Introduction

Pregnancy and pre-conception are a really important time in a woman’s life, where the health of the woman can severely impact the health of the foetus and subsequent baby.

More and more research is coming to the fore, which has uncovered so much about the mother’s health and exposure to certain elements that can adversely affect the foetus, cause miscarriage or even defects in the unborn child.

The following are defined in order to improve the chance of a healthy pregnancy with a healthy birth.

Cosmetics

It is important to note that whatever a pregnant woman puts on her skin can ultimately end up in her unborn foetus (as it crosses the placenta and is “fed” to the foetus), which can cause a number of adverse effects to the unborn child.

Most cosmetics (either expensive or cheap) contain many chemicals which are now being deemed to be unsafe for the unborn foetus. Studies are showing these chemicals can cause a number of adverse health effects, such as:

• miscarriage
• birth defects
• still birth
• feminisation of the males
• reduction in the number of male births
• reduction of fertility

The main chemicals that are the worst offenders and should be avoided are:

• Methyl paraben
• Propyl paraben
• Any paraben
• Sodium lauryl sulphate (or sulfate) – SLS
• Formaldehyde
• Toluene
• Coal tar
• Mineral oil
• Synthetic colours
• Synthetic fragrances
• Dibutyl phthalate
• Phthalates

The Pregnant? Know your chemicals – national information campaign by the Danish EPA has set out some guidelines for pregnant and breastfeeding women, which advises women to reduce the number of chemicals they are exposed to and specifically to reduce their exposure to the toxic chemicals in cosmetics and other toxic substances while they are pregnant and breastfeeding to reduce likelihood of possible adverse health effects.

The Danish EPA recommend pregnant and breastfeeding women do the following:

• avoid using any cosmetics that are not deemed safe (only organics and only ones that are certified to be close to 100% organic)
• avoid using creams and lotions on their baby (unless really necessary and then only use certified organic products)
• avoid perfume and perfumed / scented products on either themselves or their baby
• avoid colouring (dyeing) their hair
• avoid products that come in spray cans (such as hair spray)

Hair colour / dye

Women who are pregnant, breastfeeding or who are trying to conceive should avoid using hair dyes, as they contain many toxic chemicals which can be harmful to the unborn foetus. The chemicals in the hair dyes are absorbed through the skin and can be passed to the unborn foetus which may cause harmful effects.

The best (and only) way to avoid the toxic chemicals in hair dyes is for women who are pregnant or breastfeeding to avoid dyeing their hair.

Studies show that there are a number of toxic chemicals in hair dyes, which have a number of adverse health effects, from irritation, to possible cancer links. The following are the most toxic chemicals in hair dyes and should be avoided:

• 1-naphthol: this is used as an oxidising agent. It is made from coal tar and is linked to cancer. It is also used as an ingredient pesticides
• Ammonium hydroxide: this is used as a pH (acidity) adjuster and is highly acidic on the body, with some studies showing it is linked to skin cancer
• Ethanolamine: this is used as a surfactant (which create a smooth consistency). This chemical is irritating to the whole body and may aggravate asthma symptoms. Once absorbed by the skin, it can accumulate in the liver and kidneys and if exposure is high, it can damage the central nervous system. Research shows that when this chemical is combined with other ingredients in hair dyes, it can form carcinogenic substances
• O leth-5, oleth-2: these are used as emulsifiers and surfactants (to bind the ingredients together and create a smooth consistency). They are both possible allergens (especially for sensitive people) and they are linked to breast cancer
• p-phenylenediamine: this is dye made from coal tar and it is known to be potentially carcinogenic. This chemical can cause an allergic reaction and may damage the immune system
• Propylene glycol: this is used as a solvent (to make the hair dye bright and soften the hair). This chemical is toxic to the skin and is not only absorbed by the skin, but opens the skin to absorb other toxic chemicals more easily. It is also used in hair and face care products
• Resorcinol: this is used an oxidising agent (which helps to combine all the ingredients in the hair dye). This chemical is an irritant to the skin and the European Union (EU) has classified it as an endocrine disrupter (which has potential links to cancer)
• Soytrimonium chloride: this is used as a surfactant (which create a smooth consistency). This chemical is irritating to the skin and the lungs – it can aggravate asthma symptoms. There are a number of other adverse health effects associated with this chemical

Studies also show that some of the chemicals in permanent hair dyes can cause cancer of the bladder. The European Union (RU) has banned 22 hair dye substances as of December 2007 because of the concern about the link with bladder cancer.

Hair dye chemicals banned in Europe

The hair dyes chemicals that have been banned by the EU include:

• 1,7-Naphthalenediol
• 2,3-Naphthalenediol
• 2,4-Diamino-5-methylphenetol and its HCl salt
• 2,4-Diaminodiphenylamine
• 2,6-Bis(2-Hydroxyethoxy)-3,5-Pyridinediamine
• 2-Aminomethyl-p-aminophenol and its HCl salt
• 2-Methoxymethyl-p-Aminophenol
• 3,4-Diaminobenzoic acid
• 4,5-Diamino-1-((4-Chlorophenyl)Methyl)-1H-Pyrazole Sulfate
• 4,5-Diamino-1-Methylpyrazole and its HCl salt
• 4-Chloro-2-Aminophenol
• 4-Hydroxyindole
• 4-Methoxytoluene-2,5-Diamine and its HCl salt
• 5-Amino-4-Fluoro-2-Methylphenol Sulfate
• 6-Methoxy-2,3-Pyridinediamine and its HCl salt
• Acid Orange 24 (CI 20170)
• Acid Red 73 (CI 27290)
• N,N-Diethyl-m-Aminophenol
• N,N-Dimethyl-2,6-Pyridinediamine and its HCl salt
• N-Cyclopentyl-m-Aminophenol
• N-(2-Methoxyethyl)-p-phenylenediamine and its HCl salt
• Solvent Red 1 (CI 12150)

The Danish EPA have recommended pregnant and breastfeeding women avoid dyeing their hair altogether.

Safe hair dyes / colours

The only hair dyes that may not have any toxic effects are those from certain plants:

• Henna – only totally natural henna straight from the source
• Walnut shells – these provide a natural dark colour

Paint

Women who are pregnant or breastfeeding should stay away from any type of paints, primers, paint strippers, solvents, thinners and wood stains.

Current recommendations suggest that pregnant women should avoid exposure to oil-based paint, lead-based paints and latex paints that contain ethylene glycol ethers and biocides. Lead-based paints were used prior to the 1970’s, so any paint that needs to be removed should not be performed by women who are pregnant or breastfeeding due to the exposure to lead, which is implicated in lead poisoning and mental retardation in the unborn foetus and growing child.

All paints emit fumes, even the water-based ones. Pregnant and breastfeeding women are advised to avoid painting (the house or even painting pictures on canvas) to avoid exposure to any of the toxic chemicals in the various types of paints, strippers, thinners or primers.

In addition to this, it is advisable to avoid painting the baby’s bedroom after it is born. Try to paint their bedroom (but only with natural, water-based paint) when the baby is several months old and ensure it is well ventilated for about one week before you allow your child to sleep in their room. This will prevent possible exposure to the worst of the fumes.

Environmental toxins / pollution

There is mounting scientific evidence that exposure to environmental toxins and pollution produces adverse health effects for the unborn foetus, with a number of studies suggesting that women need to avoid exposure to pollution (from cars, factories and other pollution sources).

Studies show that when the unborn foetus is exposed to consistent pollution, the weight of the baby at birth is lower than normal. The research suggests that air pollution might alter cell activity in the unborn foetus, or cut the amount of oxygen and nutrients a baby receives while in the womb.

Other studies show that when a pregnant woman is exposed to lead from car pollution, this can be implicated in lead poisoning and mental retardation in the unborn foetus, which presents upon birth. Babies and infants are also more likely to be exposed to lead poisoning and lower mental growth if they live on a main road with high traffic exposure from cars.

Other studies show a link between exposure to pollution and child mortality, with babies having the highest exposure to a number of pollutant chemicals being the most likely to becomes sick and die.

Another recent study of newborns in New York City revealed that prenatal exposure to combustion-related urban air pollutants alters the structure of chromosomes (the carriers of genes) of babies in the womb. This is the first study to show a link between exposure to environmental chemicals during pregnancy and an increase in foetal abnormalities. Other studies show there is a link between these types of genetic mutations to cancer (in babies, children and adults).

There are a number of other chemicals that are emitted from car exhaust fumes, from factories and other pollution sources which have adverse effects on the unborn foetus and should be avoided as much as possible.

Women who are pregnant or breastfeeding should also steer clear of any type of pesticides, irrespective of how “natural” they may seem. The chemicals in pesticides have known neurotoxins and if the unborn foetus is exposed to them, they can cause adverse health effects, including foetal abnormalities.

Toxic plastics

The most toxic plastic that all women who are either pregnant, breastfeeding, or considering getting pregnant should avoid is plastic # 3, which is better known as PVC or vinyl.

PVC (Polyvinyl chloride) is considered by many experts to be the most toxic, carcinogenic plastic ever created. It cannot be recycled and will continue to emit toxic, carcinogenic fumes forever.

Results from animal studies show that being exposed to vinyl chloride (by breathing it in or drinking it in water) at moderate levels (100ppm) may increase the risk for liver cancer.

The US Department of Health and Human Services has determined that vinyl chloride is a known carcinogen. The International Agency for Research on Cancer has determined that vinyl chloride is carcinogenic to people and EPA has determined that vinyl chloride is a human carcinogen.

Women who are pregnant, breastfeeding or considering getting pregnant should especially avoid this plastic. PVC is found just about everywhere: packaging materials, in shower curtains, infant products, children’s toys, packaging and fashion accessories.

Other plastics to avoid

The other plastics which should be avoided are:

• # 6 (Polystyrene): Polystyrene is another plastic which is used in disposable hot drink containers, food trays, egg cartons, carpet backing, shoes, take-away containers, opaque plastic cutlery and other disposable take-away items. The Environment Protection Agency (EPA) warns that even short term exposure to this plastic can cause a number of nervous system effects and long terms exposure can lead to liver and nerve damage and cancer.
• # 7 (Polycarbonates and Others): these are plastics which are used in plastic baby bottles, the lining of metal food cans (even in some organic foods), sports water bottles, and other items. Bisphenol-A (BPA) is used to make polycarbonates and BPA is a known endocrine disrupter, which can leech from the polycarbonate plastics when they are used. This BPA is breathed in, is ingested from the liquid in the plastic containers or is absorbed through the skin. Many studies are now showing that even low level exposure to BPA is laboratory animals caused significant adverse health effects, including alterations to brain chemistry and structure, mood and behavior problems, the immune system dysfunction, as well as adverse effects to both the male and female reproductive systems. In addition to this, long term exposure to BPA is associated with a number of cancers, especially breast and endocrine cancers, allergies, asthma, as well as heart disease.

Safer plastics

Plastics should be totally avoided when pregnant, breastfeeding or when trying to conceive, but if exposure is unavoidable, use the products with the following numbers only:

• # 1: PETE or PET (Polyethylene Terephthalate) – Used for clear beverage bottles. Widely recyclable; generally considered safe, with some precautions.
• # 2: HDPE (High-Density Polyethylene) – Used for colored or cloudy bottles and jugs, yogurt containers, and other tubs. Widely recyclable, but consumers need to verify with local recyclers whether tubs and bottles (which are made differently and can’t be recycled together) need to be separated. Generally considered safe, with some precautions.
• # 4: LDPE (Low-Density Polyethylene) – Used for garbage bags, food storage bags, and some cling wrap and bottles. Not widely recyclable; generally considered safe, with some precautions.
• # 5: PP (Polypropylene) – Used in butter tubs, some baby bottles, and other rigid containers. Not widely recycled; generally considered safe.

This will ensure a better chance of reducing exposure to the worst of the carcinogenic and other detrimental effects that the toxic plastics can cause.

Due to the concern about Bisphenol A, the US Government is now cautioning women against using hot food in plastics that may contain Bisphenol A.

The USA Department of Health and Human Services has recently produced a guideline for women with babies and infants regarding Bisphenol A exposure.

Bottled water

A recent investigation by the Environmental Working Group (EWG) in the USA in 2008 determined that the bottled water they tested was either no better than tap water, or it had significant pollutants in it, at levels much higher than the limits set for bottled water.

The pollutants that were found in the bottles of water were:

• Bromodichloromethane – a known carcinogen
• Trihalomethanes – disinfectant by-products
• Pharmaceuticals – such as Tylenol, antidepressants and birth control pills
• Fertilizer residue – such as nitrate and ammonia
• Heavy metals and minerals – including arsenic
• Industrial chemicals – such as solvents, plasticisers

Pregnant and breastfeeding women (and even women trying to conceive) should avoid bottled water and only drink filtered (or unfiltered) tap water.

Genetically modified foods

A recent study by the Austrian government on laboratory mice has shown that genetically modified (GM) crops pose serious threats to reproductive health. This long term study, sponsored by the Austrian Ministries for Agriculture and Health was presented at a scientific seminar in Vienna, Austria in early November 2008.

A statement from Greenpeace about the implications of this study: “This study clearly demonstrates that GMOs (genetically modified organisms) have a lot of unknown environmental and health risks and that the safety of GMO crops can not be guaranteed. This is not the first GMO to have been discovered to pose serious health risks, and it will not be the last.”

While there have not been many studies published on the health effects of GMO crops (adverse or beneficial), the majority of the studies published do show that genetically modified crops have adverse effects on the laboratory animal’s reproductive health.

Pregnant women should avoid the following, to ensure they reduce their consumption of foods with possible contamination of genetically modified organisms:

• Canola
• Corn
• Cottonseed oil
• Lecithin
• Potatoes
• Soy

If a food is certified organic, even if it does contain the above ingredients, it should be fine. As long as the ingredient is certified organic.

Greenpeace’s True Food Network provides a list of foods which are safe (do not contain GMO) and ones which are not safe. Take this list when you go shopping.

Cleaning products

Women who are pregnant especially, but also those women who are breastfeeding are advised to avoid using cleaning products, as the fumes from the chemicals in these products can adversely affect the growing foetus.

The skin can absorb the fumes from the chemicals in cleaning products, which can then transmit these toxic chemicals to the unborn foetus and this may cause foetal abnormalities. The higher and more consistent the exposure, the more likely the damage to the foetus.

There are a number of chemical-free ways to clean the home, which should be adopted to avoid exposure to harmful chemicals.

Pregnant or breastfeeding women who cannot avoid exposure to cleaning products must wear gloves when handling these products, use them in a well ventilated room (open the windows) and exit the room as soon as possible after completion to avoid further exposure to the fumes and possible absorption through the skin to the unborn foetus.

References

• Begoun P, Barron B. Don’t Go to the Cosmetics Counter Without Me, 7th edition. Beginning Press, 2007
• Co-op America: Greener Path: Recyclable Plastic, Jan/Feb 2006. Accessed 21 November 2008
• Department of Health and Human Services: Agency for Toxic Substances and Disease Registry (ATSDR) – Polystyrene, Toxological Profile. http://www.atsdr.cdc.gov/toxprofiles/tp53-c2.pdf – accessed 30 December 2008
• Department of Health and Human Services: Agency for Toxic Substances and Disease Registry (ATSDR) – Vinyl Chloride, Toxological Profile. http://www.atsdr.cdc.gov/toxprofiles/tp20.html – accessed 30 December 2008
• Environmental Working Group. Bottled Water Quality Investigation: 10 Brands, 38 Pollutants. October 2008. Accessed 21 November 2008
• Greenpeace. Austrian Study Finds Eating GE Corn May Reduce Fertility. 12 Nov 2008. Accessed 30 December 2008
• Hansen, C., Neller, A., Williams, G.M. and Simpson, R. (2007) Low levels of ambient air pollution during pregnancy and fetal growth among term neonates in Brisbane, Australia. Environmental Research, 103 3: 383-389
• Jaakkola JJK, Knight TL. The Role of Exposure to Phthalates from Polyvinyl Chloride Products in the Development of Asthma and Allergies: A Systematic Review and Meta-analysis. Environ Health Perspect. 2008 July; 116(7): 845–853, accessed 20 November 2008
• Marshall A. GM soybeans and health safety–a controversy reexamined. Nat Biotechnol. 2007 Sep;25(9):981-7
• MotherLove.com – Bodycare Ingredients to Avoid. Accessed 28 November 2008
• Skin Deep, Environmental Working Group, searchable database with safety ratings for body care product ingredients – http://www.ewg.org, accessed 21 November 2008
• Šrám RJ, Binková B, Dejmek J, Bobak M. Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature. Environ Health Perspect. 2005 April; 113(4): 375–382. Accessed 21 June 2009
• The Campaign for Safe Cosmetics http://www.safecosmetics.org, accessed 21 November 2008
• The Green Guide. Safe, Not Sorry, Hair: The Case for Nontoxic Shampoos, Conditioners and Colors. http://www.thegreenguide.com, accessed 29 November 2008
• The Organic and Non-GMO Report. Government Funded Austrian Study on GM Crops Reducing Fertility. December 2008. Accessed 30 December 2008
• Winter R. A Consumer’s Dictionary of Cosmetic Ingredients: Complete Information About the Harmful and Desirable Ingredients Found in Cosmetics and Cosmeceuticals. Three Rivers Press; 6 Rev Upd edition, 2005

Last reviewed and updated: 27 June 2024

Move your body

Women need to get enough moderate exercise every day, in general, but especially when pregnant (unless a medical doctor advises bed rest), as it help the body in a variety of ways:

• ensures proper blood flow/circulation – to ensure all the nutrients and oxygen are being passed onto the unborn baby, which is especially required in pregnancy as there is an increase of about 50% of the blood volume
• relieves swelling – exercise helps to ensure better lymphatic and blood circulation and can reduce swelling in the legs especially
• reduces stress and tension – exercising releases endorphins which can reduce the hormones that contribute to feeling stressed and tense and this is better for the unborn baby, not just the mother

Pregnant women need at least 30 minutes of moderate exercise every day. You can try walking, yoga, pilates and some gentle (low-impact) aerobics.

Eat the good fish for Omega-3

The good and healthy fats in oily fish especially provide essential fatty acids which otherwise cannot be obtained other than from the diet. The essential fatty acids

The essential fatty acids, and especially omega-3 fatty acids are vital for proper and healthy brain development and to help reduce the risk of the child developing allergies and skin conditions such as eczema and dermatitis.

Pregnant women need to eat a variety of oily fish each week to ensure the health of your unborn child. The best and safest fish sources are those which are wild and from the deep ocean, to avoid contamination with mercury (a heavy metal found in some fish due to industrial pollution):

• salmon (not raw)
• sardines
• tuna (not raw)
• mackerel
• trout

There are also non-fish sources of omega-3 essential fatty acids, which can be eaten on a regular basis, in addition to (or instead of) the oily fish and they are:

• avocados
• hazelnuts
• walnuts
• pumpkin seeds
• sunflower seeds
• extra virgin olive oil (cold pressed is the best)
• sunflower oil

Ditch the coffee or try decaffeinated coffee

Some studies have shown that drinking more than 1-2 cups of coffee (that contain about 200mg of caffeine) per day may increase the risk of miscarriage by almost double!

Look at the amount of caffeine in the foods/drinks below and check out your risk:

• 1 cup instant coffee: 60-100mg caffeine
• 1 cup brewed coffee: 80-350mg caffeine
• 1 cup tea: 8-90mg caffeine
• 1 cup hot chocolate: 10-70mg caffeine
• 1 cup cola drink: at least 35mg caffeine
• 1 x 200g chocolate bar: 20-60mg caffeine

To limit your risk of miscarriage, ensure you limit your caffeine intake during pregnancy. Use decaffeinated coffee or better yet, try not to drink any coffee at all (if you can). Try some herbal tea or warmed up water with lemon.

Keep an eye on your weight

It is important that know that while gaining some weight during pregnancy, it is not healthy to gain too much weight, nor is it healthy to over-indulge in sweets and processed foods. It is better for you and your unborn child to eat as much natural (unprocessed) foods as possible each day, to get all the nutrients you need and to ensure weight gain is normal.

To keep you pregnancy healthy and ensure you gain only an appropriate amount of weight, the following should be considered:

• Eat at least 5-7 servings of vegetables each day
• Eat at least 3-5 servings of fruit each day
• Eat one serving of legumes each day
• Eat at least 3-5 servings of whole grains each day
• Eat good quality protein each day
• Get enough good fats in the form of vegetable oil, nuts, seeds and avocado every day
• Exercise moderately for at least 30 minutes every day
• Limit intake of processed food
• Limit intake of deep fried foods
• Limit intake of sweets and sugary food
• Limit intake of saturated fats

Know your folic acid (folate) needs

Folic acid (or folate) is a B vitamin which has been proven to prevent neural tube defects (such as spina bifida) in the unborn baby, especially in the first 12 weeks, when the foetus is developing the neural tubes.

It is recommended that women of child-bearing age get enough folic acid in their diet, either through supplementation or through food intake in the diet.

Recommended daily intake for folic acid: 600mcg

Some foods high in folic acid are:

• spinach
• green leafy vegetables
• lentils
• beans
• oranges
• orange juice
• fortified breakfast cereals and pasta

Follow a mediterranean diet

Various studies have shown that women who follow a Mediterranean diet while they are pregnant, reduce the risk of their child developing allergies by 90%.

The Mediterranean diet is a healthy diet based on the foods eaten by the people in the Mediterranean region (Italy, Greece, Turkey) and consists of eating the following foods:

• olive oil (with every meal)
• fresh fruit
• legumes
• fish (a few times a week)
• poultry (a few times a week)
• bread
• pasta
• cheese
• yoghurt

The following are restricted or disallowed on a Mediterranean diet:

• red meat (restricted)
• processed foods (disallowed)

Don’t smoke cigarettes of any kind

Cigarette smoking is dangerous not only to your health, but it is also detrimental to your unborn child.

Cigarette smoke depletes many of your vitamin levels, but especially vitamin C, which is an essential nutrient required for enabling the absorption of iron and to produce collagen needed for your body, but also for the growing foetus’ body. If you are not getting enough iron, you may become anaemic and this is not beneficial at pregnancy where your blood volume can increase by up to 50%.

In addition to this, cigarette smoking can decrease your chances in conceiving in the first place and may increase your risk of miscarriage when you are pregnant.

Before you try to conceive, talk to your doctor about ways to help you stop smoking, for your health and your child’s health.

Don’t drink alcohol

At present (2024), there is conflicting evidence about the consumption of alcohol in pregnancy – some studies show that having one glasses of alcohol on some days of the week do not harm the unborn foetus, while other studies show that any alcohol can harm the unborn foetus and cause miscarriage (or some type of abnormality in the foetus).

In order to err on the side of caution, it would be prudent to avoid all alcohol consumption when you are pregnant in order to reduce risk of miscarriage or abnormality in the foetus.

Don’t heat plastics

Recent research has uncovered a concern about a certain chemical (Bisphenol A) in plastics and in linings of cans, which could have carcinogenic effects on both the pregnant (and lactating) mother as well as on the child because of its endocrine disrupting activity. In addition, Bisphenol A (BPA) is also implicated in learning and behavioural difficulties in the child.

The BPA levels in the pregnant (and lactating) mother concentrate in the fatty tissue and also pass through the placenta into the unborn child.

BPA in plastics is especially released at high levels into the liquid when the plastics containers or bottles are heated or when hot liquid is added to a plastic container. When cans of food are heated (as would happen when canned food is placed in water and boiled), the BPA inside the can lining also leeches into the food inside.

To avoid exposure to BPA:

• always use glass or ceramic containers in the microwave
• always use a glass baby bottle (or try to find one which is certified to be BPA-free)
• always take food out of cans and use a stainless steel saucepan to heat it (or put it in the microwave into a glass or ceramic container) – better yet, avoid usage of canned food and use fresh food instead

As of April 2008, Canada has banned all plastic baby bottles that contain BPA (and most do) and is looking into the health implications of BPA on adult health and will ban all other plastics (and cans) if they deem they are also unsafe.

References

• Canada Government Health Alerts. Accessed 19 April 2008
• Duyff, RL. American Dietetic Association: Complete Food and Nutrition Guide, 2nd edition. John Wiley & Sons, NJ USA
• Environmental Working Group web site- accessed 19 April 2008
• Osiecki, H. The Nutrient Bible. Bio-Concepts Publishing QLD, 2002
• Osiecki, H. The Physicians Handbook of Clinical Nutrition. Bio-Concepts Publishing QLD, 2002
• Stoppard M. New Pregnancy and Birth: A Practical Guide for All Parents To Be. Dorling Kindersley, 2007pregnancy, healthy, pregnant, exercise, diet, nutrition, legumes, olive oil, vegetables, spinach, leafy green vegetables, immune system, foods, omega 3, omega-3, fish, folate, folic acid, allergies, baby, plastics, heating, BPA, bisphenol A, endocrine, disruptor, weight, brain, gaining eight, smoking, coffee, decaffeinated, alcohol, processed, drinking,
• Whitney EN, Cataldo DB, Rolfes SR. Understanding Normal and Clinical Nutrition, 6th Edition. Wadsworth/Thomson Learning, 2002

Last reviewed and updated: 27 June 2024

What is pre-eclampsia?

Pre-eclampsia is a serious blood pressure condition that only occurs in some women during pregnancy. It causes blood pressure to rise (which is often the most common and known symptom) in women who are pregnant.

Pre-eclampsia most commonly occurs after the 20th week of pregnancy, in those women who are affected by this condition. The high blood pressure of women with pre-eclampsia usually returns back to normal after they deliver their baby.

Around 5-10% of all women in Australia will develop pre-eclampsia during their pregnancy. Only about 1-2% of all pre-eclampsia cases are dangerous enough to threaten the lives of both the mother and the unborn foetus.

Pre-eclampsia is one of the most common reasons for early induction of pregnancy and for recommendation of a caesarian birth.

Pre-eclampsia symptoms

Pre-eclampsia generally presents with no obvious symptoms initially, so it is often hard to detect until symptoms are more pronounced. This is why it is very important for pregnant women to have regular ante-natal care to closely monitor their progress throughout the pregnancy and to prevent complications of pre-eclampsia before they occur.

Pre-eclampsia most commonly causes the following symptoms:

• High blood pressure (higher than normal)
• Proteins in the urine
• Fluid retention, especially of the feet, face or hands that suddenly occurs or gets worse (fluid retention is also a common symptom of a normal, healthy pregnancy too which is why it is so important to regularly check blood pressure during pregnancy)

More serious symptoms of pre-eclampsia are:

• Headaches
• Blurring of vision or any other type of visual problems
• Abdominal pain (usually in the upper abdomen, under the ribs)
• Basically “just not feeling right”

Causes of pre-eclampsia

The cause of pre-eclampsia is not known, but since it does occur more in some families than others, there could be a genetic basis to this condition.

Scientists believe pre-eclampsia is most likely due to a problem with the placenta (the attachment between the unborn baby and the mother’s uterus).

The most common theory for pre-eclampsia is that the blood vessels in the placenta do not develop properly which may affect the transfer of oxygen and nutrients to the unborn baby.

Risk factors for pre-eclampsia

While it is not possible to predict with a great deal of accuracy which women will develop pre-eclampsia, certain women are more at risk than others:

• Women having their first pregnancy
• Women who have diabetes
• Women who are obese
• Women pregnant with multiple foetuses
• Women who are either younger (under 18) or older (over 45) and this is their first pregnancy
• Women with any type of kidney disease
• Women with any type of cardiovascular disease
• Women with pre-existing high blood pressure (and this can be either a diagnosed or undiagnosed condition)
• Women with a family history of pre-eclampsia (mother, grandmother have experienced it)

How is pre-eclampsia diagnosed?

Pre-eclampsia is normally diagnosed through the following tests:

• Blood pressure test – to determine if blood pressure is normal or too high. Normal blood pressure is around 120/80 mmHg; Mildly high blood pressure is between 140/90 mmHg – 160/100 mmHg; moderate to severely high blood pressure is over 160/100 mmHg
• Urine test – if blood pressure is high and pre-eclampsia is suspected, a urine test can confirm if there are any proteins in the urine

The best way to ensure that pre-eclampsia does not get worse and does not cause serious complications is to have regular ante-natal checks to monitor blood pressure for any signs of this condition.

How is pre-eclampsia treated?

There are a few treatments that are available for pre-eclampsia:

Delivering the baby early

The only total cure for pre-eclampsia is to deliver the baby (babies), because the mother’s blood pressure normally returns back to normal after delivery and the other symptoms usually abate too.

If the pre-eclampsia occurs late in pregnancy, it is normal practice for the obstetrician to recommend early delivery, either through induced labour or caesarian birth. The risk for the baby is quite small.

The decision to deliver early needs to be based on several factors, including:

• Risk of complications occurring
• The severity of the pre-eclampsia (how high is the blood pressure and how much protein is in the urine); if the pre-eclampsia is not too bad, delivery is usually postponed until closer to full term, otherwise if it is severe, then delivery is advised sooner
• If the baby is being adversely affected
• The chance of premature baby doing well or better in a hospital than in an unviable womb with possible complications occurring

Other treatments

There are other treatments which can be used until the baby is safely delivered:

Magnesium sulphate

Studies show that when pregnant women with pre-eclampsia are given a magnesium sulphate supplement, it reduces their risk of developing eclampsia by about 50%. This is because magnesium sulphate is an anticonvulsant (and eclampsia is a condition which causes convulsions). Magnesium sulphate prevents eclampsia better than any other anticonvulsant medications and it is safe to use while pregnant (it does not adversely affect the baby). Magnesium sulphate is usually given by drip, by the doctor at the hospital, directly into a vein and is usually given at the time of delivery. This should not be self-prescribed!

Blood pressure medication

Some women are advised to take blood pressure medication for a short time if their pre-eclampsia is too severe. The blood pressure medication reduces symptoms, risk of complications and helps the pregnancy to progress further before delivery is required. Women taking blood pressure medication to manage their pre-eclampsia need to be strictly monitored by their obstetrician or family doctor. Examples of blood pressure medications are: Adalat, Nifecard, Aldomet

Bed rest

Bed rest is often advised for women with pre-eclampsia, but there isn’t much evidence that it makes much of a difference. It is though, common practice to admit women with severe pre-eclampsia to hospital, to monitor them and their unborn baby.

What are possible complications of pre-eclampsia?

Most women who have pre-eclampsia while pregnant do not develop serious complication, but some do. The risk of serious complications of pre-eclampsia depends mostly on the severity of the pre-eclampsia – the more severe it is, the more likely there will be serious complications.

Ante-natal care is mandatory for all pregnant women, but especially for those women in the higher risk groups, to reduce their risk of developing pre-eclampsia, treating it if it does occur, managing it properly to reduce risk of complications, thus ensure their pregnancy is as healthy as possible.

The risk of complications from pre-eclampsia is greatly reduced by early diagnosis, treatment and management.

Complications for the pregnant mother

There are a number of serious complications of pre-eclampsia that can occur for the pregnant mother, including:

• Abruptio placentae – this causes the placenta to separate from the uterine wall. This can cause vaginal bleeding and abdominal pain. This is a serious complication and requires emergency medical treatment to save the life of the mother and unborn baby
• Eclampsia – this is a type of seizure (convulsion) which is life-threatening. About 1% of women with pre-eclampsia develop this condition
• Blood clotting disorder – this is the inability of the blood to clot properly and can cause severe bleeding (leading to death if it is not stopped)
• Liver, kidney, lung problems – the proper function of any (or all) of these organs can be adversely affected
• HELLP syndrome – “haemolysis, elevated liver enzymes and low platelets”. This occurs in about 20% of women who have severe pre-eclampsia and causes serious bleeding. This is a serious complication and requires emergency medical treatment to save the life of the mother and unborn baby
• Stroke – bleeding into the brain, which causes possible brain damage and even ultimately possible death

Complications for the unborn baby

There are a number of serious complications of pre-eclampsia that can occur for the unborn baby, including:

• Abruptio placentae – this causes the placenta to separate from the uterine wall. This can cause vaginal bleeding and abdominal pain. This is a serious complication and requires emergency medical treatment to save the life of the mother and unborn baby
• Poor blood supply – if the baby does not get adequate blood supplying proper oxygen and nutrients, this can cause growth retardation to the baby. In general, babies born to women with pre-eclampsia tend to be smaller
• Stillbirth – another complication of pre-eclampsia is an increased risk of delivering a deceased baby

How is pre-eclampsia managed in pregnancy?

All pregnant women should be referred to an obstetrician (specialist who delivers babies) before they are 20 weeks pregnant if they are in any of the following high risk categories for pre-eclampsia:

• Women having their first pregnancy
• Women who have diabetes
• Women who are obese
• Women pregnant with multiple foetuses
• Women who are either younger (under 18) or older (over 40) and this is their first pregnancy
• Women with any type of kidney disease
• Women with any type of cardiovascular disease
• Women with pre-existing high blood pressure (and this can be either a diagnosed or undiagnosed condition)
• Women with a family history of pre-eclampsia (mother, grandmother have experienced it

The obstetrician will make an assessment of your risk of developing pre-eclampsia (or possible complications) and will recommend a treatment plan for you. Regular check-ups on a monthly (or fortnightly) basis will be advised to ensure you have the best care possible.

Is pre-eclampsia preventable?

There is some evidence that pre-eclampsia may be somewhat prevented in some women through the use of the following:

• Adequate intake of fish or fish oil – there is some evidence to suggest that eating fish high in omega-3 fatty acids (oily fish such as mackerel, salmon, sardines, trout and tuna), or using a fish oil supplement may play a part in either preventing pre-eclampsia occurring in the first place or preventing worsening of symptoms. This is because these types of fish help to improve circulation, thin the blood (and so reduce risk of clotting) and may also reduce blood pressure. Larger studies need to be done to confirm this as a recommended course of action for women at the highest risk of developing pre-eclampsia
• Adequate protein – there is some evidence to suggest that a diet with adequate intake of protein (between about 80g-100g per day) may assist in
• Low dose aspirin – there is some evidence that low dose aspirin can help prevent worsening of pre-eclampsia symptoms in some women
• Calcium rich foods – some evidence suggest that a diet rich in calcium may help to reduce the possibility of the condition worsening
• Magnesium rich foods – there is evidence that people who eat foods high in the mineral magnesium tend to have lower blood pressure in general. There has been no research yet to suggest that taking magnesium supplements helps prevent pre-eclampsia
• Vitamin D – there is some evidence to suggest that women who have adequate levels of vitamin D in their body are less likely to develop pre-eclampsia, especially with more serious complications. The research is limited on this, so more studies are needed to determine exactly how the vitamin from sunshine affects the body in pregnant women to possibly prevent pre-eclampsia
• Water – this is vitally necessary to reduce likelihood of dehydration in both the mother and unborn baby

Pregnant women should never self-prescribe with any medication or supplement and only take the above if they are recommended by their obstetrician specialist.

Note: Women who are at a higher risk of developing pre-eclampsia should discuss their alternative options with their obstetrician specialist before trying them because this is a serious and potentially fatal condition and needs extra care.

References

• Brown MA. Preeclampisa: a lifelong disorder. MJA 2003; 179 (4): 182-184
• DeCherney, Pernoll. Current Obstetric and Gynecological Diagnosis and Treatment, 8th ed. eMedicine 2004
• Duley L, Gulmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia (Review). 2007; 3: 6-14
• Impey L. Obstetrics and Gynecology. 2nd ed. USA: Blackwell; 2006
• Norwitz ER Repke JT. Acute complications of Preclampsia. Clinical Obstetrics and Gynecology 2002; 45 Suppl 2: 308-29
• Osieki H. The Physicians Handbook of Clinical Nutrition, 2nd edition. BiConcepts 2002
• Stoppard M. New Pregnancy and Birth: A Practical Guide for All Parents To Be. Dorling Kindersely, UK, 2007

Last reviewed and updated: 27 June 2024

General facts about caesarean birth

Today, having a baby by caesarean is very common – around 30% of all births in Australia are performed as caesarean birth.

While caesarean birth is a very common surgery in Australia, it is important to know that it is major abdominal surgery, which requires at least six weeks for the pregnant woman to recover fully. The caesarean requires an incision (or cut) to be made in the mother’s abdomen, as well as another incision (or cut) in the uterus, so the baby can be lifted out.

Caesarean can be performed either with general anaesthetic (the pregnant woman is not awake) or, if the pregnant woman has already had an epidural, she can remain conscious throughout the actual operation, as her lower spine (and associated organs) have been anaesthetised by the epidural.

Caesarean is also known as caesarean section, or c-section.

Caesarean birth: step-by-step

The caesarean surgery, in detail and step-by-step:

• Drip inserted – a drip will be inserted into your arm for the medications (pain relief and anti-nausea) and fluids
• Anaesthetics given – a local anaesthetic will be administered to the area where the spinal block and epidural will be given; the spinal block will numb you from the chest down and the epidural will numb you from the waist down (both require stillness when they are given, as they are both injected into the spine)
• Catheter inserted and abdomen screened – a catheter will be inserted into your bladder and your abdomen will be swabbed for the incision; your stomach area will be screened so that you do have to view your insides
• Incisions – the surgeon will make a cut in your abdomen and once through it, will make another cut in your uterus
• Baby pulled out – your baby will be pulled out of your uterus and you may feel a slight tugging sensation, or just some pressure as the baby comes out (but you should not feel any pain)
• Umbilical cord is cut – the umbilical cord will be cut, the baby will be checked for any obvious health issues and then you will be able to hold your baby
• Medications given – you could be given some antibiotics to prevent infection and some oxytocin to shrink your uterus
• Placenta is removed – the placenta will be removed from the uterus, after which your uterus and abdomen will be stitched up; your partner will also be able to hold the baby if it has been given the okay for health
• Back to your room – after all checks have been completed on you and your baby, you will be able to go back to your room, where you will rest at first, but within a few hours of going back to your room, you will be encouraged to take some steps to help aid your recovery
• Painkillers given – you will be given painkillers to take in the first few days after the caesarean, as you will be in pain from the major surgery; the stitches in your uterus will be dissolvable ones and will have dissolved after a few days, while the ones in your abdomen will need to be removed after about five days

Full recovery from the caesarean surgery will take approximately six weeks, due to the seriousness of the surgery. You should not lift anything heavy nor should you do any heavy manual work or exercise. Moderate, very low impact exercise such as walking, swimming, some types of yoga and pilates are recommended.

Elective caesarean birth

Some women may elect to have a caesarean prior to the birth, for one or a combination of any of the reasons below:

• low lying placenta (placenta praevia)
• the baby is in an abnormal position and natural birth is not possible
• an active genital herpes infection
• the baby’s head is too big to go through the birth canal (pelvis), which is called a “known cephalopelvic disproportion”
• pre-eclampsia
• problems with a previous birth
• breech presentation
• poor placental function
• multiple babies
• diabetes

The advantages of having an elective caesarean procedure is that it can be scheduled for a particular day and planning for the birth can be easier.

Today, more and more women are electing to have a caesarean which does not have anything to do with any of the reasons above and there is some concern about this procedure being performed unnecessarily.

Complications of birth leading to caesarean birth

There are some situations during birth, which require a caesarean to be performed, otherwise the life of the mother or baby could be at risk:

• Cord prolapse – if the umbilical cord slips down the cervix before the baby has come through, this could mean that when the baby does descend through the cervix, the umbilical cord could get squashed or compressed and this will cut off the baby’s oxygen supply; in some cases, the umbilical cord can be freed, but in general, a caesarean will be performed, usually as an emergency procedure
• Foetal distress – if the mother’s water breaks and in the clear liquid, there is some greenish-coloured substance (called meconium, it is baby’s first poo), this is a warning that the baby is in distress; or if during monitoring of the baby’s heart beat, a change is detected that indicates possible distress of the baby. If distress of the baby is suspected and the mother is not close to delivering the baby naturally, then caesarean will be performed
• Excessive bleeding – if there is an excessive amount of bleeding during birth, for any reason, a caesarean will be performed, and it will be an emergency procedure as both mother and baby’s lives could be in danger
• Breech birth – if the baby’s head is not descending correctly or if the baby’s feet are trying to come through the birth canal first, then caesarean birth will be performed
• Lack of progress – if the birthing process is slow or the contractions are not dilating (opening up) the cervix enough, the doctor or midwife will either relax or stimulate the mother (through getting the mother to sleep, take a walk, change positions or even give the mother oxytocin or helping the mother’s waters to break); if both the mother and baby doing well and not distressed by the extended labour, it will be allowed to continue, but if it continues for over 24 hours, the doctor or midwife will recommend caesarean

If caesarean is recommended during birth, it is advisable to go ahead with it (even if a natural birth was the goal of the birth), as it could mean saving the life of the mother and child.

Emergency caesarean birth

Emergency caesarean surgery is performed when something goes seriously wrong in labour and either the mother or the baby’s lives (or both) are in serious danger.

In Australia, the mother will be asked to sign the consent form for the caesarean before it is performed and her partner will not be able to stay while the surgery goes ahead, due to the seriousness of the situation. The mother will be given a general anaesthetic for the caesarian surgery.

Advantages of caesarean birth

There are a few advantages of having a caesarean birth, some of which are below:

• the baby is born in a safe and controlled environment
• the mother’s perineum remains intact
• the baby’s birth can be scheduled and the mother can plan accordingly
• the mother does not have to feel the pain of labour and can enjoy the birth (as long as there are no complications and it is not an emergency caesarean birth)

Disadvantages of caesarean birth

There are a few advantages of having a caesarean birth, some of which are below:

• it is major abdominal surgery which carries risk – damage to the mother’s organs and infection
• there is a higher risk that the baby may suffer respiratory distress (doesn’t immediately breath) as it did not go through the birth canal
• the mother is immobile for a few hours, as the drugs used to numb the body take a while to wear off, plus the mother will still have a drip and catheter in place during this time
• mother’s recovery time is much longer (around six weeks) than for a natural birth, so certain activities are restricted during this time so recovery is not compromised
• bonding with the baby may be delayed, as some mothers will not be able to hold the baby immediately after the caesarean birth (especially so if there were any complications, which need further care and monitoring of the baby)
• some women feel disappointed or guilty, as they were not able to have a natural birth

References

• Co-op America: Greener Path: Recyclable Plastic, Jan/Feb 2006. Accessed 21 November 2008
• Department of Health and Human Services: Agency for Toxic Substances and Disease Registry (ATSDR) – Polystyrene, Toxological Profile. http://www.atsdr.cdc.gov/toxprofiles/tp53-c2.pdf – accessed 30 December 2008
• Department of Health and Human Services: Agency for Toxic Substances and Disease Registry (ATSDR) – Vinyl Chloride, Toxological Profile. http://www.atsdr.cdc.gov/toxprofiles/tp20.html – accessed 30 December 2008
• Environmental Working Group. Bottled Water Quality Investigation: 10 Brands, 38 Pollutants. October 2008. Accessed 21 November 2008
• Greenpeace. Austrian Study Finds Eating GE Corn May Reduce Fertility. 12 Nov 2008. Accessed 30 December 2008
• MotherLove.com – Bodycare Ingredients to Avoid. Accessed 28 November 2008
• Osieki H. The Physicians Handbook of Clinical Nutrition, 2nd edition. BiConcepts 2002
• Stoppard M. New Pregnancy and Birth: A Practical Guide for All Parents To Be. Dorling Kindersely, UK, 2007

Last reviewed and updated: 14 May 2024