1. family and parenting
2. motherhood
3. pregnancy

FA M I LY
H E A LT H
P R O G R A M
TM
Brought to you by LYSOL® Products
Looking After
In proud partnership with
You and
Your Pregnancy
See inside for special SPOTLIGHT ON sections from the
Family
Health Program 1
Centers for Disease Control and
Prevention!
W elcome . . .
. . . to the Family Health Program™ brought to you in proud partnership
with the Centers for Disease Control and Prevention’s “Learn the Signs.
Act Early.” Campaign, Visiting Nurse Associations of America (VNAA) and
the makers of LYSOL® brand products.
Looking After You and Your Pregnancy places special focus on you during
this exciting — and sometimes confusing — time. This informative
guide explores need-to-know areas of prenatal care, well-being and germ
protection to help keep you and your home “healthy” as you prepare for
the arrival of baby.
A Health Program Especially for You
A pregnant woman has special needs, and during this period in your life, you can be more susceptible to
infectious diseases than other healthy adults. Daily lifestyle decisions can also affect not only your own
health, but that of your developing baby, too.
As public health experts, we know that there are several things you can do to keep yourself — and the
baby inside you — healthy, including:
• Prenatal care
• Specific immunizations that are safe before and/or during your pregnancy
• A healthy diet and lifestyle that keeps your growing baby safe — including no alcohol or smoking
• Thorough personal and home hygiene to help prevent the spread of disease-causing germs
Your Healthy Home
The CDC, VNAA and LYSOL® partnership team is committed to education for the health and well-being
of you and your soon-to-arrive baby. In fact, this book is the first in a series that targets moms-to-be
and moms of young children at different ages. We are also committed to keeping you and your family
healthy by providing safe and convenient disinfecting and cleaning solutions for your home. For more
on what we are doing to ensure a healthy home for you and your family, visit: www.cdc.gov,
www.vnaa.org, and www.lysol.com.
We wish you all the best in Looking After You and Your Pregnancy!
Andy Carter
President and CEO
Visiting Nurse Associations
of America
2
Family Health Program
Tom Bach
Professional Relations Manager
Reckitt Benckiser Inc., the makers of LYSOL®
Looking After
You and Your Pregnancy
Maintaining a healthy pregnancy is impacted by many things. Throughout Looking After You and Your
Pregnancy, you’ll find practical information and tips for staying healthy as you get ready for your new
arrival. You’ll discover need-to-know advice in such areas as prenatal care, nutrition and food safety,
keeping your home clean and healthy, and more. In addition, you’ll find references to help you locate
further information on those subjects of particular interest to you.
So, please read on!
Watch for these special sections that feature important information from the Centers for Disease
SPOTLIGHT ON Control and Prevention’s National Center on Birth Defects and Developmental Disabilities.
A Healthy Pregnancy
Table of Contents
Planning for Pregnancy
Prenatal Care . . . Before Getting Pregnant ............. 4
Gynecological Health .................................................... 4
SPOTLIGHT ON Folic Acid: Before and During Pregnancy ... 5
Vaccinations . .................................................................. 6
Existing Health Conditions ......................................... 7
SPOTLIGHT ON About Diabetes and Pregnancy
.................. 8
Genetic Testing .............................................................. 10
Healthcare During Pregnancy
Prenatal Care .................................................................. 11
SPOTLIGHT ON Medications During Pregnancy .................... 15
SPOTLIGHT ON Preventing Infections During Pregnancy . . 16
Pregnancy: Changes, Challenges and
Suggestions .................................................................. 17
Pregnancy Weight Gain ................................................ 25
Bed Rest ........................................................................... 26
Preparing for Multiple Births ..................................... 28
A Healthy Lifestyle During Pregnancy
Handwashing .................................................................. 31
Exercise ............................................................................ 32
Oral Care .......................................................................... 34
Grooming During Pregnancy ...................................... 35
Nutrition During Pregnancy . ..................................... 36
Food Safety During Pregnancy ................................... 39
SPOTLIGHT ON Smoking . ............................................................ 41
SPOTLIGHT ON Alcohol ................................................................ 42
Caffeine ............................................................................ 43
About Recreational Drugs ........................................... 43
Wearing A Seatbelt During Pregnancy ..................... 44
Emotions and Stress ..................................................... 44
Pregnancy and Sleep ..................................................... 46
Choose Your Pediatrician . ........................................... 47
Health and Well-Being at Home
Safety
First Aid Kits . ................................................................. 48
Germs
Germ Growth at Home ................................................. 49
In the Kitchen . ............................................................... 51
In the Bathroom . ........................................................... 52
Flooring and Furniture . ............................................... 53
Animals, Insects, and Rodents
Household Pets . ............................................................. 54
Insects, Rodents, and Wild Animals . ........................ 55
The contents of Looking After You and Your Pregnancy are for informational purposes only and should
never replace the advice and care of a licensed healthcare professional. Neither Reckitt Benckiser
nor VNAA guarantees the accuracy, completeness or timeliness of any information contained in this
booklet, and neither shall be liable for any loss, damage or injury directly or indirectly caused by or
resulting from such information or its use. VNAA’s cooperation in the publication of Looking After You
and Your Pregnancy does not and shall not in any manner be interpreted to constitute an endorsement
by VNAA of any products or services that may be advertised or referenced in the publication.
The web links provided in each chapter were
current at time of publication. In the event that
they change and/or are no longer available, we
suggest that you visit the “home page” of the
named organization or company. From there,
search for topical information.
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A HEALTHY LIFESTYLE DURING PREGNANCY
Handwashing
Keeping your hands clean is one of the best ways to keep from getting sick and spreading
illnesses. Cleaning your hands helps get rid of germs you pick up from other people . . .
from the surfaces you touch . . . and from the animals with which you come in contact.
There are two key aspects to proper hand cleaning:
when to wash and how to wash. Both are particularly
important as you keep yourself healthy during
pregnancy (and prepare for handling the baby a few
months down the road!).
When to Wash
• Before eating
• Before, during, and after handling or preparing food
• Before dressing a wound, giving medicine, or
inserting contact lenses
• Before picking up an infant
• Before and after changing a diaper
• After contact with blood or body fluids (like vomit,
nasal secretions, or saliva)
• After you use the bathroom
• After handling animals or their toys, leashes, or waste
• After touching something that could be contaminated
(such as a trash can, cleaning cloth, drain, or soil)
• More often when someone in your home is sick
• Whenever your hands look dirty
How to Wash
• Wet your hands and apply liquid, bar, or powder soap.
• Rub hands together vigorously to make a lather,
and scrub all surfaces, including under and around
the nails.
• Continue for 20 seconds! It takes that long for the
soap and scrubbing action to dislodge and remove
stubborn germs. Need a timer? Imagine singing
“Happy Birthday” all the way through — twice!
• Rinse hands well under running water.
• Dry your hands using a paper towel or air dryer.
• If possible, use your paper towel to turn off the faucet.
Additional Handwashing Tips
• Consider using hand lotion to prevent chapped
hands — choose a mild, fragrance free formula if
pregnancy has made your skin sensitive. If using
lotions, use liquids or tubes that can be “squirted”
so that your hands don’t have direct contact with
the lotion spout. Direct contact with the spout
could contaminate the lotion inside the container.
• When assisting a child with handwashing, hold the
baby (or if it’s a toddler, have him or her stand on
a safety step) so that his/her hands can hang freely
under the running water. Assist the child with the
How to Wash steps [at left], and then wash your own
hands.
When Soap and Water Aren’t Available . . .
Clean hands are especially important as you work to
stay healthy through your pregnancy. You can still
keep your hands clean even if water isn’t available.
Hand sanitizers are designed to kill germs on hands
that are not visibly dirty, without the need for water
or towels.
Hand Sanitizing Gel or Foam:
• Apply gel or foam per label directions.
• Rub hands together briskly, including the front and
back, between fingers, around and under nails until
hands are dry.
Hand Wipes:
• Wipe all areas of hands until they are visibly clean.
• Use one or more wipes, and dispose of them in an
appropriate trash container.
• Let hands air dry.
For More Information . . .
Clean Hands: www.cdc.gov/cleanhands or www.cleaning101.com
Handwashing and Germ Prevention: www.lysol.com/avian_flu/OOP_Brochure.pdf
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Exercise
The 2005 U.S. Dietary Guidelines and the American College of Obstetricians and
Gynecologists (ACOG) recommend that healthy pregnant women get 30 minutes or
more of moderate intensity physical activity every day. In fact, exercising during a healthy
pregnancy can be extremely beneficial!
In addition to keeping the heart, bones, and mind
healthy, exercise during pregnancy can:
• Provide a sense of well-being.
• Lessen discomfort, fatigue, and the “aches and pains”
of pregnancy, including constipation and varicose
veins.
• Increases the blood flow to your skin, giving you a
healthy glow.
• Increase the likelihood of early recovery after delivery.
• Strengthen and tone the abdominal, back, thigh
and gluteal muscles, which help to improve posture.
• Lower the risk of high blood pressure during
pregnancy.
• Help prevent gestational diabetes . . . or, combined
with changes in diet, help bring the disease under
control.
• Improve sleep during pregnancy.
• Prevent wear and tear on your joints (which become
loosened during pregnancy due to normal hormonal
changes) by activating the lubricating “synovial” fluid
in your joints.
• Prevent excessive weight gain and prepare you to
regain your “pre-pregnancy” body.
Types of Exercise to Consider:
• Low-impact exercises like yoga or pilates, walking,
swimming, water aerobics, dancing and cycling.
• Aerobics and yoga classes designed specifically for
pregnant women. You may find that a variety of
activities helps keep you motivated to continue
exercising throughout your pregnancy — and beyond.
Always check with your healthcare provider before
beginning any kind of exercise during pregnancy.
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Types of Exercise to Avoid:
These activities are not recommended for pregnant
women:
• Those in which you can get hit in the abdomen
— like kickboxing, soccer, basketball or ice hockey.
• Those in which you can fall — like horseback
riding, downhill skiing, or gymnastics.
• Weight training and sit-ups after the first trimester,
especially if you are at risk for preterm labor. Lifting
reduces the blood flow to the kidneys and uterus,
and exercises done on your back (including sit-ups
and leg lifts) cause your heart rate to drop, also
decreasing the flow of oxygenated blood to your body
and the baby.
• Scuba diving. Scuba diving can create gas bubbles in
your baby’s blood that can cause many health problems.
If you have any questions about doing a certain sport
or activity during your pregnancy, talk to your
healthcare provider for specific guidelines.
Checklist for Exercise: Strategies for
Staying Safe
Follow these tips to have safe and healthy workouts:
• Drink lots of fluids — before, during and after
exercising.
• Start slowly, progress gradually, and cool down
slowly. Even 5 minutes a day is a good start if you’ve
been inactive. Add 5 minutes each week until you
reach 30 minutes per day.
D id You Know . . .
During pregnancy, your body produces a hormone
known as relaxin, which is believed to help
prepare the pubic area and the cervix for the birth.
• Relaxin loosens the ligaments in your body,
making you less stable and more prone to injury.
• In addition, your center of gravity has shifted,
making it easier to lose your balance.
• If you can’t talk without breathlessness, you may
be exercising too intensely. You should also keep
your heart rate below 160 beats per minute.
• Dress comfortably in loose-fitting clothes and
wear a supportive bra to protect your breasts.
• Take frequent breaks.
• Don’t exercise if you’re sick.
• Don’t exercise on your back after the first
trimester. This can put too much pressure on an
important vein and limit blood flow to the baby.
• Avoid jerky, bouncing and high-impact
movements. Connective tissues stretch much
more easily during pregnancy, so impact puts you
at risk of joint injury.
• Don’t exercise at high altitudes (more than 6,000
feet) or in extreme heat or humidity.
• If you feel uncomfortable, short of breath, or tired,
take a break and take it easier when you resume
exercise.
About Kegel Exercises
The “pelvic floor” muscles support the rectum, vagina,
and urethra in the pelvis. Pelvic floor exercises, or
Kegel exercises, can help you strengthen these
muscles, which may in turn help you have an easier
delivery. They will also help you avoid leaking urine
during and after pregnancy.
• Kegels are easy, and you can do them any time you
have a few seconds — sitting in your car, at your
desk, or standing in line at the store. No one will
even know you’re doing them!
• To find the correct muscles, pretend you’re trying
to stop urinating. Squeeze those muscles for a few
seconds, then relax. You’re using the correct muscles
if you feel a pull. Your healthcare provider can also
help you identify the correct muscles.
• Don’t tighten other muscles (stomach or legs, for
example) at the same time. You want to focus on the
muscles you’re exercising.
• Don’t hold your breath while you do them. It’s
important that your body and muscles continue to
receive oxygen while you do any type of exercise.
K egel Caution:
Don’t do Kegels by stopping and starting your flow
of urine while you’re actually going to the bathroom.
This can lead to incomplete emptying of your bladder,
which increases the risk of urinary tract infections.
Exercise Safety Alerts
When to Call Your Healthcare Provider
Who Shouldn’t Exercise?
Stop exercising and call your healthcare provider as
soon as possible if you have any of the following:
• Dizziness
• Fluid leaking from
• Headache
the vagina
• Chest pain
• Vaginal bleeding
• Calf pain or swelling
• Decreased fetal
• Abdominal pain
movement
• Blurred vision
• Contractions
If you have any of these conditions, you may not
be able exercise during pregnancy:
• heart disease
• persistent bleeding in the
second or third trimester
• lung disease
complications
with past
•
• obesity
pregnancies
• severe diabetes
premature
labor
•
• thyroid disease
•seizure disorder
In all cases — check with your healthcare provider before beginning any exercise program!
For More Information . . .
Exercise during Pregnancy: www.marchofdimes.com/pnhec/159_515.asp and
www. kidshealth.org/parent/nutrition_fit/fitness/exercising_pregnancy.html and
www.womenshealth.gov/pregnancy/pregnancy/fit.cfm
Healthy Moms and Babies: lysol.com/germ-information-center/resources
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Oral Care
Good oral care is a critical aspect of your overall health. But it’s particularly important
when you’re pregnant, as recent studies have shown that oral disease can be passed along
to your baby.
During pregnancy, your teeth and gums need special care.
• Every expectant mother should have a complete oral
exam prior to or very early in pregnancy. You may
even want to see your dentist more often than usual.
• All needed dental work should be managed early,
because having urgent treatment during pregnancy
can present risks. Interventions can be started
to control risks for gum inflammation and disease.
• This also is the best time to change habits that may
affect the health of teeth and gums, and the health
of the baby.
HEALTH ALERT: Remember to tell your dental
professional that you are pregnant — especially if
he/she is planning to X-ray your teeth.
Pregnancy hormones can also leave your mouth more
vulnerable to bacteria and plaque, both of which can
make your already sensitive gums even more tender. To
help alleviate the problem, be sure to follow a rigorous
brush-and-floss routine every day. Follow these general
guidelines to keep your teeth and gums healthy and to
ease bleeding gums you may be experiencing.
Steps for Healthy Teeth and Gums
• Brush at least twice a day with fluoride toothpaste.
Use a soft-bristled toothbrush.
• Floss daily.
• Limit the number of times you eat sweet or starchy
snacks each day.
• See your dentist regularly.
Why Oral Care Matters
Any infection in your mouth, including cavities and
gum (“periodontal”) disease, can affect the health of
your whole body.
• The more unfilled cavities you have, the more
cavity-causing germs you have.
• Consult your healthcare provider or dental
professional for additional information about oral
care and how oral health impacts your and your
baby’s health.
More Dental Smarts
• Brush your tongue as well as your teeth to
minimize the amount of bacteria in your mouth.
• Skip the sweets, especially when you won’t be able
to brush your teeth soon after indulging.
• Make sure you get plenty of vitamin C in your diet,
which strengthens gums and reduces the chances
of bleeding.
• Consume plenty of calcium to keep your teeth (and
your bones) strong.
• Can’t brush after a meal? Try chewing a piece of
sugarless gum or grabbing a handful of nuts
(unless you’re allergic) or a small chunk of cheese.
All have antibacterial properties.
D id you know . . .
Pregnant women with gum disease are much more
likely to have premature babies with low-birth
weight. This may result from the transfer of bacteria
in the mother’s mouth to the baby during pregnancy.
The microbes can reach the baby through:
• The placenta (a temporary organ joining the
mother and fetus which supplies the fetus with
blood and nutrients)
• The amniotic fluid (fluid around the fetus)
• The layer of tissues in the mother’s stomach
For More Information . . .
Oral Care, including mouth care and nutrition: www.ada.org/public/index.asp.
Oral Health at Various Life Stages: www.colgate.com/app/Colgate/US/OC/Information/OralHealthAtAnyAge.cvsp
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Grooming During Pregnancy
Pregnancy usually brings about that healthy glow . . . but it can also make you feel like
you barely recognize your own body anymore. Use the following tips and suggestions for
keeping up with daily grooming as everything else around you seems to be changing!
Bathing
Shaving
It can take a surprising amount of effort to navigate
the tub or shower and reach everywhere you need to
reach. However, a daily bath or shower is plain old
good hygiene — and makes you feel good to.
• Make sure the water is tepid, not scorching, so you
don’t overheat.
• Keep your baths and showers short (under ten
minutes) so you don’t overheat or overdry your skin.
• Avoid scented bath products — especially if you’re
feeling queasy, and because pregnancy makes you
more prone to urinary tract infections and vaginal
irritation.
You’re probably finding more rapid hair growth on
your legs and underarms, due to pregnancy hormones.
It also may be hard to see beyond your belly! Shave
with care using these guidelines:
• Be aware that your balance may be off — so sit
down to shave. Use lots of shaving gel and a new
blade so you’ll be less likely to draw blood.
• If possible, enlist a willing partner or friend to shave
you, or sit on the edge of your bed and try an electric
razor. Or, consider getting your legs and underarms
waxed if your skin isn’t feeling too sensitive.
A Note from CDC about Saunas
Saunas, hot tubs, and steam rooms should be avoided
while you are pregnant. Excessive high heat may be
harmful during your pregnancy.
Hair Care
It takes special care to wash and dry your hair during
pregnancy. Keep in mind that your balance may be off
as your center of gravity shifts.
• If washing hair in the shower — take care not to
slip and fall.
• As you bend over to wash or dry your hair, be
mindful of postural hypotension — the drop in
blood pressure (and resulting dizziness) that can
happen when you straighten up quickly.
• Avoid overheating yourself (and causing possible
dizziness) as you blow dry. Use a warm setting and
leave the bathroom door open.
Skincare and Makeup
Chances are, your skin needs special attention right
now. If you have particular skin issues triggered by
your pregnancy hormones, you might need to adjust
the types of cosmetics you use during your pregnancy.
• Wash your face gently, using products and
regimens best suited to your particular skin type.
Use a concealer that matches your skin tone to
camouflage blotchy skin and dark circles.
• If you’re oily or breaking out, switch to
noncomedogenic, oil-free moisturizers and
foundation; if you use a cream blush, you may
wish to switch to powder.
O nline Beauty Tip
For more on skin and body challenges and
looking good during pregnancy, check out
www.whattoexpect.com/pregnancy/
looking-good/whose-body.aspx
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Nutrition During Pregnancy
The main focus of nutrition during pregnancy is to eat healthfully to get the nutrients you
and your unborn baby need. Consult with your healthcare provider to develop the plan and
approach that works best for your needs during pregnancy.
In addition, there are some nutritional basics that can serve as guidelines as you eat
nutritiously for two (or more!). If you’re expecting multiples, also see Your Nutrition with
Multiples on page 29.
It’s All About Balance
Nutritional Know-How
Whether or not you’re pregnant, a healthy diet includes
proteins, carbohydrates, fats, vitamins, minerals, and
plenty of water. The U.S. government publishes Dietary
Guidelines that can help you determine how many
servings of each kind of food to eat every day. Eating a
variety of foods in the proportions indicated is a good
step toward staying healthy.
To support your healthy diet, consider these
guidelines and review them with your healthcare
provider:
• It is not necessary to literally “eat for two” during
pregnancy. Generally, you need to consume about
300 calories more per day than you did before you
became pregnant to meet the needs of your growing
baby. Although protein should supply most of these
extra calories, your diet needs to be well-balanced,
including fresh fruits, grains, and vegetables.
• Drink extra fluids throughout pregnancy to help
your body keep up with the increases in your blood
volume — at least 6 to 8 glasses of water, fruit juice,
or milk each day. (You’re drinking enough fluid
when your urine looks almost clear or is a very light
yellow.)
• You should never try to diet during pregnancy. If
you do, your unborn baby might not get the right
amounts of protein, vitamins, and minerals. Low
calorie diets can break down a pregnant woman’s
stored fat. This can lead to the production of
substances called ketones, and constant production
of this “sign of starvation” can result in a mentally
retarded child.
• Doctors don’t usually recommend starting a strict
vegan diet when you become pregnant. However,
if you already follow a vegetarian diet, you can
continue to do so during your pregnancy if you do it
carefully.
— Ask your healthcare provider about supplemental
protein and vitamin B12 and D supplements. To
ensure that you and your baby receive adequate
nutrition, consider consulting a registered
dietitian for help with planning meals.
It’s essential to plan simple and healthy meals that
include choices from all of the recommended groups.
In addition, USDA’s MyPyramid — the U.S.’s
framework for healthy dietary management —
includes nutritional and activity guidelines that can
help you maintain a healthy diet and lifestyle. You
can find this information at www.mypyramid.gov.
MyPyramid encourages you to:
• Make smart choices from every food group.
• Find your balance between food and physical activity.
• Get the most nutrition out of your calories.
• Eat the recommended daily servings from each food
group:
— Meat/Poultry/Fish/
— Grains
Dry Beans/Eggs/Nuts
— Vegetables
— Oils
— Fruits
— Milk/Yogurt/Cheese — Discretionary Calories
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Vitamins and Minerals
By eating a balanced diet, you’re more likely to get
the nutrients you need. But you will need more of the
essential nutrients (especially iron, calcium, and folic
acid) than you did before you became pregnant. Your
healthcare provider will probably prescribe prenatal
vitamins to be sure both you and your growing baby
are getting adequate nutrients. (See Prenatal Care
beginning on page 11.)
• Iron: Iron deficiency during pregnancy is one of
the most common causes of anemia — the reduced
ability of the blood to carry oxygen to your body’s
cells and the growing baby.
— The Recommended Dietary Allowance (RDA)
for iron has been set at 30 milligrams (mg) per
day during the second and third trimesters of
pregnancy. In addition, the Centers for Disease
Control and Prevention (CDC) recommends that
pregnant women start taking a low-dose iron
supplement (30 mg/day) or a multivitamin with
iron beginning at the time of their first prenatal
visit.
— Major dietary sources of iron include:
• Meats: liver, kidneys, red meat, dark poultry,
salmon
• Eggs
• Peas and legumes (dried beans)
• Dried fruits
• Dark green leafy vegetables
• Enriched breads and cereals
• Blackstrap molasses
— Keep in mind that it’s hard to get enough iron
from your diet to support a pregnancy — so ask
your healthcare provider about iron supplements.
• Calcium: Most women — including those who are
pregnant — don’t typically get the daily 1,000 mg
of calcium that’s recommended by the Dietary
Guidelines. Because your growing baby’s calcium
demands are high, you should increase your calcium
consumption to prevent a loss of calcium from your
own bones.
— Prenatal vitamins may also contain extra
calcium — ask your healthcare provider.
— If you have lactose intolerance or dislike milk
products, ask about a calcium supplement.
— Good dietary sources of calcium include:
• Low-fat dairy products including milk, cheese,
and yogurt
• Calcium-fortified products, including orange
juice, soy milk, cereals
• Sardines or salmon
• Dark green vegetables including spinach, kale,
and broccoli
• Tofu
• Dried Beans
• Almonds About Food Cravings
Following your cravings is fine, as long as you crave
foods that contribute to a healthy diet. Frequently,
these cravings diminish about 3 months into the
pregnancy.
• Some pregnant women crave chocolate, spicy foods,
fruits, and comfort foods, such as mashed potatoes,
cereals, and toasted white bread.
• Other women crave non-food items, such as clay and
cornstarch. The craving and eating of non-food items
is known as “pica” — and can be dangerous to
both you and your baby. If you have urges to eat
non-food items, notify your healthcare provider.
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Common Nutrients Needed During Pregnancy
Nutrient
38
Needed for
Best Dietary Sources
Protein
cell growth and blood production
lean meat, fish, poultry, egg whites,
beans, peanut butter, tofu
Carbohydrates
daily energy production
breads, cereals, rice, potatoes, pasta,
fruits, vegetables
Calcium
strong bones and teeth, muscle
contraction, nerve function
milk, cheese, yogurt, sardines or
salmon, spinach
Iron
red blood cell production
(needed to prevent anemia)
lean red meat, spinach, iron-fortified
whole-grain breads and cereals
Vitamin A
healthy skin, good eyesight,
growing bones
carrots, dark leafy greens, sweet
potatoes
Vitamin C
healthy gums, teeth, and bones;
assistance with iron absorption
citrus fruit, broccoli, tomatoes,
fortified fruit juices
Vitamin B6
red blood cell formation; effective
pork, ham, whole-grain cereals,
use of protein, fat and carbohydrates bananas
Vitamin B12
formation of red blood cells,
maintaining nervous system
health
meat, fish, poultry, milk
(Note: vegetarians who don’t eat dairy
products need supplemental B12)
Vitamin D
healthy bones and teeth; aids
absorption of calcium
fortified milk, dairy products, cereals,
and breads
Folic acid
blood and protein production,
green leafy vegetables, dark yellow
effective enzyme function, protects fruits and vegetables, beans, peas, nuts
against some birth defects of the
brain and spine
Fat
body energy stores
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meat, whole-milk dairy products, nuts,
peanut butter, margarine, vegetable oils
(Note: limit fat intake to 30% or less of
your total daily calorie intake)
PASTEURIZED
Food Safety During Pregnancy
While you’re pregnant, you are in a “high-risk group” for foodborne illness. Part of maintaining
a healthy diet throughout pregnancy entails practicing good food safety behaviors (See In
the Kitchen on page 51) and avoiding foods and situations that could make you sick.
As you follow good food safety practices, you should
also be aware that there are three additional food-related
issues that could affect your pregnancy: Listeriosis,
Methylmercury, and Toxoplasmosis. These serious
diseases can be life-threatening to an unborn baby.
Methylmercury
Listeriosis
However, there are certain types of fish that you
should avoid eating during pregnancy due to a higher
level of “methylmercury.”
• Mercury, which occurs naturally in the environment,
is also released into the air through industrial
pollution. It can accumulate in streams and oceans,
where it turns into methylmercury.
• The methylmercury builds up in fish, especially
those that eat other fish. Ingesting too much of it
while pregnant can cause damage to the developing
brain of a fetus.
Listeria monocytogenes is a harmful bacterium that can
be found in refrigerated, ready-to-eat foods (meat,
poultry, seafood, and foods made with unpasteurized
milk), and soil. It can also be found in foods made
from animals.
• Listeria is unusual because unlike other foodborne
bacteria, it can grow at refrigerator temperatures
where most other foodborne bacteria do not.
When eaten, it may cause listeriosis, an illness to
which pregnant women and their unborn children
are very susceptible.
• The symptoms can take a few days or even weeks
to appear, and may include fever, chills, muscle aches,
diarrhea or upset stomach, headache, stiff neck,
confusion, and loss of balance. In more serious cases,
listeriosis could also lead to the mother’s death.
Most of the time, however, pregnant women who are
infected with listeriosis don’t even feel sick — so they
can easily pass the infection to their unborn babies
without even knowing it.
To prevent listeriosis, you should avoid these foods:
• Soft, unpasteurized cheeses (often advertised as
“fresh”) such as feta, goat, Brie, Camembert, queso
fresco, queso blanco, and blue cheese
• Unpasteurized milk, juices, and apple cider
• Raw eggs or foods containing raw eggs, including
mousse, tiramisu, raw cookie dough, homemade ice
cream, and Caesar salad dressing (although some
store-bought brands of the dressing may not
contain raw eggs — check the label)
• Raw or undercooked meats, fish (sushi), or shellfish
• Processed meats such as hot dogs and deli meats
(unless reheated until steamy-hot)
Fish and shellfish can be an extremely healthy part
of your pregnancy diet. They contain beneficial
omega-3 fatty acids and are high in protein and low
in saturated fat.
When you choose seafood, eat a variety of fish and
shellfish and limit the amount to about 12 ounces
per week — that’s about two meals.
• When you’re eating canned tuna, choose light tuna,
which has less mercury than canned white tuna.
Because canned albacore (or white) tuna and tuna
steaks are generally considered to be higher in
mercury than canned light tuna, the U.S. Food and
Drug Administration (FDA) recommends that you
eat no more than 6 ounces a week.
• Also, check any local health advisories before
consuming any recreationally-caught fish.
A void These Fish
During Pregnancy
They have been shown to have
high levels of methylmercury:
• shark
• swordfish
• king mackerel
• tilefish
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Toxoplasmosis
You may have heard that pregnant women should
avoid changing the litter box. This is due to the
potential to contract “toxoplasmosis” — an infection
that can cause serious problems for your unborn baby.
• Toxoplasmosis is caused by a parasite called
Toxoplasma gondii.
• It can be found in raw and undercooked meat;
unwashed fruits and vegetables; water; dust; soil;
dirty cat-litter boxes; and outdoor places where cat
feces can be found.
Toxoplasmosis can be difficult to detect, although
symptoms typically include swollen glands, fever,
headache, muscle pain, or a stiff neck. However, just
as with listeriosis — a woman infected with the
parasite may not have noticeable symptoms, thus
making it easy to expose her fetus to toxoplasmosis
without even being aware that she’s ill.
Prevention of toxoplasmosis is very important. It’s a
serious disease, but the strategies for avoiding it are
quite simple. In addition to following the Four Simple
Steps to Food Safety (see page 51), you should also:
• Avoid eating any meats that aren’t well cooked.
• Make sure someone else changes your cat’s litter box.
• Be sure to wear gloves when gardening, in case cats
have used the flower beds — and wash your hands
as soon as you’re done.
• Avoid drinking untreated water.
A bout Food Safety
This section explores the specific risks for
foodborne illness during pregnancy. On page 51,
you’ll also find basic food safety guidelines that
should be followed every day, both before and
after your baby is born.
In the meantime, if you have eaten risk-related
foods at some point during your pregnancy, try
not to worry too much, but avoid them for the
remainder of the pregnancy. If you’re really
concerned, talk to your healthcare provider.
For More Information . . .
Food Safety During Pregnancy: www.cfsan.fda.gov/~pregnant/pregnant.html
Safe Internal Cooking Temperatures: www.isitdoneyet.gov
A Healthy Diet: www.kidshealth.org/parent/pregnancy/pregnancy/eating_pregnancy.html
Nutrition and Pregnancy Weight Gain: www.webmd.com/baby/guide/healthy-weight-gain
My Family and Healthy Eating: www.lysol.com/topic_eating.shtml#top
Seafood Safety: www.cfsan.fda.gov/~lrd/seafsafe.html
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SPOTLIGHT ON
Smoking
Smoking During Pregnancy Can Cause
Problems for a Woman and Her Baby.
Most people know that smoking causes
cancer, heart disease, and other major
health problems. But women who smoke
during pregnancy put themselves and
their unborn babies at risk for other
health problems.
Did You Know?
• Smoking makes it harder for a woman to get
pregnant.
• Women who smoke during pregnancy are more
likely than other women to have a miscarriage.
• Smoking during pregnancy causes major health
problems for mom and baby.
—For example, smoking is one of the causes of
problems with the placenta: the source of the
baby’s nutrition and oxygen during pregnancy.
• Smoking during pregnancy can cause a baby to
be born too early and have low birth weight —
making it more likely the baby will become sick
or die.
• Smoking during and after pregnancy is one of the
causes of Sudden Infant Death Syndrome (SIDS).
• Babies born to women who smoke are more likely
to have a cleft lip or cleft palate — types of birth
defects.
The Good News
Quitting smoking before getting
pregnant is best. But for women who
are already pregnant, quitting as early
as possible can still help protect against
some health problems, such as low birth
weight. It is never “too late” to quit
smoking.
Quit for Good
It is important to quit smoking for good. Some
women might think it is safe to start smoking again
after their baby is born. But these babies are not
out of harm’s way. Babies who are around cigarette
smoke have weaker lungs than other babies. They are
more likely to have other health problems such as
infections and more frequent asthma attacks. Being
around cigarette smoke is also one of the causes of
Sudden Infant Death Syndrome (SIDS) .
Though quitting for good can be hard, the benefits are
worth it — a healthy baby and many more years of
good health to enjoy with him or her.
For More Information . . .
Tobacco Use and Pregnancy: www.cdc.gov/
reproductivehealth/TobaccoUsePregnancy/
Smoking During Pregnancy: www.cdc.gov/Features/
PregnantDontSmoke/ or call 1-800-CDC-INFO.
Important Information from the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities
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SPOTLIGHT ON
Alcohol
When a Pregnant Woman Drinks
Alcohol, So Does her Unborn Baby.
Fetal alcohol spectrum disorders, or
FASDs, are caused by drinking alcohol
during pregnancy. These conditions
are among the top preventable birth
defects and developmental disabilities.
Remember, if a pregnant woman does not drink
alcohol, she will prevent serious disabilities caused by
alcohol in her unborn baby.
5 Things You Should Know About Drinking Alcohol
During Pregnancy
1. Drinking alcohol during pregnancy is one of the
top preventable causes of birth defects and
developmental disabilities, known as fetal
alcohol spectrum disorders (FASDs).
FASDs can cause problems in how a person grows,
learns, looks, and acts. FASDs can also cause
birth defects of the heart, brain, and other major
organs. These problems last a lifetime.
2. There is no known amount of alcohol that is safe
to drink while pregnant.
All drinks with alcohol can hurt an unborn baby.
A 12-ounce can of beer has as much alcohol as a
5-ounce glass of wine or a 1-ounce shot of liquor.
3. There is no safe time to drink during pregnancy.
Alcohol can harm a baby at any time during
pregnancy. It can cause problems in the early
weeks of pregnancy, before a woman even knows
she is pregnant.
4. About 1 in 12 pregnant women
in the United States reports
alcohol use.
And about 1 in 30 pregnant women
in the United States reports binge
drinking (having five or more drinks
at one time).*
5. FASDs are 100% preventable.
FASDs are 100% preventable — if a woman does
not drink alcohol while she is pregnant.
*In these findings, binge drinking was defined as having five or more
drinks at one time. More recently, the definition of binge drinking for
women has been changed to four or more drinks at one time.
In 2005, the U.S. Surgeon General Gave Advice
About Pregnancy and Alcohol Use.
• A pregnant woman should not drink alcohol.
• A woman who is trying to get pregnant should
not drink alcohol because she will not know she is
pregnant for the first few weeks of the pregnancy.
• A pregnant woman who has already used alcohol
during her pregnancy should stop right away.
• Because nearly half of all pregnancies in the United
States are unplanned, women of childbearing age
should talk with their doctor about how to prevent
an alcohol-exposed pregnancy.
• Health professionals should ask women of
childbearing age about their alcohol use, tell them
about the risks of alcohol use during pregnancy, and
advise them not to drink alcohol during pregnancy.
For More Information . . .
Alcohol During Pregnancy: www.cdc.gov/ncbddd/fas/ or call 1-800-CDC-INFO.
Important Information from the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities
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Caffeine
High caffeine consumption has been linked to an increased risk of miscarriage, so try to
limit or avoid caffeine altogether if you can.
Here are some steps for reducing your caffeine intake:
• Cut your consumption down to one or two cups
a day.
• Gradually reduce the amount of caffeine by
combining decaffeinated and regular coffee.
• Eventually cut out the regular coffee altogether.
Remember that caffeine is not limited to coffee.
Green and black tea, cola, and many other soft drinks
contain caffeine. Try switching to decaffeinated
products (which may still have some caffeine, but in
much smaller amounts) or caffeine-free alternatives.
Chocolate also contains caffeine, but in much smaller
amounts, so you can still enjoy it in moderation.
Whereas there are 95 to 135 milligrams in a cup of
brewed coffee, the average chocolate bar has anywhere
from 5 to 30 milligrams of caffeine.
A bout Caffeine: Read the Label
Caffeine, found in tea, coffee, soft drinks and
chocolate, should be limited. Be sure to read
labels when trying to cut down on caffeine during
pregnancy. More than 200 foods, beverages, and
over-the-counter medications contain caffeine!
About Recreational Drugs
Pregnant women who use illegal drugs may be placing their unborn babies at risk for
premature birth, poor growth, birth defects, and behavior and learning problems.
What’s more — their babies could also be born addicted to those drugs themselves.
• If you’re pregnant and using drugs, talk to your
healthcare provider or local health clinic. Ask for a
recommendation for a resource that can help you
quit your habit and have a healthier pregnancy.
• If you’ve used any drugs at any time during your
pregnancy, it’s important to inform your healthcare
provider. Even if you’ve quit, your unborn child
could still be at risk for health problems.
For More Information . . .
Healthy Habits During Pregnancy: www..cdc.gov/ncbddd/bd/abc.htm
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Wearing a Seatbelt During Pregnancy
About two-thirds of all pregnancy trauma in the United States is the result of car accidents.
Research shows that wearing a seat belt properly can greatly reduce the risk of injury in a
car accident. When worn properly, a seat belt can, in fact, potentially save two lives.
Regardless of the stage of your pregnancy, a seat belt
should be used with both the lap belt and shoulder
harness in place. Here are some guidelines for wearing
it properly:
C rash Test Dummies
• Place the lap belt below your abdomen, across your hips.
• Lay the shoulder belt diagonally between your breasts.
• Make sure that both the lap and shoulder restraints
are as snug as possible without being uncomfortable.
Seat belt studies have been performed using a
crash dummy that simulates a pregnant woman.
These studies have shown that when a seat belt
is worn properly, there’s no potentially damaging
force placed upon the uterus or the baby.
For More Information . . .
Use of Seatbelts During Pregnancy: health.discovery.com/centers/pregnancy/americanbaby/seatbelts.html
Safe Car Travel: www.nhtsa.gov
Emotions and Stress
Don’t let stress make you sick during your pregnancy. Many women carry a high burden
of stress even when they’re not pregnant — but now is the time to try extra hard to not
let stress affect your health.
Even coping with family and friends during this
unfamiliar time can be stressful. Here are ways to
help you handle your stress.
• Relax. Choose something that calms you down
— like deep breathing, yoga, meditation, or
massage therapy. Or, take a few minutes just to sit,
listen to soothing music, or read a book.
• Make time for yourself. It’s important to care for
yourself. Set aside at least 15 minutes each day in
your schedule to do something for yourself, like
taking a bubble bath, going for a walk, or calling a
friend.
• Sleep. Stress could get worse if you don’t get
enough sleep. You also can’t fight off illness as well
when you sleep poorly. (See Pregnancy and Sleep on
page 46.)
• Eat right. Follow a pattern of good nutrition —
it’s important right now for so many reasons, and
reducing stress is one of them.
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• Get moving. If your healthcare provider has
cleared you for exercise, work toward getting your
30 minutes each day. It will enable your body to
make “endorphins,” a chemical that relieves stress
and improve your mood.
• Talk to friends. Talk to your partner or a friend to
help you work through your stress. Friends are good
listeners — and are likely to be eager to help you in
any way they can.
• Write down your thoughts. Grab a pen and paper
and write down what’s going on in your life! Keeping
a journal can be a great way to get things off your
chest and work through issues. And one day, you can
go back and read about how you made it through
your pregnancy.
• Help others. Helping someone else can help you.
Help your neighbor, or volunteer in your community.
Think about creating a “chat club” for other pregnant
women in the area.
• Get a hobby. Find something you enjoy. Make sure
to give yourself time to explore your interests.
• Plan your time and set limits. When it comes to
things like work and family, figure out what you
can really do. Think ahead about how to spend your
time. Write a to-do list, and then decide what’s
most important to do. Don’t be afraid to say NO to
requests for your time and energy.
• Don’t be tempted to deal with stress in unhealthy
ways. Continue to practice good nutrition, and
avoid alcohol and smoking for the sake of your
pregnancy.
• Get help from a professional if you need it. Talk to
a therapist. A therapist can help you work through
stress and find better ways to deal with problems.
If you are feeling really down, be alert for signs of
depression.
pregnancy changes cause similar symptoms and
are happening at the same time — like tiredness,
problems sleeping, stronger emotional reactions,
and changes in body weight. But these symptoms
may also be signs of depression.
• A family history of depression, hormonal changes,
or emotional and physical stress may all play a part
in whether or not you find yourself suffering from
depression.
• If you suspect that you are depressed, talk to your
partner, a family member, or a member of your
healthcare team and get help. If necessary, your
health professional may refer you to a specialist
for treatment. The treatment is often managed by
nurse practitioners specializing in pregnancy and
mental health.
W ork and Pregnancy
Symptoms of depression may include:
Worrying about how to navigate your job in
relation to your pregnancy can add a lot of stress
to your life, too.
For a complete overview of options and some
helpful strategies, including information on the
Family and Medical Leave Act (FMLA), short term
disability (STD), and maternity leave, visit
www.whattoexpect.com/indexaspx?puid=
e798a004- c1f9-4492-8b3ed5edf3ff38 5e&p=1
About Depression
Depression that occurs during pregnancy is called
perinatal depression. Researchers believe it to be
one of the most common complications both during
and after pregnancy. Often, the depression is not
recognized or treated, because some normal
• Feeling restless or irritable
• Feeling sad, hopeless, and overwhelmed
• Crying a lot
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Trouble focusing, remembering, or making
decisions
• Feeling worthless and/or guilty
• Loss of interest or pleasure in activities
• Withdrawal from friends and family
• Having headaches, chest pains, heart palpitations
(the heart beating fast and feeling like it is
skipping beats), or hyperventilation (fast and
shallow breathing)
• Being afraid of hurting yourself
For More Information . . .
Depression During Pregnancy: www.womenshealth.gov/pregnancy/pregnancy/depressed.cfm
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Pregnancy and Sleep
It’s important to get enough sleep during your pregnancy. Your body is working hard,
so you’ll probably feel more tired than usual.
You may sleep more than usual during the first
trimester of your pregnancy. Keep in mind that it’s
normal to feel tired as your body works to protect and
nurture the developing baby.
It’s usually later in pregnancy that most women really
have trouble getting enough deep, uninterrupted sleep.
Why It’s Hard To Sleep
The primary cause of sleep problems during pregnancy
is the increasing size of the fetus, which can make it
hard to find a comfortable sleeping position. If you’ve
always been a back or stomach sleeper, it may be
difficult to get used to sleeping on your side as your
healthcare provider will likely recommend. Also,
shifting around in bed becomes more difficult as the
pregnancy progresses and your size increases.
Other symptoms that can interfere with sleep include:
• Increased heart rate • Leg cramps and backaches
• Shortness of breath
• Heartburn and constipation
What To Do When You Can’t Sleep
There are bound to be times when you just can’t sleep.
Here are some strategies for overcoming this hurdle:
• Cut out caffeinated drinks like soda, coffee, and
tea from your diet as much as possible. Restrict any
intake of them to the morning or early afternoon.
• Avoid drinking a lot of fluids or eating a full meal
within a few hours before going to bed at night.
• If nausea is keeping you up, try eating a few crackers
before you go to bed.
• Get into a routine of going to bed and waking up at
the same time each day.
• Avoid exercise right before you go to bed. Instead,
do something relaxing, like soaking in a warm bath
for 15 minutes or having a warm, caffeine-free drink,
such as milk with honey or a cup of herbal tea.
• If a leg cramp awakens you, it may help to press your
feet hard against the wall or to stand on the leg. Also,
make sure that you’re getting enough calcium in your
diet, which can help reduce leg cramps.
• Take a class in yoga or learn other techniques to help
you relax after a busy day. (Discuss any new activity or
fitness plan with your doctor first.)
• If fear and anxiety are keeping you awake, consider
enrolling in a childbirth or parenting class. More
knowledge and the company of other pregnant
women may help to ease the fears that are keeping
you awake at night.
• If possible, take short naps (30 to 60 minutes) during
the day to make up for lost sleep — but avoid long
naps during the day.
• Try lying on your side with your knees bent. This
is likely to be the most comfortable position as your
pregnancy progresses. Lying on your side can also
help prevent or reduce varicose veins, constipation,
hemorrhoids, and swelling in your legs.
• Try experimenting with pillows to discover a
comfortable sleeping position.
— Some women find that it helps to place a pillow
under their abdomen or between their legs.
— Or, place a bunched-up pillow or rolled-up blanket
at the small of your back to relieve some pressure.
— You’ll find that there are many “pregnancy
pillows” on the market. If you’re thinking about
purchasing one, talk with your healthcare provider
first about which one might work for you.
If you really can’t sleep, you might want to get up and
do something instead of tossing and turning. Read a
book, listen to music, watch TV, catch up on letters
or email, or pursue some other activity you enjoy.
Eventually, you’ll probably feel tired enough to go
back to bed and get some sleep.
For More Information . . .
Getting Sleep: kidshealth.org/parent/pregnancy_newborn/pregnancy/sleep_during_pregnancy.html
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Before Baby Comes…Choose Your Pediatrician!
As you anticipate the arrival of your little one, there is one more important decision to
make: choosing your baby’s doctor.
Your pediatrician will be an important part of your
family’s health care, and while every doctor in your
community may not be a part of your health care
plan, most plans do have several choices.
Choosing a pediatrician is as much about finding the
right fit for you and your family as evaluating the
doctor’s experience and qualifications. Consider
whether the pediatrician is someone you feel
comfortable asking questions of and whether he or
she shares the same philosophies regarding child
rearing. Also consider whether you want a male or
female, young or old doctor.
Here are some questions to ask or consider when
selecting a pediatrician.
• What type of insurance does the practice accept?
What are hospital charges and fees for office visits?
• How many other pediatricians are in the practice?
Who will be your child’s primary doctor for
scheduled appointments?
• Does the practice have more than one office? In
which office does the doctor you’re meeting with
spend the most time?
• Is the office staff friendly and accommodating?
• What are the office hours? Does the practice have a
call center to answer questions after office hours?
• Are there separate waiting areas for sick and well
children?
• Does the practice have evening or weekend hours?
• What are the doctor’s views on bottle-feeding,
antibiotics, immunizations, parenting methods and
alternative medicine?
• What does the doctor do to stay current with the
latest trends in child development, preventing and
treating diseases, nutrition, etc.?
• How does the doctor monitor child development?
What types of information is provided about
milestones children should reach in terms of how
they play, learn, speak, and act?
• What types of childhood developmental screening
is conducted? Does the practice use a standardized
screening tool for developmental delays, such as
autism?
M essage from CDC
It’s time to change how we view a child’s growth.
It’s natural to measure your child’s height and
weight. But you should measure other ways your
child is growing, too.
From birth to 5 years, there are milestones your
child should reach in terms of how he or she plays,
learns, speaks and acts. A delay in any of these
areas could be a sign of a developmental problem,
even autism. The good news is, the earlier it’s
recognized the more you can do to help your child
reach his or her full potential. Talk with a doctor
or nurse about your child’s total development.
To learn more about child development and
download free milestone checklists, visit
www.cdc.gov/actearly.
For More Information . . .
Choosing a Pediatrician: askdrsears.com
Download a pediatrician/family doctor interview sheet from Babycenter.com.
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Special thanks to:
VNAA Reviewer
VNAA Staff
Donna Grande
VP of Communications and Development
Visiting Nurse Associations of America
Project Editor
Tom Bach
LYSOL®
LYSOL® Reviewer
Donna J. Gaber, BA, MT
Infection Control Practitioner
Consultant for LYSOL®
CDC Reviewers
Spotlight
SPOTLIGHT
ON content reviewers and
various content reviewers from
Centers for Disease Control and Prevention
Germ Protection Center
www.vnaa.org/vnaa/g/?h=html/
germ_protection_center_home
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www.lysol.com
JMH Education, New York, NY www.jmheducation.com
Shelley Ludwick, RN
Clinical Programs Consultant
Visiting Nurse Associations of America