During pregnancy, a woman must eat

adequately to supply enough nutrients to the fetus, so it can grow, as well as to support her own nutrition.

Adequate protein intake is vital because so much is needed by a fetus to build a body framework. Adequate protein may also help prevent complications of pregnancy such as pregnancy-induced hypertension or preterm birth.

Either deficiencies or overuse of vitamins may contribute to birth anomalies.

Most women should gain somewhere between 25 and 35 pounds during pregnancy. Most will gain 2 to 4 pounds during the first trimester, and then 1 pound a week for the rest of the pregnancy. The amount of weight gain depends on your situation:

Women who are underweight coming into pregnancy should gain slightly more weight than the average woman (0.5 kg per month or week).

An obese woman might be advised to gain less than average (0.3 kg).

Recommended rates of weight gain per week during the second and third trimesters are 1.1 pound, 0.9 pound, and 0.66 pound for pregnant women who are underweight, normal weight, and overweight, respectively.

Inadequate weight gain has been associated with low birth weight, whereas excessive weight gain has been associated with fetal macrosomia and maternal obesity Women should avoid fasting (>13 hours without food) They should have five feedings per day (breakfast, lunch, afternoon snack, dinner, and bedtime snack). Pregnant women should never skip breakfast. Weight gain is an important consideration during pregnancy, and the clinician should emphasize the right amount of nutrition over the right amount of weight gain. Normal pregnancy requires an increase in daily caloric intake of 300 kcal.

Calorie needs increase during pregnancy to help support a woman's maternal body changes and the baby's proper growth and development. The RDA for energy intake during pregnancy is an additional 300 calories per day for the second and third trimester, in addition to maintenance needs.

All the calories you consume during pregnancy should be healthy calories that contain plenty of protein, complex carbohydrates, fiber, vitamins, and minerals. Complex carbohydrates such as fruit, whole-grain starches, cereal, pasta, rice, potatoes, corn, and legumes should be the main source of energy.

Good nutrition is important during pregnancy and breastfeeding, as there is an increased need for calories and for most nutrients.

a) Folate (B vitamin)

A particularly important nutrient during pregnancy is folic acid,

folic acid, before conception and throughout the first 12

weeks, reduces the risk of having a baby with a neural tube defect

(for example, anencephaly or spina bifida).

The recommended dose is 400 micrograms per day.

b) Calcium--keep bones healthy and strong.

Adequate calcium intake during both

pregnancy and breastfeeding is also important, since calcium is drawn from the mother.

is essential in the maintenance of skeletal growth and bone health –

vitamin D regulates calcium and phosphate absorption and metabolism.

Protein needs increase during pregnancy to help develop the body cells of the growing baby. Other changes that are taking place in your body during pregnancy also require protein, such as the building of the placenta.

Most women do not have a problem meeting their protein requirements. Consuming plenty of lean meats, fish, tuna, eggs, and legumes, as well as increasing your dairy servings, will ensure you meet your protein needs. If you are a vegetarian, consume a variety of legumes, grain products, eggs, low-fat or fat-free dairy products, vegetables, fruits, and soy foods to ensure proper protein intake.

Also be aware of increased fluid needs. Water is an important nutrient and is essential for the nourishment that passes through the placenta to the baby.

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ALERT! Raw foods can increase your risk for bacterial infection. Avoid anything raw, including sushi and other raw seafood, undercooked meat or poultry, beef tartar, raw or unpasteurized milk, soft-cooked or poached eggs, and raw eggs (possibly found in eggnog). 

c) Omega 3

--development of the central nervous system, brain growth and eye development in your baby before and after he or she is born

--oily fish like salmon, trout, herring, anchovies and sardines, chicken, eggs, canned tuna and flaxseed oil

d) Iodine

--required for healthy thyroid function in both the mother and unborn baby

--insufficient iodine can lead to brain development and neurological issues problems in the baby

e) Zinc

--rapid cell growth that occurs during pregnancy

--found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts

f) Vitamin C

--increased in pregnancy due to larger blood volume in the mother and the growth of the unborn baby

--fruit and vegetables

g) Fiber

--high fiber intake combined with plenty of fluid is encouraged to help prevent constipation

--wholegrain breads and cereal products, legumes, nuts, vegetables and fruit

h) Water

--drink eight to twelve glasses of fluid a day

Iron supplementation should not be offered routinely to all pregnant women.

It does not benefit the mother's or the baby's health and may have unpleasant maternal side effects.

Iron supplements are particularly important for pregnant women who have anemia.

Vitamin A supplementation during pregnancy as part of routine antenatal is not recommended.

vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided.

In settings where there is a severe public health problem (prevalence of night blindness is 5% or higher in pregnant women or 5% or higher in children 24–59 months of age), related to vitamin A deficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness.

Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided.

Pregnant women should be informed that liver and liver products may also contain high levels of vitamin A, and therefore consumption of these products should also be avoided.

Avoid undercooked meat, poultry and eggs During pregnancy, you're at increased risk of bacterial food poisoning. Your reaction might be more severe than if you weren't pregnant.

Avoid eating ripened soft cheese, there is no risk with hard cheeses.

Avoid eating pâté (of any sort, including vegetable)

caffeine to 300 milligrams a day

Seafood can be a great source of protein, and the omega-3 fatty acids in many fish can promote your baby's brain and eye development.

However, some fish and shellfish contain potentially dangerous levels of mercury. Too much mercury could harm your baby's developing nervous system.

The bigger and older the fish, the more mercury it's likely to contain.

Breastfeeding has been shown to significantly reduce morbidity and improve cognitive development during infancy and childhood.The benefits of breastfeeding include:

for the newborn,excellent nutrition and provision of immunologic protection

for the mother, more rapid uterine involution, economy, maternal–child bonding, to some extent natural contraception, , more rapid weight loss associated with extra calorie expenditure. Contraindications to breastfeeding include certain maternal infections and use of medications.

Sexual Activity Sexual intercourse is not restricted during a normal

pregnancy, although advice about more comfortable positions in later pregnancy may be appreciated.

in later pregnancy may be appreciated Sexual activity may be restricted or prohibited under certain high-risk circumstances, such as known placenta previa, premature rupture of membranes, or actual or history of preterm labor.

Travel is acceptable under most circumstances. Prolonged sitting increases the risk for thrombus formation and thromboembolism.

should be informed about the correct use of seatbelts (that is, three-point seatbelts 'above and below the bump, not over it').

International travel that places the patient at a high risk for infectious disease (such as travel to areas with a high rate of transmission of malaria or typhoid fever) should be avoided, whenever possible. When such travel cannot be avoided, appropriate vaccinations should be administered

Exercise;In the absence of either medical or

obstetric complications, up to 30 minutes of moderate exercise per day on most if not all days of the week is acceptable strenuous exercise ,activities with a high risk for falling or for abdominal trauma and Supine exercises after the first trimester should be avoided.

regarding work A woman with an uncomplicated pregnancy can usually continue to work until the onset of labor

Strenuous work is best avoided

A teratogen is any agent or factor that can cause abnormalities of form or function (birth defects) in an exposed fetus.

The most important determinants of the developmental toxicity of an agent are timing, dose, and fetal susceptibility.

Many agents have teratogenic effects only if taken while the susceptible fetal organ system is forming.

Teratogens may be assigned to three broad categories:

(1) drugs and chemical agents, (2) infectious agents, and (3) radiation.

ALCOHOL Alcohol is the most common teratogen to which a fetus is exposed, and

alcohol consumption during pregnancy is a leading preventable cause of mental retardation, developmental delay, and birth defects in the fetus. There is no established safe level of alcohol use during pregnancy.

avoid drinking alcohol in the first 3 months of pregnancy if possible because it may be associated with an increased risk of miscarriage.

Fetal Alcohol Syndrome  a pattern of mental and physical defects that can develop in a fetus when a

woman drinks alcohol during pregnancy Tobacco Use TOBACCO SMOKING. Maternal tobacco smoking interferes with prenatal

growth, including birth weight, birth length, and head circumference. Pregnant women should be strongly encouraged to avoid smoking

it is important to educate patients about the risks of smoking for both themselves and their newborns and to coordinate appropriate resources to help patients quit.

Substance Abuse The use of illicit substances by women of childbearing age has led to an increased number of neonates having had in utero exposure and subsequent risk of adverse effects from a variety of drugs. Fetal drug exposure often is unrecognized because of the lack of overt symptoms or structural anomaly following birth. Illicit drugs may reach the fetus via placental transfer or may reach the newborn through breast milk. The specific effect on the fetus and newborn varies with the respective substances. An opiate-exposed fetus may experience withdrawal symptoms in utero if the woman stops or when the woman goes through withdrawal, either voluntarily or under supervision, or after birth when the delivery by way of the placenta ceases. Universal screening, using biologic specimens, of women and newborns for substance abuse is not recommended. However, all pregnant women should be asked at their first prenatal visit about past and present use of alcohol, nicotine, and other drugs, including recreational use of prescription and over-the-counter medications. Use of specific screening questionnaires may improve detection rates. A woman who acknowledges use of these substances should be counseled about the perinatal implications of their use during pregnancy, and offered referral to an appropriate drug-treatment program if chemical dependence is suspected. Careful follow-up during the postpartum period is also recommended.

MEDICATIONS METHYL MERCURY Industrial pollution is the major source of mercury entry in our ecosystem. Large fish, such as tuna, shark, and king mackerel, retain higher levels of mercury from the smaller fish and organisms they consume. Hence, women who eat these fish are storing high levels of mercury. HERBAL REMEDIES Herbal remedies are not regulated as prescription or over-the-counter drugs, the identity and quantity of their ingredients are unknown, and there are virtually no studies of their teratogenic potential. Because it is not possible to assess their safety, pregnant women should be counseled to avoid these substances. Remedies containing substances with pharmaceutical properties that could theoretically have adverse fetal affects include the following:

radiation exposure has the potential to cause gene mutations, growth impairment, chromosome damage and malignancy, or fetal death, large doses are required to produce discernible fetal Effects. RADIATION. Prenatal ionizing radiation exposure occurs frequently as a result of therapeutic or diagnostic medical and dental procedures.

Nausea and vomiting in early pregnancy Nausea and vomiting complicate up to 70% of pregnancies.

Most mild cases of nausea and vomiting can be resolved with lifestyle and dietary changes, including consuming more protein, vitamin B6 , or vitamin B6 with doxylamine.

Usually, nausea and vomiting improve significantly by the end of the first trimester.

When medication is deemed necessary, antihistamines appear to be the drug of choice,

Heartburn (gastric reflux) is common, especially postprandially, and is often associated with eating large meals or spicy or fatty foods.

Avoiding lying down immediately after meals and elevating the head of the bed may help reduce heartburn.

When these simple measures fail, antacids, such as calcium carbonate, should be used.

Constipation is physiologic in pregnancy, associated with increased transit time, increased water absorption, and often decreased bulk.

Dietary modification, including increased fiber and water intake, can help lessen this problem.

Stool softeners may be used in combination with bulking agents. Irritant laxatives should be reserved for short-term use in refractory cases.

Increased rest, with elevation of the legs, and avoidance of constipation are recommended.

Backaches are common during pregnancy and are lessened by avoiding excessive weight gain. Additionally, exercise, sensible shoes, and specially shaped pillows can offer relief. In cases of muscle spasm or strain, analgesics (such as acetaminophen), rest, and heat may lessen the symptoms.

Leg cramps Leg cramps, usually affecting the calves, are common during pregnancy.

Massage and stretching may afford some relief during an attack. Both calcium and sodium chloride appear to help reduce leg cramps in pregnancy.

Pregnant women should be informed that few over-the-counter medicines have been established as being safe to take in pregnancy.

Over-the-counter medicines should be used as little as possible during pregnancy.

Prescribing during pregnancy involves the balance between benefit to the mother and potential harm to the fetus.

Few medicines have been established as safe to use in pregnancy. Prescription medicines should be used as little as possible during pregnancy and should be limited to circumstances where the benefit outweighs the risk