Pregnancy Journal (Deluxe, Cloth-bound edition): A Week-By-Week Guide to a Happy, Healthy Pregnancy

Product Information

British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity. 2012. https://www.bap.org.uk/pdfs/BAP_Guidelines-Addiction.pdf Clifford A, Lang L, Chen R. Effects of maternal cigarette smoking during pregnancy on cognitive parameters of children and young adults: a literature review. Neurotoxicol Teratol. 2012;34(6):560–70. https://doi.org/10.1016/j.ntt.2012.09.004. For any substance, three or more of the following should have been present together at some time during the previous year. Delpisheh A, Brabin L, Brabin BJ. Pregnancy, smoking and birth outcomes. Women Health. 2006;2(3):389–403. https://doi.org/10.2217/17455057.2.3.389. The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). Implications

If you are pregnant, you should aim for at least 30 minutes of moderate intensity activity per day. If you have not been exercising, begin with no more than 15 minutes, three times per week - then increase gradually to 30 minutes. Those who regularly exercise before pregnancy are safe to continue. Top tipsTo evaluate the causal link between SDP and the identified conditions which were found to have an association with SDP, a causal link analysis was conducted using established methods [ 11]. The evidence on the identified conditions was assessed and categorised using the following criteria: The causal link analysis of the conditions that were found to have an association with SDP suggested that five mother-related and 10 infant-related conditions had a causal link with SDP. PPROM and intellectual disability in children did not fulfil the criteria for the casual link although meta-analyses reported a statistically significant relationship with SDP. Health conditions with conflicting results Weight loss is strictly not recommended during pregnancy as it can be harmful to the health of the growing baby. If you have a high BMI or are reducing your physical activity during pregnancy, your energy requirements may not change (see table above for a guide to weight gain and pregnancy). A dietitian would be able to guide you on avoiding excessive weight gain while ensuring you are eating well. Should I take additional nutritional supplements? Haberg SE, Bentdal YE, London SJ, Stigum H, Kvaerner KJ, Nystad W, et al. Pre- and postnatal parental smoking and acute otitis Media in Early Childhood. Am J Resp Crit Care. 2009;179:1. This is assuming weight gain of 0.5-2 kg in the first trimester. When do I need to consider higher energy intake?

Lee L, Lupo P. Maternal smoking during pregnancy and risk of congenital heart defects: a systematic review and a meta-analysis. Circ Conf. 2012;125(10 SUPPL. 1):398. UK National Institute for Health and Care Excellence (NICE). Antenatal and postnatal mental health: clinical management and service guidance (clinical guideline CG192). 2018. https://www.nice.org.uk/guidance/CG192Advise her of the risks of smoking and of alcohol and cannabis use during pregnancy. The biggest risk for her pregnancy at present is her smoking. Abayomi JC, Charnley MS, Weeks A, Wilding JPH. An observation of gestational weight gain in obese pregnancies [Internet]. Vol. 74, Proceedings of the Nutrition Society. 2015. Available from: http://dx.doi.org/10.1017/s0029665115002979 Clarify with her how much cannabis and alcohol she is using. Brief intervention may be sufficient, but regular or heavy use of either substance may warrant referral to specialist drug and alcohol services. Scientific Advisory Committee on Nutrition (SACN). Health matters: reproductive health and pregnancy planning. 2018. Available from: https://www.gov.uk/government/publications/health-matters-reproductive-health-and-pregnancy-planning/health-matters-reproductive-health-and-pregnancy-planning Huang JS, Lee TA, Lu MC. Prenatal programming of childhood overweight and obesity. Matern Child Health J. 2007;11(5):461–73.

If you need further support if you are under (BMI<18.5kg/m 2) or over weight (BMI>25 kg/m 2) or having a multiple pregnancy - ask to be referred to a dietitian. Another health condition with mixed findings was leukaemia. One meta-analysis [ 64] including 19 studies indicated an insignificant decreased risk (OR = 0.99, 95% CI, 0.92–1.06) whereas another review [ 66] of 21 studies found an increased risk (OR = 1.10, 95% CI, 1.02–1.19). The difference could be explained by the different studies included, since there were only five studies common to both, and the association between SDP and leukaemia is unclear. Support pregnant women using alcohol to stop (ideally) or reduce their alcohol consumption. 20 There are several screening tools for use in the non-pregnant population, such as the three question AUDIT-C, 27 although there is limited evidence for its validity during pregnancy. 28 29Tolerance, whereby increased doses of the substance are required to achieve effects originally produced by lower doses Marufu TC, Ahankari A, Coleman T, Lewis S. Maternal smoking and the risk of still birth: systematic review and meta-analysis. BMC Public Health. 2015;15(1):239. https://doi.org/10.1186/s12889-015-1552-5. Banderali G, Martelli A, Landi M, Moretti F, Betti F, Radaelli G, et al. Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review. J Transl Med. 2015;13(1):327. https://doi.org/10.1186/s12967-015-0690-y. Kantor R, Kim A, Thyssen JP, Silverberg JI. Association of atopic dermatitis with smoking: A systematic review and meta-analysis. J Am Acad Dermatol. 2016;75(6):1119–25.e1. Walsh RA, Redman S, Brinsmead MW, Byrne JM, Melmeth A. A smoking cessation program at a public antenatal clinic. Am J Public Health. 1997;87(7):1201–4. https://doi.org/10.2105/AJPH.87.7.1201.

Methadone or buprenorphine (as per standard protocols) is prescribed at a dose that stops or minimises illicit opioid use, with a focus on maintaining stability. 7 Methadone dosing may need to be increased in the third trimester of pregnancy as its metabolism increases. 20 Consider split dosing to minimise fetal intoxication or withdrawal. 47 The choice of buprenorphine versus methadone should be individualised to the patient, and switching during pregnancy, particularly if use is well maintained, is discouraged. 7 Box 1 Questions to consider asking about substance use during pregnancy or in women planning a pregnancy Difranza JR, Lew RA. Effect of maternal cigarette-smoking on pregnancy complications and sudden-infant-death-syndrome. J Fam Pract. 1995;40(4):385–94. Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol. 2009 Dec;21(6):521-6. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/19809317 Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013 Jul 27;382(9889):331–7.Weak evidence – more than one systematic review reported conflicting findings (group 3) or one systematic review reported limited number of studies (< 8) which found a relationship (group 4). Pregnancy and pre-pregnancy are both good times to think about healthy eating. What you eat now will help your baby to grow and develop healthily, giving them the best start in life. It will also be good for your health. This fact sheet is intended to support those considering pregnancy and those already pregnant with making healthy lifestyle choices. Healthy eating during pregnancy