The thoroughly modern pregnancy

Take charge of your health '—and your baby'’s. Here are the latest facts on how to avoid complications, eat in a brand-new way & do the perfect prenatal exercise.

There’s never been a better time to have a baby. The vast majority of infants in the United States are born healthy, most mothers experience no serious problems during pregnancy, and many, if not most, deliveries are medically uneventful. Folic acid has been proven to help prevent several serious birth defects, and doctors have even learned to successfully treat certain disorders in babies while they’re still in the womb. Unfortunately, not all the news is so good. For example, the percentage of babies born prematurely—at less than 37 weeks gestation—rose to 12 percent in 2002, the highest level in two decades and a 27 percent increase since 1982. Gestational diabetes is skyrocketing: In the past 10 years, this pregnancy complication has increased 35 percent. The news on Cesarean sections isn’t great, either—26 percent of babies are delivered by C-section now, compared with only 5.5 percent in 1970. While a growing number of those procedures are elective, many are unscheduled, unplanned and unwanted. Overall, however, we know more than ever about how to have healthy babies, happy pregnancies and (relatively) easy deliveries. Following is a wrap-up of the latest news and advice on how to make this happen to you.

The Perfect Exercise

If you’re looking for a workout to soothe your pregnant body and mind, try tai chi. A slow, graceful activity with a low risk of injury, tai chi reduces stress, sharpens coordination, builds leg strength and helps prevent back pain. It also creates a strong connection to your baby. This “taste of tai chi” was designed by Fit Pregnancy fitness editor Teri Hanson.

to start: Begin each move in Wu Chi Stance: With feet placed wider than hips, knees bent, arms resting at your sides, “sink” your weight into your legs. Then do each move slowly for 1 minute, rest for 30 seconds in Wu Chi, and go into the next move. As you progress, move in a “flow” sequence without resting. Finish with a final Dan Tien Connection.

AVOID COMPLICATIONS

Good news: Research is indicating that simple lifestyle factors such as exercise and diet can help prevent three growing pregnancy complications. The following are the best ways to do this, according to Siobhan Dolan, M.D., M.P.H., assistant medical director of the March of Dimes (MOD):

1) PREMATURE BIRTH Prematurity is the top cause of newborn death, and you can reduce your risk of early delivery by being in good health before you conceive. Have infections (including gum disease and sexually transmitted diseases) treated; get chronic health problems such as hypertension or diabetes under control; tell your doctor what medications you take; be in the best physical shape possible; try to achieve your ideal weight; stop smoking, drinking alcohol and/or using recreational drugs; and start taking folic acid supplements (400 micrograms daily). Uterine infections are commonly associated with preterm birth, and new research reported in the Journal of the American Medical Association has identified proteins in a pregnant woman’s blood that can indicate the presence of such an infection and allow for early treatment with antibiotics. Some herbal remedies traditionally considered a natural way to relieve pregnancy discomforts are now under suspicion and should not be used without your obstetrician’s approval. For example, large amounts of some herbal teas, including peppermint and red raspberry leaf, may cause uterine contractions, increasing the risk of miscarriage or preterm labor, according to the MOD, which also warns against using herbal tablets, capsules and extract.

2) gestational diabetes Developing diabetes during pregnancy can lead to a large, difficult-to-deliver baby, increasing the risk of delivery complications and a C-section. Such rising rates go hand in hand with Americans’ increasing tendency to be overweight. Starting pregnancy at a healthy weight and gaining no more than the recommended 25 to 35 (see “How Much Weight Should You Gain?” on pg. 148) can help lower your risk for gestational diabetes. And a new study in the American Journal of Epidemiology found that women who exercised before and during pregnancy had a 70 percent lower risk of gestational diabetes.

3) cesarean section Choose a hospital and/or obstetrician with a low Cesarean-section rate (15 percent or less); consider a midwife-assisted delivery; wati until you are in active labor before going to the hospital; work with a trained doula; get good prenatal care and avoid excess weight gain during pregnancy. Also, keep hydrated and change positions often during labor so you can stay comfortable and energized in case labor is long.

STAY EMOTIONALLY HEALTHY

For some women, hormone shifts, relationship problems, a negative body image, financial pressures and other reasons make pregnancy stressful. Be sure to watch out for the following:

depression If you’re feeling blue, check in with your doctor. During pregnancy, depression is treated with talk therapy or, if that fails and the depression is serious, with medications such as Zoloft and Prozac, according to Petra M. Casey, M.D., an obstetrician at the Mayo Clinic in Rochester, Minn. “These drugs should be used with caution, but depression has major risks also—even suicide—so we must balance that with the potential risks of antidepressants,” Casey says.

stress Although some studies suggest that sky-high stress levels contribute to preterm delivery, low birth weight, and behavior and learning problems in toddlers, other research fails to show a link. “We don’t have any clear answers on this issue,” says Kimberly A. Yonkers, M.D., an associate professor in the psychiatry department at Yale School of Medicine in New Haven, Conn. In any case, it’s wise to reduce stress as much as possible during pregnancy, particularly if it causes you to lose sleep, eat poorly or reach for cigarettes or alcohol for relief. If something is causing you stress, make a change if you can, since stress can, at the very least, contribute to fatigue, headaches and backaches.

rules to eat by

Here are three up-to-the-minute rules for the healthiest possible diet for you and your growing baby.

1) Say no to low-carb “Forget low-carbohydrate diets when you’re pregnant,” says Marilyn Tanner, R.D., a spokeswoman for the American Dietetic Association. “Smart, or complex, carbs are the way to go.” That’s because they provide energy, vitamins, minerals and fiber. Limit refined, processed “white” foods (bread, crackers, pasta, etc.). Instead, choose whole-grain products, including brown rice, along with fruits, vegetables, beans and nonfat dairy products.

2) Know where your fish comes from Some farm-raised fish contain high levels of industrial pollutants known as PCBs. When possible, eat fish that has been caught in the wild, suggests Suzanne Havala Hobbs, Dr.PH, a registered dietitian who teaches in the School of Public Health at the University of North Carolina at Chapel Hill. But even wild fish can be contaminated—for example, pregnant women are warned not to eat fish from Lake Michigan. Check local advisories for safety information about fish caught in your area.

3) Consider going organic Many nutritionists maintain that conventionally grown produce can be as safe as organic, but the decision is yours. “Go with your gut because you’re the one in charge of that baby inside you,” Tanner says. Or, go halfway and buy organic when selecting these 12 fruits and vegetables; according to the Environmental Working Group (EWG), they contain the most pesticide residue: strawberries, cherries, peaches, potatoes, spinach, apples, celery, pears, bell peppers, imported grapes, nectarines and red raspberries. You can also reduce exposure to contaminants by eating more of the "cleanest" produce, according to the EWG: asparagus, avocados, bananas, broccoli, cauliflower, sweet corn, kiwi, mangos, onions, papaya, pineapples and peas. And no matter what kind you buy, be sure to wash all produce carefully before eating.

RECIPES

Napa Cabbage Salad

SERVES 4

PREP/cook Time: 25 minutes

1 pound thin asparagus, ends removed

1 box (12.3 ounces) silken firm tofu

2 cups spinach leaves, sliced

4 cups Napa cabbage, sliced

1 cucumber, peeled and finely diced

4 scallions, thinly sliced on the diagonal

1 small radish, cut into fine matchsticks

1 T toasted sesame seeds

Dressing:

1 garlic clove

4 T light peanut oil

2 T rice vinegar

1 t brown sugar

1 T soy sauce

1/2 jalapeño pepper, seeded and minced

1 T peanut or cashew butter or tahini

6 mint leaves, chopped fine

2 T cilantro, chopped

2 T basil, slivered

Bring a skillet of salted water to a boil, add asparagus and simmer until tender, about 4 minutes. Drain and place on paper towel. Blot water from tofu, then cut into 1/2-inch cubes.

To make dressing, mash garlic in a mortar, add rest of ingredients and mix together. Arrange vegetables and tofu on a plate. Sprinkle with sesame seeds, add dressing, toss and serve.

Nutritional information per serving (3 cups): 282 calories, 61% fat (19 g), 20% carbohydrate (14 g), 19% protein (13 g), 6 g fiber, 4.5 mg iron, 201 mg calcium, 306 mcg folate. Gotta have meat? Replace the tofu with 12 ounces of chicken breast, cut into strips.

Chickpea and Tomato Stew

SERVES 4

PREP/cook Time: 60 minutes

1 T extra-virgin olive oil

1 large onion, diced

3–4 medium potatoes, cut into large chunks

2 large cloves garlic, pressed

1–2 pinches red pepper flakes

1 1/2 t paprika

1–2 pinches thyme

1/4 cup chopped fresh parsley

1 32-ounce can peeled, diced tomatoes

2 T tomato paste

2 15-ounce cans chickpeas, drained, rinsed

15 ounces vegetable stock

Salt and freshly ground black pepper

1 bunch chard (red or green), stems removed and leaves coarsely chopped

4 t extra-virgin olive oil, divided

Heat olive oil over high heat in a wide, nonstick sauté pan. Add onion, potatoes, garlic, pepper flakes, paprika, thyme and parsley. Sauté 2 minutes, lower heat to medium and cook, stirring occasionally, for 15 minutes. Add tomatoes, tomato paste, chickpeas and vegetable stock; season with salt and pepper, then cover and simmer until potatoes are tender (about 15 minutes). Cook chard in water until tender, 7–10 minutes. Salt lightly. Top stew with chard, drizzle 1 teaspoon olive oil over each serving and garnish with additional parsley if desired.

Gotta have meat? Add 12 to 16 ounces firm-fleshed fish (such as ahi, salmon or snapper); simmer with tomatoes and chickpeas for 10 minutes.

keep fit

In our grandmothers’ day, exercising during pregnancy was considered dangerous for both mother and baby. By the time our mothers were becoming parents, obstetricians were a bit more tolerant of the practice, but few actively encouraged patients to exercise.

We’ve since learned that being active during pregnancy energizes you, builds stamina for labor and delivery, reduces your risk of gestational diabetes and improves your mood. And there’s more: According to the American Council on Exercise, it can help prevent or relieve back pain, leg cramps, varicose veins, insomnia, constipation and swelling of your hands and feet. Add to that improved posture and circulation, and there’s no excuse to spend your pregnancy on the couch.

Of course, one of the most important roles of exercise is in helping to keep weight in check. As overweight and obesity rates in America rise, the March of Dimes is calling on all women of childbearing age to maintain a healthy weight before, during and after pregnancy. “Obesity among women of childbearing age is at a crisis level,” says Jennifer L. Howse, M.D., president of the MOD. “We are concerned because it means more women are overweight or obese when they become pregnant, and this can have serious consequences for both mother and baby.”

Here’s the latest official thinking on exercise during pregnancy:

The American College of Obstetricians and Gynecologists (ACOG) now recommends that pregnant women get 30 minutes or more of moderate exercise on most, if not all, days of the week.

Before you start, check with your OB or midwife. Women with an “incompetent cervix,” risk factors for premature labor, bleeding during the second or third trimester, placenta previa, preeclampsia or several other medical conditions should not work out while pregnant.

Start out slowly, and don’t get overheated. However, with your doctor’s OK, vigorous types of exercise such as running are fine, provided you don’t exceed your prepreg-nancy activity level. In many cases, athletes can even continue their activities, says Raul Artal, M.D., chairman of obstetrics and gynecology at Saint Louis University School of Medicine in Missouri. But plain old walking is an excellent prenatal exercise; Walking Through Pregnancy and Beyond (The Lyons Press, 2004) by Mark and Lisa Fenton with Tracy Teare, is a comprehensive guide.

Tai Chi Tips

Stand with your knees slightly bent, your head in line with your hips, spine erect but not rigid, abdominals drawn in. Move slowly and gently, keeping your legs moving at all times. Breathe in through your nose and out through your mouth, keeping your face “soft” and your jaw relaxed. Keep your tongue on the roof of the mouth just behind your teeth; doing this will actually help you balance correctly. Try to still your mind, focusing on the connection between you and your baby. As your pregnancy progresses, you may choose to do tai chi on a large stability ball, in a chair or in chest-height water. — Teri Hanson

Tai Chi Flow for Pregnancy

This video program, designed by Carolyn Cooper, features calming qigong exercises and tai chi movements and is appropriate for all three trimesters. (Tai Chi Flow, 2003; 40 minutes; $20 plus shipping and handling). www.taichiflow.com 888-399-3569

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