Staying Healthy in Pregnancy

Staying healthy during your pregnancy

Mental health during pregnancy

What about mental health concerns in pregnancy?

Pregnancy is often seen as a happy time for the parents to be. It is normal for you and your partner to feel many different emotions as you prepare to become parents. You may find your mood changes quickly from excited or happy to sad or anxious.

If feelings of sadness or anxiety don't get better it could be a sign of something more serious. Did you know that mental health concerns like depression and anxiety can start or get worse during pregnancy, not just postpartum? In fact about 20% of women suffer from perinatal depression and/or anxiety. Perinatal depression can happen at any time in the pregnancy. It is more common in the second and third trimesters.

What are the symptoms of depression?

  • You and your partner may not always know that what you are feeling is more than the emotional ups and downs of pregnancy.  Learning about the signs of perinatal depression and be alert for them. Mothers don't always know that what they are feeling is more than the "baby blues". Talk to your health care provider, if your symptoms last for more than two weeks. You are not alone.
  • Fathers to be can also experience depression. It can start during pregnancy and/or after the baby is born. Most symptoms of depression are the same for men and women. They may present differently in men. Some common symptoms of depression in men are:
    • Mood swings
    • Anger and irritability
    • Physical symptoms like headaches or fatigue
    • Hyperactive behaviour

What are the possible effects?

Mental health disorders in pregnancy can have many effects. They can affect you, your partner, your baby and your pregnancy.

Some of the possible effects are:

  • Baby being born too early
  • Low birth weight
  • Miscarriage
  • Not getting enough prenatal care
  • Postpartum depression
  • Difficulty building a positive relationship with your baby during pregnancy
  • Problems forming a secure attachment after the baby is born

What can you and your partner do?

  • Remind yourself this is not your fault. It is normal and you are not alone.
  • Talk to each other and your family about how you are feeling.
  • Be ready to listen.
  • Don't try to do everything. Ask for help.
  • Take care of yourself. Try to get as much sleep as possible. Eat healthy foods and be active.
  • Talk to your doctor about medications.
  • Call Ottawa Public Health Information 613-PARENTS / Toll free 1-866-426-8885.
  • Call the Crisis Line at 613-722-6914 or toll-free 1-866-996-0991. Open 24 hours a day to provide immediate support.

Pregnacy and Dental Health

Keeping your teeth and gums healthy during pregnancy has many benefits for you and your baby.

Did you know…

  • Morning sickness can leave stomach acids in your mouth that can damage the surfaces of your teeth and promote tooth decay
  • Changes in hormone levels during pregnancy can cause swollen gums that bleed during brushing and flossing, often known as “pregnancy gingivitis”
  • If you have gum disease or an infection you may be at risk of having a premature or low birth-weight baby

Visiting the dentist and the hygienist

  • Regular dental cleanings and check-ups are important before, during, and after pregnancy
  • Be sure to tell them that you are pregnant
  • You may want to postpone routine dental radiograph until after your baby is born
  • Should your dentist recommend an emergency radiograph, the dental office will provide a leaded apron to shield you and your baby from this low dose

What can you do to help?

  • Brush your teeth and your gums with a soft toothbrush twice a day, using a pea size amount of fluoride toothpaste. Also, gently brush your tongue
  • Gently floss daily to remove plaque from between your teeth and gums. If your gums bleed, keep on flossing
  • Eat healthy nutritious food and avoid sweets
  • If you gag, use a small, child-size toothbrush and lean your head down and over the sink while brushing. It helps relax the throat and allows the saliva to flow out

Morning sickness

  • Nausea and vomiting can happen during pregnancy. Causes of morning sickness include changes in hormone levels, tension, worry or fatigue.
  • Try eating unsalted crackers or dry toast before getting out of bed in the morning
  • Rinse your mouth with tap water, or a fluoride mouth rinse after vomiting, which will protect your teeth from the damaging stomach acids
  • If vomiting persists, notify your doctor
Nutrition tips for pregnant women

Eating well during pregnancy is important for your baby's healthy growth and development. Healthy eating will also help you:

  • Feel better and give you more energy. 
  • Gain the healthy amount of weight and get your body ready for breastfeeding. 
  • Reduce health problems like high blood pressure and low blood iron. 
  • Establish healthy eating for your family for life. 
What should I eat?

Canada's Food Guide will help you choose the right amount and variety of food for you and your baby. 

Healthy eating means that you: 

  • Eat three meals a day with healthy snacks in between. 
  • Choose healthy foods like a variety of vegetables and fruit, whole grains, yogurt, cheese, and milk (or soy beverage), legumes (beans, peas, and lentils), tofu, and lean meats.
  • Drink water to satisfy your thirst. 

For more information on eatign during pregnancy see: 

If you are experiencing nausea, vomiting, heartnurn, poor appetite or swelling, consult your doctor. See UnlockFood.ca for Tips to Help You Feel Better During Pregnancy. 

How much should I eat?

Extra energy (calories) are usually not needed in the first 3 months of pregnancy. During the last 6 months of pregnancy, you need some extra energy (calories), portein and other nutrients (vitamins, minerals). Most of the time, it means you need to eat a little more healthy foods each day. You can: 

  • Add an extra healthy snack (e.g. fruit and yogurt, whole grain crackers with peanut butter) or 
  • Eat a bit more at your meal (e.g. extra glass or milk or soy beverage at lunch and more grains or vegetables at dinner)
Do I need supplements?

Prenatal supplements help you and your baby get all the nutrients you need during pregnancy. A balanced diet will help you get most nutrients. You need extra folic acid and iron during pregnancy. These are often hard to get from your diet. Your daily multivitamin should have 0.4 mg (milligrams) of folic acid and 16-20 mg of iron. Take a multivitamin for at least three months before pregnancy and keep taking your multivitamin during pregnancy and breastfeeding. Ask your healthcare provider to recommend a multivitamin that is right for you.

Note: More is not better. Do not take higher doses of any supplement unless instructed by your health care provider.

Folic acid
Folic acid is a B vitamin, important for the development of your baby's brain and spinal cord. These develop in the first four weeks of pregnancy. Not getting enough folic acid can put your baby at higher risk of having a Neural Tube Defect (NTD). Neural tube defects affect the brain and spinal cord's development.

How can I make sure I am getting enough folic acid?

  • Eat good sources of folic acid such as:

    • Green vegetables, e.g. spinach, asparagus, kale, broccoli, Brussel sprouts 
    • Salad greens, e.g. Romaine lettuce, endive, mustard greens
    • Beets 
    • Dried beans, lentils, chickpeas, and split peas 
    • Avocado
    • Sunflower seeds
    • Peanut butter 
    • Breads and pasta made with enriched flour 
  • Take a multivitamin with 0.4 mg of folic acid every day starting at least three months before you get pregnant. Continue taking it during pregnancy and breastfeeding.

Some women need more folic acid than others. Talk to your health care provider about the amount of folic acid that is right for you.

For more information, see UnlockFood.ca for Facts about Folate.

Iron 

During pregnancy, you need more iron for many reasons. Iron is needed to support the increased amount of blood your body makes during pregnancy. It helps your baby to grow properly and supports brain development. Babies also keep stores of iron that they get from their mother to use after they are born.

Most multivitamins have iron. Health Canada recommends that pregnant women make sure that their multivitamin has 16-20 mg of iron. Some women need more iron than others do. Talk to your health care provider about the right amount of iron for you.

What foods are sources of iron?

Animal sources of iron:

  • Beef, chicken, pork, lamb
  • Fish and seafood
  • Eggs

Iron from animal foods is better absorbed by your body than from plant sources.

Plant sources of iron are:

  • Dried fruit, e.g. dried figs, raisins, prunes, and dried apricots
  • Vegetables such as artichokes, avocados, peas, broccoli, spinach, pumpkin, and squash
  • Cereals, e.g. oatmeal, breakfast cereals (note: most cereals are fortified with iron)
  • Pasta (note: pasta is fortified with iron)
  • Nuts and seeds

Vitamin C helps the absorption of the iron from plant sources. Eat these foods with food that is rich in vitamin C. Some sources of vitamin C include:

  • Citrus fruits
  • Kiwi, cantaloupe, strawberries
  • Green peppers, cabbage, broccoli
  • Tomato sauce

For more information, see UnlockFood.ca for What You Need to Know About Iron.

Calcium and vitamin D
Calcium helps to build healthy bones and teeth for your baby. Vitamin D helps your body absorb and use the calcium you eat. It also helps to protect your bones from being depleted from calcium. The baby (fetus and newborn) is fully dependent on you for their supply of vitamin D. It is important that you have good levels of vitamin D to meet your needs and those of your baby.

Calcium and vitamin D needs are the same for pregnant and non-pregnant women. However, low levels of vitamin D and calcium are common during pregnancy putting you and the baby at risk.

Your body can make vitamin D when you are in sunlight, but it is important to get enough from food sources all year.

What foods are sources calcium?

  • Milk, yogurt, kefir and cheese
  • Soy beverages
  • Tofu
  • Sesame seeds
  • Broccoli, bok choy and kale
  • Canned sardines and salmon with bones

What foods are sources of vitamin D?

  • Milk and soy beverage
  • Margarine
  • Fatty fish, e.g. salmon, trout, sardines
  • Egg yolk
  • Mushrooms

Talk to your health care provider about your need for a supplement with calcium and vitamin D.

For more information, see UnlockFood.ca for What You Need to Know About Calcium and What You Need to Know About Vitamin D .

Omega-3 fats 

Omega-3 fats are needed for the development of your baby's brain, nerves and eyes. Generally, eating a variety of healthy foods from Canada’s Food Guide with attention to including fish, oils, nuts and seeds will help you meet your needs.

What foods are sources of Omega-3 fats?

  • Salmon and other fatty fish
  • Soybean oil and margarine  
  • Walnuts
  • Ground flaxseed

The benefits of eating fish, generally out weigh the risks linked to mercury exposure found in some fish. There are specific recommendations for pregnant women because mercury can cross the placenta and have adverse effects on the baby.

What fish can I eat?

  • Large fish accumulate more mercury over time. Limit these to no more than 150 g (5 oz) per month: tuna (albacore), shark, swordfish, marlin, orange roughy, escolar.
  • Choose these fish which are high in omega-3: salmon, anchovy, char, herring, Atlantic mackerel, pollock (Boston bluefish), smelt, rainbow trout, lake whitefish, shrimp, clam, mussel, and oyster.
  • Choose other safe fish: cod, haddock, halibut, sole, snapper, perch, bass, tilapia scallops and squid,
  • Choose “light” tuna: look for skipjack or tongol on the label.

Do I need a supplement?

You do not need to take an omega-3 supplement even if you do not eat fish. Avoid taking cod liver oil, especially if you are already taking a multivitamin supplement. You may, unintentionally, get excessive amounts of vitamin A which can cause birth defects and liver toxicity in high doses. 

For more information on Omega-3 and fish during pregnancy:

Caffeine

Caffeine passes to your baby through the placenta and may be linked to negative effects on the pregnancy and your baby's development. It can also affect you and your baby's sleep. 

Small amounts of caffeine are generally safe for the baby. Limit your amount of caffeine to no more than 300 mg a day. This means no more than 500 mL (2 cups) of coffee per day. Be aware that caffeine is also found in many other foods and drinks that you may consume on a regular basis like tea, chocolate, and cola drinks.

For more information, see UnlockFood.ca on Facts on Caffeine and Health Canada on Caffeine in Foods.  

Alcohol 
Alcohol should not be consumed during pregnancy in any amount. The consumption of alcohol during pregnancy can cause serious harm to the baby, including, Fetal Alcohol Spectrum Disorder (FASD). Birth defects and developmental disorders caused by FASD can be prevented through avoiding alcohol during pregnancy. 
Herbal products and teas 
Herbal in a tablet, capsule or extract forms are not recommended while you are pregnant. Very little is known about the safety of many herbal products during pregnancy, which is why it is best to avoid them. 

You may look for herbal teas to limit your caffeine intake during pregnancy. However, some teas are unsafe during pregnancy because of potential adverse effects on pregnancy and the baby. 

These herbal teas are considered safe if taken in moderation (two to three cups per day): 

  • Citrus peel / orange peel 
  • Ginger 
  • Lemon balm 
  • Linden flower (not recommended for persons with pre-existing cardiac conditions) 
  • Rose hip 

Avoid teas with: 

  • Aloe 
  • Buckthorn bark 
  • Chamomile 
  • Coltsfoot 
  • Comfrey 
  • Duck roots 
  • Juniper berries 
  • Labrador tea 
  • Lobelia 
  • Pennyroyal 
  • Sassafras 
  • Senna leaves 
Reducing food allergies in your baby

You do not need to avoid allergens like peanuts and eggs during pregnancy or breastfeeding (unless you have a known allergy yourself). In fact, even if your baby is at high risk for developing food allergies, your best advice is to continue eating these foods, if possible. If you decide to avoid certain foods while pregnant or breastfeeding, speak with a Registered Dietitian or your health care provider to make sure you are getting all the nutrients you and your baby need. 

For more information on preventing food allergies see: 

Physical activity

Having an active pregnancy is important for your health and the health of your baby. If you exercised regularly before you were pregnant, you still can during your pregnancy. Exercising regularly means that you do at least 150 minutes of exercise each week over a minimum of 3 days per week.

All women without contraindication should be physically active throughout pregnancy. It’s always a good idea to talk to your health care provider before starting or changing your physical activity habits. 

What are some of the benefits of being active during pregnancy?

  • Lowers the risk of diabetes in pregnancy
  • Lowers the risk of high blood pressure in pregnancy
  • Gives you more energy
  • Helps pregnant women to gain the right amount of weight
  • Helps to lower stress
  • Helps you sleep better
  • Provides social contact and support

Choose activities you enjoy. Keep it fun by doing activities with your family and friends. Try doing an exercise class with other pregnant women. Walking, swimming and stationary bike are some great activities you can do in pregnancy.

How can I exercise safely?

If you aren’t active, start exercising slowly. Try aerobic activity 3 times per week for 15 minutes. Then you can increase to 30 minutes of aerobic activity and/or resistance training, at least three times a week. Being active in a variety of ways every day is encouraged. 

Always:

  • Do a warm-up and cool-down with every workout.
  • Breathe normally when you exercise - don't hold your breath.
  • Drink water before, during and after exercise.  
  • Eat a light snack about 30-60 minutes before exercise.
  • Use the talk test. If you can’t talk without getting out of breath then you need to slow down.

Avoid:

  • Activities with sudden starts, stops, jumping, and twisting.
  • Activities that have a danger of falling.
  • Exercising on an empty stomach.
  • Getting too hot. Your body temperature should not go higher than 38°C.
  • Outdoor exercise when it is warm and humid outside.
  • Exercise when you are sick or have a fever.
  • Hot tubs, saunas, whirlpools and hot yoga. Check temperature of heated pools before using.

After your 16th week of pregnancy, don't do exercises that need you to lie on your back as you may feel light-headed, nauseous or unwell. Try exercises that can be done while you are sitting, standing or lying on your side instead.

Pregnant women should stop exercising and call their health care provider for these reasons:

  • Bleeding from the vagina
  • Any 'gush' of fluid from the vagina
  • Extreme fatigue or shortness of breath
  • Chest pain
  • Painful contractions of the uterus
  • Headaches, dizziness or faintness

Call your local community center or check the City of Ottawa's Recreation Guide to find exercise programs in your area.

For more information on exercise during pregnancy, visit: http://www.ontarioprenataleducation.ca/active-living/

Stress

Stress is our bodies' reaction to a real or imagined threat or challenge. Stress is a part of everyday life. Everyday stress helps you to focus, problem solve and get a task done.  The body reacts to this stress in many ways, such as your heart rate goes up and your muscles become tense, making you ready to take action. Once the stress is gone, the body returns to normal. Sadly, stress can also last a long time and be overwhelming for some people. The body and brain are constantly reacting to this type of stress. Overtime it can affect your mental and physical health, including during pregnancy.

Learning ways to deal with stress before pregnancy can help improve your mental and physical health during pregnancy, the health of your baby and the well-being of your family, such as:

  • Increasing your chances of becoming pregnant. Stress can change some women's periods and timing of the egg leaving the ovary. Also, men can have a low sperm count because of stress.
  • Increasing the chance of your baby being born at term
  • Helping your baby's brain and body to grow and develop.

Helping you adapt to the emotional changes and challenges of pregnancy and becoming new parents.  

What are some signs of stress?

  • Feeling tired all the time.
  • Feeling tense or anxious.
  • Feeling sad or irritable.
  • Frequent minor health complaints.
  • Change in appetite or sleep patterns.
  • Change in relationships.
  • Using alcohol, medications or other drugs to relax.
  • Trouble concentrating and making decisions.

What can you do to lower your stress level? You can try to:

  • Get to know yourself, how you think and feel under stress.
  • Think about what helped you cope with stress in the past.
  • Take care of your body - eat well, be active, enjoy nature and get enough sleep.
  • Learn to take time each day to breathe deeply, relax and still your mind.
  • Connect with family, friends, co-workers, neighborhood resources or faith groups to build a community to support you and your family.
  • Reach out to family, friends or a health professional to talk about your mental health and to ask for the help you need. Enjoy life, listen to music or laugh with a friend
  • Keep things simple and learn to say "no".  Don't take on more than you can handle.
  • Learn to problem solve - be realistic as to what you can and cannot do 
Healthy Weight Gain

How much weight should I gain?

It is important to gain a healthy amount of weight during pregnancy. A healthy weight gain will help your baby grow and have a healthy start. . How much weight you need to gain in pregnancy depends on your Body Mass Index (BMI) before pregnancy. It also depends on if you are having more than one baby. BMI is a number based on a comparison of your weight and height. You may not gain much weight in the first three months, about 0.5 - 2 kg or 1.1 - 4.4 lbs. Your weight gain will be gradual for the rest of your pregnancy, about 1lb (0.42kg) per week.

Suggested weight gain for pregnant women

BMI

before pregnancy

Recommended

Total Weight Gain

Suggested Total Weight Gain

for Twin Pregnancy

BMI < 18.5

Underweight

12.5 - 18 kg

(28 - 40 lbs)

No guideline currently available

BMI 18.5 - 24.9

Normal weight

11.5 - 16 kg

(25 - 35 lbs)

17 -25 kg

(37 - 54 lbs)

BMI 25 - 29.9

Overweight

7.0 - 11.5 kg

(15 - 25 lbs)

14 -23 kg

(31 - 50lbs)

BMI 30 or greater

Obese

5 - 9 kg

(11 - 20 lbs)

11 -19 kg

(25 - 42lbs)

Talk to your health care provider about pregnancy weight gain, especially if you have any sudden weight gain or loss.

Resource: Pregnancy Weight Gain Calculator

Where does it all go?

Your baby makes up only a part of the weight that you gain in your pregnancy. Your body must add blood, muscle, and other tissues to build a healthy baby and this is why the right weight gain is important when you're pregnant.

Want to speak with a Registered Dietitian?

  • Call Telehealth Ontario and ask to speak with a Registered Dietitian. Available Monday-Friday 9am-5pm at 1-866-797-0000 (TTY: 1-866-797-0007)

Do you have more questions about parenting?

Updated July, 2019

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