Spreading Love the Brooklyn Way: Prepare for a Safe & Healthy Pregnancy

Everyone is different. Speak with a provider to determine the best time to become pregnant. If you are planning to have or have had a medical procedure or immunization, ask about the best time to conceive following treatment. You may also have pre-existing conditions that require treatment during pregnancy.

Your provider can help you decide what treatment and medicines you should or should not take. If you are thinking of having a second baby, wait 18-24 months before trying again to give your body time to recover.

Additionally, if you are facing emotional challenges or a chronic mental health condition at this time, speak with your loved ones and your provider to determine if this is the best time to conceive. While pregnancy is a joyful event, for some people it can also be stressful to have your body and life change.

If you have a pre-existing physical or mental health condition, pregnancy may lead to depression, increased anxiety, or aggravated chronic illness. A birthing person’s mental health can also affect their unborn baby, causing low birthweight, higher anxiety, and developmental issues down the line.

As you think about your family planning timeline, remember to make these suggested dietary changes three months to a year before your planned pregnancy. Most importantly, take folic acid at least three months before pregnancy to decrease the risk of premature birth, having a low birth weight, and developmental disabilities.

Deciding where to seek care can be challenging. You may be asking yourself, “Should I have a home birth or be seen at a birthing center, or should I have my baby at a hospital?” 

In making your decision, consider whether or not you have any pre-existing conditions that may put you at risk for a home or birthing center birth. You should speak with a provider and do your research prior to making this decision. Depending on the level of care you require, you may want to consider whether hospitals have maternal fetal medicine (MFM) specialists, 24-hour midwives, or Level II and III neonatal intensive care units (NICUs).

Healthy eating is key to a healthy pregnancy. Although staying on top of a healthy diet can be challenging, it is important to begin making these changes at least three months before trying to have a baby. Ideally both parents should plan to make healthy dietary changes three months to a year before you plan to have a baby, and pregnant people should continue a healthy diet throughout their entire pregnancy

Check nutrition labels to identify the ingredients content of shelf food. Try maintaining a diet composed of fruits, vegetables, whole grains, lean meats, and dairy products. Also, consider the dietary changes below. If you need help buying groceries, locating a WIC (Women, Children, and Infants) program can be a great resource.

Before and during pregnancy, increase intake of:

• Folic acid. Folic acid, or folate, is a B vitamin that helps reduce your baby’s risk of birth defects leading to conditions like learning disability. It also decreases the risk of premature birth and having a low birth weight baby.
  Amount needed per day: 400 micrograms (mcg) while planning pregnancy; 600 to 1,000 micrograms throughout pregnancy.
  Food sources: Leafy, dark green vegetables, citrus fruits, nuts, legumes like peas and lentils, and whole grains all contain folic acid. You should also take a prenatal vitamin which usually contains 800 micrograms of folic acid.

• Calcium. Calcium helps strengthen your bones, heart, muscles, and nerves. It can also protect you against cancer, diabetes, and high blood pressure.
  Amount needed per day: At least 1,000 mg while planning pregnancy (three 8 oz glasses of skim milk); 1,300 mg for pregnant people 18 and younger.
  Food sources: Cheese, yogurt, sardines, canned salmon, beans, lentils, almonds, milk, green and leafy vegetables, and other fortified foods such as some tortillas and crackers.

• Vitamin D3. Vitamin D3 helps you absorb calcium and phosphorus to maintain strong and healthy bones. Vitamin D3 is the easiest type of Vitamin D supplement for pregnant people to absorb. Higher doses can be more effective in preventing the risk of your child developing weak bones, enamel defects, and attention deficit hyperactive disorder (ADHD). It also lowers chances of pregnancy-related hypertension (preeclampsia), gestational diabetes, and premature birth.
  Amount needed per day: 600-4000 IU
  Food Sources: Fish, eggs, and liver. Vitamin D2 is less potent, but is still an effective alternative. You can find this in fortified foods like cow and plant-based milk, yogurt, and orange juice.

• Omega-3. Omega-3 helps build stronger bones, promote brain health, improve mood, prevent cancer, and lower blood pressure and cholesterol levels that can prevent  heart disease. The addition of Vitamin D3 to Omega-3 supplements provides additional immune support.
  Amount needed per day: 250-500 mg or 2 servings (6-8 oz) of cold-water fish per week.
  Food Sources: Cold-water fish, walnuts, oysters, flaxseeds, chia, and hemp seeds.

During pregnancy, also increase intake of:

• Proteins. Protein promotes healthy baby tissue and organ growth, especially in the brain and immune system. It also helps you build breast and uterine tissue to support your growing baby.
  Amount needed per day: 71 grams
  Food Sources: Anything that comes from animals, including lean meat, poultry, seafood, and eggs. Other plant-based options include seeds, nuts, beans, peas, and soy products.

• Iron. The body uses iron to produce hemoglobin, an important protein that carries oxygen to the body’s tissues. In order for oxygen to reach your baby during pregnancy, your body needs double the iron intake. If you are low on iron, you can develop iron deficiency anemia, causing headaches and fatigue. Severe iron deficiency anemia can increase risks of premature birth, low birth weight babies, and postpartum depression.
  Amount needed per day: 27 mg
  Food sources: Poultry, fish, lean red meat such as skinless chicken, turkey, and steak with the fat removed; and iron-fortified products like beans and vegetables. Iron in meat products are most easily absorbed. For optimal iron absorption in non-meat products, eat natural foods high in Vitamin C like strawberries or oranges. Do not take iron with calcium-fortified products as it can decrease its effectiveness.

• Water. It is important to stay hydrated. Water not only aids digestion and waste removal, it also helps nutrients circulate throughout the body and forms the amniotic fluid around the unborn baby that contains nutrients like protein, glucose, and lactate.
  Amount needed per day: 8 to 12 cups (64 to 96 ounces)

• Supplements. Some of the listed nutrients can also be obtained through prenatal supplements. Consult with your doctor if you are considering pregnancy or are pregnant. Some herbal supplements might not be appropriate for pregnancy. Take supplements in the morning for the best results.

Avoid or decrease intake of:

• Caffeine. Pregnant women should limit their caffeine consumption to less than 200 mg per day (about two, six-ounce cups of a caffeinated beverage per day). Caffeine can raise your blood pressure and heart rate, and increase frequency of urination, leading to dehydration. It can also cause your unborn baby to become more active during the later stages of pregnancy.
  
• Soda, sugar and other sweeteners. It is best to limit sugar in all forms, as it can raise blood pressure and lead to gestational diabetes. Limit soda, juice, cookies, cakes, candy, and other sweetened foods or drinks throughout your pregnancy. Even diet soda can cause leg cramps and for babies it can cause speech, visual and motor issues, among other things. Some less obvious forms of sugar are found in complex carbohydrates such as bread, pasta, potatoes, rice, corn, and other starchy foods that break down into sugars when consumed. Natural and artificial sweeteners, while safe to consume, should be limited as well. Artificial sweeteners have no nutritive value, but those containing sucralose (like Splenda) are better because they are not absorbed and passed through the placenta to the unborn baby.
  
• Processed meat, raw meat, raw fish, fish high in mercury, or runny yolk. Pregnant people are ten times more likely to get infected by listeria, a bacteria found in raw or undercooked fish, processed meats and raw meats. Runny egg yolk can similarly lead to salmonella infection. This also includes refrigerated pate and smoked fish. Fish can be a healthy addition to most diets. You should avoid fish that are high in mercury. To make an informed decision, visit the U.S. Food & Drug Administration website.
  
• Unpasteurized (raw) dairy. Unpasteurized milk and foods made with unpasteurized milk (soft cheeses, including feta, queso blanco and fresco, Camembert, brie or blue-veined cheeses, etc.) can increase the likelihood of a bacterial infection since they have not gone through a heating process to remove potential bacteria.
  
• Alcohol, cigarettes, and other drugs. Alcohol, tobacco, marijuana, and opioids taken during and before pregnancy can lead to infant intellectual and developmental disorders. They can also cause preterm birth, stillbirth, maternal mortality, and neonatal abstinence syndrome (NAS), a type of withdrawal behavior among infants. Reduce substance intake at least three months before becoming pregnant. Find a treatment center near you if you would like help managing substance use.
  
• Excess sodium. Edema, or swelling of the face, hands, legs, ankles, and feet is a common pregnancy symptom. Too much sodium can cause more swelling. It can also lead to increased blood pressure, stroke, heart failure, kidney failure, stomach cancer, osteoporosis, and more. Look out for high sodium content in bread, condiments, cereal, and sweet drinks.

Birthing bodies go through a lot of big changes during pregnancy. Luckily, regular exercise before, during, and after pregnancy can improve your physical and mental health in big ways.

During pregnancy, exercise can reduce back pain, ease constipation, promote healthy weight gain, and strengthen your heart and blood vessels. It can also help improve your mood and decrease the risk of developing gestational diabetes and blood clots postpartum. Women and birthing people exercising regularly are more likely to have a safer and easier birth and quicker postpartum recovery.

Pregnant people should have at least 150 minutes of moderate intensity aerobic activity per week. You can divide your exercises into 10-15 minutes of short routines throughout the day or do 30 minutes of exercise all at once. Aerobic exercises help increase oxygen in your body, which is important since your body will need more oxygen for you and your baby.

Try these exercises.

Pelvic floor exercises help strengthen your stability. The pelvic floor is the set of muscles in and around your pelvic area, supporting the bladder, uterus, and bowels. These are also the same muscles you will use during childbirth; they are stretched to several times their length during pregnancy so ensuring they are strong is important. Ensure adequate hydration when exercising.

Consult with your midwife or doctor before intensive exercise if you are experiencing any medical complications like vaginal bleeding, abdominal or pelvic pain, amniotic leakage of fluid, dizziness, headache, chest pain, calf pain or swelling, muscle weakness affecting balance, labor pains, or regular contractions.

Here are some easy activities you can do throughout the week:

• Brisk walking
• Indoor stationary cycling
• Indoor step or elliptical machines
• Swimming
• Modified yoga, pilates and stretching

Modify your exercises.

During pregnancy, your body changes. Hormonal changes may cause ligaments supporting your joints to become more relaxed, increasing your risk of injury. Extra weight shifts to the center of gravity at the front of your body. Your breathing might become more difficult as you share oxygen with your unborn baby. It is important to modify your movements for low-impact exercise routines, and always stay hydrated.

Avoid:

• Holding your breath as this can affect oxygen flow for you and your baby.
• Jerky, bouncy and high-impact motions like extensive jumping, hopping, running, and bouncing that can irritate joints.
• Exercising in high-heat and humid environments that may cause heat stress, including hot yoga and hot pilates.
• Performing exercises flat on your back or front, as your growing belly can increase pressure on a vein leading to your heart.
• Abdominal crunches or waist-twisting/bending movements causing urinary frequency.
• Contact sports like football, soccer, basketball, and softball that risk hitting the abdomen.
• Activities with a risk of falling like horseback riding, skiing, gymnastics or outdoor biking.

Prenatal care.

It is important to get regular checkups throughout your pregnancy. All qualified health insurance plans cover routine prenatal, childbirth, and newborn care services. Prenatal care can start as soon as you become pregnant.

This includes:

• Routine medical checkups from a doctor or midwife, lab tests, and access to specialists during your pregnancy;
• Parent education, including information on pregnancy, labor, birth, and postpartum care;
• Services from a licensed midwife affiliated or practicing in a qualified hospital, clinic, or private practice;
• In- and out-of-hospital care during pregnancy and childbirth;
• Inpatient hospital coverage for birthing person and newborn for at least 48 after vaginal births and at least 96 hours after cesarean births (“c-sections”);
• Breastfeeding or bottlefeeding counseling, support, and equipment during pregnancy and after birth, for as long as you’re nursing (this includes a breast pump); and
• Necessary maternal and newborn clinical assessments.
  

Uninsured?

If you don’t have health insurance and are pregnant, plan to get pregnant, or just gave birth, you can get coverage for yourself or your baby through the New York State of Health (NYSOH) Marketplace or through Medicaid. Call NYSOH at 1-855-355-5777 for help.

Marketplace insurance carries New York State’s Medicaid for Pregnant People, which offers free or low-cost coverage regardless of immigration status during pregnancy and up to 12 months after birth. You can also call 311 which will direct you to the Human Resources Administration (HRA), or contact this list of providers, to sign up.

Some local community health centers also provide free or low-cost services for pregnant people.

Covered services include:

• HIV counseling and testing
• Help in applying for other programs, such as WIC and low- or no-cost health insurance for your children and family
• Full health care for you until at least two months after delivery
• Health care for your baby for at least one year after birth
• Family planning services

If you are not pregnant and uninsured, but would like pre-pregnancy support, contact your local Planned Parenthood health center.

Prenatal care is the medical care you get during a pregnancy by a doctor or a licensed midwife (certified nurse midwife or certified midwife). Prenatal care should be started as early as possible—preferably in the first trimester (before 12 weeks of pregnancy).

Standard prenatal care usually starts with your provider taking a thorough medical history from you. They will also ask you about medical conditions in your family. Your provider will then take blood tests, perform an ultrasound to make sure your pregnancy is developing normally, and may suggest certain vaccinations to keep you safe from infection during your pregnancy.

Your doctor or midwife may prescribe prenatal vitamins, iron, and/or other medications necessary to treat certain medical conditions. As your pregnancy progresses, your provider will continue to monitor your vital signs, weight, lab tests, and the growth of your future baby. Some hospitals may have fetal testing units where all of these assessments can be provided in one place. Your provider will make sure you are healthy and will help you prepare for a safe birth.

The frequency of your prenatal visits will depend on how far along you are in pregnancy. Typically, you will meet with your provider every 4 weeks until 28 weeks of pregnancy. Between week 28 to weeks 36-37 of pregnancy, you should schedule a prenatal visit every 2-3 weeks. After that, your visits should be weekly. You may have more frequent visits if you have a high-risk pregnancy. You should bring any concerns to your doctor or midwife.

Standard prenatal tests you will receive include: genetic testing, sonograms, and non-stress testing.

Genetic testing can help screen for birth defects and genetic disorders (like down syndrome) before and during your pregnancy. Testing poses no risk, and can be conducted during the first and second trimesters, which combined are 94-96% accurate. Testing may involve taking a sample of amniotic fluid from the placenta, and may include:

• Carrier screening. This simple blood test assesses both parents for hereditary disorders like sickle cell and cystic fibrosis and can be conducted before or during pregnancy.
• Screenings for birth defects of the brain and spine or chromosomal disorders. Different tests involving ultrasound, blood tests, or both during pregnancy help detect whether your unborn baby might be at risk for birth defects of the brain and spine (like spina bifida) or chromosomal disorders (like down syndrome).
• Diagnostic tests. If the above screening tests indicate a genetic risk to your unborn baby, your doctor might recommend a diagnostic test that involves taking and analyzing cells from your uterus.

A sonogram, also known as a fetal ultrasound, is a safe imaging technique that uses sound waves to visualize your baby’s development, identify potential problems, and make diagnoses.

A sonogram helps you determine or identify: 

• Your due date
• How long you have been pregnant 
• Where the unborn baby is located (in the uterus or fallopian tube) 
• Fetal anatomy (examines the body parts of the unborn baby to look for birth defects)
• Your unborn baby’s sex at birth
• Your unborn baby’s movement, breathing, and heart rate
• The location of the placenta 
• The amount of amniotic fluid surrounding the unborn baby
• Potential childbirth complications
• The position of the unborn baby

Non-stress testing is a type of fetal testing, or testing of your unborn baby. This is when a stretchy girdle or two bands are placed over a pregnant person’s belly to track the unborn baby’s heart rate and monitor for contractions. Generally, a strip with a graph will be generated. A midwife or doctor will evaluate this fetal monitoring strip to gauge how the baby is doing. Fetal monitoring may be performed in the fetal/antepartum testing unit and in labor and birthing units. Fetal/Antepartum testing units are areas in a medical facility where routine and specialized ultrasounds, non-stress testing, amniocentesis and/or genetic counseling are performed in consultation with a Maternal Fetal Medicine Specialist.

It is important to be up-to-date on your immunizations to protect you and your unborn baby. Your provider should check your immunity to measles, mumps, rubella (MMR), chickenpox, and Hepatitis B during pregnancy in order to offer you vaccination after the birth of your baby. Vaccines with live viruses—such as measles, mumps, and chickenpox—should not be administered while pregnant. Some vaccines without live viruses—such as human papillomavirus vaccine (HPV)—are also not recommended during pregnancy.

The following are examples of vaccines that are safe for pregnant and breastfeeding people; it is recommended that you  get the following vaccines even though immunity testing will not check for them:

• COVID-19: Receive as new boosters are released; stay up to date on booster guidance here.
• Flu: Receive annually beginning in late August.
• Tdap (tetanus, diphtheria, pertussis or whooping cough): During the 27th through 36th week of each pregnancy.

See here for a comprehensive list of immunization recommendations during and after pregnancy. If you have not been checked for immunity, be sure to ask your provider.

A Maternal Health Home is a free program, often based in hospitals, that will work with you to coordinate all your pregnancy and postpartum services. This includes referrals to necessary specialty care, mental health services, and social support to address your personal challenges, including parenting support and education.

Not all hospitals or health systems have Maternal Health Home programs. For the ones that do, the Maternal Health Home is a valuable resource for parents-to-be. The purpose of the Maternal Health Home is to put you at the center of your pregnancy care. Your local Maternal Health Home care team can include physicians, specialists, midwives, social workers, care coordinators, translators, and doulas who are all trained to support you through your unique pregnancy journey.

People who have more complex pregnancies often have more frequent prenatal visits or appointments with other specialists. They may need help coordinating appointment times and transportation. The Maternal Health Home will also assess behavioral health conditions and provide extra support to help manage anxiety and appointments with therapists and other mental health professionals. Lastly and most importantly, if you have other, unique needs, the Maternal Health Home will help address those needs.

The Maternal Health Home team will help guide you to necessary community resources. If you decide you need help with food, housing, legal services, baby supplies, breastfeeding support and more, your maternal home team will do their best to direct these resources to you. They are very good at connecting you to other organizations within your own community.

During pregnancy, you might be at a higher risk of developing complications related to diabetes and hypertension. This may be associated with your medical history, prior pregnancies, obesity, family history, age, and length of time between prior pregnancies, among other causes.

Diabetes

Diabetes is a medical condition related to your body’s insulin production. Insulin is a hormone that helps blood sugar be used by cells in the body for energy.

Type 1 diabetes means the body does not produce enough insulin.

Type 2 diabetes means the body produces insulin but does not use it well.

If you already have Type 1 and/or Type 2 diabetes before pregnancy, it is called pre-gestational diabetes. In the United States, about 1 in every 10 people have diabetes. Diabetes is a serious condition which can lead to damage in other organs, including the heart, eyes, kidneys, nerves, and feet. About 1-2% of pregnant women and birthing people in the U.S. enter into pregnancy with a diagnosis of pre-gestational diabetes.

Gestational diabetes is diabetes that develops during pregnancy. It occurs when your body produces insulin but does not use the insulin well. When insulin is not working properly, blood sugar rises in the birthing person and can transfer to the unborn baby, causing the baby to grow larger than normal. This is called macrosomia. This can increase the likelihood of a cesarean delivery (“c-section”) or other complications during pregnancy, such as high blood pressure.

You will be tested for gestational diabetes around 24-28 weeks pregnant when it usually develops. You should be tested earlier if you have risk factors for diabetes, such as being overweight, having gestational diabetes in a prior pregnancy, being older than 35, or having a relative with diabetes. About 6-9% of pregnant women and birthing people will develop gestational diabetes, and this may be higher in certain communities.

If high blood sugar is present in early pregnancy (or even before pregnancy is diagnosed), this may lead to birth defects. Speak with your provider to properly manage your diabetes and control your blood sugar to prepare for your pregnancy. Do not abruptly stop your diabetes medication prior to seeing your provider.

During the family planning stage, you can work on prevention techniques by increasing your physical activity and modifying your diet . During pregnancy, it is important to get tested, eat healthy, exercise, and monitor your unborn baby regularly. Following childbirth, remember to test your blood sugar 4-12 weeks after birth, and then every 1-3 years to ensure your blood sugar levels remain normal. It is also important to get adequate sleep and practice stress reduction. Approximately 40% of women who have gestational diabetes will develop Type 2 diabetes later in life. It is important to continue to follow a healthy diet, a consistent exercise schedule and weight management plan, and to test for the development of diabetes throughout your life.

High blood pressure

Between 2017 to 2019, high blood pressure—or hypertension—during pregnancy increased from 13.3% to 15.9% among delivery hospitalizations in the U.S. Hypertension in any form is present in about 15% of pregnancies. Hypertensive disorders of pregnancy can complicate pregnancy by causing a stillbirth, fetal growth restriction, preterm birth, and early pregnancy loss. There are several different types of disorders:

Pre-gestational hypertension is when you have high blood pressure or chronic hypertension prior to pregnancy. It is important that you not abruptly stop your medications prior to seeing your provider.

Gestational hypertension is elevated blood pressure that happens only during pregnancy, usually after 20 weeks. It is important for your doctor to monitor gestational hypertension to ensure it does not develop into preeclampsia. In certain circumstances, it may be necessary to treat gestational hypertension with medications. Gestational hypertension usually goes away after birth, though it may not, and it may increase your risk of hypertension in the future.

Preeclampsia is a condition of high blood pressure with other lab test abnormalities. Preeclampsia develops after 20 weeks of pregnancy, and may affect other organs in your body. Symptoms of preeclampsia include headache, right upper quadrant pain in your abdomen (liver, gallbladder, intestines, stomach, kidneys), altered vision, acute onset nausea, and vomiting. If you start noticing symptoms, that means the organs in your body may be affected. Notify your provider as soon as you begin to experience symptoms.

The treatment for preeclampsia is giving birth to the unborn baby. If the baby is premature, sometimes the birth will be able to be postponed with very careful monitoring of the birthing person. Oftentimes, you will need to receive a medication called magnesium sulfate. Rarely, preeclampsia will develop into eclampsia.

Eclampsia is a life-threatening complication of pregnancy. Eclampsia will require immediate administration of magnesium sulfate and delivery of your baby. Eclampsia is a condition of severely high blood pressure readings, seizures, and/or coma that may threaten the life of the birthing person or the unborn baby. Eclampsia is an emergency situation that will mobilize many different members of your health care team to come to your assistance.

Postpartum preeclampsia is a rare but serious medical condition that can happen within 48 hours to 6 weeks of childbirth, even without a history of preeclampsia during pregnancy. Pay attention to your blood pressure after giving birth, and continue monitoring signs and symptoms, which will be similar to preeclampsia. Contact 911 immediately if you experience any symptoms.

It is a good idea for all pregnant people to request a prescription for a blood pressure monitor from their provider to self-monitor at home.  You are at risk for preeclampsia if you:

• Are over the age of 35
• Have a history of preeclampsia or chronic hypertension
• Have a body-mass index (BMI) greater than 30
• Have type 1 or 2 diabetes
• Are pregnant with more than one baby
• Have kidney disease
• Have an autoimmune disease