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What are some common do’s and don’ts?

Medications in pregnancy:

In general, unless actually required, it is better to minimise or avoid medication use and talk to your doctor or Obstetrician first.

Most medications for chronic conditions are able to or need to be continued in pregnancy to keep your condition under control.  If you take regular medications, please, talk to us or your other specialists before stopping or starting new medications once you are pregnant.

There are very few medications which are completely incompatible with pregnancy.  If you know you are pregnant and a new medication is prescribed for you, please, let the doctor know about your pregnancy.  If you have concerns discuss with your Obstetrician prior to taking.

Advice can also be obtained through:

1. The Monash Medicines Information Centre – a great resource on medicine safety in pregnancy and breast feeding on 9594 2361
2. The Medicines Line on 1300 633 424

https://www.betterhealth.vic.gov.au/health/ServiceProfiles/medicines-line-service

Pain relief:

Paracetamol alone or in combination with codeine, such as Panadeine or Panadeine Forte, are safe to use.  The latter, however, can be very constipating, and addictive so should only be considered following medical review and for strong pain.  Morphine, oxycodone and tramadol might be prescribed during emergencies or for chronic pain but their use should be supervised as the baby can also withdraw from these after birth.

Non-steroidal anti-inflammatories such as Neurofen (ibuprofen) or Voltaren (diclofenac) including skin rubs should be avoided especially in the first and third trimesters.  Occasionally they are required for inflammatory conditions if alternatives are ineffective.  We will advise you on appropriate use if needed.

Low dose aspirin (150mg at night) is very safe in pregnancy and frequently recommended for women at high risk of preeclampsia, growth restriction and some maternal conditions.

For musculoskeletal pains try hot packs (safe to back, hips and lower abdomen), stretching exercises, physiotherapy and generally continuing to move as muscle spasm tends to make these worse.  Pregnancy massages and acupuncture or dry needling can also be of benefit.  Seeing the chiropractor or osteopath is not contraindicated but they need to be aware you are pregnant and should be gentler with any manipulations due to the hormone related increased mobility of your joints in pregnancy which can more easily result in an injury.

Anti-nausea medications:

When nausea and vomiting in pregnancy interfere with everyday life, use of anti-emetics can be considered.  Commonly used medications include doxylamine (Restavit) – over the counter, and without prescription – metoclopramide (Maxolon), ondansetron and prochlorperazine (Stemetil).  Whilst some associations of concern have been made between some of these and pregnancies, proof of causation of harm is much harder to establish, and these medications may be recommended after discussion with your doctor.

Antibiotics:

Most antibiotics are safe to use in pregnancy such as for urine or suspected bacterial chest infections.  Commonly penicillin, ampicillin and cefalexin are prescribed and all have a great safety profile.  It is important to treat proven infections early and you can always check with your doctor or the above medicines information lines if you have any concerns.

Thrush treatments:

Vaginal thrush or yeast overgrowth is very common in pregnancy. This can be more problematic with or after antibiotic use. It can be treated with Canesten 1% or Nystatin cream or pessaries by inserting the cream applicator or pessary well into the vagina. Restoring your gut health by having natural yoghurt, Yakult or probiotics can also be helpful here.

If you have a cold:

Decongestant nasal sprays and Cold and Flu tablets containing phenylephrine or pseudoephedrine should not be used as they might reduce the blood flow to the womb. This is especially important if you have a small baby. Instead, you can use Saline nasal spray or a steroid based nasal spray such as Nasonex (no prescription needed) to help with your blocked nose. The sinus saline washout or irrigation systems are also very effective for nasal congestion in pregnancy.

Simple pain relief as above can be considered for a headache and muscle and joint aches.

Cough syrups are generally not needed but most are safe in pregnancy.  Check with your GP, Pharmacist or Obstetrician if there is a particular preparation you wish to try.

The symptoms of a cold, in particular the nasal congestion and cough, can take a bit longer to recover from while pregnant due the many physiological changes occurring in the body.  However, if you have persistent fever and worsening symptoms you should see your GP and treat any complications

Sex during pregnancy:

For most women this is safe and enjoyable.  You might find that certain positions are less comfortable with advancing pregnancy.

In certain circumstances such as if you have ruptured membranes (broken waters) or a placenta praevia (placenta close to or covering the cervix opening), especially if there has been bleeding, vaginal intercourse is advised against.

Personal hygiene:

Face moisturisers are usually safe to continue.  Avoidance of preparations high in Vitamin A derivatives is recommended against in pregnancy.  Most acne face washes such as those containing benzoyl peroxide or salicylic acid are safe to continue.

• https://www.healthline.com/health/pregnancy/pregnancy-safe-skin-care

Sunscreen especially the zinc-based preparations are fine to use, and it is important to protect your skin.  No adverse effects of their use in pregnancy have been found.  Further information can be found at:

https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/about-sunscreen/sunscreen-faqs

Stretch mark creams are mostly of unproven efficacy.  A simple sorbolene preparation is usually a good way to keep your skin supple.  If you wanted to use Cocoa butter or Bio oil which claim to improve the appearance of scars, these can be safely used, but can occasionally be associated with skin allergic reactions.  Scar Away is a fairly expensive preparation which has shown some results in reducing the appearance of skin stretch marks.

Hair dye is safe in pregnancy. The scalp skin might be more sensitive and reducing the frequency of this might be needed.  In general hair dye chemicals would not penetrate through the skin.  If you are concerned, more organic hair dressing options exist.

• https://www.babycenter.com.au/x3273/is-it-safe-to-dye-my-hair-during-pregnancy

Nail polish is safe but should be conducted in well ventilated environments.

Laser for hair removal or the treatment of certain conditions such as acne or rosacea is likely safe but the evidence around this in pregnancy is limited.  The best choice here might be to avoid it but, if a long period off treatment is likely to worsen your condition, it can be considered.

Warm baths in pregnancy so long as your membranes (or waters) are intact are fine.  Hot baths or spas of higher temperature can raise your core body temperature too much and should be avoided or used for short periods only. Additionally, due to blood diverting to the skin you are more likely to feel faint coming out of a hot bath or a shower and should be careful.

Dentist visits are encouraged. Bad dental health has associations with poor pregnancy outcomes. Scale and clean and local anaesthetics for fillings are perfectly safe to continue. Prevention of dental problems is better than treatment and pre-emptive dental appointments and completing any major required dental work before a pregnancy is the best advice. Generally, dentists will avoid major dental work in pregnancy due to the increased blood flow to the mouth and gums. Occasionally extractions or a root canal cannot be postponed and antibiotics may also be given at that time. If very concerned about a tooth a dentist might recommend an X-ray. The scatter (spread of the radioactive beam to other parts of the body) from these is usually minimal. The dentist might use a lead apron to protect your chest and abdomen. They would normally refrain from routine X-rays when you are pregnant.

X-rays are generally avoided in pregnancy especially for routine purposes such as immigration requirements. The highest concern with high amounts of radiation is in the first trimester. For health problems such as persistent chest infections, fluid on the lungs, suspected pulmonary emboli (blood clots in the lungs) and sudden severe headaches X-rays, nuclear medicine studies and MRI may be recommended. The very small risks to your baby of the radiation to diagnose these conditions appropriately would be completely outweighed by the benefits to your health. Where possible ultrasound or MRI would be used instead. MRI without contrast is often used to clarify further many suspected fetal problems.

House painting can be done during pregnancy.  Ensure there is good ventilation and ideally that water-based paints with low volatile organic compounds (VOCs) are utilised.  Solvent based paints and paint stripping are best avoided. For more information, please, see:

https://www.nhs.uk/common-health-questions/pregnancy/can-paint-fumes-affect-my-unborn-baby/

1. Royal Australian College of Obstetrics and Gynaecology – Common Questions in Pregnancy
   https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Common-Questions-in-Pregnancy-2020-V2_1.pdf?ext=.pdf

Are prenatal vitamins important?

Even women with balanced diets may be unable to meet the dietary requirements of pregnancy.  Hence, multivitamins are important for most pregnant women to take.  Micronutrients such as selenium, molybdenum and many vitamins can be hard to absorb from diet alone.

A notable exception are pregnant individuals with hyperthyroidism.  Since virtually all pregnancy multivitamins contain iodine, they are not appropriate.  An iodine free women’s health multivitamin and additional folic acid would be a good substitute.

There are multiple suitable pregnancy and breastfeeding multivitamins in every pharmacy and supermarket.  Most contain similar ingredients.  A notable difference is the iron content.  Since iron is constipating, you might choose a lower content preparation in early pregnancy and a higher one later on when iron deficiency is more likely.  Some of the better known preparations and in order of highest to lowest amount of iron are Elevit, Blackmore’s, Suisse, Nature’s Own but there are many.  We do not recommend any one specifically and their relative cost might also influence your choice.

How do I optimise my nutrition?

A healthy, varied, well balanced diet, high on fibre and fresh vegetables and fruit as well as a protein source is the best start for your growing baby and you.

Wash your fruit and vegetables well and choose a variety of colours.  Use produce in season which is likely to be fresher.

Red meat, chicken and eggs are good sources of protein but if you are a vegetarian there are many alternatives such as legumes (chick peas, lentils, beans), tofu and dairy.  2-3 servings of fish per week which is low in mercury and high in Omega 3 fatty acids such as salmon, canned tuna or mackerel.  Larger fish such as flake are higher in mercury.  Omega 3 (DHA) is contained in most multivitamins but even if your intake is low, supplementation does not appear to make babies smarter.  However, in some instances it might reduce the risk of preterm birth.  So, intake of Omega 3 via diet and/or multivitamins is encouraged.

Dairy intake is important for meeting the increased calcium needs during pregnancy.  If you are lactose intolerant there are many lactose-free options nowadays.  Yoghurt can help with gut balance and reduce vaginal thrush or yeast overgrowth.  If dairy products are not high on your list of preferred foods, you can consider some additional calcium 1000mg/d in the form of calcium supplements.  This would be particularly important if you have had a prior history of preeclampsia or are at high risk of it in the current pregnancy and your calcium intake is low.

Abstain from alcohol as no amount has been proven safe.  Mothers who regularly drink or binge in high quantities are at higher risk of infants with birth defects, behavioural anomalies and lower intelligence.  If you forgot or did not know yet you were pregnant and had a drink at a function, there is no need to panic.

Caffeine in moderate amounts is fine to consume i.e. 1-2 cups of espresso type coffee per day.  Remember to account for tea, cola, chocolate and energy drinks (not recommended) which would all contribute to the total caffeine intake.

Listeria food contamination which can have severe consequences is fortunately very rare in Australia.  Most women know to avoid deli items such as soft cheeses, pate and salamis.  All commercially produced soft cheeses are made with pasteurised milk in Australia so the risk from these is very low.  Raw fish sushi from reputable sushi outlets with good turnover is safe but if you are concerned a California roll or cooked tuna and teriyaki chicken are good alternatives.

Additional information can be found here:

https://www.betterhealth.vic.gov.au/health/HealthyLiving/pregnancy-and-diet

https://www.pregnancybirthbaby.org.au/healthy-diet-during-pregnancy

https://www.healthline.com/nutrition/13-foods-to-eat-when-pregnant#eggs

Is it safe to exercise in pregnancy?

It is important to remain active in pregnancy which can improve many common pregnancy discomforts, constipation, gestational diabetes control, mood and psychological wellbeing and maintain your weight.

Pregnancy is not a time to become really fit but to keep fit.

The recommendation for 150min/week (5 times of 30 min) of moderate aerobic exercise is a good guide.  If you have not exercised before, begin with 3 times of 15 minutes increasing gradually to 4-5 sessions of 30 min.  Most pregnant women can safely maintain a similar exercise level to pre-pregnancy especially in the first two trimesters.  However, you should listen to your body and if you experience pain, significant breathlessness or faintness, modify or cease exercise and discuss with your doctor.

Exercises such as walking/jogging, swimming/water aerobics, stationary exercise bike, elliptical cross-fit trainers, steppers, climbers and treadmills are all appropriate.

Pilates and yoga are particularly helpful for improving your core strength and flexibility.

If you exercise at very high levels, this will need to be modified.  Increasing your heart rate to more than 75% of the maximum for your age, is not recommended as it may be diverting blood away from the uterus (womb).

Few issues to be mindful of:

• Avoid overheating especially in the first trimester, don’t exercise in the hottest part of the day, on hot/humid days or for long periods of time
• Wear clothing which promotes cooling and drink sufficient water
• Avoid sports requiring sudden direction changes. Increased joint laxity, due to relaxin – a pregnancy hormone, can lead to a higher chance of injury.
• Gentle stretching before and after exercise but avoid overstretching
• Proper warm up and cool down with exercise
• Contact sports or sports where collision or projectiles can cause injury to your abdomen
• Avoid exercising flat on your back after 20 weeks gestation
• Scuba diving / horse riding / martial arts are discouraged

In some pregnancy conditions such as fetal growth restriction, placenta praevia, ruptured membranes or pre-existing significant heart and lung disease, milder forms of exercise such as walking only might be advised.  Occasionally abstaining from all exercise might be necessary after discussion with your doctor.

Helpful links are

1. Royal Australian College of Obstetrics and Gynaecology – Exercise During Pregnancy
   https://ranzcog.edu.au/womens-health/patient-information-resources/exercise-during-pregnancy
2. Sports Medicine Australia – Pregnancy and Exercise Brochure
   https://sma.org.au/sma-site-content/uploads/2017/08/SMA_AWiS_Pregnancy_-_Exercise.pdf
3. American College of Obstetrics and Gynaecology – Exercise during pregnancy
   https://www.acog.org/womens-health/fqs/exercise-during-pregnancy
4. https://www.pregnancybirthbaby.org.au/exercising-during-pregnancy
5. https://www.betterhealth.vic.gov.au/health/HealthyLiving/pregnancy-and-exercise
6. The pregnant athlete
   https://sma.org.au/sma-site-content/uploads/2017/08/torode.pdf