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Melanie Cole (Host):  What are some of the most important steps a woman can take to have a healthy pregnancy that will benefit both mom and baby? My guest today is Dr. Vanessa Gregg. She is a board certified obstetrician and gynecologist at UVA Health System. Welcome to the show, Dr. Gregg. When should women start preparing to have a healthy pregnancy? How soon before they get pregnant should they start thinking about these things?

Dr. Vanessa Gregg (Guest):  It’s always a good idea for a woman to check in with her healthcare provider before she becomes pregnant, if at all possible. Some of the things to focus on at that pre-conception visit include any health conditions or medications that may affect planning for a healthy pregnancy. In addition, the provider can look at vaccines and make sure that the woman is up to date on those things. Then, just thinking about planning for a healthy diet and a healthy exercise program going into pregnancy to optimize that healthy state at the beginning of pregnancy. In particular, also, I think it is valuable to start a vitamin in advance of becoming pregnant because it’s really helpful to have a good level of folic acid, in particular, in the system at the time of conception.

Melanie: What are some of the common misconceptions about what women should and shouldn’t do before and during pregnancy?

Dr. Gregg:  Certainly, before pregnancy most women don’t need to make very many adjustments, if any, particularly if they already are at a healthy body weight, have a healthy lifestyle and generally not struggling with any serious health problems. During pregnancy, similarly, most women can continue to do most of the things that they were doing before. Women can exercise, travel and enjoy most of the things that they enjoyed before pregnancy.

Melanie: Okay. So, they can? Women drink and then they say, “Oh, I didn’t realize I was pregnant and I had some drinks.” What do you tell women about alcohol when they’re thinking about getting pregnant but not there yet.

Dr. Gregg:  Because we don’t know what amount of alcohol could be safe in pregnancy, our general assumption is that no amount of alcohol is safe during pregnancy. Lots of times we hear of women who had a glass of wine and then figured out that they were pregnant. Probably if it’s a small amount and it’s very early on, that probably isn’t going to have any serious impact on the pregnancy. I think that this is an area where it can be challenging for women to make these kinds of decisions because there are some health bodies actually that suggest that women who are contemplating pregnancy should give up alcohol entirely. I think the key is if a woman is in tune with her body, she’s aware of when she is likely to become pregnant and then avoid alcohol if pregnancy is likely already underway. I think that that is probably the safest approach that we can confidently recommend.

Melanie:  Let’s start talking about things like prenatal vitamins. What are we looking for in those?

Dr. Gregg:  There are lots of different prenatal vitamins on the market. For the most part, I think almost anything that a woman picks up that is labeled as prenatal vitamins is probably going to be fine. The key things are they are going to have a range of general nutrients. They are going to avoid the things that are thought to be contraindicated for pregnant women. The focus is really on folic acid and then, iron is another important component of prenatal vitamins, which is a little bit different from other women’s vitamins. Another thing that’s become a popular component of women’s prenatal vitamins is DHA. DHA is thought to help promote healthy brain development. DHA can be gotten in the diet through leafy green vegetables, fish and sometimes other dietary sources. Probably not all women get enough of those fatty acids from their diet and so manufacturers have started putting DHA in prenatal vitamins. What I tell women is, I don’t think that DHA in a prenatal vitamin is going to hurt and it may help. We don’t know for sure how much of that DHA is easily accessible out of a vitamin compared to if it comes from a dietary source. I do think a prenatal with DHA in it is a reasonable thing to do.

Melanie:  What about exercise? Especially in those early days, if someone has been an exerciser can they continue right through their pregnancy or is that not the time to start an exercise program if you’ve never exercised?

Dr. Gregg:  Women who are already exercising and have a healthy exercise program going should definitely plan to continue that during pregnancy. Even women who have not been exercising prior to pregnancy should plan to work with their healthcare provider and design a safe program for exercise during pregnancy. We know that exercising is good for almost everyone and certainly good for almost all pregnant women. Of course, there will be some exceptions and that’s something the individual woman will want to discuss with her healthcare team. For most women, pregnancy is a time where exercise is safe and appropriate and can help reduce the risk of excessive weight gain and even, in some cases, help reduce the risk for gestational diabetes during pregnancy.

Melanie:  Are there some types of exercise you’d like to recommend and some types that you would like women to stay away from?

Dr. Gregg: In general, we want to pick activities that are low impact and thought to be safe during pregnancy. Some of the best choices would be walking, swimming, using a stationary bicycle, low impact aerobics. Some yoga and Pilates could be a good idea but there are certain poses and positions that would be desirable to avoid. Any woman who is going to do yoga or Pilates in pregnancy should just check in with her instructor or with her healthcare provider to make sure that she is making good choices. There are lots of things in those areas – yoga and Pilates and mat based activities--that can be great during pregnancy. In terms of activities to avoid – the biggest things to avoid would be high impact activities like sports where you might be struck in the abdomen. That is something that you would want to avoid during pregnancy. Things that could have extreme effects on the oxygen demands – so scuba diving, sky diving, things at high altitude or underwater--may be challenging though basic swimming at a pool like the YMCA or something like that would be very reasonable.

Melanie:  What else would you like women to know about a healthy pregnancy and, specifically, nutrition and healthy eating during pregnancy?

Dr. Gregg:  A lot of the things that are recommended for diet during pregnancy are the same as what we would recommend for all women in general. That is to focus on lean protein, lots of fruits and vegetables, low fat dairy products. Protein is certainly an important component of the diet for pregnant women. There are some things that are a little bit different and are to be avoided during pregnancy. In particular, that would be raw meat, raw fish and with fruits and vegetables, it is important to make sure that things are carefully washed and that the risk for infection from food is minimized just by careful food handling.

Melanie:  So important. In just the last few minutes, Dr. Gregg, give women your best advice when they’re thinking about getting pregnant all the way through their pregnancy and even after and what you tell women every single day about the best keys to a healthy pregnancy.

Dr. Gregg:  I think it’s just so valuable to approach pregnancy with a positive attitude and to feel confident that if a woman is taking good care of herself and her body, she is very likely to have a healthy pregnancy. I think focusing on just general good nutrition and low impact exercise is a good recipe for a healthy pregnancy.

Melanie:  Why should women come to UVA Health Systems for their pregnancy care?  

Dr. Gregg:  At UVA, we have a wonderful team of doctors, nurses, nurse midwives and other members of our team who are in a great position to take wonderful care of women during pregnancy and birth and beyond. We have a wonderful breast feeding medicine team. We are a baby friendly hospital. We work very hard to keep moms and their babies together and to promote bonding and breast feeding for our families. I think it is also wonderful that we have all the resources that any mom and baby and family could need in the hospital – every resource, every expertise that someone might need during their birth and postpartum care.

Melanie:  What great information. Thank you so much, Dr. Gregg, for being with us today. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.