Your health and safety in pregnancy

Is there any reason I shouldn't work while I'm pregnant?

If you're having a low-risk, normal pregnancy, you can certainly continue working. But of course you must make sure that the kind of work you do and your working conditions will not put your health or your baby's health at risk.

In many countries women's health and employment rights are protected by law during pregnancy and afterwards. In the UK for instance, women have the right to a risk assessment in pregnancy to make sure their work will not harm them and their employers are legally required to provide a safe work environment for them. If this is not possible, the employer is required to transfer or suspend her on full pay.

Unfortunately for us, maternity benefits and legal protection are not as clear cut nor as extensive in Malaysia. The Employment Act 1955 provides:
• a minimum of 60 consecutive days of maternity leave, and further states that employment cannot be terminated while a woman is on maternity leave
• a minimum maternity allowance of RM6 a day
• that if an eligible employee dies from any cause during the confinement period, her maternity allowance is paid to her nominee.

However, if your monthly income is more than RM1,500, you are not covered by the Act. You will have to rely on your employment contract or employee handbook. Check to see if there are any maternity benefits or additional privileges during pregnancy. You could also check with your trade union representative.

So what can I do to take care of myself while I am pregnant at work?

Health and safety issues are not just about obvious physical problems, but also things like mental and physical fatigue, movements and postures, travelling and noise. So any concerns you have about your work should be brought up with your boss.

Even if your job requires minimal standing and nothing more risky than lifting a telephone, you may find some simple measures will make you feel more comfortable. You could try:

• Taking breaks. Put your feet up if you've been standing, or stand and walk around every two hours if you've been sitting. This will help decrease swelling in your feet and ankles, and it should keep you more comfortable. Throw in a few stretching exercises to protect your back.

• Resting when you can. The more strenuous your job, the more you may want to reduce physical activity outside work.

• Wearing comfortable shoes and loose clothing.

• Taking time to eat regular meals. Add fibre to your diet to ease constipation.

• Choose lunches that are balanced and nutritious. Consider packing your lunch from home so you can avoid the risks of eating at dirty hawker stalls (including food poisoning).

Can I work right up to my due date?

You are legally allowed to work for as long as you want -- it is your choice when to start maternity leave.
Towards the end of your pregnancy, you may find yourself feeling tired very quickly, so take it as easy as possible. And don't be a hero -- if you can afford to start your maternity leave a week or two before your due date, consider using it to rest, prepare and indulge yourself. Remember that this may be the last quality time you have for yourself for a long time to come...

Are jobs that require a lot of physical activity dangerous?

A demanding job may become too difficult and even dangerous towards the end of pregnancy. If you have a strenuous job, talk to your doctor about it. If your doctor thinks you must reduce your activities, speak to your employer about a suitable alternative. If this is not possible, consider getting your doctor to write a letter to your employer stating that you need to take sick leave for an extended period.

Is there any risk associated with working at a computer?

There's no evidence that working at a computer causes any harm to your developing baby.

If I have any possible pregnancy complications, should I stop working?

Talk it over with your doctor, as it will depend on your condition. But you may be advised to stop if you've previously given birth to more than one premature baby, have either diabetes or high blood pressure, have a history of miscarriage, or are expecting twins.

Caffeine and pregnancy: what's safe?

Do I have to give up caffeine now that I'm pregnant?

You don't have to give up caffeine, but you may want to cut down.

If you have too much caffeine your baby could have a lower birth weight than he should (CARE 2008). A low birth weight increases the risk of your baby having some health problems when he's born and in the future. There is also a possibility that high levels of caffeine could cause miscarriage (FSA n.d. b). One study suggested that even low levels of caffeine could be linked to miscarriage (Weng et al 2008).

Guidelines issued by the Food Standards Agency recommend that pregnant women have no more than 200mg of caffeine a day (FSA n.d. a). This is equivalent to two mugs of instant coffee or four cups of tea or five cans of cola per day (FSA n.d. a).

What exactly does caffeine do to my body?

Caffeine is a stimulant; it increases your heart rate and metabolism, which in turn affects your developing baby (OTIS 2006). But while unremitting stress isn't healthy, brief bouts of fetal stress, such as that your baby would feel after you drink a cup of coffee, shouldn't cause him any harm. It's akin to your dashing to the bus, another situation that briefly boosts your heart rate and metabolism.

Anyone who drinks coffee regularly knows that it can be addictive and that large amounts can also cause insomnia, nervousness, and headaches (Chawla et al 2006). It's also a diuretic, which causes your body to lose water and other fluids, all of which you need to maintain a healthy pregnancy.

Tea and coffee can also hamper your body's ability to absorb iron if you drink it with a meal or within half an hour of a meal (FSA n.d. b).

Which foods and beverages contain caffeine?

Caffeine can be found in coffee, tea, colas, and chocolate. Some over-the-counter drugs, including headache and cold tablets, stay-awake medications, and allergy remedies also contain caffeine. Always seek your pharmacist's advice before you buy over-the counter remedies, and don't forget to mention that you are pregnant.

Even the amount of caffeine in coffee and tea can vary widely depending on whether the coffee grounds or tea leaves are brewed or instant, weak or strong. Colas and other drinks vary in caffeine content, too. See the list below for average caffeine amounts in some common foods and beverages (FSA n.d. b). You might be surprised how easily you can get a large dose of caffeine.
• 1 mug of instant coffee = 100mg
• 1 cup of instant coffee = 75mg
• 1 cup of brewed coffee = 100mg
• 1 cup of tea = 50mg
• 1 can of cola = 40mg
• 1 can of "energy" drink = 80mg
• 1 x 50g bar of plain chocolate = up to 50mg
• 1 x 50g bar of milk chocolate = up to 25mg

I'd like to kick the caffeine habit - just to be safe. Any tips?

You may find your taste buds do the cutting back for you. Many women find their fondness for a cup of coffee evaporates during the first trimester when their sense of taste changes and nausea can strike.

Otherwise, to reduce the caffeine in homemade hot beverages, brew them for a shorter time. If you love a soothing cup of Earl Grey, steeping your tea bag for just one minute instead of five reduces the caffeine by as much as half. Many tea companies now offer decaffeinated black or green teas.

Although herb teas often have no caffeine, make sure you read the ingredients list. You'll want to avoid large amounts of caffeine as well as certain herbs and additives that may not be safe during pregnancy. (Read more on the safety of herbs in pregnancy.)

If you're a devoted coffee or cola fan, caffeine withdrawal isn't easy. To minimise symptoms, which include headaches, fatigue, weakness and drowsiness, ease off gradually (Chawla et al 2006). Cut back by half a cup of the beverage each day. You can also try switching from freshly brewed to instant coffee.

If coffee fills an emotional need, such as your private coffee break, or it's an early morning ritual or the perfect end to a meal, you could switch to a cup of decaffeinated coffee or tea. If you're hankering for an ice-cold cola, reach for the caffeine-free version at least some of the time or, better yet, try a glass of mineral water with a dash of lime cordial.

We are trying to get pregnant and my doctor told me to start taking folic acid. How much should I be taking?

It's a good idea to start taking extra folic acid before conception. This essential nutrient, one of the B group of vitamins, reduces the risk of neural tube defects such as spina bifida in a developing baby. Spina bifida is a serious congenital condition, which occurs when the tube around the central nervous system (the neural tube) fails to close completely.
The neural tube develops during the first few weeks of pregnancy. At this stage, you may not even know that you are pregnant, which is why taking folic acid now is a good idea. The neural tube grows to form the baby's brain and spinal cord; the long bundle of nerves which runs inside the backbone to connect the brain with the rest of the body. When you are pregnant, you need extra folic acid, especially in the early weeks of pregnancy when your baby's body is being formed.

Although neural tube defects are very rare, the Department of Health recommends taking a 400 (mcg) microgram supplement of folic acid daily from the time of conception until the 12th week of pregnancy.

If you are not pregnant, you usually need to buy the supplement. Ask the pharmacist for advice on which supplements contain the recommended amount. Women who have previously had a baby with a neural tube defect or are on drug therapy for epilepsy are often prescribed higher doses of 5 milligrams (mg) per day; speak to your GP for guidance before becoming pregnant again.

As well as taking a supplement, you should also increase the amount of naturally occurring folates in your diet. Foods rich in folates include dark green leafy vegetables such as sprouts, spinach, and broccoli; other vegetables such as peas, cabbage, cauliflower, potatoes and green beans; baked beans; fruits (especially citrus fruits); dried beans; yeast extract and milk. Some types of bread and breakfast cereals are fortified with folic acid (check the nutritional information chart on the packaging);.

Like many vitamins, folates can be easily destroyed by cooking. Try steaming, microwaving or stir-frying vegetables which have high levels of folates, or cook them in the minimum amount of water.

Exercises recommended throughout pregnancy

Why is exercise recommended during pregnancy?

Exercise does wonders for you during pregnancy. It helps prepare you for childbirth by strengthening your muscles and building endurance, and makes getting your body back in shape once the baby's born much easier. Staying active during pregnancy doesn't necessarily mean going for the burn. Your body releases a hormone called relaxin during pregnancy which loosens your joints in preparation for delivery, so you need to take care with the choice of exercise and pay attention to technique. It's important to find exercises that won't injure you or harm the baby.
Ideal exercise gets your heart pumping, keeps you supple, manages weight gain, and prepares your muscles for the hard work of labour and delivery -- without causing undue physical stress for you or your baby. Many activities such as running and weight training are fine in the beginning, but you may need to modify your regime as you grow bigger. You'll be better off avoiding activities that could put you at risk of slips and falls, such as cycling, rollerblading, horseriding and skiing, although people who take part in these sports competitively often continue well into their pregnancy.
The following exercises are fairly safe for expectant mothers, although some of them may not work for you during the last few months of your pregnancy. To be safe, consult your doctor before embarking on any of these activities.

Walking

One of the best cardiovascular exercises for pregnant women, walking keeps you fit without jarring your knees and ankles. It is safe throughout the nine months of pregnancy and can be built into your day-to-day schedule.

Swimming

Healthcare providers and fitness experts hail swimming as the best and safest exercise for pregnant women. Swimming is ideal because it exercises both large muscle groups (arms and legs), provides good cardiovascular benefits, and allows pregnant women to feel weightless despite the extra weight of pregnancy.

Aquanatal classes

Many women find aquanatal classes enjoyable during pregnancy. Exercising while standing in water is gentle on joints and can help lessen swelling in legs, which is a common symptom in late pregnancy. However, it is difficult to find such a class in Malaysia, so you may have to stick with doing laps at the nearest pool.

Yoga and stretches

Yoga and stretching can help maintain muscle tone and keep you flexible with little if any impact on your joints. However, you may have to augment a yoga regime by walking a few times a week to give your heart a workout. Be careful not to overdo the stretching. You will be more supple as a result of the effects of relaxin, which causes your ligaments to be more pliable. Don't hold the stretches for too long or try to develop your flexibility too much.

Pilates

Pilates is a form of exercise which combines flexibility and strength training with body awareness, breathing and relaxation. The exercises are based on certain movement patterns performed with your tummy and pelvic floor muscles -- known in Pilates as the "stable core" or base. These muscles are also known as deep stabilising muscles. Because Pilates targets the tummy and pelvic floor muscles and these muscles can weaken during pregnancy, Pilates exercises can be useful. Many Pilates exercies are performed on a "hands and knees" position, and this is an ideal position for pregnancy. It helps to take a lot of stress off your back and pelvis and towards the end of your pregnancy can help to position your baby ready for delivery.

Weight training

If weight training is already part of your exercise routine, there's no reason to stop, although you will need to avoid using heavy weights and assuming certain positions. If you take the necessary precautions and have good technique, weight training is a great way to tone and strengthen your muscles. Avoid overheating and fatigue, and gradually taper off as the pregnancy advances.

Dance

You can get your heart pumping by dancing to your favourite tunes in the comfort and privacy of your living room, but steer clear of dance movements which call for you to leap, jump, or twirl or wiggle your hips. Remember -- technique is important. Avoid sudden changes of direction. If you sign up for a class, you can lose yourself in music, stay fit, and meet others.

Low-impact aerobics and Fitball

One good thing about an aerobics class is that it's a consistent time slot when you know you'll get some exercise. If you sign up for a class specifically designed for pregnant women, you'll get to enjoy the camaraderie of others just like you, and can feel reassured that each movement has been deemed safe for you and the baby.

Pregnancy exercise guide

Does exercise help during pregnancy?

Because exercise promotes muscle tone, strength and endurance, it can help you carry the weight you gain during pregnancy, prepare you for the physical stress of labour, and make it easier to get back into shape after the baby is born. Being active during your pregnancy can also reduce the physical discomforts of backache, constipation, fatigue and swelling; can improve your mood and self-image; and can even help you sleep more soundly.

What are the benefits of exercise in pregnancy?

Why exercise? It's may be hard enough just to get dressed every day if you're feeling bloated and sick to your stomach, but believe it or not, a little effort can leave you feeling energised and perhaps a bit like your pre-pregnancy self. Because exercise promotes muscle tone, strength and endurance, it can help you carry the weight you gain during pregnancy, prepare you for the physical stress of labour, and make getting back into shape after the baby is born much easier. Before beginning any exercise programme, make sure you follow safety guidelines, especially now that you're pregnant.
Exercising now will:
Give you more energy
Pregnancy can rob you of energy, but regular bouts of exercise, such as brisk walking, will make you feel able to tackle your daily tasks. Exercise strengthens your cardiovascular system, so you don't tire as easily. With muscles that are strong and toned, you need less effort to engage in any activity, be it shopping for food or sitting through meetings at the office.

Help prepare you for the rigours of childbirth
It makes perfect sense: the better shape you're in, the stronger you'll be to cope with labour and the delivery. Giving birth is akin to running a marathon -- it requires stamina, determination and focus. Keeping physically active during pregnancy is good preparation for the hard work of labour. The UK’s Royal College of Obstetricians and Gynaecologists (RCOG) states that weight-bearing exercise throughout pregnancy can reduce the length of labour and decrease delivery complications. Additionally, some research has shown that fetuses of women who exercised during labour may tolerate labour better than those of the non-exercisers.

Reduce pregnancy discomfort
Exercise stretches and strengthens your muscles, which helps your body cope better with the aches and pains of pregnancy. Stretches ease back pain, walking improves your circulation, and swimming can strengthen your abdominal muscles.

Fend off the pregnancy blues
Pregnancy is a nine-month rehearsal for a big event -- childbirth -- and, after the initial excitement of telling everyone is over, you're left with a lot of waiting. By the sixth or seventh month, pregnancy can become downright tedious. And boredom may result from the increased weight gains and tiredness restricting your social activities. Finding a new activity appropriate for pregnant women may be one answer. "The best thing I can do at the moment to get some relief from feeling as big as a house is to do aquarobics... I find the relaxation session at the end -- when we float to music -- very therapeutic. It also gets you out of the house," says Kim.

Help you sleep better
When you're carrying all that extra weight in front of you, finding a comfortable position to sleep in at night can be a real challenge. Exercise will help you work off any excess energy, and will tire you enough to lull you into a deeper, more restful slumber.

Reduce stress and lift your spirits
Pregnancy and having a child is a life-changing, momentous event which can leave you feeling ecstatic yet overwhelmed and anxious at the same time. One good way to shake the blues is by dancing to the beat of a happy tune. One study found that exercise can boost your levels of serotonin, a brain chemical linked to mood, putting you in better spirits. When you're feeling a little blue, try putting on your favourite CD and kicking up your heels in the living room, or sign up for a low-impact aerobics class. Make sure you follow low-impact aerobics and let your teacher know that you are pregnant.

Improve your self-image
Face it: your body's not the svelte thing it used to be, and although you know it's for a good cause, watching the scale creep its way up to numbers you've never seen before can be disheartening. Staying active can make you feel less frumpy. It can also help you shed weight faster postnatally.

Help you get your body back faster postnatally
This alone is reason enough for many women to embark on a pregnancy exercise regime. As Angela puts it, "I am ready to get back to an active lifestyle and reclaim my body!" If you've managed to maintain your strength and muscle tone all through your pregnancy by staying fit, your body will have an easier time bouncing back after you give birth.

Nausea and vomiting in pregnancy (morning sickness)

What is pregnancy sickness?

No-one knows why the first sign of pregnancy for many mums-to-be is an early morning dash to the bathroom. With around eight out of 10 pregnant women feeling sick, and half of them actually vomiting, many women spend the early weeks of pregnancy feeling awful rather than "blooming".

Pregnancy sickness is the commonest medical condition of early pregnancy, but how badly affected you may be varies widely from woman to woman. You may get the odd bout of mild queasiness when you first wake up, or find that certain smells trigger your nausea throughout the day, or you may have to endure weeks or even months of feeling or being sick morning, noon and night.

"Morning sickness" is misnamed. It may be worse in the morning, but most sufferers get it throughout the day and into the evening. Pregnancy sickness can take over your life for a time. If you get it badly you may find yourself unable to work, to care for your toddler or other children, to cook, shop or run your home. When you should be feeling happy and excited about your pregnancy you may feel miserable and ill, and your relationships with your husband, family and friends may become strained.

Women with unrelenting pregnancy sickness often feel that nobody really understands what they are going through. Not surprisingly, this can lead to depression. Talking to a fellow sufferer can help you feel less alone. Organisations such as the Ibu Resource Group can help you find a pregnancy support group in your area.

The most severe form of pregnancy sickness is called hyperemesis gravidarum (literally "excessive vomiting in pregnancy"). If you are vomiting many times a day, are unable to eat and drink without vomiting, and if you are losing weight then you probably have hyperemesis. Unlike normal pregnancy sickness, hyperemesis can affect your health and that of your baby, so talk to your doctor as soon as you can.

Why am I feeling sick?

Although it won't help your nausea, feeling sick is actually a good sign that your pregnancy hormone levels are high. The cause of pregnancy sickness is unknown, but it is thought to be connected to the hormone human chorionic gonadotrophin (HCG). This is produced in large quantities until your placenta takes over the job of maintaining and nourishing your baby at around 12 to 14 weeks. Other hormones such as oestrogen and the thyroid hormone thyroxine are also thought to be responsible.
If you also suffer from travel sickness, your symptoms may be linked to a disorder in the balancing mechanism in your inner ear. Other, rare, causes of pregnancy sickness include a disturbance to one of the brain's "feel good" chemicals, serotonin, or a digestive infection called helicobacter pylori.

If you are tired, hungry, or stressed the nausea may be worse, and if you are expecting twins or triplets you will have higher levels of pregnancy hormones, and may get more severe sickness.

An evolutionary theory is that a pregnant woman's increased sense of smell and nausea is a protective measure, making her less likely to be harmed by poisons or toxins in the environment.

Whatever the cause, it can be a shock for a previously healthy woman to find herself overwhelmed by pregnancy sickness. No-one understands why some women get it and others escape, but seeing your pregnant friends "blooming" can feel horribly unfair. It may help to remember that nothing you have done is causing your symptoms.

Some doctors still believe that pregnancy sickness is a psychological condition, but a recent review of studies found no evidence for this.

How long will it last?

Pregnancy sickness usually starts at around five or six weeks of pregnancy and improves for most women by 14 weeks. Some women find it persists until16 weeks, whereas others experience varying degrees of nausea or vomiting for the whole nine months until the birth. Fortunately, this is unusual, especially if you get help early on.

If you have pain, a fever or a headache, or if you get nausea and vomiting for the first time after nine weeks of pregnancy, see your doctor as you may be suffering from another condition.

Will it affect my baby?

Pregnancy sickness won't threaten your baby's well-being as long as you're able to keep some food down, and drink plenty of fluids.

Eat a balanced diet if you can, but if you are feeling very sick, eat whatever you can cope with. Your baby can catch up on his nutrients later on in your pregnancy when you're feeling better.

Your food choices may be odd for a while - you might only be able to manage potatoes and water for a month - but try not to worry about it, and catch up on the healthy eating later. Your liver stores many of the nutrients your baby will need to develop normally, so it won't matter too much if you are not eating. It's important that you take a folic acid supplement though, as this will help your baby's spine and nervous system develop. Take it at the time of day when you're most likely to keep it down.

If you are vomiting many times a day, are unable to eat and drink without vomiting, and are losing weight, see your doctor early on or you may become dehydrated. There are treatments that can help you at home, or you may need to be admitted to hospital.

Getting help and support

You may find that a combination of dietary changes, self help and natural remedies mean you can tolerate your sickness until it eases off. If nothing works, and you are still suffering, see your doctor as early as possible. Treatment becomes more difficult the longer you leave it. He can discuss other ways of coping, including medication.

Tell your husband, your family and your friends how you're feeling, and what you need, as they may not know how to help you. There's no need to feel guilty about asking for help with practical things like shopping, cooking and chores - you're ill! You may have to tell the people you work with about your pregnancy (and your sickness) earlier than you wanted, to get the support you need.

If you had pregnancy sickness with your first baby, there are things you can do to prevent or lessen it second time around. Again it's important to start early.

It can sometimes be hard to get help for pregnancy sickness. Pregnancy books and magazines often skim over the issue, as do medical textbooks, and you may find that your doctor doesn't have all the information you need. The internet can be invaluable. There are many useful websites with information for women and health professionals on this subject.

Diet for a healthy pregnancy

Fine-tune your diet - even if you already eat well

Now that you're a mum-to-be, it's important to try and increase your intake of certain vitamins and minerals (such as folic acid and iron). You may also need to slightly increase your calorie intake as your pregnancy progresses.
If your diet is poor to begin with, it is even more important to make the transition to eating nutritious, well-balanced meals. Limit junk food, as it offers little more than empty calories, which means calories with few or no nutrients.
Your body becomes more efficient when you're expecting a baby and makes even better use of the energy you obtain from the food you eat. The average woman does not need any extra calories for the first six months of pregnancy and only about 200 extra calories per day for the last three months.

Two hundred calories is equivalent to:
• two slices of wholemeal toast and margarine/butter
• one popiah roll (not fried)
• plain thosai (without gravy or curry)
• one slice of cheese on toast
Your own appetite is the best indication of how much food you need to eat. You may find your appetite fluctuates during the course of your pregnancy:
• In the first few weeks your appetite may fall away dramatically and you may not feel like eating proper meals, especially if you suffer from nausea or sickness.
• During the middle part of your pregnancy your appetite may be the same as before you were pregnant or slightly increased.
• Towards the end of your pregnancy your appetite will probably increase, but if you suffer from heartburn or a full feeling after eating you may find it helpful to have small frequent meals.
The best rule to remember is to eat when you are hungry. Don't worry about your changing appetite as long as you are following the advice given about the type of food you need to eat and you are gaining weight at the appropriate rate, which your doctor or obstetrician will monitor.

Eat the right kinds of fish

Experts generally recommend that pregnant women and children under 16 don't eat shark, swordfish or marlin, as it may contain potentially unsafe levels of naturally occurring mercury. Also avoid bottom feeders, such as catfish, as they may ingest more pollutants.

They also advise that pregnant and breastfeeding women, and those who intend to become pregnant, should eat no more than four medium-size cans of tuna, or two fresh tuna steaks per week. This advice is based on two medium-size cans with a drained weight of 140g per can and fresh tuna steaks weighing about 140g when cooked or 170g raw. Also consider sardines, anchovies and mackerel (commonly grilled in an ikan bakar dish) as these smaller fishes are also high in oil)

Fish contains proteins, minerals, vitamin D and omega-3 fatty acids, which your baby will miss out on if you give it up altogether. Find out more about the benefits of fish for your developing baby and how to get the right balance of fish in your diet.

Some foods are no-nos

During pregnancy you should try to avoid:
• Raw seafood, such as oysters or sushi that has not been frozen before making.
• The cockles found in laksa and char kway teow are supposed to be boiled before they are added to these dishes, but you may want to ask the hawker to leave them out as you can't know how thoroughly they were cooked.

• Steamboat ingredients that are not cooked through - make sure the broth is brought to boil every time new ingredients are added, especially shellfish, meats and eggs.

• Cheeses with a white, "mouldy" rind, such as Brie and Camembert, and blue-veined cheeses like Stilton. All these cheeses could contain listeria, a bacteria that could harm your baby.

• Pate, raw or undercooked meat, poultry and eggs (cook all meat until there are no pink bits left and eggs till they are hard). All are possible sources of bacteria that can harm your unborn child.

• Liver and liver products (pate, liver sausage) should be avoided, too, because they may contain large amounts of the retinol form of vitamin A, too much of which could be bad for your developing baby.

• It is recommended that some women avoid peanuts and foods that contain them. If you, your husband, or any of your other children (if you have any) have a history of allergies such as hayfever, asthma, or eczema, avoiding peanuts during pregnancy and breastfeeding may reduce your baby's chances of developing a potentially serious peanut allergy.

• Many women choose to avoid or cut down on alcoholic drinks during pregnancy, too. Drinking too much alcohol can cause physical defects, learning disabilities, and emotional problems in children, so many experts recommend that you give up alcohol completely while you are pregnant.

If you decide to drink alcohol during your pregnancy, it is recommended by experts that you drink no more than one or two units of alcohol, no more than once or twice a week, and don't get drunk.

• You might want to cut down on caffeine, too. This may be easy for women who are suddenly revolted by the stuff during their first trimester, but that doesn't happen for everyone. Why is caffeine a potential problem? Research has linked consuming more than 300mg of caffeine a day with an increased risk of miscarriage and low birth weight, and one study has linked even low levels of caffeine to miscarriage. To be on the safe side stick to no more that three mugs of instant coffee, three cups of brewed coffee, six cups of tea or eight cans of cola per day. Or, you may want to be more cautious and cut down further on caffeine, or switch to non-decaffeinated hot drinks and colas, instead.

Take a suitable prenatal vitamin-mineral supplement

In an ideal world - free of morning sickness or food aversions - a well-balanced diet would be all an expectant mum ever needed. But in the real world, a prenatalvitamin-mineral supplement may be good insurance to help you meet your nutritional needs. Ask your doctor whether you should take a vitamin supplement.

Folic acid is one supplement that is particularly important to take before you conceive -- and for the first three months or so of pregnancy. A lack of this B vitamin has been linked with neural tube birth defects such as spina bifida. Not surprisingly, Positive Parenting, the expert education programme initiated by the Malaysian Paediatric Association, stresses that a folic acid supplement is absolutely necessary to prevent birth defects - you can get a prescription from your doctor.

Some experts recommend that you take a supplement containing 10 mcg of Vitamin D every day. If you are Asian, if you keep well-covered and don't get much sunlight on your skin then you may be at greater risk of Vitamin D deficiency - see your doctor for individual advice.

Later on in your pregnancy some women may need to take an iron supplement. Your iron levels will be checked periodically during your pregnancy, and your doctor will advise you about your individual needs.

If you are a strict vegetarian, have a medical condition such as diabetes, gestational diabetes, pre-eclampsia, or anaemia, or if you have a history of low-birthweight babies, do talk with your doctor about any special supplements you might need.

Remember, though, that more is not always better: Vitamin A supplements which contain retinol, the animal form of vitamin A, can be toxic to unborn babies in large quantities. The plant-based carotene type of vitamin A is safe in pregnancy. Megadoses of most vitamins and minerals could be harmful to your developing baby.

Don't go on a diet

Dieting during pregnancy is potentially hazardous to you and your developing baby. Some diets can leave you low on iron, folic acid, and other important vitamins and minerals. Remember, weight gain is one of the most positive signs of a healthy pregnancy.

Women who eat well and gain an appropriate amount of weight are more likely to have healthy babies. So if you're eating fresh, wholesome foods and gaining weight, relax: you're supposed to be getting bigger!

If you are overweight, you can improve your diet, cut out junk food and get some exercise (see your doctor first). Research has shown that in these circumstances it is safe to not gain any weight or even to lose weight during your pregnancy, as your body's fat reserves will provide your baby with enough calories.

Gain weight gradually

Weight gain varies amongst individuals and depends on many factors. Although you will be weighed at each visit to your doctor, remember that there is no evidence that a specific weight gain has any effect on your baby's health.

Average weight gain during pregnancy seems to be between 8 kilos / 18 pounds and 15 kilos / 32 pounds. Concentrate on eating a healthy diet: plenty of carbohydrates, lots of fruits and vegetables, reasonable amounts of protein, and just a little in the way of fats and sugars.

When you put on weight may be as important as the total amount. Most women gain the least weight during the first trimester and steadily increase, with the greatest amount being put on over the course of the third trimester when the baby is growing the most.

Eat small meals every few hours

Even if you're not hungry, chances are your baby is, so try to eat every four hours. And if morning (or all-day) sickness, food aversions, heartburn, or indigestion make eating a chore, you may find that eating five or six small meals, rather than the usual three larger ones, is easier on your body.

Remember, your developing baby needs regular sustenance, so try not to miss meals.

Occasional treats are OK

You don't have to give up all your favourite foods just because you're pregnant. But processed foods and snacks and sugar-packed desserts shouldn't be the mainstay of your diet, either. So as far as snacks are concerned, try a banana rather than luxury ice cream, or a frozen fruit sorbet instead of cendol. But don't feel guilty if you fancy the occasional biscuit. Enjoy every bite!

Sex during pregnancy

Can I have sex while I'm pregnant?

Absolutely. With a normal pregnancy, you can keep doing it right up until your waters break. Do check with your doctor first if you're having any problems with your pregnancy, such as placenta praevia or bleeding or if you have a history of miscarriages.

Will sex harm the baby?

You won't hurt the baby by making love, even with your husband on top. The thick mucus plugcervix helps guard against infection. The amniotic sac and the strong muscles of the uterus also protect your baby. Though your fetus may thrash around a bit after orgasm, it's because of your pounding heart, not because he knows what's happening or feels pain. There are some important circumstances, however, in which you may be advised not to have intercourse.

Will it feel as good?

Even better for some women, not as good for others. Increased blood flow to the pelvic area can cause engorgement of the genitals and heighten the sensation. But the same engorgement gives other women an uncomfortable feeling of fullness after intercourse ends. Also, some women feel abdominal cramps during or after intercourse.

I haven't really been in the mood since I got pregnant. Is this normal?

Yes. The big changes in your body are bound to change your sex life. Some women, finally free from worries about conception and contraception, feel sexier than ever. But others are just too tired or nauseated to make love, especially in the first trimester. The second trimester is often marked by a resurging libido. Your desire may wane again in the third trimester as birth, labour and your belly loom large, or you may simply feel unattractive.

Will my husband's sex drive change?

Most men find their pregnant wife attractive. But a husband's desire may be dampened by concerns for the health of the mother and baby, apprehension about the burdens of parenthood, fear that sex can hurt the baby or even self-consciousness about making love
in the presence of their unborn child.

Is oral sex safe?

Yes, normal oral sex won't harm you or your baby and many consider it a good solution if intercourse is deemed too risky.

Which positions are the most comfortable?

Here are some time-tested positions and tips for making love while you're pregnant:
• Lie sideways. Having your husband on top demands increasingly creative gymnastics as your tummy swells. But lying partly sideways allows your husband to keep most of his weight off your uterus.
• Use the bed as a prop. Your bulge isn't an obstacle if you lie on your back at the side or foot of the bed with your knees bent, and your bottom and feet perched at the edge of the mattress. Your husband can either kneel or stand in front of you.
• Lie side-by-side in the spoons position, which allows for only shallow penetration. Deep thrusts can become uncomfortable as the months pass.
• Get on top of your husband. It puts no weight on your abdomen and allows you to control the depth of penetration.
• Enter from a sitting position, which also puts no weight on the uterus. Try sitting on your husband's lap as he sits on a [sturdy] chair.
Have faith - where there's a will, there's a way. With a little experimenting, you and your husband are sure to find a technique that works for you.

My home pregnancy test showed a faint line. Am I pregnant?

Anna McGrail

Tests you can do at home are very sensitive and can pick up the presence of pregnancy hormones in your system even before you have missed a period.
For a home pregnancy test to give you a positive result, your body has to be making a detectable level of the hormone human chorionic gonadotrophin (hCG). However, not all pregnancy tests can detect the same amount of hCG; a sensitive test is one which turns positive even if a low amount of the hormone is present. The more sensitive a pregnancy test is, the earlier it will show a positive result.

If the test you're using is only faintly positive, it may not be very sensitive. If you still have the box, it should say somewhere what the test's sensitivity is; the lower the number, the better the test. For example, a test with a sensitivity of 20 IU/L (milliInternational Units per Litre) will tell if you're pregnant sooner than a test with a sensitivity of 50 IU/L. Read the side of the box to see what it says.

Many women get a faintly positive result if they're not as far along as they expected. If this turns out to be the case for you, taking another test in two or three days should give you more exact results. Most home urine tests should be positive by the time your period is due if your body is making the normal amount of hCG.

Pregnancies with complications also produce hCG but in lesser amounts, so that could be causing the faint line. If your test is faintly positive and then a few days later turns completely negative, you may have had a very early miscarriage.

Experts estimate that about 50 per cent of fertilised eggs don't make it, and a further 15 per cent of recognised pregnancies end in miscarriage, so unfortunately this is very common. It is only since pregnancy tests became so sensitive that people have realised how often early miscarriages can happen. In the past, these very early losses might not even have been noticed, and the woman would never have known she had been pregnant.

Home pregnancy tests

What is a home pregnancy test?

A home pregnancy test measures the presence of the hormone human chorionic gonadotrophin (hCG) in your urine. This hormone is first secreted at the time the fertilised egg implants in the uterus (about six days after fertilisation) by the cells which go on to form the placenta. Levels of the hormone build up rapidly in your body in the first few days following implantation. Usually, home pregnancy tests should be able to pick up the hCG in your urine by the first day you miss your period. Levels of hCG peak between the 60th and 90th days of pregnancy (about the ninth week of pregnancy).

If you have a negative result when you first test, it may be that the levels of hCG have not yet reached a level where they can be detected by a test, even by the day your period is due, so you may want to wait a few days then test again.

Not all pregnancy tests are the same. Some are more sensitive and usually more expensive as a result. The more sensitive tests can detect pregnancy even if you have only a small amount of hCG in your system. Concentrations of hCG are reported in milliInternational Units (mIU) or amounts equal to 1/1000th of an IU per millilitre. A test with a sensitivity of 20 IU/L is more sensitive than one with 50 IU/L. You should be able to find this information on any pregnancy test box.

How do I use a home pregnancy test?

You can test any time of day, and as early as the first day of your missed period for most tests. More sensitive tests may be able to detect low levels of hCG a few days before your period is due but testing this early may give you an inaccurate result (see below). Avoid drinking too much fluid just before testing as this could dilute the pregnancy hormone in your urine. Over-the-counter medicines, such as paracetamol, should not affect the result, but fertility drugs containing hCG may do so.

First, read the directions carefully, because the instructions will vary with different brands. Some require you to urinate in a pot and then, using a dropper, place a small sample into a testing well. Others let you pee directly onto a stick. But, fundamentally, all pregnancy tests work the same way; they measure the amount of hCG in your body. What's different is how they display results (positive or negative). Some change the colour of the urine sample, others show pink or blue lines on the test strip, reveal a red plus or minus sign, or the actual words "pregnant" or "not pregnant", in a window.

How long does it take to see the results?

You can check the results in about five minutes; the longest five minutes ever. If you're testing in the bathroom, you may want to go to another part of the house and find something else to do. A watched pot never boils, and a watched pregnancy test is just excruciating.

Are home pregnancy tests accurate?

If you follow directions to the letter, home pregnancy tests are 97 per cent accurate. But mistakes do happen, which is why some kits come with two tests. There are several reasons why a home pregnancy test may be negative: you may not be pregnant, or your body may not be making a normal amount of hCG. If you test too early (before the first day of your missed period), you may get a false negative result because not enough of the hormone has built up in your system. If the test comes back negative but you still suspect you're pregnant, wait a few days, read the directions carefully, and try again. False positives, when the test says you're pregnant but you're not, are rare.

If you have irregular periods, it may be harder to calculate when your period is due. Allow for your longest cycle in recent months before testing. If you have recently stopped taking the contraceptive pill, you may not know how long your natural cycle is so you may end up testing either too soon or too late. If your test is negative in either of these situations, you should test again in three days.

BabyCenter tip: Perform the test first thing in the morning when your urine is most concentrated.

Where can I buy one?

Home pregnancy tests may be purchased without a prescription at most pharmacists. You can also buy them online by mail order.

How are home pregnancy tests different from ones performed by doctors?

Many clinics use home pregnancy tests to verify pregnancies, in which case, they're exactly the same. Occasionally, women are given blood tests, but they aren't all that different from home pregnancy tests, either. Both types look for hCG in your body. A blood test is much more sensitive than any over-the-counter kit, which means it can determine whether you're pregnant just six to eight days after you ovulate.

Early pregnancy

Just pregnant? Congratulations! We've rounded up the most common early pregnancy issues and worries so that you can find what you need.
Some of these articles were written for our UK sister site, but we are working hard to make more of them local to your needs.

Top 10 signs of pregnancy

If you're extremely tuned in to your body's rhythms, you may begin to suspect you're pregnant soon after conception. But most women won't experience any early pregnancy symptoms until the fertilised egg attaches itself to the uterine wall, several days after conception. Others may notice no signs of pregnancy for weeks and begin to wonder "Am I pregnant?" only when they miss a period. Below is a list of some of the first signs of impending motherhood. You may experience all, some, or none of these symptoms of pregnancy:

1. Food cravings. Yes, it's a cliché, but food cravings sometimes can be a sign of pregnancy. Don't rely on them as a sure symptom (it may be all in your head, or even a sign that your body is low on a particular nutrient), but if cravings are accompanied by some of the other symptoms on this list, start counting the days from your last period.

2. Darkening of your areolas. If the skin around your nipples gets darker, you may have successfully conceived, though this may also signal a hormonal imbalance unrelated to pregnancy or be a leftover effect from a previous pregnancy.

3. Implantation bleeding or cramping. 3. About eight days after ovulation, you may experience implantation spotting, a slight staining of a pink or brown colour, as well as some cramping. This is caused by the egg burrowing into the endometrial lining. You might also see some spotting around the time you expect your period.

4. Frequent urination. Once the embryo implants and begins producing the hormone human chorionic gonadotropin (hCG), you may find yourself going to the bathroom more often.

5. Fatigue. Feeling tired? No, make that exhausted. High levels of the hormone progesterone can make you feel as if you've run a marathon when all you've done is put in a day at the office. Fatigue is a hallmark of early pregnancy, though probably not a surefire symptom on its own.

6. Tender, swollen breasts. If you're pregnant, your breasts will probably become increasingly tender to the touch, similar to the way they feel before your period, only more so. Once your body grows accustomed to the hormone surge, the pain will subside.

7. Altered sense of taste. You may notice that your sense of taste changes. Some women say they have a metallic taste in their mouth, others that they cannot stand the taste of coffee, tea, or a food they usually like.

8. Morning sickness. If you're lucky, morning sickness won't hit you until a few weeks after conception. (A lucky few escape it altogether.) But as early as a couple of days following conception, you may begin feeling nauseated and queasy. And not just in the morning, either -- pregnancy-related nausea can be a problem morning, noon, or night.

9. A missed period. If you're usually pretty regular and your period is late, it's worth trying a pregnancy test. A missed period is the surest sign of pregnancy in a woman of childbearing age who usually has regular periods.

And finally...

10. A positive home pregnancy test. If you've waited to test until at least the first day of a missed period and a blue line appears in the test window, you're most likely to be in the family way. Make an appointment with your doctor to confirm the good news, and head on over to our pregnancy area. Congratulations!