A healthy pregnancy rests on a few simple steps that health services recommend. The checklist below sets them out, and the rest of this guide explains each one, with links to the organisations behind the advice.
Advice differs a little between countries. Where it does, we say so, and your midwife or doctor can tell you what applies to you.
Your healthy pregnancy checklist
These eight steps cover the essentials:
- Take 400 micrograms of folic acid every day, from before you conceive until at least 12 weeks (NHS guidance on pregnancy vitamins).
- Contact a midwife, doctor or maternity service as soon as you know you're pregnant.
- Eat a varied diet, and avoid or thoroughly cook the foods most likely to carry infection. You don't need to eat for two.
- Don't drink alcohol, and get support to stop smoking.
- Stay active: the NHS suggests aiming for 150 minutes of moderate activity a week (NHS guidance on exercise in pregnancy).
- Ask which vaccines are recommended in pregnancy where you live.
- Get to know your baby's usual movements, and call straight away if they slow down or change (NHS guidance on baby movements).
- Learn the warning signs that need urgent care, and save your maternity unit's number in your phone.
Start your antenatal care early
Contact a midwife, doctor or local maternity service as soon as you know you're pregnant. In the UK, for example, the first full appointment (often called the booking appointment) usually happens between 8 and 12 weeks (NHS guide to antenatal care).
At that first appointment, you'll be asked about your health, any conditions you have, and past pregnancies. Your blood pressure and urine are checked at many appointments. This helps spot conditions such as pre-eclampsia early, before you'd notice symptoms (NHS guidance on pre-eclampsia).
You can contact your maternity service at any time if you're worried; you don't have to wait for your next appointment. Your maternity notes should include useful numbers, such as your maternity unit's. Save them in your phone, and keep your notes with you in case you need urgent care (NHS guide to antenatal care).
Supplements: what to take and what to skip
Folic acid is the key supplement for early pregnancy, and the NHS also advises vitamin D. Whether you need iron or calcium depends on your circumstances.
Folic acid
Folic acid helps prevent serious birth defects of the baby's brain and spine, called neural tube defects, such as spina bifida. These develop in the first weeks of pregnancy, often before you know you're pregnant (CDC: about folic acid).
Take 400 micrograms every day. Ideally, start at least a month before you conceive (CDC) and continue until at least 12 weeks. If you didn't take it beforehand, start as soon as you find out you're pregnant (NHS guidance on pregnancy vitamins).
It's hard to get enough folate from food alone, so take the supplement even if you eat plenty of leafy greens and fortified cereals (NHS).
Some people need a higher dose, which is available on prescription. This includes people who (NHS; CDC):
- have diabetes
- take medicine for epilepsy, or anti-retroviral medicine for HIV
- have had a pregnancy affected by a neural tube defect
- have a neural tube defect, or a family history of one (this also applies to the baby's biological father)
If any of these apply to you, talk to your doctor, ideally before you try to conceive.
Vitamin D
Vitamin D helps your body control calcium and phosphate, which keep your bones, teeth and muscles healthy (NHS).
In the UK, the NHS recommends a daily 10-microgram supplement, at least from September to March. If you have dark skin or usually cover your skin outdoors, you may need it all year, so ask your midwife or doctor. Don't take more than 100 micrograms a day, as too much could be harmful (NHS).
Vitamin D advice varies between countries, so check what's recommended where you live.
Iron and calcium
Iron advice also differs between countries. The WHO recommends daily iron and folic acid supplements in pregnancy to help prevent anaemia, low birth weight and premature birth (WHO recommendation on iron in pregnancy). In the UK, the NHS advises an iron supplement if a blood test shows your iron is low (NHS).
Your iron levels are checked with blood tests during antenatal care, so ask whether you need a supplement (NHS guide to antenatal care). Iron supplements can cause constipation. If they do, ask your doctor whether you can switch to a different type (NHS guidance on common pregnancy problems).
Calcium helps build your baby's bones and teeth. Good sources include milk, cheese and yoghurt, calcium-fortified soya drinks, tofu, green leafy vegetables, and fish with edible bones, such as sardines (NHS).
Some people at higher risk of pre-eclampsia are prescribed calcium if they don't get enough from food. Don't start calcium supplements unless your midwife or doctor advises it (NHS guidance on pre-eclampsia).
Supplements to avoid
Don't take cod liver oil or any supplement containing vitamin A (retinol), as too much vitamin A could harm your baby. If you take a multivitamin, check the label to make sure it contains no vitamin A (NHS).
What to eat, limit and avoid
You don't need a special diet in pregnancy, but a few foods are best avoided or cooked thoroughly (NHS guidance on a healthy diet in pregnancy).
You don't need to eat for two
You may feel hungrier than usual, but you don't need to 'eat for two', even if you're expecting twins or triplets (NHS).
Aim for a varied diet with at least 5 portions of fruit and vegetables a day, starchy foods (choosing wholegrain or higher-fibre options), some protein every day, and dairy or calcium-fortified alternatives (NHS).
If you're hungry between meals, try fresh fruit, plain or lower-sugar yoghurt, a small sandwich with salad, vegetable or bean soup, or unsweetened cereal or porridge with milk (NHS). Peanuts and peanut butter are fine unless you're allergic or have been told to avoid them (NHS guidance on pregnancy vitamins and nutrition).
Foods to avoid or cook thoroughly
Some foods can carry infections such as listeria and toxoplasma. The risk is low, but these infections can cause miscarriage or stillbirth, or make a newborn baby seriously ill (NHS guidance on foods to avoid in pregnancy).
Avoid these, or cook them until steaming hot where shown (NHS):
- Raw or undercooked meat. Cook meat until it's steaming hot, with no pink or blood.
- Raw fish and shellfish, including sushi made with raw fish.
- Unpasteurised milk, cream, yoghurt and ice cream.
- Soft mould-ripened cheeses (such as brie and camembert) and soft blue cheeses, unless cooked until steaming hot. Pasteurised hard cheeses, such as cheddar and parmesan, are fine.
- Cold cured meats (such as salami and chorizo) and cold-smoked fish (such as smoked salmon), unless cooked until steaming hot.
- Liver and liver products, which are high in vitamin A.
- Game, such as venison or pheasant, which may contain lead.
US advice also says to heat deli meats, cold cuts and hot dogs until steaming hot before eating them (CDC guidance on preventing listeria). Wash fruit, vegetables and salad well to remove any soil, which can carry toxoplasma (NHS). Keep pre-packed sandwiches and salads chilled, and eat them before their use-by date (NHS).
Fish, caffeine and herbal tea
Fish is a healthy choice. The NHS suggests 2 portions a week, including 1 of oily fish such as salmon, sardines or mackerel. But have no more than 2 portions of oily fish a week, as it can contain pollutants (NHS).
Limit tuna to 4 cans or 2 tuna steaks a week, and avoid shark, swordfish and marlin (NHS).
Too much caffeine has been linked to a higher chance of miscarriage and stillbirth, so the NHS advises no more than 200 mg a day. As a rough guide, a cup of instant coffee has about 100 mg, and filter or coffee-shop coffee often has more. A cup of tea has about 75 mg, a can of cola about 40 mg, and a 250 ml can of energy drink about 80 mg (NHS).
There's little research on herbal teas in pregnancy. The NHS suggests no more than 4 cups a day, and avoiding any tea that contains liquorice root (NHS).
Alcohol, smoking and medicines
Alcohol and tobacco can both harm your baby, and it's never too late to stop either (CDC guidance on alcohol and pregnancy; NHS guidance on stopping smoking in pregnancy).
Alcohol
There's no known safe amount of alcohol in pregnancy, and no safe time to drink (CDC). The safest choice is not to drink at all (NHS guidance on alcohol in pregnancy).
Alcohol passes through the placenta to your baby. It can cause fetal alcohol spectrum disorder (FASD), a lifelong condition that can affect learning, behaviour and physical development. The more you drink, the greater the risk (NHS).
If you find it hard to stop, talk to your midwife, doctor or pharmacist. Confidential support is available (NHS).
Smoking
Stopping smoking is one of the best things you can do for your baby, and it helps even in the last few weeks of pregnancy. It lowers the risk of stillbirth, premature birth, low birth weight and sudden infant death syndrome (SIDS) (NHS).
Second-hand smoke can harm your baby too, and it can be harder to quit if people around you smoke. Ask your midwife about stop-smoking support. Nicotine replacement, such as patches or gum, can be used in pregnancy if you can't stop without it (NHS).
Medicines
Check with a pharmacist, midwife or doctor before taking any medicine in pregnancy (NHS guidance on common pregnancy problems). If you already take a prescribed medicine, tell your doctor as soon as possible, but don't stop taking it until you've spoken to them (NHS guidance on mental health in pregnancy).
Staying active safely
Exercise is safe for you and your baby in pregnancy, and it's usually fine to carry on with activities you already do (NHS guidance on exercise in pregnancy).
The NHS recommends aiming for 150 minutes of moderate activity a week, including 2 sessions of muscle-strengthening exercise. Moderate activity makes you breathe faster and feel warmer: you can still talk, but not sing. Walking, swimming and yoga all count (NHS).
Regular activity is linked to a lower risk of gestational diabetes and pre-eclampsia, and can help your sleep, mood and mental health (NHS). The WHO also links it to a lower risk of excessive weight gain in pregnancy and of depression after the birth (WHO fact sheet on physical activity).
If you're new to exercise, start with about 10 minutes a day and build up gradually. Don't take up a new vigorous activity, such as running, while pregnant. If you have a health condition, ask your midwife which activities are safe for you (NHS).
To exercise safely (NHS):
- avoid sports with a risk of falling or of a blow to your bump, such as hockey, rugby or mountain biking
- don't scuba dive
- don't exercise on an empty stomach, as it could make you feel faint
- drink water, keep cool, and tell any instructor that you're pregnant
- later in pregnancy, avoid lying flat on your back for more than a few minutes
- stop if you feel uncomfortable, too hot or unwell
If you notice any of the warning signs listed under 'When to get medical help' below, stop and get help straight away.
Easing common discomforts
Pregnancy discomforts are rarely a cause for alarm, but mention anything that worries you to your maternity team (NHS guidance on common pregnancy problems).
Nausea and vomiting
Nausea and vomiting, often called morning sickness, are very common in early pregnancy and can happen at any time of day. Hormone changes are thought to be one cause. It usually eases by 16 to 20 weeks and doesn't put your baby at increased risk (NHS guidance on morning sickness).
These may help (NHS):
- get plenty of rest, as tiredness can make nausea worse
- eat small, frequent meals of plain, starchy food, such as toast, crackers, rice or pasta
- avoid foods and smells that make you feel sick
- sip fluids little and often
- try foods or drinks containing ginger (check with a pharmacist before taking ginger supplements)
Contact your midwife or doctor if you're vomiting and (NHS):
- you can't keep food or fluids down for 24 hours
- your urine is very dark, or you haven't peed for 8 hours
- you feel very weak, dizzy or faint when you stand up
- you have tummy pain or a high temperature
- you vomit blood, or you're losing weight
A severe form of pregnancy sickness, called hyperemesis gravidarum, can need specialist treatment, sometimes in hospital (NHS).
Heartburn and constipation
Heartburn and indigestion are common, especially from about 12 weeks. Hormone changes relax the muscle between your stomach and gullet, and your growing baby presses on your stomach (NHS guidance on heartburn in pregnancy).
It can help to eat smaller meals more often, avoid eating in the 3 hours before bed, sit up straight when you eat, and prop up your head and shoulders in bed. If you need medicine, ask a pharmacist and tell them you're pregnant. Don't take antacids within 2 hours of folic acid or iron, as they can stop these being absorbed (NHS).
Hormone changes can also cause constipation. Fibre-rich foods (such as wholemeal bread and cereals, fruit, vegetables, beans and lentils), plenty of water and regular exercise can help (NHS).
Feeling faint, and sleeping on your side
You may feel faint in pregnancy, usually because of hormone changes. Get up slowly after sitting or lying down. If you feel faint while lying on your back, turn onto your side (NHS).
After 28 weeks, avoid going to sleep on your back, as this has been linked to a higher risk of stillbirth (NHS).
Gums and teeth
Red, swollen gums are common in pregnancy. The CDC estimates that 60% to 75% of pregnant women have gingivitis, an early stage of gum disease that changing hormones can make worse (CDC guidance on oral health in pregnancy).
Keep brushing your teeth and cleaning between them every day. Dental care is safe and important in pregnancy, so keep up your check-ups (CDC).
Gum disease has been linked with premature birth and low birth weight, but how they are connected isn't fully understood (CDC).
Vaccines to ask about
Some vaccines are recommended in pregnancy because they protect you and pass protection to your baby for their first months. Schedules differ between countries and are updated from time to time, so ask your midwife or doctor which vaccines are offered where you live.
Whooping cough (pertussis)
Whooping cough can be life-threatening for newborns. According to the CDC, about 7 in 10 deaths from whooping cough are in babies under 2 months old. Many babies with whooping cough don't cough at all; instead, it can make them stop breathing (CDC guidance on vaccines in pregnancy).
Antibodies from the vaccine pass to your baby and protect them until they're old enough for their own vaccination (NHS guidance on vaccinations in pregnancy). The NHS usually offers it at around 20 weeks (from 16 weeks, ideally before 32 weeks). US guidance recommends it in every pregnancy, ideally between 27 and 36 weeks (CDC guidelines for vaccinating pregnant women).
Flu
Pregnancy makes flu more likely to lead to complications such as pneumonia, and to a hospital stay. The NHS recommends the flu vaccine in pregnancy (NHS).
Flu vaccination in pregnancy has also been linked to fewer flu infections in babies in their first months, when they're too young for their own flu vaccine (CDC).
RSV
RSV (respiratory syncytial virus) usually causes coughs and colds, but it can cause serious lung infections in babies. An RSV vaccine in pregnancy makes your baby less likely to get severe RSV in their first 6 months (NHS).
The NHS offers it from around 28 weeks. US guidance is a single dose at 32 to 36 weeks, given between September and January, or an antibody injection for the baby instead (CDC).
Vaccines usually avoided
Live vaccines, such as MMR (measles, mumps and rubella), aren't usually given in pregnancy. If you need one, you'll usually be advised to wait until after your baby is born (NHS).
Your baby's movements
There's no set number of movements you should feel each day. What matters is any change in your baby's usual pattern (NHS guidance on baby movements; CDC list of urgent maternal warning signs).
You'll usually start to feel movements between 16 and 24 weeks. In a first pregnancy, you might not notice them until after 20 weeks. If you haven't felt your baby move by 24 weeks, tell your midwife (NHS).
You don't need to count kicks. Instead, get to know your baby's usual pattern from day to day. You should feel your baby move right up to and during labour (NHS).
Call your midwife or maternity unit straight away if your baby is moving less than usual, you can't feel them moving, or their usual pattern changes. Don't wait until the next day, even if it's the middle of the night (NHS).
Don't use a home heartbeat monitor (doppler) to check on your baby. Even if you hear a heartbeat, it doesn't mean your baby is well (NHS).
Looking after your mental health
Pregnancy can be stressful. Some people have depression or anxiety for the first time, and others find that earlier symptoms come back (NHS guidance on mental health in pregnancy).
Talking about your feelings with someone you trust, staying active and making time for things you enjoy can all help. Be honest with your midwife or doctor about how you really feel (NHS).
Talking therapies, such as cognitive behavioural therapy (CBT), can often help. If you need medicine, you'll be offered the safest type for you and your baby (NHS).
Speak to your midwife or doctor if you're worried about your mental health. If you're in a mental health crisis, or have thoughts of harming yourself or your baby, get help straight away (NHS; CDC).
Pre-eclampsia and gestational diabetes
Your routine antenatal checks look for both of these conditions, which often cause no symptoms at first (NHS guidance on pre-eclampsia; NHS guidance on gestational diabetes).
Pre-eclampsia
Pre-eclampsia is a pregnancy condition that causes high blood pressure. It's most likely from 20 weeks onwards, but it can happen at any point in pregnancy, and sometimes in the days or weeks after birth (NHS).
Get checked immediately, without waiting for your next appointment, if you have (NHS):
- a severe headache that doesn't go away
- problems with your vision, such as blurring or flashing lights
- pain just below your ribs
- sudden swelling of your face, hands or feet
- heartburn that doesn't go away with heartburn medicine
- vomiting, or feeling very unwell
You may be at higher risk if, for example, you've had pre-eclampsia before, or you have diabetes, high blood pressure, kidney disease or an autoimmune condition such as lupus. If so, your midwife or doctor may prescribe aspirin to take every day from 12 weeks. Don't start taking aspirin unless they advise it (NHS).
Gestational diabetes
Gestational diabetes is high blood sugar that develops in pregnancy, most often in the second or third trimester. It happens when your body can't make enough insulin for its extra needs, and it usually goes away after the birth (NHS).
It usually causes no symptoms, so it's found through screening. In the UK, people with risk factors are offered a glucose test at 24 to 28 weeks, or earlier if they've had gestational diabetes before (NHS). Screening differs between countries, so ask how it works where you live.
You're at higher risk if you (NHS):
- have a body mass index (BMI) above 30
- had gestational diabetes in a previous pregnancy
- previously had a baby weighing 4.5 kg (10 lb) or more
- have a parent, brother or sister with diabetes
- are of south Asian, Black, African-Caribbean or Middle Eastern origin
- have had weight-loss surgery
- are over 40
Most people with gestational diabetes have otherwise normal pregnancies and healthy babies. The risks are lower when it's found early and well managed (NHS).
When to get medical help
Trust your instincts. You can contact your maternity team at any time if you're worried, without waiting for your next appointment (NHS guide to antenatal care).
Contact emergency services
Call emergency services if you're pregnant and bleeding, and (NHS guidance on vaginal bleeding in pregnancy):
- the bleeding is heavy, soaking a pad soon after you put it on
- you have severe pain in your tummy
- you have pain in your shoulder
- you feel faint, dizzy or sick, or you pass out
Get medical help straight away
Call your maternity unit or doctor straight away, day or night, if you have any of the following. If you can't reach them, seek urgent medical care.
- any bleeding from your vagina
- a gush or trickle of fluid from your vagina
- regular contractions or tightenings, period-type pain, or backache that isn't usual for you, before 37 weeks
- your baby moving less than usual, or a change in their usual pattern of movements
- a severe headache that doesn't go away or keeps getting worse, changes in your vision, or sudden swelling of your face, hands or feet
- a temperature of 38°C (100.4°F) or higher
- severe tummy pain that doesn't go away
- chest pain, a racing or pounding heart, or trouble breathing
- dizziness or fainting
- pain, swelling or redness in one leg or arm
- vomiting so that you can't keep fluids down
- thoughts of harming yourself or your baby
Sources: NHS guidance on vaginal bleeding, premature labour, baby movements and pre-eclampsia; CDC list of urgent maternal warning signs.
Contact your midwife or doctor
Get in touch with your midwife or doctor if:
- you haven't felt your baby move by 24 weeks (NHS)
- sickness means you can't keep food down for 24 hours, or you're losing weight (NHS)
- you're worried about your mood or mental health (NHS)
- it hurts to pee or there's blood in your pee, which may be a urine infection: contact your doctor within 24 hours (NHS)
Frequently asked questions
Is it safe to fly when you're pregnant?
For most people, yes: flying isn't harmful to you or your baby. If you have any health problems or pregnancy complications, talk to your midwife or doctor before you fly (NHS guidance on travelling in pregnancy).
Airlines set their own rules for late pregnancy, and after 28 weeks your airline may ask for a letter confirming your due date. Check before you book, and make sure your travel insurance covers pregnancy-related care (NHS).
On journeys longer than 4 hours, there's a small risk of blood clots. Drink plenty of water and move about every 30 minutes or so. Compression stockings from a pharmacy can also help reduce leg swelling (NHS).
Can I dye my hair while I'm pregnant?
Most research suggests it's safe. Your scalp absorbs very little dye, and the chemicals are only harmful in very high doses (NHS guidance on hair dye in pregnancy).
Some people prefer to wait until after 12 weeks. Do a strand test first, wear gloves, use the dye in a well-ventilated room, and don't leave it on longer than the instructions say. Highlights, where dye goes on strands of hair rather than your scalp, reduce any risk further (NHS).
I drank alcohol before I knew I was pregnant. Should I worry?
Try not to worry: the chance of your baby being affected is likely to be low. The important thing is to stop drinking now (NHS guidance on alcohol in pregnancy).
It's never too late to stop, because your baby's brain keeps developing throughout pregnancy (CDC). If you're concerned, talk to your midwife or doctor.
I ate something I should have avoided. What should I do?
If you had a small amount and didn't get ill, it's unlikely to affect your baby. Talk to your midwife or doctor if you're worried (NHS guidance on foods to avoid in pregnancy).
Get urgent advice if you feel unwell afterwards, or if you've had vomiting and diarrhoea for more than 48 hours (NHS).
Your next steps
Pregnancy advice can feel overwhelming, but the essentials are few: take folic acid, start antenatal care early, eat well, avoid alcohol and smoking, keep active, ask about vaccines and learn the warning signs.
These questions are worth asking at your next appointment:
- Which vaccines do you recommend for me, and when?
- Do I need any supplements besides folic acid, such as vitamin D or iron?
- Am I at higher risk of pre-eclampsia or gestational diabetes?
- Who should I call if I'm worried, including at night and at weekends?
If something doesn't feel right, contact your maternity team. You don't need to wait for your next appointment.
This article is for general information only. It doesn't replace advice from your midwife, doctor or other healthcare professional about your own pregnancy.
Comments are welcome. Please keep your comments respectful and avoid sharing personal medical information. Content on Healthy89 is for educational purposes only and should not replace professional medical advice.