A healthy lifestyle

before and during

pregnancy
 CONTENTS

When planning a pregnancy

Start taking folate........................................ 4

Avoid alcohol............................................... 5
Avoid tobacco products............................... 5
Check your medication................................ 5
Exercise daily............................................... 5
Published: 10/2016

Ordering number: IS-2455E A healthy lifestyle during pregnancy

Published by: Norwegian Directorate of Health Food and drink............................................ 6

Contact: Alcohol...................................................... 14
Division Public Health Physical activity......................................... 16
Postal address: Tobacco products...................................... 18
Pb. 7000, St Olavs plass, 0130 Oslo
Street address: Medicines.................................................. 20
Universitetsgata 2, Oslo Emotional changes.................................... 22
Tel.: +47 810 20 050 Sex............................................................ 23
Fax: +47 24 16 30 01
www.helsedirektoratet.no Sleep......................................................... 24
Domestic violence..................................... 26
The brochure may be ordered from:
trykksak@helsedirektoratet.no More information ..................................... 27

2 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 3
WHEN PLANNING
A PREGNANCY
Many women are motivated to lead healthy
lives during pregnancy. However, making
some changes before getting pregnant will
make it easier to keep up the good habits
throughout your pregnancy and after the
baby is born. It also gives your baby the best
start in life.
This brochure gives you advice on how to
prepare for pregnancy and take good care of
yourself and your unborn baby.
Start taking folate
Take a tablet containing 0.4 mg folate daily
from when you stop using contraception.
Folate is a water-soluble B vitamin and is
essential for normal cell division and growth.
A folate supplement before and during preg-
nancy reduces the risk of your baby being
born with a spinal cord defect. Folate is availa-
ble to buy at a pharmacy. You should continue
taking the folate supplement for the first three
months of your pregnancy.
4 A healthy lifestyle before and during pregnancy
Avoid alcohol
Alcohol can harm your unborn baby at any
stage of your pregnancy. It is hard to tell ex-
actly when ovulation happens. If you are not
using any contraception and can get pregnant,
you should avoid alcohol.
Avoid tobacco products
Planning a pregnancy might be a good op-
portunity to stop smoking or using smoke-
less tobacco products (snus). Smoking affects
ovulation and can make it more difficult to
get pregnant. All forms of tobacco use during
pregnancy are harmful for your baby's growth
and development. For advice on quitting and
the various aids to help you, see page 19.
Check your medication
Consult your doctor if you use any medication
on a regular basis. You will be told if your
medication needs to be continued, changed
or stopped. However, never stop taking pre-
scription medicines without consulting your
doctor first.
Exercise daily
Try to make sure you get some physical ex-
ercise every day. If you have a sedentary job,
you can take short breaks to move around,
stand up or e.g. climb the stairs. Regular physi-
cal activity boosts your energy and your gen-
eral health. Exercise that makes you hot and
short of breath, is even more beneficial. If you
haven't worked out on a regular basis before,
take it easy in the beginning and increase the
intensity gradually. Keep in mind that every-
day activities also count as exercise.
A healthy lifestyle before and during pregnancy 5
A HEALTHY LIFESTYLE Eat fish several times a week
Fish is rich in omega-3 fatty acids, vitamin D,
DURING PREGNANCY selenium and iodine which all play an impor-
tant role in the development of your baby's
brain and central nervous system. It is there-
fore beneficial to eat fish two to three times
Food and drink a week. Vary your intake between low-fat and
Eating and drinking habits play a big role in fatty fish, and eat fish as a topping on bread.
a healthy pregnancy. Good nutrition affects
both your own health and your baby's devel- Salmon, mackerel, herring, trout, eel, halibut
opment, growth and health later in life, too. and sardines are examples of fatty fish, while
cod, coalfish, pollock, haddock, monkfish,
plaice and cusk are examples of low-fat fish.
Some types of fish (pike, arctic char, common
perch, trout and fresh tuna and uncooked
fermented fish (Norwegian rakfisk) should be
Healthy eating advice avoided during pregnancy.
Learn more at matportalen.no
Eat a variety of foods Coffee and tea
Pregnant women can drink coffee and tea, but
Eat at least five portions of vegetables,
no more than
berries and/or fruit daily
12 cups of coffee per day or
Eat fish 2-3 times a week 34 cups of tea per day
Bear in mind that cola (Coke) and energy drinks
Eat wholegrain foods daily contain caffeine. High caffeine intake increases
the risk of having a low-birthweight baby.
Opt for lean meat and limit your intake
of processed meat and red meat
Foto: Marianne Ramstad Malone

Opt for low-fat dairy products

Opt for oils, liquid margarine and soft

margarine instead of hard margarine
and butter

Opt for low-salt foods

Limit your daily intake of sugary foods,

or avoid them completely

Drink water as a thirst quencher

6 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 7
You don't need to eat for two Dairy products
Your baby's nutritional needs will be met if In order for your baby to develop normally, it
you eat healthy food in normal portions. needs milk and other dairy products, which
In the last trimester, your baby's energy re- are vital sources of dietary calcium. Choose
quirements will be slightly greater, about 300 low-fat dairy products.
calories more per day. It equals a slice of bread
with spread (an open sandwich) and a glass of Meat and other sources of protein
semi-skimmed milk, or a portion of oatmeal Lean meat, chicken, eggs, beans, lentils and
porridge and an additional fruit or berries. peas are good sources of protein. Meat is also
a good source of iron and several other nu-
Eat fruit and vegetables trients. Pregnant women can eat all types of
Eat "five a day". One portion is 100 grammes, meat as long as it has been properly cooked.
which equals a small piece of fruit and a hand-
ful of berries or a vegetable. At least half of Keyhole labelling
your "five-a-day" should be vegetables, which Keyhole-labelled foods contain
can be varied according to season, price and less fat, salt and sugar and
availability. more fibre than other products
of the same type.
Opt for wholegrain foods
Products made of wholegrain such as coarse
bread, brown rice and wholemeal pasta
should be part of your diet. Your iron require-
ment increases when you are pregnant and
wholemeal products are good sources of iron
and folate. Wholegrain products contain a lot
of fibre, which is good for your digestion and
helps to prevent constipation.

8 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 9

Dietary supplements and vitamins
Folate
All women who are planning a pregnancy or
who know they are pregnant should start tak-
ing a folate supplement of 400 micrograms
per day from as early on as possible until the
end of the 12th week of pregnancy. Folate is
a water-soluble B vitamin that prevents spina
bifida, a birth defect where the backbone fails
to close. Foods rich in folate are wholegrain
products, fruit and vegetables, especially
green vegetables like broccoli, kale, Brussels
sprouts and spinach.
Vitamin D
Both mother and child need a sufficient
amount of vitamin D. You get this vitamin
from eating fatty fish and from exposure to
sunlight. Some types of milk, cheese and mar-
garine are fortified with vitamin D. In addition,
pregnant women are recommended to take
5 ml cod-liver oil (standard medicine spoon or
large teaspoon) or the equivalent as cod-liver
oil capsules.
Iron
Your iron requirement increases when you are
pregnant. Iron is present in wholegrain foods,
meat, liver, spinach, potatoes and green veg-
etables. The blood tests done at your antena-
tal care appointments show if you need iron
supplements. These supplements should only
be taken on the advice of your midwife or doc-
tor because too much iron is not good for your
unborn baby.
10 A healthy lifestyle before and during pregnancy
Calcium
For your baby's skeleton to develop properly,
you need extra calcium. Rich sources of calcium
are milk, cheese, yoghurt, seeds, sardines, leafy
green vegetables, nuts, almonds and dried fruit.
Iodine
Iodine is a chemical element that has many vi-
tal functions in the body. Iodine deficiency can
inhibit nervous system development in the
unborn child. Dairy products and seafood are
the main sources of dietary iodine. Pregnant
and nursing women who avoid fish and dairy
products may have problems getting enough
iodine in their diet. If so, one option is to take
iodine as a dietary supplement. You can get
information about this at your antenatal care
appointments or at a pharmacy.
Vitamin B12
Vitamin B12 is needed for forming new red
blood cells and for development of your
baby's nervous system. Vitamin B12 is found
in beef, pork, fish, eggs and milk, that is, only
animal products.
Vegetarian and vegan diets
It is possible to get all the nutrients you need
through a vegetarian diet. However, you must
be careful to eat a wide variety of foods to
meet your nutritional needs to get enough
vitamin B12, iodine, vitamin D and calcium.
For pregnant and and breastfeeding women
who have vegan diet, vitamin B12 and iodine
are essential. A deficiency of these nutrients
can disrupt development of the unborn child,
so they should take a supplement.
A healthy lifestyle before and during pregnancy 11
Food to be cautious about Weight gain

During pregnancy, you have to be a bit more
aware of what is safe to eat than usual. Some
foods contain microorganisms like toxoplasma
gondii and listeria. These are not harmful for
you if you are infected, but can harm your un-
born baby.
It is common to gain between 11 and 16 kilo
during pregnancy. How much is healthy for
you depends on how much you weighed be-
fore pregnancy. If you were underweight, you
should put on more and if you were over-
weight, you should put on less.

Toxoplasma gondii is found in some cats. Being either overweight or underweight can
Sources of infection are direct or indirect con- cause complications in pregnancy and health
tact with cat droppings, unclean sand, and un- problems for you and your child. The birth it-
washed fruit and vegetables. self may also be more complicated for women
who are overweight. If you are overweight,
Listeria infection can be caused by foods that you should not attempt to lose weight during
have not been properly cooked. Other sources your pregnancy, but you can safely limit your
of infection include foods kept for a long time weight gain.
in the fridge or which are nearing the end of
their use-by date such as processed meat and
fish, including cured and smoked salmon, un-
pasteurised milk and some cheeses. Cured
foods and fermented, but uncooked foods
should be avoided altogether.

The website matportalen.no provides up-to-

date information on what is safe to eat and
what to avoid.

Remember that kitchen hygiene is important

too. Wash your hands, knives and chopping
boards thoroughly after they have been in
contact with raw meat. Rinse fruit, berries and
vegetables. However, the risk of your baby be-
ing harmed by what you eat is very small.

12 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 13
Alcohol
Avoid alcohol in all forms (beer, "alcopops", cider,
wine, spirits etc.) throughout your pregnancy.
Many women are used to drinking alcohol in
different situations. When you are pregnant it
is important to abstain. There is neither a safe
lower limit nor a safe stage during which you
can drink alcohol when you are expecting a
baby. Alcohol can harm your unborn baby any
time during your pregnancy.
What can happen to
your baby if you drink?
If a pregnant woman drinks alcohol, it is taken
up rapidly in the bloodstream and crosses over
undiluted to the baby via the placenta. No-one
knows how much alcohol it takes to harm a baby.
If you have been drinking
Some women worry because they drank alco-
hol before they knew they were pregnant. The
vast majority of those who had some alcohol
before knowing they were pregnant give birth
to healthy babies. The most important thing is
to avoid alcohol as soon as you know you are
pregnant.
Talk to your midwife, regular GP (fastlege) or
the social services if you are worried or need
support to change your drinking habits and
abstain from alcohol.
Rustelefonen 08588 is a national helpline in
Norway that provides free information about
alcohol and drugs. See rustelefonen.no.

All organs in the baby could be affected and

normal development may be disrupted. The
brain is particularly at risk because it devel-
ops through the whole pregnancy. Alcohol can
cause miscarriage and stillbirth and a range of
lifelong physical, behavioral and intellectual dis-
abilities. A child whos mother drank alcohol
during pregnancy may suffer learning, concen-
tration and memory problems and may have
difficulty understanding the consequences of
its actions.
Large amounts of alcohol during pregnancy can
lead to a range of physical, neurological and
behavioural abnormalities and impairments.
The disorders are classified under the umbrella
term foetal alcohol spectrum disorders, FASD.
The most severe diagnosis is foetal alcohol
syndrome, FAS. Children with FAS are typically
affected by poor growth, brain damage and dis-
tinctive facial characteristics.
The more alcohol the mother drinks, and the
more often she drinks increases the risk for FASD.

14 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 15
Physical activity Staying active during pregnancy
You can be physically active and maintain fit-
Being physically fit and having strong mus- ness and workout routines throughout your
cles, joints and bones improve your chances pregnancy. Be careful about heavy lifting that
of a healthy pregnancy. strain your pelvis, belly and back. You should
avoid activities where there is a high risk of
falling or taking blows to your belly such as
30 minutes a day
martial arts, handball and football.
Try to be physically active for at least 30 min-
utes every day. This is good for both you and
Pelvic floor exercises strengthen the muscles
your baby. These 30 minutes can include both
of the pelvic floor and prevent urinary inconti-
strength and fitness training. The physical ef-
nence both during and after pregnancy.
fort should heat you up and make you short
of breath. There's no harm in doing harder
exercise, as long as it doesn't cause you pain.
If you have any pregnancy complications, you For more advice on exercise and pregnancy, see
can get advice on exercise and workouts suit- helsenorge.no/gravid/trening-graviditet-og-fodsel
able for you.

Maintain or start This activity log can help you get started
Women who have been used to working out helsedirektoratet.no/publikasjoner/
a lot before can typically keep it up, but per- aktivitetsdagbok-for-deg-som-vil-komme-
haps with slightly lower intensity. If you have i-bedre-form
not led an active life before, now is a good op-
portunity to get into exercising. You can start
with a low intensity activity such as fast walk-
ing or swimming. Go for something you enjoy
and try to find someone to join you, as this is
more motivating.

More everyday activity

Remember that doing daily errands and tasks
can also be good exercise! Take the stairs in-
stead of the lift, ride your bike instead of driv-
ing and so on. Limit the time you spend sitting
still by taking short breaks and moving around.

16 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 17
Tobacco products
Women who do not smoke or use smokeless
tobacco (snus) have a lower risk of a number
of complications during pregnancy.
If a pregnant mother smokes, her baby gets
less oxygen and nutrients. This can impair the
baby's growth and prevent it from gaining
weight before birth. Low birthweight babies
often have more health problems.
The more you smoke, the greater the risk
of complications. Children of mothers who
smoked during pregnancy are more at risk
of learning deficits, frequent ear infections,
colds and airways problems than non-smoking
mothers.
If you or anyone around you smokes, your
baby will be exposed to smoke. A smokefree
environment is best for both you and your
baby.
By not smoking, you
reduce the risk of
pregnancy outside the womb
(non-uterine pregnancy)
your waters breaking early and bleed-
ing, both of which increase the risk of
infection and premature birth
placenta previa, where the placenta
blocks the neck of the womb, and pla-
cental abruption, where the placenta
separates from the womb before birth
miscarriage
stillbirth of the baby in the weeks up to
the birth
premature birth and low birthweight.
18 A healthy lifestyle before and during pregnancy
Using smokeless tobacco (snus) during preg-
nancy carries risks which are very similar
to those of smoking. The nicotine in smoke-
less tobacco causes the blood vessels of the
placenta and uterus to contract so the baby
receives less oxygen and nutrition.
Using snus and other smokeless tobacco prod-
ucts can, like smoking, cause low birthweight,
premature birth and stillbirth.
Help to quit
Nicotine is highly addictive and some people
find it difficult to stop smoking or using smoke-
less tobacco. Pregnant women sometimes ask
if cutting down helps, but quitting altogether
is best for your unborn child.
At slutta.no you can find out
what help and counselling is
available for quitting.
If you contact the chatline or
call the freephone number
800 400 85, you can receive
free coaching and follow-up
for up to a year.
The application Slutta
('Quit') can also be a helpful
tool .
Many municipal healthy life centres
(Frisklivssentraler) offer individual
and group support in overcoming
the addiction.
A healthy lifestyle before and during pregnancy 19
Medicines
You will need to think about any medicines
you take if you are planning a pregnancy. Gen-
erally, pregnant women are recommended to
take as little medicine as possible.

This also applies to over-the-counter medi-

cines. You should be careful right from the first
three months when the basis of your babys
organs is formed.

Some medical conditions however require

medicinal treatment because the condition is
more dangerous than the medicine. You must
consult your doctor about whether to continue
taking a medicine, switch to another one or
stop taking it completely.

Only change your dose or stop taking the med-

icine on a doctor's advice.

You should also avoid herbal and alterna- Illustrasjon: Anne Kristin Berge

tive medicines. This is because little is known

about their effects on the unborn baby.

"Trygg Mammamedisin" is a public service

that offers individual advice on safe medicines
for pregnant and nursing women. This service
is provided online over the internet.
The illustration shows how both healthy and
Learn more at harmful substances, like alcohol and nicotine,
tryggmammamedisin.no can cross over to the child via the placenta.

20 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 21
Emotional changes
Many women are more emotional than usual
when they are pregnant. Mood swings are
common. These are caused by a combination
of hormonal effects and bodily changes. Tired-
ness, lack of sleep and other minor ailments
may increase this emotionality.
Your partner may find it difficult to understand
what's happening because your mood may go
from happy to sad in no time. Although your
child may be longed for and planned, anxieties
may overshadow the joy of expecting a baby.
Getting enough exercise, sleep, healthy food
and spending time with your partner or close
friends may help get you through days when
you are down. Mood swings commonly affect
pregnant women in the first and last trimesters.
Some women feel very vulnerable or sad.
These feelings typically present themselves
towards the end of your term or within the
first few months after giving birth.
Your midwife, public health nurse or doctor
can offer you counselling and follow-up. Some
women may need to see a psychologist with ex-
perience and expertise in postnatal depression.
22 A healthy lifestyle before and during pregnancy
Sex
Many women benefit from an active sex life
when pregnant because of their high levels of
female hormones. Women who didn't previ-
ously achieve orgasm may begin to do so.
Others may experience loss of libido during
pregnancy. In the first and last months of a
pregnancy especially, you may be put off sex
by morning sickness, other complaints or gen-
eral fatigue. If so, the need for closeness and
cuddles may matter more to you. Your part-
ner may also find his desire for sexual intimacy
changes during the pregnancy. It is important
to talk about this with each other.
Towards the end of your pregnancy, sexual
activity is often less frequent. As your belly
grows, it may get in the way of sexual inter-
course. If both of you are still keen to have sex,
there are many different positions to try.
Some people worry that sex during pregnancy
might be risky. But the baby is well protected
by your waters and no movements, pounding,
thrusting or climax and ejaculation can harm
it. During orgasm, the womb contracts and the
belly hardens into a ball. This does not harm
the baby and does not speed up delivery of
the baby in a normal pregnancy. Orgasm may
cause mild contractions, but these settle down
and go away after a short while.
A healthy lifestyle before and during pregnancy 23
Pregnancy complications
If you have had repeated miscarriages or pre-
viously had a preterm baby (before week 37),
talk to a healthcare professional about sex
during pregnancy.
It is not uncommon to see some spotting
(traces of blood) after having sex. This is due
to the increased blood supply to the cervix
and vagina, which causes them to bleed more
easily. Spotting is not harmful, but if you start
bleeding more, you should contact a doctor,
midwife or maternity ward to have it checked.
Sex to bring on labour?
There is no solid evidence that sex can bring
on labour, but there is nothing to stop you try-
ing. Semen contains hormones called prosta-
glandins that can help to soften the cervix. In
the woman, production of another hormone,
called oxytocin, can be increased by stimulat-
ing the breasts and through orgasm. Oxytocin
can help to induce contractions of the uterus.
If your waters have broken, sexual intercourse
is not advisable due to the risk of infection.
Sleep
It is common to experience poorer-quality
sleep when you are pregnant. This may be due
to changes in your body, but also to thinking
about the birth and your baby being on the
way.
Towards the end of your pregnancy, when
your body is heavier and you have more dis-
comfort and minor ailments, your sleeping
problems may increase. Happily though, the
body is designed to need less sleep towards
the end of pregnancy. This is because it needs
to get used to being awake at night once the
baby has been born and needs feeding. If you
24 A healthy lifestyle before and during pregnancy
are having sleeping problems, the best advice
is to accept the situation as normal when you
are pregnant. It may be exhausting, but it is
not harmful.
Tips for getting a good night's sleep
Don't drink too much just before going
to bed
Avoid using a mobile or other screen
just before bedtime
Find a comfortable position to sleep in.
Use extra pillows as support between
your knees and for your back
Don't just lie there tossing and turning
if you can't sleep. Get out of bed and
do something else for a little while
Get some rest during the day if you
need it, but not for too long
Avoid coffee and other caffeinated
drinks in the evening
Physical activity makes you sleep better,
but avoid hard workouts just before
bedtime
Take time-out during the day to work
through any worries and concerns
Learn a relaxation technique and use it
during wakeful nights
Consult a doctor if your sleeping
problems don't clear up and you are
completely exhausted
A healthy lifestyle before and during pregnancy 25
Domestic violence More information
Some women are subjected to domestic vio- Facebook. com/smaagrep
lence during pregnancy. Domestic violence, Dietary advice in Norwegian
also called intimate partner violence, can have
serious consequences for both the pregnant Regular General
woman herself and the unborn child. Practitioner (GP) Fastlege
https://helsenorge.no/
Intimate partner violence may also involve foreigners-in-norway/
controlling behaviour and monitoring of the general-practitioner
partner, limited access to financial resources
and being robbed of personal freedom.
Pregnancy and birth
To help pregnant women who are subjected www.matportalen.no/
to violence, healthcare professionals within rad_til_spesielle
the maternity care service have to address _grupper/tema/gravide
any issues of concern as early as possible with Folder in English and
all pregnant women. The aim is for women Norwegian side by side
who are the victims of violence to be given an
opportunity to talk about their situation and Maternity and child health clinic Helsestasjon
receive the follow-up they need. https://helsenorge.no/hjelpetilbud-i-kommunen/
helsestasjon-og-skolehelsetjenesten
If you are afraid to become or you have been (in Norwegian)
a victim of violence contact your midwife or
doctor, a family counselling office, a crisis cen-
tre or the police. Healthy life centre - Frisklivssentral
https://helsenorge.no/hjelpetilbud-i-kommunen/
Learn more from frisklivssentral
dinutvei.no (in Norwegian)

Family counselling centre Familievernkontor

www.bufdir.no/en/English_start_page/Family_
counselling_services/Family_counselling

Crisis centre Krisesenter

www.krisesenter.com/finn-ditt-senter
(in Norwegian)

Police Politi
www.politi.no

26 A healthy lifestyle before and during pregnancy A healthy lifestyle before and during pregnancy 27
 Utforming: www.ideverkstedet.no

Norwegian Directorate of Health

Pb. 7000 St Olavs plass, 0130 Oslo
Tel.: 810 20 050 Fax: 24 16 30 01
helsenorge.no
helsedirektoratet.no
IS-2455E