get a lot of nutrients from different sources or food groups such as grains, proteins, vegetables, fruits, and dairy. Other sources of nutrients are fats and vitamins and minerals.

Proteins help your body with muscle and tissue growth and also with your baby’s growth. Protein can be found in foods like:

  • Beef, pork, fish and poultry
  • Eggs
  • Milk, cheese and other dairy foods
  • Beans and peas
  • Nuts and Seeds
  • Soy products like tempeh and tofu

Carbohydrates are found in food like grains and they’re your body’s fuel to help you do your activities. . There are different types of carbohydrates. Foods can have a combination of all three types of carbohydrates.

Simple carbohydrates are broken down fast, spiking your blood sugar quickly. It’s best to limit foods high in simple carbohydrates like:

Complex carbohydrates give longer lasting energy and can be found in:

  • Whole grain products, like bread, rice and pasta
  • Beans
  • Starchy vegetables like potatoes and corn

Fiber is also a type of complex carbohydrate and can be found in plant foods. Fiber can help with digestion. The following foods are good sources of fiber:

  • Vegetables such as cabbage, spinach, kale
  • Fruits like, berries, oranges, apples and peaches with the skin
  • Legumes such as chickpeas, black beans, lentils

Certain amounts of fat are also important for your body. During pregnancy, the fats you eat are a source of energy and help with your baby’s organs and the placenta. However, be careful not to eat too much saturated fat (such as butter, heavy cream and meats with high content of fat) and trans fat (often found in margarine, microwave popcorn, cookies and pastries made with vegetable shortening) because those can cause problems for your health.

Other nutrients that you need during pregnancy to keep yourself and your baby healthy include:

  • Folate or Folic acid. These can help prevent birth defects of the brain and spine in your baby, called neural tube defects. This can be found in enriched and fortified products (like bread, rice, cereals), leafy green vegetables, citrus fruits and beans and peas. Enriched and fortified means the nutrient was added to a food product.
  • Calcium. This strengthens bone and teeth for your baby and also helps your body stay healthy during pregnancy. Good sources of calcium are dairy products, broccoli and kale. Fortified cereals or juices may also be a good source.
  • Vitamin D. This is also helpful for building your baby’s bones and teeth. Good sources include fatty fish like salmon or fortified milk or orange juice.
  • Iron. This helps your body create more blood to help make sure your baby gets enough oxygen. Good sources of iron are meat products and beans. Your body can absorb iron more easily if you also get enough Vitamin C. Vitamin C can be found in orange juice, citrus fruits and strawberries.
  • DHA. This is a kind of fat call an omega-3 fatty acid. This is important for brain and eye development of your baby.
    Iodine. This is a mineral that helps with your baby’s brain and nerve growth.

How much should you eat each day during pregnancy?

Most pregnant women need only about 300 extra calories per day during the last 6 months of pregnancy. A glass of skim milk two small crackers and a tablespoon of peanut butter have approximately 300 calories. The exact amount depends on your weight before pregnancy. If you’re underweight before pregnancy, you may need more calories. If you’re overweight before, you may need less. Talk to your provider about what’s right for you.

Use this sample menu to plan healthy meals.

Knowing how big each of these serving sizes is can be tricky. Here are some everyday items that can help:

  • 1 cup is about the size of a baseball.
  • 1/3 cup is about as much as you can fit in your hand (a rounded or full handful).
  • ½ cup is about the size of a tennis ball.
  • ¼ cup is about the size of a golf ball.
  • 1 tablespoon is about the size of ½ a ping pong ball.
  • 1 ounce of meat (chicken, pork, beef, fish, etc.) is about the size of two thumbs.
  • 3 ounces of meat is about the size of a deck of cards or the palm of your hand.
  • A small fruit (orange or apple) is about the size of a tennis ball.

Go to ChooseMyPlate.gov website to learn more about how to make healthy food choices during pregnancy. ChooseMyPlate shows the amounts and foods that you may want to eat at every trimester during your pregnancy. They break down food into five groups:

  • Grains. These include bread, pasta, oatmeal, cereal and tortillas.
  • Fruits. These can be fresh, frozen, canned or dried
  • Vegetables. These can be raw, cooked, frozen, canned, dried or 100% vegetable juice.
  • Dairy. These include milk and products made from milk like cheese, yogurt and ice cream. While pregnant, make sure you eat pasteurized dairy foods (this means it has gone through a heating process that makes it safer to eat) and try to choose fat-free or low-fat types.
  • Protein Foods. These include meat, poultry, seafood, beans, peas, eggs, tofu, nuts and seeds.

Follow these ChooseMyPlate guidelines:

  • Make 1/2 of your plate fruits and vegetables.
  • Drink skim milk or 1% milk.
  • Make 1/4 of your plate grains. When you eat grains, try to use whole grains ½ of the time.
  • Make 1/4 of your plate protein. Use different sources of protein such as low mercury fish 2 or 3 times a week. See more information about fish in the section below. Choose lean meats and poultry.
  • Aim at eating less “empty” calories. This means the food has a lot of calories but not a lot of nutrients such as candy, chips, or sugary drinks.

Other ways to eat healthy and make sure you’re getting enough nutrients are:

  • Eat snacks that have good amounts of nutrients such as fruit, cereal and yogurt. Choose snacks that are low in fat and sugar.
  • You may find it easier to eat six smaller meals throughout the day. This can also be helpful later in pregnancy to avoid indigestion.
  • Drink six to eight glasses of water each day.
  • Take your prenatal vitamin every day. This is a multivitamin made just for pregnant women and can help you make sure you get enough folic acid and iron.
  • Make sure your whole meal fits on one plate. Don’t make huge portions.

Is it OK to eat fish when you're pregnant?

Yes, as long as you eat the right kinds! Most fish are low in fat and high in protein and other nutrients your body needs like omega-3 fatty acids. Omega-3 fatty acids are important for brain development.

You may have heard about mercury in fish. Mercury is a metal that can harm your baby. Fish get mercury from water they swim in and from eating other fish that have mercury in them. Eating the recommended amounts of fish that is low in mercury during pregnancy hasn’t shown problems in babies. When you're pregnant, it's OK to eat fish as long as it's low in mercury. And be careful to limit the amount.

If you're pregnant, thinking about getting pregnant or breastfeeding, eat 8 to 12 ounces each week of fish that are low in mercury. These include:

  • Shrimp
  • Salmon
  • Sardines
  • Catfish
  • Canned light tuna
  • Albacore (white) tuna — Don't have more than 6 ounces of this tuna in 1 week.

For more information on safely choosing fish to eat, you can visit the FDA website. Find out which types of fish are safer to eat and how often you can eat them.

How can I eat healthy if I am a vegetarian?

If you’re a vegetarian and pregnant, it’s possible to get the nutrients you need. Talk to your provider about how to get the nutrients you and your baby need during pregnancy. Some helpful tips are:

  • Make sure you get enough protein from sources like soy milk, tofu and beans. If you’re on a diet that allows for animal products, you can also eat eggs, milk and cheese.
  • Eat lots of foods that have good amounts of iron such as vegetables and legumes like spinach, white beans, kidney beans and chickpeas.
  • For calcium if you cannot have dairy foods, eat dark leafy greens, calcium-enriched tofu and other products enriched with calcium such as soy milk, rice milk or orange juice.
  • Some cereals and milk may also be fortified with Vitamin B12.

What if I have other concerns about my diet?

Some women may be lactose intolerant, they can’t fully digest lactose in dairy products. Others are unable to eat things like gluten (found in wheat, barley and rye) due to Celiac Disease. Your provider can help you plan your diet or advise you take certain supplements. Other helpful tips for healthy eating are:


Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden

Objective: To investigate associations between maternal overweight and obesity and infant mortality outcomes, including cause-specific mortality.

Design: Population based cohort study.

Setting and participants: 1,857,822 live single births in Sweden 1992-2010.

Main outcome measures: Associations between maternal body mass index (BMI) in early pregnancy and risks of infant, neonatal, and postneonatal mortality, overall and stratified by gestational length and by causes of infant death. Odds ratios were adjusted for maternal age, parity, smoking, education, height, country of birth, and year of delivery.

Results: Infant mortality rates increased from 2.4/1000 among normal weight women (BMI 18.5-24.9) to 5.8/1000 among women with obesity grade 3 (BMI ≥ 40.0). Compared with normal weight, overweight (BMI 25.0-29.9) and obesity grade 1 (BMI 30.0-34.9) were associated with modestly increased risks of infant mortality (adjusted odds ratios 1.25 (95% confidence interval 1.16 to 1.35) and 1.37 (1.22 to 1.53), respectively), and obesity grade 2 (BMI 35.0-39.9) and grade 3 were associated with more than doubled risks (adjusted odds ratios 2.11 (1.79 to 2.49) and 2.44 (1.88 to 3.17)). In analyses stratified by preterm and term births, maternal BMI was related to risks of infant mortality primarily in term births (≥ 37 weeks), where risks of deaths due to birth asphyxia and other neonatal morbidities increased with maternal overweight and obesity. Obesity grade 2-3 was also associated with increased infant mortality due to congenital anomalies and sudden infant death syndrome.

Conclusions: Maternal overweight and obesity are associated with increased risks of infant mortality due to increased mortality risk in term births and an increased prevalence of preterm births. Maternal overweight and obesity may be an important preventable risk factor for infant mortality in many countries.


Causes of death associated with preterm delivery

Previous studies reported that women who deliver preterm or extremely preterm (22-27 weeks) have increased risks of developing conditions such as heart disease or diabetes in later life. Also Read - Baby Born Onboard An IndiGo Flight: Travel Guidelines During Last Month Of Pregnancy

In the new study, researchers analysed data on length of pregnancy for over two million women who gave birth in Sweden from 1973-2015. They found that women who delivered preterm or extremely preterm had 1.7-fold and 2.2-fold increased risk of death from any cause, respectively, during the next 10 years compared to those who delivered full term. Cardiovascular and respiratory disorders, diabetes, and cancer were among the several specific causes of death associated with preterm delivery.


Risks If You’re Pregnant And Obese

As already discussed, a pregnant woman who is obese is at a greater risk of many health problems, including:

  • miscarriage
  • blood clots
  • gestational diabetes
  • high blood pressure
  • heavy bleeding

While these problems can affect a pregnant woman, whether obese or not, it can increase the risk of developing these problem increases. Being obese may elevate the risk of the following health problems for the baby:


Nutrition During Pregnancy

Eating well is one of the best things you can do during pregnancy. Good nutrition helps you handle the extra demands on your body as your pregnancy progresses. The goal is to balance getting enough nutrients to support the growth of your fetus and maintaining a healthy weight.

The popular saying is that pregnant women &ldquoeat for two,&rdquo but now we know that it&rsquos dangerous to eat twice your usual amount of food during pregnancy. Instead of &ldquoeating for two,&rdquo think of it as eating twice as healthy.

If you are pregnant with one fetus, you need an extra 340 calories per day starting in the second trimester (and a bit more in the third trimester). That's roughly the calorie count of a glass of skim milk and half a sandwich. Women carrying twins should consume about 600 extra calories a day, and women carrying triplets should take in 900 extra calories a day.

Vitamins and minerals play important roles in all of your body functions. Eating healthy foods and taking a prenatal vitamin every day should supply all the vitamins and minerals you need during pregnancy.

Take only one serving of your prenatal supplement each day. Read the bottle to see how many pills make up one daily serving. If your obstetrician&ndashgynecologist (ob-gyn) or other obstetric care provider thinks you need an extra amount of a vitamin or mineral, he or she may recommend it as a separate supplement.

No, do not take more than the recommended amount of your prenatal vitamin per day. Some multivitamin ingredients, such as vitamin A, can cause birth defects at higher doses.

During pregnancy you need folic acid, iron, calcium, vitamin D, choline, omega-3 fatty acids, B vitamins, and vitamin C. See the below table for recommended amounts.

Key Vitamins and Minerals During Pregnancy

Calcium (1,300 milligrams for ages 14 to 18 years 1,000 milligrams for ages 19 to 50 years)

Builds strong bones and teeth

Milk, cheese, yogurt, sardines, dark green leafy vegetables

Helps red blood cells deliver oxygen to your fetus

Lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, prune juice

Essential for healthy brain development

Iodized table salt, dairy products, seafood, meat, some breads, eggs

Important for development of your fetus&rsquos brain and spinal cord

Milk, beef liver, eggs, peanuts, soy products

Vitamin A (750 micrograms for ages 14 to 18 years 770 micrograms for ages 19 to 50 years)

Forms healthy skin and eyesight

Carrots, green leafy vegetables, sweet potatoes

Vitamin C (80 milligrams for ages 14 to 18 years 85 milligrams for ages 19 to 50 years)

Promotes healthy gums, teeth, and bones

Citrus fruit, broccoli, tomatoes, strawberries

Vitamin D (600 international units)

Builds your fetus&rsquos bones and teeth

Helps promote healthy eyesight and skin

Sunlight, fortified milk, fatty fish such as salmon and sardines

Helps form red blood cells

Helps body use protein, fat, and carbohydrates

Beef, liver, pork, ham, whole-grain cereals, bananas

Vitamin B12 (2.6 micrograms)

Helps form red blood cells

Meat, fish, poultry, milk (vegetarians should take a supplement)

Folic acid (600 micrograms)

Helps prevent birth defects of the brain and spine

Supports the general growth and development of the fetus and placenta

Fortified cereal, enriched bread and pasta, peanuts, dark green leafy vegetables, orange juice, beans. Also, take a daily prenatal vitamin with 400 micrograms of folic acid.

Excess weight during pregnancy is associated with several pregnancy and childbirth complications, including:

Obesity during pregnancy also increases the risk of:

Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Folic acid may help prevent major birth defects of the fetus&rsquos brain and spine called neural tube defects (NTDs).

When you are pregnant you need 600 micrograms of folic acid each day. Because it&rsquos hard to get this much folic acid from food alone, you should take a daily prenatal vitamin with at least 400 micrograms starting at least 1 month before pregnancy and during the first 12 weeks of pregnancy.

Women who have had a child with an NTD should take 4 milligrams (mg) of folic acid each day as a separate supplement at least 3 months before pregnancy and for the first 3 months of pregnancy. You and your ob-gyn or other obstetric care provider can discuss whether you need to supplement with more than 400 micrograms daily.

Iron is used by your body to make the extra blood that you and your fetus need during pregnancy. Women who are not pregnant need 18 mg of iron per day. Pregnant women need more, 27 mg per day. This increased amount is found in most prenatal vitamins.

In addition to taking a prenatal vitamin with iron, you should eat iron-rich foods such as beans, lentils, enriched breakfast cereals, beef, turkey, liver, and shrimp. You also should eat foods that help your body absorb iron, including orange juice, grapefruit, strawberries, broccoli, and peppers.

Calcium is a mineral that builds your fetus&rsquos bones and teeth. Women who are age 18 or younger need 1,300 mg of calcium per day. Women who are 19 or older need 1,000 mg per day.

Milk and other dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli, fortified foods (cereals, breads, and juices), almonds and sesame seeds, sardines or anchovies with the bones, and dark green leafy vegetables. You also can get calcium from calcium supplements.

Vitamin D works with calcium to help the fetus&rsquos bones and teeth develop. Vitamin D also is essential for healthy skin and eyesight. All women, pregnant or not, need 600 international units of vitamin D a day.

Good sources of vitamin D include fortified milk and breakfast cereal, fatty fish (salmon and mackerel), fish liver oils, and egg yolks.

Many people do not get enough vitamin D. If your ob-gyn or other obstetric care provider thinks you may have low levels of vitamin D, a test can be done to check the level in your blood. If it is below normal, you may need to take a vitamin D supplement.

Choline plays a role in your fetus&rsquos brain development. It also may help prevent some common birth defects. Experts recommend that pregnant women get 450 mg of choline each day.

Choline can be found in chicken, beef, eggs, milk, soy products, and peanuts. Although the body produces some choline on its own, it doesn&rsquot make enough to meet all your needs while you are pregnant. It&rsquos important to get choline from your diet because it is not found in most prenatal vitamins.

Omega-3 fatty acids are a type of fat found naturally in many kinds of fish. Omega-3s may be important for brain development before and after birth.

Women should eat at least two servings of fish or shellfish per week before getting pregnant, while pregnant, and while breastfeeding. A serving of fish is 8 to 12 ounces (oz).

Some types of fish have higher levels of mercury than others. Mercury is a metal that has been linked to birth defects. Do not eat bigeye tuna, king mackerel, marlin, orange roughy, shark, swordfish, or tilefish. Limit white (albacore) tuna to only 6 oz a week. You also should check advisories about fish caught in local waters.

Flaxseed (ground or as oil) is a good source of omega-3s. Other sources of omega-3s include broccoli, cantaloupe, kidney beans, spinach, cauliflower, and walnuts.

B vitamins, including B1, B2, B6, B9, and B12, are key nutrients during pregnancy. These vitamins:

Supply energy for your fetus&rsquos development

Your prenatal vitamin should have the right amount of B vitamins that you need each day. Eating foods high in B vitamins is a good idea too, including liver, pork, chicken, bananas, beans, and whole-grain cereals and breads.

Vitamin C is important for a healthy immune system. It also helps build strong bones and muscles. During pregnancy, you should get at least 85 mg of vitamin C each day if you are older than 19, and 80 mg if you are younger than 19.

You can get the right amount of vitamin C in your daily prenatal vitamin, and also from citrus fruits and juices, strawberries, broccoli, and tomatoes.

Drink throughout the day, not just when you are thirsty. Aim for 8 to 12 cups of water a day during pregnancy.

There are many tools that can help you plan healthy meals. One useful tool is the MyPlate food-planning guide from the U.S. Department of Agriculture. The MyPlate website, www.choosemyplate.gov, can help you learn how to make healthy food choices at every meal.

The MyPlate website offers a MyPlate Plan, which shows how much to eat based on how many calories you need each day. The MyPlate Plan is personalized based on your:

The MyPlate Plan can help you learn about choosing foods from each food group to get the vitamins and minerals you need during pregnancy. The MyPlate Plan also can help you limit calories from added sugars and saturated fats.

Bread, pasta, oatmeal, cereal, and tortillas are all grains. Whole grains are those that haven&rsquot been processed and include the whole grain kernel. Oats, barley, quinoa, brown rice, and bulgur are all whole grains, as are products made with those grains. Look for the words &ldquowhole grain&rdquo on the product label. When you plan meals, make half of your grain servings whole grains.

You can eat fresh, canned, frozen, or dried fruit. Juice that is 100 percent fruit juice also counts in the fruit category. Make half your plate fruit and vegetables during mealtimes.

You can eat raw, canned, frozen, or dried vegetables or drink 100 percent vegetable juice. Use dark leafy greens to make salads. Make half your plate fruit and vegetables during mealtimes.

Meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds all contain protein. Eat a variety of protein each day.

Milk and milk products, such as cheese, yogurt, and ice cream, make up the dairy group. Make sure any dairy foods you eat are pasteurized. Choose fat-free or low-fat (1 percent) varieties.

Oils and fats are another part of healthy eating. Although they are not a food group, they do give you important nutrients. During pregnancy, the fats that you eat provide energy and help build the placenta and many fetal organs.

Oils in food come mainly from plant sources, such as olive oil, nut oils, and grapeseed oil. They also can be found in certain foods, such as some fish, avocados, nuts, and olives. Most of the fats and oils in your diet should come from plant sources. Limit solid fats, such as those from animal sources. Solid fats also can be found in processed foods.

Weight gain depends on your health and your body mass index (BMI) before you were pregnant. If you were underweight before pregnancy, you should gain more weight than a woman who had a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight. The amount of weight gain differs by trimester:

  • During your first 12 weeks of pregnancy&mdashthe first trimester&mdashyou might gain only 1 to 5 pounds or none at all.
  • If you were a healthy weight before pregnancy, you should gain a half-pound to 1 pound per week in your second and third trimesters.

See the below table for recommended weight gain during pregnancy.

Weight Gain During Pregnancy

Less than 18.5 (underweight)

*Assumes a first-trimester weight gain between 1.1 and 4.4 pounds

Source: Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press.

During the first trimester with one fetus, usually no extra calories are needed. In the second trimester, you will need an extra 340 calories per day, and in the third trimester, about 450 extra calories a day. To get the extra calories during the day, have healthy snacks on hand, such as nuts, yogurt, and fresh fruit.

Excess weight during pregnancy is associated with several pregnancy and childbirth complications, including:

Obesity during pregnancy also increases the risk of:

Birth defects, especially NTDs

You and your ob-gyn or other obstetric care provider will work together to develop a nutrition and exercise plan. If you are gaining less than what the guidelines suggest, and if your fetus is growing well, gaining less than the recommended guidelines can have benefits. If your fetus is not growing well, changes may need to be made to your diet and exercise plan.

Birth Defects: Physical problems that are present at birth.

Body Mass Index: A number calculated from height and weight. BMI is used to determine whether a person is underweight, normal weight, overweight, or obese.

Calories: Units of heat used to express the fuel or energy value of food.

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman&rsquos abdomen.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Folic Acid: A vitamin that reduces the risk of certain birth defects when taken before and during pregnancy.

Gestational Diabetes: Diabetes that starts during pregnancy.

High Blood Pressure: Blood pressure above the normal level. Also called hypertension.

Macrosomia: A condition in which a fetus grows more than expected, often weighing more than 8 pounds and 13 ounces (4,000 grams).

Neural Tube Defects: Birth defects that result from a problem in development of the brain, spinal cord, or their coverings.

Obstetric Care Provider: A health care professional who cares for a woman during pregnancy, labor, and delivery. These professionals include obstetrician&ndashgynecologists (ob-gyns), certified nurse&ndashmidwives (CNMs), maternal&ndashfetal medicine specialists (MFMs), and family practice doctors with experience in maternal care.

Obstetrician&ndashGynecologist (Ob-Gyn): A doctor with special training and education in women&rsquos health.

Oxygen: An element that we breathe in to sustain life.

Placenta: An organ that provides nutrients to and takes waste away from the fetus.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Preterm: Less than 37 weeks of pregnancy.

Trimester: A 3-month time in pregnancy. It can be first, second, or third.


Risk factors for preterm birth

The specific cause of preterm birth is unclear, but there are certain things associated with preterm birth, including:

  • Previous pregnancy with a preterm birth
  • Abnormal uterus
  • Being underweight or overweight before pregnancy
  • Being pregnant with twins or other multiples
  • Multiple miscarriages or abortions
  • IVF pregnancy
  • Stress
  • Improper care during pregnancy
  • Drug abuse, smoking, or drinking during pregnancy
  • Underlying health issues such as diabetes, hypertension, or thyroid
  • Blood clotting issues
  • STDs or vaginal infections
  • UTIs
  • Mother&rsquos age factor -less than 17 years or more than 35 years of age
  • Shortening of the cervix
  • Conception within 6 months of pregnancy

In fact, many women with no known risk factors have a premature birth, which means it can happen to anyone.