Written by Dr Ryan Lee, Consultant obstetrician and Gynaecologist Specialist

Becoming a mother is a joyful and exciting time, yet it comes with many new demanding challenges. With several physical and mental changes occurring from start to finish – preparing for pregnancy, experiencing the three trimesters, delivering a baby, and post-delivery recovery – it’s crucial to arm yourself with the necessary information for a smooth and successful pregnancy.

1. Preparing for Pregnancy  

Pregnancy and labour contribute to added stress on your body, so entering into pregnancy with a healthy mind and body is paramount. There are several ways to do this, namely:

• Getting pregnant early

Women are born with a finite number of eggs that dwindle every month. Consequently, women above 35 years old are more likely to face difficulty getting pregnant, miscarriages, and bearing babies with Down Syndrome. They are also likely predisposed to pregnancy complications such as high blood pressure (Hypertension), pre-eclampsia (Hypertension with high protein in urine), and diabetes mellitus.

• Eating a healthy balanced diet

Choose plenty of fruits (citrus encouraged), leafy vegetables, whole grains, low-fat dairy, and lean proteins. Avoid highly processed fatty foods and sugary drinks, prioritising good hydration by drinking 6 to 8 glasses of water per day. Limit caffeine intake to no more than two cups of coffee per day.

• Avoiding alcohol

Drinking alcohol may affect fertility as it affects your hormone levels, menstruation, and ovulation. Alcohol can also increase the risk of miscarriage, premature births, stillbirth, smaller babies, and birth defects.

• Quitting smoking

Studies have shown that babies born to mothers who smoke or are exposed to secondhand smoke are more likely to be born premature and have lower birth weights.

• Exercising regularly

30 minutes of exercise a day or 150 minutes a week is beneficial. Exercise also helps maintain or lose the weight necessary to keep your body mass index (BMI) below 25. Obesity is associated with pregnancy complications such as high blood pressure, gestational diabetes, and difficult labour.

• Taking folate or folic acid

A minimum of 400 micrograms at least 3 months before getting pregnant can reduce the risk of brain and spinal cord birth defects also known as neural tube defects.

2. Pre-pregnancy health screening 

Make an appointment to see your doctor regarding pre-pregnancy counselling approximately three months before trying to get pregnant. Even if you’ve had previous pregnancies, your doctor can review your past medical conditions and evaluate any new risks that need to be addressed.  This is paramount especially if you have had a past medical history of hypertension, diabetes mellitus, thyroid problems, or previous pregnancy complications such as preterm labour, pre-eclampsia, placenta separation, or poor pregnancy outcomes.

Your doctor may perform pre-pregnancy check-ups which include

• Physical exam to check your weight, blood pressure, and pulse rate
• Pelvic-vaginal exam to check the health of your pelvic organs
• Cervical smear to check for  cervical cancer by taking a sample of cells from the neck of the womb (cervix)
• Ultrasound scan to check for fibroids which are tumours arising from the muscle layer of the womb and check the ovaries for ovarian cysts.

It is also important to optimise your medical conditions like controlling your blood pressure within a target range of less than 135/85 mmHg and/or keeping diabetes with a glycaemic target HbA1C of 6.5% before it is safe to get pregnant.  Your doctor will advise you to take medications that are safe in pregnancy. It is important not to stop any medication on your own before consulting a doctor. Furthermore, blood tests such as a health screening panel can check if you are medically fit for pregnancy.

3. Pre-pregnancy fertility check-up

Studies have shown that healthy couples < 40 years of age have an 80%  chance of falling pregnant within a year with regular unprotected sex.

Fertility starts declining in the mid-thirties, hence women should be strongly advised to get pregnant before the age of 35 years old. Consequently, it is important to seek help early by visiting your doctor for fertility check-ups.  Your doctor may order other tests that include

• Hormonal profile such as measuring follicle-stimulating hormone ( FSH) levels, luteinizing hormone (LH), oestradiol, and thyroid function for hormonal imbalances that may affect fertility.

• Ovarian reserve like anti-Mullerian ( AMH) test which is an indicator of a woman’s egg supply

• Ovulation assessment by measuring hormone levels of progesterone in the blood

• Male semen analysis to assess the quality, quantity and movement of sperm

4. Confirm early pregnancy and coping with changes in pregnancy

You missed your period and tested positive after a urine pregnancy test. Congratulations! You should book an appointment with your obstetrician & gynaecologist 7-8 weeks from the first day of your last menstrual period to confirm the pregnancy and establish the estimated due date (EDD). You should consider arranging for an earlier doctor’s visit if you have any signs and symptoms of pain, bleeding, previous ectopic pregnancy (pregnancy outside the womb), and any pre-existing medical conditions like hypertension, or diabetes that may complicate a high-risk pregnancy.

You should read up about normal changes in pregnancy and anticipate how to cope with these changes. These include common pregnancy signs and symptoms like backache, feet swelling, nausea and vomiting, heartburn, frequent urination, and constipation. Most women cope with these changes with ‘common sense’, asking their doctor for advice if necessary. However, a small proportion of women may have warning signs that warrant a doctor’s visit such as persistent vomiting until unable to tolerate any oral intake until feeling faint abdominal pain and/or vaginal bleeding, watery vaginal discharge or not feeling well in general.

5. Antenatal care plan

Pregnancy can be divided into the 1st, 2nd and 3rd trimester. After knowing your EDD, your doctor will also go through the antenatal care plan with you in the 1st to 3rd trimester.

• In the 1st trimester, it is important to do antenatal blood tests to test for infections, screen for anaemia, genetic conditions like thalassemia, and blood group type and rhesus status. Next, first trimester screening (FTS) for chromosomal problems like Down Syndrome can be performed using ultrasound or blood tests known as non-invasive prenatal testing (NIPT). In addition, pre-eclampsia screening can be done where your doctor will recommend aspirin to take from 12 weeks gestation if you are screened at high risk for developing pre-eclampsia before 37 weeks gestation.

• In the 2nd  trimester, a detailed ultrasound known as foetal anomaly’ scan is performed around 20 weeks gestation to detect any structural birth defects that can affect  3-5 % of all pregnancies.

• In the 3rd trimester, an oral glucose tolerance test ( OGTT) to test for gestational diabetes (GDM) is done around 24-28 weeks gestation. The OGTT may be performed earlier in pregnancy if there are any risk factors for developing diabetes such as previous history of GDM, previous big baby, history of stillbirth, or persistent glucose on urine sample.  At about 35 weeks gestation, your doctor will do a lower vaginal swab to screen for Group B Streptococcus ( GBS) infection, a common bacteria found in the vagina — antibiotics will be prescribed in labour to reduce the risk of GBS infection to the baby if GBS is detected.

6. Staying healthy in pregnancy 

Besides going through the antenatal care plan, your doctor will also advise you on how to stay healthy during pregnancy. These include nutrition, physical activity, weight gain, good hygiene, stopping smoking or drinking, and optimising any underlying medical illness with your doctor.

• Nutrition- Ensure adequate intake of nutrients including folic acid, iron, calcium and vitamin D. A minimum daily requirement of 400 mcg folic acid is recommended until 12 weeks gestation to reduce the risk of fetal brain and spine defects. Iron should be taken if you are found to have iron deficiency anaemia to reduce fatigue and post- delivery heavy bleeding. Calcium and vitamin D supplementation can reduce the risk of pregnancy induced hypertension . In addition, harmful food such as fish with high mercury, undercooked or raw poultry, excessive vitamin A, unpasteurised milk and soft cheese containing listeria bacteria should be avoided.
• Physical activity with moderate exercise. 30 minutes per day or 150 minutes per week is recommended in pregnancy. These include low impact aerobics , jogging, yoga, pilates and swimming. Avoid high impact or vigorous sports that increase injury.
• Weight gain should be around 11-16 kg for the entire pregnancy in women with a body mass index < 25. There’s no need to ‘eat for two’  because an additional 300 kcal ( one slice of bread) per day is needed for adequate fetal growth. Women with BMI > 25 should gain around 7-11 kg instead as obesity has a higher risk of complications like diabetes, hypertension, infection, and difficult labour.

• Good hygiene such as washing hands is paramount to reduce the risk of harmful infections such as toxoplasmosis , cytomegalovirus. Furthermore, avoid changing cat litter that is associated with toxoplasmosis infection.

7. Planning for labour and delivery

Ensure regular check-ups with your doctor and consider attending antenatal classes. In addition, consider a birth plan to plan for your labour.

Your pregnancy journey has now reached crunch time! Full term pregnancy lasts between 37-40 weeks. You may start to experience signs and symptoms of early or established labour including the regular onset of painful tightenings,  vaginal bleeding with bloody ‘show’, and leaking clear fluid where you should come to the hospital immediately.  You may be offered an induction or speeding up of labour by medication. Your doctor will deliver your baby by vaginal delivery or caesarean section depending on various indications.

8. Immediate post-delivery care

Congratulations on your delivery! Welcome to motherhood!  You are encouraged to have ‘skin-to-skin’ after delivery to establish a special bonding with your baby. The immediate post-delivery care consists of wound care with pain relief, medications to prevent constipation, possible antibiotics, blood-thinning injections to prevent blood clots and vitamins.

The pediatrician will assess your baby with developmental checks and blood tests for metabolic diseases and jaundice.

9. Breastfeeding for at least 6 months

Breastfeeding is recommended for at least 6 months, without any other food or drinks during this time. Benefits of breastfeeding include maternal weight loss, providing sufficient nutrients, and anti-oxidants, boosting your baby’s immune system, lowering risks of allergies, eczema, and promoting bonding with your baby.

10. Gradual post-delivery recovery

Healthy eating, regular physical activity, adequate rest, and looking after your mental well-being after delivery may help you return to a healthy weight. After pregnancy, gradually resume routine moderate intensity physical activity and gradually return to a healthy weight.

Kudos to you for giving birth and growing your family! I hope these ten tips have helped you immensely throughout your pregnancy journey.