During your pregnancy, eat a balanced, alcohol-free diet, which is beneficial for your baby. Specific requirements for vitamin B9, iron and calcium must be ensured. If you are following a specific diet, talk to your doctor.

Pay attention to food hygiene to prevent toxoplasmosis and listeriosis.

MAINTAIN A BALANCED AND DIVERSIFIED DIET

Nutritional needs during pregnancy are very specific: energy needs increase from the 2nd trimester and especially during the 3rd trimester and specific needs appear: additional needs for iron, calcium and vitamins.

A balanced and energetic diet essential for the proper development of the baby

Energy intake through the diet should not be less than 1,600 kcal/day as this may affect fetal growth. To meet nutritional needs, the diet must be diversified and balanced.

A balanced diet means eating :

- Five fruits and vegetables a day ;

- Bread, cereals and other slow sugars (legumes) at every meal according to your appetite ;

- Dairy products three times a day ;

- Protein (meat, fish or eggs) every day ;

- Unlimited water.

It is also important to limit your intake of fat, salt and sugary products. For the latter, choose slow sugars (starches, cereals, bread, pulses) and get into the habit of including them in all your meals.

In addition to the three main meals, you can introduce a snack from the second trimester onwards.

To avoid cravings and hunger pangs, don't skip meals and eat a good breakfast. Don't hesitate to have a snack as this will allow you to avoid heavy meals and snacking that can make you too fat.

By eating this way, you will feel better, have more energy and promote reasonable weight gain. Depending on your state of health, your doctor will give you personalized advice on how to adapt your diet.

Alcohol (more than one glass of wine per week) is totally contraindicated during your pregnancy. Alcoholic substances easily cross the placenta barrier and enter the fetus' bloodstream directly. They are responsible for serious consequences for the unborn child.

SPECIFIC DIETARY NEEDS FOR PREGNANT WOMEN

During your pregnancy, certain foods are best to eat to provide everything you and your baby need.

Folate or vitamin B9 (or folic acid)

Folic acid (vitamin B9), also known as folate, is essential for your baby's growth. During the first weeks of pregnancy, it plays an important role in the proper development of the embryo's nervous system, especially in the closure of the neural tube (failure to close is responsible for spina bifida)

The necessary folate intake can be provided by the daily diet in yeast, liver, fresh or canned or frozen fruits and vegetables (spinach, watercress, lamb's lettuce, melon, walnuts, almonds, chickpeas, chestnuts, dandelion), but is insufficient.

During a preconception consultation, your doctor or midwife will prescribe a vitamin B9 supplement if possible before conception (at least 4 weeks before) and up to 12 weeks of amenorrhea.

Pregnancy plans: think about vitamin B9

If you are planning to become pregnant, talk to your doctor who will prescribe vitamin B9 even before conception.

But don't self-medicate or take dietary supplements without talking to your doctor or midwife. They may contain trace elements or other vitamins, the consumption of which in high quantities is contraindicated.

Calcium and vitamin D

Calcium is essential for building your baby's skeleton, especially during the third trimester. If you don't provide enough, your baby won't hesitate to dip into your own stash. Dairy products (except raw milk products) are the best source of calcium.

Eat three dairy products a day: milk, yoghurt, cottage cheese, cheese, etc. Don't like dairy? Think of calcium-rich mineral waters.

Vitamin D facilitates the absorption of calcium. This vitamin is essentially made by the body under the action of the sun's rays on the skin. You can also find it in oily fish (salmon, mackerel, sardines) or in dairy products fortified with vitamin D.

Your doctor or midwife may prescribe vitamin D in the second part of pregnancy.

Iron

The need for iron is increased in pregnant women. Iron is essential, especially at the end of pregnancy to avoid any risk of deficiency that causes anemia. You will find it in pulses, fish, meat.

Your doctor or midwife may prescribe iron.

Caution with certain foods and vitamins

Avoid consuming :

- More than one soy-based food per day (e.g. tofu) due to their phytoestrogen content ;

- Yoghurts and margarines enriched with phytosterols ;

- Multivitamins containing vitamin A, which is contraindicated during pregnancy (teratogenic effect).

SOME SPECIAL SITUATIONS

You're vegan

If you are vegan, consult your doctor about this. Supplementation is necessary because the vegan diet, which excludes all foods of animal origin including eggs and milk, leads to deficiencies in vitamin B12, vitamin D, iron, iodine and calcium in both mother and child.

You want to take dietary supplements

Don't take them without talking to your doctor or midwife. Even though dietary supplements are over-the-counter and considered foodstuffs, they may contain vitamins or trace elements whose consumption in high amounts is contraindicated during pregnancy.

You're expecting twins

There's no need to eat twice as much because your nutritional needs are only slightly higher.

Source: https://www.ameli.fr/assure/sante/devenir-parent/grossesse/grossesse-en-bonne-sante/grossesse-alimentation/alimentation-grossesse

Tests and treatments recommended during pregnancy

Before pregnancy if possible, otherwise at the first consultation:

-  If no history, consult a specialist nurse for genetic disease screening (סקר גנטי).

-  If there is a known history of a genetic disease in the couple or family, consult a geneticist (יעוץ גנטי).

-  If taking medication, consult a teratology physician - Cervical screening smear (PAP) or HPV PCR screening Test. To be done if more than 3 years old.

-  Folic acid intake (400 micrograms to 5 mg daily); if possible, start 2 months before pregnancy onset.

-  Vitamin B12 check, and supplementation especially in vegetarian patients.

-  Flu Vaccination Board (שפעת), September to January.

-  Consultation with an obstetrician gynecologist to assess the possibility of a high-risk pregnancy.

During pregnancy:

Between 4 and 11 weeks of amenorrhea, and in any case, during the first consultation:

-  Check patient and spouse’s medical history and family history.

-  Check obstetric and gynecological history.

-  Provide an update on drug and other allergies.

-  Clinical examination.

-  Weight/height ratio. Body Mass Index (BMI)

-  Prescribing Baseline: Blood Count (CBC), fasting blood glucose. Serology rubella, toxoplasmosis, cytomegalovirus, varicella, syphilis, hepatitis B and C, blood group and irregular agglutinins (indirect coombs). HIV serology.

-  Echography of pregnancy dating and verification of embryonic vitality.

-  In case of multiple pregnancy, check for the presence of one or more separate or separate egg sacs.

Between 11 and 13+5 weeks of amenorrhea:

-  Fetal Neck Ultrasound (שקיפות עורפית)

-  First trimester Trisomy 21 blood screening (PAPP-A, free B HCG). To be done promptly after ultrasound.

-  Possibility of free fetal DNA testing for Down syndrome and other fetal genetic abnormalities (NIPT)

Between 14 and 16 weeks of amenorrhea:

-  Early morphological ultrasound (סקירת מערכות מוקדמת). - Genetic counselling for fetal abnormalities on ultrasound. (יעוץ גנטי).

-  Iron intake with folic acid begins.

-  Taking vitamin D.

-  Cytomegalovirus serology control in early pregnancy

Between 16 and 18 weeks of amenorrhea:

-  Trisomy 21 triple screening test (חלבון עוברי - תבחין משולש)

-  The integrated test includes the neck thickness associated with the first and second Down syndrome screening blood test.

Between 17 and 20 weeks of amenorrhea:

-  In case of abnormalities in the integrated test result, genetic counselling to discuss the indication of amniocentesis (בדיקת מי שפיר).

Between 20 and 24 weeks of amenorrhea:

-  Second morphological ultrasound (סקירת מערכות מאוחרת).

-  Genetic counselling for fetal abnormalities on ultrasound. (יעוץ גנטי).

Between 24 and 27 weeks of amenorrhea:

- Screening for gestational diabetes: Load test at 50 g glucose or in certain indications, load test at 100 g glucose (העמסת סוכר).

-  Blood Count (CBC).

-  Cytomegalovirus serology check in case of negativity in early pregnancy.

-  Administrative registration for maternity.

Between 28 and 30 weeks of amenorrhea:

-  Injection of anti-D immunoglobulins in case of Rhesus negative Blood Group. Make an indirect coombs blood test beforehand.

-  Pertussis vaccination reminder (שעלת) no later than 36 weeks.

After 30 weeks:

-  Possible enrollment in preparation for childbirth and breastfeeding. Between 32 and 35 weeks of amenorrhea:

- Ultrasound of the third trimester to assess the weight and position of the fetus, the amount of amniotic fluid, the location of the insertion of the placenta and control the fetal morphology.

Between 34 and 38 weeks of amenorrhea:

-  Laboratory tests: Blood count (CBC), Urine tests, Vaginal and rectal sampling to eliminate the presence of streptococcus B (GBS).

Between 40 weeks and 42 weeks of amenorrhea:

-  Fetal monitoring and ultrasound twice a week.

-  Indication in some cases of medically induced childbirth.

Between 6 and 8 weeks after delivery:

-  Visit to the gynecologist.

-  Presentation, if necessary, of the different contraceptive options.

N.B.:

1- Definitions:

-  Amenorrhea weeks: The number of weeks since the first day of the last period.

-  Date of pregnancy onset: date of fertilization, usually 14 days after the first day of last menstrual period

- In case of irregular cycles or imprecise terms, the onset of pregnancy is evaluated by an early ultrasound and a date of final theoretical menstruation is fixed by subtracting 14 days from the evaluated date of fertilization.

2- It is advisable to make a visit per month with control of blood pressure, weight and analysis of urine for abnormalities (infection, albumin).

3- This table is for information purposes only. In the end, only the gynecologist doctor is entitled to decide on the necessary examinations for each patient according to the clinical context.

Dr Marc Sion ZERAH, Gynecologist-Obstetrician, Attached to Hadassah Ein Kerem Hospital, Jerusalem

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Tips for Preventing Infections Before and During Pregnancy

Some infections before and during pregnancy can hurt both you and your developing fetus. They can cause serious illness, birth defects, and lifelong disabilities, such as hearing loss or learning problems. Here are 10 tips to help prevent infections before and during pregnancy:

1. Protect yourself from Zika virus:

Zika virus can be passed from a pregnant woman to her fetus during pregnancy or to her baby around the time of birth.

Zika virus infection during pregnancy can cause microcephaly (a birth defect where a baby’s head and brain are smaller than babies of the same age and sex) and other severe brain defects.

If you are pregnant, do not travel to areas with Zika.

If you must travel to an area with Zika, talk to your doctor or other healthcare provider rst and strictly follow
steps to prevent mosquito bites during the trip.

 If you have a partner who lives in or has traveled to an area with Zika, use condoms from start to nish,
 every time you have sex (vaginal, anal, or oral) to protect against infection or do not have sex during the pregnancy.

If you are trying to become pregnant

Talk with your healthcare provider before traveling to areas with Zika and strictly follow
 steps to prevent mosquito bites during the trip.

See CDC’s advice for men and women who are thinking about pregnancy.

2. Wash your hands with soap and water after the following:

- Using the bathroom

- Touching raw meat, raw eggs, or unwashed vegetables

- Preparing food and eating

- Gardening or touching dirt or soil

- Handling pets

- Being around people who are sick

- Getting saliva (spit) on your hands

- Caring for and playing with children

- Changing diapers

Learn more about washing your hands.

3. Reduce contact with saliva and urine from babies and young children

A common virus called cytomegalovirus (CMV) can cause problems for some babies, including microcephaly and hearing loss. A woman who is infected with CMV can pass the virus to her developing baby during pregnancy. Women may be able to lessen their risk of getting CMV by reducing contact with saliva and urine from babies and young children. Some ways to do this are by not sharing food and utensils with babies and young children, and washing hands after changing diapers. These actions can’t eliminate your risk of getting CMV, but may lessen your chances of getting it.

4. Avoid unpasteurized (raw) milk and foods made from it.

Do not eat soft cheeses, such as feta, brie, and queso fresco, unless they have labels that say they are pasteurized.

Unpasteurized products can contain harmful bacteria. Learn more about Listeria.

5. Do not touch or change dirty cat litter.

Have someone else do it. If you must change the cat litter yourself, be sure to wear gloves and wash your hands afterwards. Dirty cat litter might contain a harmful parasite. Learn more about toxoplasmosis.

6. Stay away from wild or pet rodents and their droppings.

Have a pest control professional get rid of pests in or around your home. If you have a pet rodent, like a hamster or guinea pig, have someone else care for it until after your baby arrives. Some rodents might carry a harmful virus. Learn more about lymphocytic choriomeningitis virus (LCMV).

7. Get tested for sexually transmitted diseases (STDs), such as HIV and hepatitis B, and protect yourself from them.

Some people that have HIV, hepatitis B, or an STD do not feel sick. Knowing if you have one of these diseases is important. If you do, talk to your healthcare provider about reducing the chance that your baby will become sick. Learn more about STDs.

8. Talk to your healthcare provider about vaccinations (shots).

Some vaccinations are recommended before you become pregnant, during pregnancy, or right after delivery. Having the right vaccinations at the right time can help keep you healthy and help keep your baby from getting very sick or having life-long health problems. Learn more about vaccinations.

9. Avoid people who have an infection.

If you have not yet had or did not have the vaccine before pregnancy, stay away from people who you know have infections, such as chickenpox or rubella. Learn more about chickenpox.

10. Ask your doctor about group B strep.

About 1 in 4 women carry this type of bacteria, but do not feel sick. An easy swab test near the end of pregnancy will show if you have this type of bacteria. If you do have group B strep, talk to your healthcare provider about how to protect your baby during labor. Learn more about group B streptococcus.

These tips can help you prevent infections that could harm you and your developing baby. You will not always know if you have an infection and sometimes you will not feel sick. If you think you might have an infection or think you are at risk, see your healthcare provider. Be sure to talk with your healthcare provider to learn more about safe food preparation, wearing insect repellent when outside, taking medicine, and other important topics.

Source: CDC Centers for Disease Control and Prevention

https://www.cdc.gov/pregnancy/infections.html

Page last reviewed: September 29, 2022

The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour.

Keep up your normal daily physical activity or exercise (sport, running, yoga, pilatis, dancing, or even walking to the shops and back) for as long as you feel comfortable.

Exercise is not dangerous for your baby. There is evidence that active women are less likely to experience problems in later pregnancy and labour.

Exercise tips for pregnancy

Do not exhaust yourself. You may need to slow down as your pregnancy progresses or if your maternity team advises you to. If in doubt, consult your maternity team.

As a general rule, you should be able to hold a conversation as you exercise when pregnant. If you become breathless as you talk, then you're probably exercising too strenuously. 

If you were not active before you got pregnant, do not suddenly take up strenuous exercise. If you start an aerobic exercise programme (such as running, swimming, cycling or aerobics classes), tell the instructor that you're pregnant.

Remember that exercise does not have to be strenuous to be beneficial.

Exercise tips when you're pregnant:

> Always warm up before exercising, and cool down afterwards.

> Try to keep active on a daily basis – 30 minutes of walking each day can be enough,   but if you cannot manage that, any amount is better than nothing.

> Avoid any strenuous exercise in hot weather.

> Drink plenty of water and other fluids.

> If you go to exercise classes, make sure your teacher is properly qualified and knows that you're pregnant, as well as how many weeks pregnant you are.

> You might like to try swimming because the water will support your increased weight. Some local swimming pools provide aqua-natal classes with qualified instructors. 

> Exercises that have a risk of falling, such as horse riding, downhill skiing, gymnastics and cycling, should only be done with caution. Falls carry a risk of damage to your baby.

Exercises to avoid in pregnancy

> Do not lie flat on your back for long periods, particularly after 16 weeks, because the weight of your bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint.

> Do not take part in contact sports where there's a risk of being hit, such as kickboxing, judo or squash.

> Do not go scuba diving, because the baby has no protection against decompression sickness and gas embolism (gas bubbles in the bloodstream).

> Do not exercise at heights over 2,500m above sea level – this is because you and your baby are at risk of altitude sickness.

Fetal Movements Count: Kick Counts

Counting fetal kicks ( or movements) during pregnancy can be a valuable tool for monitoring the fetus’s health.

Kick counting involves counting the number of times you feel the fetus move in a specific period. A change in the typical pattern could indicate the fetus is stressed.

What is kick counting in pregnancy ?

Counting kicks (fetal movement counting) in pregnancy is a way to monitor the fetus. It involves expectant parents tracking fetal kicks and movements during development in your uterus. Changes in movement patterns can sometimes indicate the fetus is under stress. Knowing the fetus's normal movement patterns can help you sense when something seems off.

The two main ways to track fetal kicks are:

> Count the number of kicks you feel in a one-hour period.

> Measure the amount of time it takes for the fetus to kick 10 times.

Most pregnant people will begin feeling the fetus kick around 20 weeks into pregnancy. If it’s your first pregnancy, it might be later. If you’ve been pregnant before, you might feel the fetus kick a little sooner. Fetuses move at different times and in different ways. By the time your third trimester rolls around (28 weeks of pregnancy), you should have a general sense of the movement patterns of the fetus.

Discussing fetal movements with your healthcare provider at your prenatal visits gives them insight into how the fetus is developing.

What do fetal kicks feel like?

Kicks from inside your uterus feel soft and may be hard to distinguish (especially the first movements). The fetus is small, and its movements aren’t strong. Some people describe kicks as flutters, swishes, rolls, jabs or butterflies. Fetal movements will vary depending on fetal age and get stronger in the third trimester (28 to 40 weeks in pregnancy).

Don’t panic if you’re not sure what you’re feeling. You’ll eventually learn the movement patterns of the fetus and when it is more likely to be active.

Why should I count my fetal kicks?

Kick counting can help you be more aware of fetal movements. If you know what’s normal for the fetus, then you can more easily determine when something feels wrong. Changes in fetal movement may be an early sign of distress or can indicate a problem with the pregnancy. Once you know the fetus's activity level, you can alert your healthcare provider if changes occur.

Feeling the fetus move in your uterus is a good thing and indicates a healthy and growing fetus. But even healthy fetuses can experience distress. That's why knowing what’s normal for the fetus can be a good way to identify potential problems. A normally active fetus that slows down may concern your healthcare provider.

When should I start counting kicks?

It’s a good idea to always be aware of your fetal movements during pregnancy. Kick counting becomes more important in the third trimester (between weeks 28 and 40) when lack of movement may suggest the fetus is stressed.

How do I count kicks?

There are a few ways to count fetal kicks. Using an app on your phone may help, or you can use a timer or clock and a piece of paper.

Ten movements (kicks, flutters or rolls) in one hour is considered typical fetal movement. Don't panic if you don't feel 10 movements in an hour. Feeling fewer than 10 kicks doesn't mean something is wrong. It may also take a little longer than one hour to feel 10 movements. This is usually OK and not a cause for worry.

Here are the steps to count fetal kicks:

> Choose a time when you are least distracted or when you typically feel the fetus move.

> Get comfortable. Lie on your left side or sit with your feet propped up.

> Place your hands on your belly.

> Start a timer or watch the clock.

> Count each kick. Keep counting until you get to 10 kicks.

> Once you reach 10 kicks, jot down how many minutes it took.

Alternatively, you can set a timer for one hour and grab a piece of paper. Once the timer starts, make a mark on the paper each time you feel a kick. At the end, tally up the number of marks you've made. Remember, you're looking for 10 movements in two hours.

After a few days of kick counting, you'll notice patterns and what’s normal for the fetus. Every fetus is different. You’re figuring out what’s normal for the fetus. Once you know that, you can call your healthcare provider if you notice significant shifts in fetal movement patterns.

How many kicks should I feel in a day ?

Healthcare providers have different opinions on how many movements you're looking for within a set amount of time. The American Congress of Obstetricians and Gynecologists (ACOG) recommends that you time how long it takes you to feel 10 kicks, flutters, swishes or rolls. Ideally, you want to feel 10 movements within two hours.

If you don't feel 10 movements in two hours, it's OK. There are ways to "wake up" the fetus or you can try again when the fetus is more active.

If you still can't feel the fetus move, contact your healthcare provider for advice.

When should I feel the fetus kick the most ?

Fetal movements are unique, just like fetuses. You may notice the fetus is more active at certain times during the day. It’s common for pregnant people to notice more movement after they’ve eaten a meal. This is because of the increase in sugar (glucose) in your blood. Others notice more movement in the evenings when they are going to bed. It may also be that you simply don’t feel the fetus moving during the day because you're busy, at work or caring for your other children.

Fetuses also tend to be more active at night. Experts believe this might be because your movements during the day help rock them to sleep in your uterus.

How do I wake the fetus up to count kicks?

It might be easier to count kicks once you determine the active times of the day for the fetus. Even then, there will be times when the fetus doesn’t want to cooperate. Some things you can try to get the fetus to move are:

> Taking a walk or moving your body.

> Drinking juice or another sweet beverage.

> Eating a meal.

> Lying down on your left side (this maximizes blood flow).

> Playing loud music.

When should I worry about low kick counts?

Try not to be alarmed if the fetus hasn’t moved in several hours. It’s normal for fetuses to have periods of rest, sleep and activity — just like you.

In some cases, you may just need to increase the time to two hours instead of one hour. If after two hours you haven’t felt 10 movements, it might be time to let your healthcare provider know. They can decide if more monitoring is necessary based on your pregnancy and health history.

Remember, kick counting shouldn’t make you stressed. Talk to your obstetrician or midwife to see how many kicks you can expect to feel each day and what to watch for. If your pregnancy is healthy and the fetus is thriving, monitoring fetal movement shouldn’t be something to worry about.

When should I contact my doctor?

Contact your healthcare provider if fetal movements change abruptly, slow down or stop. Most of the time decreased fetal movement isn’t a sign of a problem. It's better to be safe than sorry and let your healthcare provider know. They can check the fetal heart rate or perform an ultrasound to make sure everything is OK.

Do fetuses kick less before labor?

No, fetuses don’t move less before labor. By the time the fetus is full-term (39 weeks), you may feel more rolls and fewer kicks. Some people mistake this for less movement when it’s just a different type of movement. You should still be able to feel the same number of movements per day. Remember, only you know what is normal for the fetus. Contact your healthcare provider if you notice changes in your fetal movements.

Conclusion

Kick counts are a great tool for monitoring the well-being of the developing fetus. Decreased movement can be an early warning sign of a problem in pregnancy. This is not always the case. But if you know their regular pattern and the normal number of kicks, you may notice changes more quickly.

To do a kick count, set a timer and track the number of movements you feel in an hour. You should feel the fetus kicking, rolling, fluttering or moving in your uterus during that time.

Talk to your healthcare provider if you have any concerns about fetal movements. They may want to evaluate you and the fetus to make sure everything is progressing OK.

Source: Cleveland Clinic