How to have a healthy pregnancy

For most women, pregnancy is a rollercoaster ride of joy punctuated by crippling doubt, countless Google searches and perpetual risk assessment.

Suddenly everything is measured in weeks (or fruit – the baby is compared to everything from a blueberry to a mango), a whole host of anatomical words enter the vernacular, and a woman’s entire lifestyle comes under scrutiny. 

Unsurprisingly, a survey conducted by pregnancy charity Tommy’s found that 86 per cent of women felt overwhelmed by the amount of pregnancy information available, not helped by the fact that guidelines and rhetoric seem to change by the year. 

To ease confusion, we’ve compiled a comprehensive guide to having a healthy pregnancy with the most up-to-date advice on foods to avoid, safe exercise and how to sleep better. Here’s what we cover:

• Eating for two?
• What to eat when you’re pregnant
• Prenatal vitamins and supplements
• Foods to avoid when pregnant
• How to sleep better when pregnant
• Is it safe to exercise when you’re pregnant?
• Do’s
• Don’ts

Eating for two?

This is one myth the NHS is keen to overturn as even by the third trimester, women only need an additional 200 calories a day (that’s two slices of wholemeal toast and margarine). The NHS website says most women gain between 10 and 12.5kg (22-28lb), mainly after week 20, but given those gains vary greatly, the focus should be on adopting healthy eating habits and staying active.

Foods women are encouraged to eat in order to help their baby develop and grow are fairly straightforward, but it’s those to avoid that cause confusion. “We know women receive a great deal of health-related information during their pregnancies,” says Dr Caroline Taylor, associate professor in nutrition at the University of Bristol, who runs The Pear Study, which aims to find out how guidance on diet in pregnancy affects what women eat. “Even in the last 15 years, protocol has changed with certain foods. For example, before 2009 the advice was to avoid peanuts if there was a history of allergies, now it’s to avoid them only if you have a nut allergy. Before 2019, all uncooked or partially cooked eggs were to be avoided, but now it’s okay if they are hen’s eggs stamped with the British Lion mark or produced under the Laid in Britain scheme. And before September 2022 smoked fish was fine and sushi was okay if the fish had previously been frozen. Nowadays raw fish should be avoided and smoked fish cooked thoroughly.”

What to eat when you’re pregnant

During pregnancy, women in England are urged to follow a healthy diet broadly similar to the general population with the exception of specific foods and drinks.

“A baby’s rapid growth and development during pregnancy puts many metabolic demands on a mother’s body, which requires plenty of nutritional fuel,” says nutritionist and hormonal health specialist Lola Ross. “A healthy pregnancy diet should be based around diverse wholefoods: colourful vegetables, fruit, legumes, wholegrains, small amounts of dairy and organic animal produce that provide you with protein, healthy fats, insoluble/soluble fibre and micronutrients needed to support both mum and baby during pregnancy.”

The NHS recommends eating at least two portions of fish a week, one oily – such as salmon, sardines or mackerel – but also instructs women to avoid eating more than two portions of oily fish a week. Taylor warns that this puts some women off eating fish altogether: “The advice on fish requires women to keep a tally of weekly intakes and determine what a portion looks like, as well as to be able to identify oily versus white fish. Our research finds this to have a negative effect on the amount of fish eaten, meaning pregnant women and their babies are missing out on the many beneficial effects.” 

According to Taylor’s research, most women say NHS information on eating fish is light on positive messaging, and she points out that while the mercury and pollutant content of oily fish is of concern, the benefits (despite increased levels of maternal blood or hair mercury) may outweigh any adverse effects and are now well established. 

Prenatal vitamins and supplements

The jury may still be out on the benefits of additional prenatal vitamin supplementation while following a healthy, varied diet, but official guidance dictates pregnant women should be taking 400mg of folic acid every day until the 12-week mark to help avoid neural tube birth defects such as spina bifida. It also states that supplements containing vitamin A, such as cod liver oil, should be avoided.

It’s recommended that pregnant and breastfeeding women take a vitamin D supplement between September and March when skin is less exposed to sunlight, with Ross advising that this is particularly important for black and brown women living in the Global North who have a higher risk of vitamin D deficiency, which can pose pregnancy or birth complications.

“It’s important to get your vitamin D levels checked via your GP or a nutritionist so they can prescribe tailored, safe supplement doses.” Because nutrient status can be compromised by stress and by eating nutrient-depleted crops and animal products as a result of industrialised farming, some people, adds Ross, may still want to consider supplementation. 

Foods to avoid when pregnant

Official guidance on foods to be avoided in pregnancy is based on several factors, including reduction of teratogens (substances that can cause birth defects) and microbiological and toxicological hazards. But while advice on alcohol, cigarettes and foods high in saturated fat or sugar is unequivocal (namely to avoid the former altogether and limit the latter), foods such as cheeses and fish are a little murkier. According to preliminary findings by The Pear Study, fish guidance was cited as the “most complicated” with all research participants significantly underestimating the amount of tuna they could eat, while only 32 per cent of midwives correctly recalled the overall advice on eating fish.

Current recommendations are to avoid eating shark, swordfish and marlin due to high levels of mercury, which can damage a developing baby’s nervous system, and to eat no more than two tuna steaks (or four tins) per week as tuna can also contain higher mercury levels. Raw shellfish and cold-smoked or cured fish such as smoked salmon and gravlax are also off the menu to minimise the risk of contracting listeriosis, which can lead to miscarriage or stillbirth. Oily fish such as mackerel and sardines, which can contain pollutants, should be limited to two portions a week. 

“Aside from fish, much of the public health guidance during pregnancy is based on avoiding foods that may harbour harmful bacteria such as listeria,” says Ross. “This bacteria can be found in soft cheeses with rinds, like brie, undercooked eggs and unpasteurised dairy products. Undercooked or raw meats are also best avoided, as they may contain the toxoplasmosis parasite, which can harm foetal development.”

And when it comes to your daily brew? “Caffeine has been shown to produce adverse effects on foetal development and is also an anti-nutrient – a substance that can interfere with the metabolism of nutrients such as iron and magnesium that we take in from our diet, so avoid as much as possible,” Ross explains.

How to sleep better when pregnant

One of the biggest ironies of pregnancy is that while we are urged to bank as much shut-eye as possible, and are well-versed in the benefits of rest to mother and baby, it’s often a time when women experience poor sleep. “Sleep disturbance and insomnia are common in pregnancy, and up to 80 per cent of pregnant women will suffer from this at some point,” says Shazia Malik, consultant obstetrician and gynaecologist. 

“In the first trimester, it is common to feel hotter at night due to hormonal changes, pass urine more frequently and have sore breasts and nipples. In the third trimester, backache and hip discomfort become more common, as well as the frequent trips to the bathroom at night,” Malik says. “Some women may also find that as the birth approaches, they feel more anxious which can affect sleep too. Leg cramps are not uncommon, and as your baby grows, the kicks become stronger and can sometimes wake you too.” 

Unsurprisingly, a survey into pregnant women’s attitudes and behaviour towards sleep and exercise found that almost all (95 per cent) experienced “barriers” to that elusive eight hours, whether it be 3am bathroom breaks or all-night baby gymnastics, although the same study also found that positive attitudes to sleep were associated with longer sleep duration and better sleep hygiene.

On a more worrying note, a review published by the University of Oxford found that sleep disturbances were significantly associated with adverse maternal and foetal health outcomes such as pre-eclampsia and gestational diabetes. 

So how can you sleep better when you’re pregnant? According to Malik, ensure that your bed is comfortable, your room temperature is cool and that you have pillows to support your back and hips. 

“Magnesium supplements can help with leg cramps, and staying fit and active as well as doing stretches can really help to keep stiff and sore muscles at bay. Avoiding caffeine, especially after lunchtime, can help, and seeking help for anxiety and sharing any worries or concerns is crucial at any point of pregnancy.” Malik also advises resisting your phone or tablet if you wake up. Instead, get up for half an hour in low light, do some breathing exercises or listen to sleep music.

Most experts (including the NHS and Tommy’s) advise that pregnant women should sleep on their sides, especially from 28 weeks onwards, after several reliable research trials found that sleeping on your back doubles the risk of stillbirth (don’t worry if you do wake up on your back, as it’s the position you go to sleep in that you hold for the longest time – simply settle back to sleep on your side).

Is it safe to exercise when you’re pregnant?

Despite the benefits of staying active during pregnancy, research suggests that most pregnant women are not meeting recommended levels of exercise. Almost all pointed to physical symptoms such as nausea, back pain and tiredness, as well as psychosocial factors such as lack of time or misguided beliefs about the safety of moderate to vigorous exercise, as things that negatively impacted their ability to hit the gym. 

“I’m always asked, ‘Is it safe to exercise when you’re pregnant?’ and the answer is a resounding yes,” says leading performance coach, personal trainer and nutritional expert Dalton Wong, who has trained many of his celebrity clients throughout pregnancy. “Aside from the mental health benefits that exercise provides, it is a great way to counter bad posture and reduce pain as the weight of your belly, breasts and curvature of the spine changes. Exercising during each trimester will allow your spine, hips and knees to become stronger, which will help support your changing body.” 

Dos

• Try pregnancy yoga or Pilates classes which are a great form of exercise and tailored to your specific needs. “I would always suggest that you start by getting professional guidance in order to practise safe prenatal yoga,” says Wong. “Once you have a plan, you can proceed to doing it by yourself. If you currently do yoga, you can of course modify your plan to suit your pregnancy, just avoid doing deep closed twists, intense backbends or obviously prone poses.”
• Choose low-impact exercises such as swimming. “If you do cardio, I would suggest you go for a lower-impact version so you can continue training throughout your pregnancy,” says Wong.
• Do “specific exercises for your glutes/core as they will help stabilise your lower back”, according to Wong. “Focusing on the muscles around your middle back and stretching out your chest can help strengthen the spine. When we make an effort to work on muscles around a joint, it helps improve its stability.”

Don’ts

• Don’t start a new exercise plan unless it’s under professional guidance and avoid exercises you haven’t done before or those where there is a risk of falling, such as skiing or horse riding.
• “Abdominal exercises should only be prescribed by a professional and tailored to your specific needs,” says Wong. “Avoid crunches as they can cause your upper abs to separate. Post-pregnancy, our aim is to close or reduce muscle separation with exercises that strengthen the core, such as hip extensions/bridges, bird dogs and side planks. As the core gets stronger, planks and crunches can be added in.”
• “Avoid rotational exercises where your hips move one way and the shoulders the other. This could cause back pain due to your spinal muscles being weaker,” says Wong.
• Don’t push yourself. “Relaxin is a hormone that helps loosen your muscles, joints and ligaments during pregnancy in preparation for birth. When you exercise, this hormone could allow your muscles, joints and ligaments to go further than your normal range, which can lead to strains or muscle and ligament pulls,” warns Wong.
• Tommy’s advises against lying flat on your back for long periods of time, especially after 16 weeks, as the weight of the baby puts pressure on the major blood vessels, which can cause low blood pressure and dizziness and reduce blood flow to the baby.