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Barbara Rutkowski, EdD, MSN, CCM – Vice President, Clinical Operations, Advanced Plan for Health

Many of our clients have asked us for tips that they may pass along to their members who are pregnant to boost the chances of a healthy pregnancy. We have compiled the following information to be shared.

Working with Physicians and Clinicians

The most important step that women can take is to ensure an optimal pregnancy is to get prenatal care as soon as they suspect pregnancy. Skilled physicians and other clinicians can counsel women on an individualized plan to encourage a healthy lifestyle and help them address particular health problems and risk factors that they may have.

They should also always report adverse symptoms to their clinician immediately.

It is important to control diabetes, abnormal weight – whether too much or too little – hypertension and other pre-existing health conditions, and to check on the safety of any medications and supplements that are being taken. Some medications can cause birth defects. Physicians may suggest better alternatives, do tests, or watch the medication effects carefully.

Eating, Drinking and Well-Being Tips

To minimize potential problems, women who could be pregnant and those trying to start a family should work diligently to eat well, exercise, get adequate rest and sleep, minimize stress, drink water, breathe fresh air and follow their physician’s treatment plan to care for any chronic health conditions. Other suggestions to optimize sleep can be found in the July APH Blog on Brain Health.

Another good place to start is by reading food labels to avoid ingesting unneeded chemicals, hidden fat, salt and additives and cut down on sugary foods and beverages – especially colas. A good roadmap to follow is suggested by the results in a recent clinical trial, which concluded that pregnant women who followed a Mediterranean-type diet (minus the wine) that included a daily portion of tree nuts (half being walnuts) and extra virgin olive oil, were 35 percent less likely to develop gestational diabetes and on average, gained 2.75 pounds less, when compared to women who received standard prenatal care.

It is important to drink plenty of water and to avoid consuming alcohol during pregnancy (and when there is a possibility of pregnancy) as it is the leading cause of birth defects, developmental delays, premature births, low birth weights, miscarriages and fetal alcohol syndrome in varying degrees. Because the alcohol passes quickly through the umbilical cord to the unborn fetus along with food and oxygen and can adversely impact development during pregnancy. The March of Dimes has published helpful information on the effects of alcohol.

Vitamin Use

Folic acid, an important B vitamin, is essential to new cell development of skin, nails and hair. For pregnant women, folic acid is critical in preventing severe birth defects in the spinal column and brain. According to the Centers for Disease Control, all women who could get pregnant should be taking 400 micrograms of folic acid every day in a vitamin supplement in addition to the folic acid they ingest from fortified breads, masa flour cereals and pasta. Checking food labels on vitamins and foods can help to determine the percentage of folic acid.

During the first three to four weeks of pregnancy, the neural tube is forming, which becomes the spinal cord and brain. When folic acid intake is insufficient, even at this time when many people do not know they are pregnant, the neural tube may not seal properly at the ends before additional fetal growth occurs. This developmental sealing flaw results in problems at the top end of the neural tube such as, hydrocephalus or even anencephaly. At the lower end of the neural tube, the developmental sealing failure may result in varying degrees of spina bifida, which often includes external protrusion of nerves and tissues, some paralysis, incontinence and other lifelong health issues. That is why the CDC recommends that women in childbearing years consume adequate folic acid before, during and after pregnancy as a precaution.

Women should speak with their physician about the correct dose for them and even the folic acid formulation if there are problems in tolerating this vitamin.

Controlling Their Environment

It is important to try to eliminate as many internal and external environmental and health threats as possible. As an example, avoiding contact with infected people, as options for taking cold and flu remedies are limited in pregnancy.

Women in childbearing age should also be careful with poisonous household products used inside and outside of the home, and take all precautions in using them to avoid undue exposure.

Women who are pregnant should avoid changing the kitty litter and having contact with cat feces. They should also have the cat tested for toxoplasmosis, which may negatively impact 1 in 1,000 pregnancies.

It is important to wear gloves for gardening and when touching uncooked meat, to wash fresh fruit and vegetables thoroughly, to eat only thoroughly cooked meat and to sanitize counters and dishes touched by raw meat.

Having working fire and carbon dioxide detectors at home are also critical to life and health. High levels of carbon dioxide can build in the home causing people to die in their sleep. This gas is colorless and odorless. It is important to have gas-power heating systems checked at least annually. Avoid using a generator indoors after a power outage. Avoid heating the house with the oven, using portable heating units or cooking with charcoal indoors. If there are symptoms of persistent, unexplained headaches, dizziness or nausea – the fire department can check a home for carbon dioxide. It could save lives. For more tips, refer to the CDC Preventive Guidance Directive here.

Workplace Considerations

The Occupational Safety and Health Administration (OSHA) has a page on their website dedicated to Reproductive Hazards. They list physical, chemical and biologic hazards in the workplace. This list can assist employers in complying with regulations, OSHA recommendations and minimizing workplace exposure, while understanding any reporting requirements.

A frightening element is that most of the 4 million workplace chemicals, physical agents and biologics to which employees could be exposed have been studied in animals but not in humans. According to OSHA, more than 1,000 chemicals were found to have an impact on reproduction in animals, which includes fertility in men and women, the ability to normally carry the pregnancy and / or the impact on the health of the unborn and children.

Women in childbearing age, who think they could get or may be pregnant, should talk with their employer about ways to mitigate exposure to chemical, biologic and physical hazards in their job. Details on resolving workplace hazards are beyond the scope of this blog.

A Medscape article titled “Night Shifts, Long Hours Linked to Miscarriages and Preterm Births” reported on studies showing that pregnant women have a higher incidence of premature births and miscarriages when they work rotating shifts or long hours. According to the study author, Margie Davenport (University of Alberta), avoiding shift work and long hours reduces the risk of low birth weight babies, miscarriages, premature births and the tendency to develop high blood pressure and eclampsia. Davenport theorized that these adverse effects could be due to changes in hormones and circadian rhythm from the stress and disruption accompanying shift work and long hours, which impacts fetal growth and the timing of delivery.

If long hours or shift work are necessary, encourage workers to focus on living the healthy habits discussed in the “Eating, Drinking, and Well-Being Tips” section of this blog.

Stop Smoking and Vaping

Smoking and vaping are hazardous to your health and that of an unborn baby.

The Maternal and Child Health Journal states that “Smoking cessation during pregnancy can reduce the risk of poor birth outcomes.” Their study concluded that women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants which increases risks of infant mortality and morbidity, including chronic conditions later in life.

WebMD also published an article “More Pregnant Women Vaping, Study Says”. They state that pregnant women erroneously believe that vaping is safer than smoking while pregnant. The article goes on to state that with vaping, babies face the same risks from nicotine exposure – including brain and lung damage and increasing risks of sudden infant death syndrome.

The FDA published an article on Understanding the Health Impact and Dangers of Smoke and ‘Vapor’. They have highlighted a particular focus on how aerosols and vaping are negatively impacting developing brains in young people, who are drawn to marketing of flavored choices and claims of lower addiction. Aerosol delivery is especially troublesome, because the inhaled tiny particles get deeper into the lungs with their inherent toxic products that are still being studied as a cause of major health problems.

Getting Prepared in Advance

Some areas that should be prepared in advance are workplace and community benefits. The March of Dimes has great ideas to explore on potential workplace benefits that need to be considered. Having childcare options, taking leave time and finding community resources and support groups can take time. There can also be waiting lists for childcare. There are even mom support networks that sell gently used baby clothes and equipment at attractive prices.

Addiction to Drugs and Pain Medication

The March of Dimes says that at least five percent of pregnant women are addicted to street drugs or abused prescription pain relievers. These substances pass directly to the fetus, causing fetal addiction and double the chance of stillbirths, as well as prematurity, birth defects and fetal withdrawal at birth, a very miserable experience for the newborn and an avoidable expense to health plans. Addicted individuals who are pregnant or contemplating pregnancy need to get help by talking with their health provider or contacting: National Council on Alcoholism and Drug Dependence at (800) 622-2255 or using the Substance Abuse Treatment Facility Locator online or calling (800) 662-HELP (4357).

Major Medical Conditions

For pregnancies where the fetus may be compromised or potentially afflicted with a major cardiac, neurologic or other health condition, an expert pregnancy clinician may refer patients to genetic or perinatal sub-specialists who specialize in maternal-fetal high-risk pregnancies. There are even Centers of Excellence where advanced surgical procedures and interventions can be performed while the fetus is in utero, which improves viability and health problems after birth. This online reference provides guidelines to consider before pursuing these breakthrough interventions for in utero treatments.

Educational Resources

There are many helpful and educational books and online articles available for families having their first baby. Some discuss development, and some help childbearing adults understand the changes that are part of pregnancy and having children. It is important to look for credible sources when researching educational information. A good source is materials written by obstetricians and other reputable medical and clinical professionals.

Thriving During Pregnancy

While this article highlighted some smart steps to avoid adverse outcomes in pregnancy, pregnant women should focus on spending time living a healthy lifestyle, controlling their environment, learning to control stress, reducing excessive sodium intake, exercising, drinking plenty of water, preparing for a new baby and getting ready for a whole new chapter in life.

We Can Help!

At Advanced Plan for Health, our focus is on analytics, changing member health behaviors and supporting them as they reach favorable health outcomes in areas such as pregnancy. Contact us to learn more about these capabilities, and how we can help you make a difference in your populations.


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