1. Maintaining a balanced nutritional intake.
**weight – an indicator of maternal stability and health
**folic acid – CNS development; green leafy vegetables
2. Bathing – personal hygiene
- daily tub baths and shower are recommended.
- as pregnancy advances, change tub bath to sponge bath
- if vaginal bleeding/rupture of membrane are present, tub bath is contraindicated
3. Breast Care – general rule is to wear a firm, supportive bra with wide straps and is non-wired
- wash breast with clear tap water (no soap) daily to remove colostrum
- if colostrum secretion is profuse, place gauze or breast pads inside the bra
4. Dental Care – good tooth brushing habits should continue throughout pregnancy
- encourage pregnant woman to see her dentist regularly
- encourage snacking of nutritious food
5. Perineal Hygiene – douching is contraindicated
- wash perineal area regularly with mild soap and water
6. Dressing – avoid garters, extremely firm girdles with panty legs and knee-high stockings
- shoes should be moderately high or flat
7. Sexual Activity
Common Myths:
- Coitus on the expected date will initiate labor
- Orgasm will initiate labor
- Coitus during fertile days of a cycle will cause a 2nd pregnancy or twins
- Coitus might cause rupture of membrane
8. Exercise – to prevent circulatory statis on the lower extremities
- it can also offer a general feeling of well-being
- exercise program should consist of:
> 5 minutes warm up
> 20 minutes “stimulus phase”
> 5 minutes cool down
9. Sleep – needs an increased amount of sleep to build new body cells during pregnancy
- if the woman has trouble falling asleep, drinking a glass of warm milk may help and relaxation exercises
- left Sim's lateral position with top leg forward
10. Travel – early in normal pregnancy, there is no restrictions
- when traveling, avoid eating uncooked food and drinking unpurified water
- if long trip, plan for frequent stretch/rest periods
Prevention of Fetal Exposure to Teratogens
Teratogen – any factor, chemical or physical that adversely affects the fertilized ovum, embryo, or fetus.
Factors that influence the effect of teratogen to the fetus:
a. strength of teratogen
b. timing of teratogenic insult
c. Teratogen's affinity to specific tissue
Thalidomide causes limb defects.
Tetracycline causes tooth enamel deficiency.
I. Teratogenic Maternal Infections
- either sexually transmitted or systemic infection (syphillis, herpes, gonorrhea)
- TORCH → group of diseases
Toxoplasmosis – protozoan infection
- uncooked meat, handling a cat stool in soil or cat litter
- almost no symptoms
- for fetus: CNS damage, hydrocephalus, microcephaly, retinaldeformities
Rubella – mother: causes mild rash and mild systemic illness
- flu-like symptoms
- for fetus: deafness, mental and motor challenges, cataracts, cardiac defects, retardation, cleft lip and palate
Cytomegalovirus (CMV) – member of the herpes virus family
- transmitted by droplet infection from person to person
- fetus: severely neurologically challenged, eye damage, deafness, chronic liver disease
Herpes Simplex Virus (Genital Herpes Infection) – virus spreads into the bloodstream and crosses the placenta
- 1st trimester severe congenital anomalies or spontaneous miscarriage
- 2nd / 3rd trimester – premature birth, IUGR (intrauterine growth retardation)
II. Medication use
General principle: almost all medications cross the placenta and can potentially affect the fetus
- no meds (including OTC and herbal) should be used during pregnancy without the approval of primary caregiver
III. Substance Use and Abuse
a) Caffeine – may be safe if taken in moderation during pregnancy
- increases the risk of spontaneous abortion
b) Tobacco – contraindicated
- LBW, preterm labor, abortions, stillbirths, SIDS, birth defects and neonatal respiratory disorders
c) Alcohol – no safe amount of alcohol consumption during pregnancy
d) Marijuana – fetus: stressed nervous system
e) Cocaine – spontaneous abortion and premature labor
- infants are small and have higher incidence of low birth weight
IV. Environmental Teratogens
Mental and Chemical Hazards
- pesticides and carbon monoxide
- arsenics (by – product of copper and lead smelting)
- paints
- mercury
- formaldehyde
Radiation (x-ray, photocopiers)
Hyperthermia and Hypothermia
V. Teratogenicity of Maternal Stress
Common Myths:
- if a woman sees a mouse during pregnancy, her child will be born with a furry / mole-like birthmark
- eating strawberries causes strawberry birthmark
- looking at a handicapped child while pregnant will cause child in utero to be handicapped the same way
** common sense and awareness of fetal – maternal physiology have dispelled these superstitions
