Healthy Pregnancy Recommendations
The following recommendations were developed by the Neurological Health Foundation (NHF) Scientific
Advisory Board, and they are designed to help you have a healthy pregnancy and a healthy and happy baby.
These recommendations are based on the latest medical research and clinical experience, and should reduce
the risk of miscarriage and decrease the risk of physical and mental health problems to you and your baby.
Note that most Preconception Recommendations apply to both parents, as both a healthy mother and father
are important to having a healthy baby.
1. Preconception (start at least 3 months before conception for optimal benefits)
A. Improve Nutrition with Healthy Diet (organic as much as possible)
a. See Nutrition Handout
b. Schedule personal consultation with knowledgeable nutritionist to improve your diet
c. Preconception supplement – see Preconception and Prenatal Supplement Handout
Avoid:
Totally avoid high-mercury fish (shark, swordfish) – instead, choose fish with the lowest
levels of mercury -– see Nutrition During Pregnancy Handout for list
Avoid fish skin (high in toxics)
Avoid fats in non-organic meats (high in toxics)
Raw or undercooked meat or meat cooked at extremely high temperature (charred)
Undercooked or raw seafood and unpasteurized soft cheeses
High levels of caffeine (more than 300 mg, or more than 3 cups of coffee or 5 cups of tea
per day)
Soda and especially diet soda
Artificial food additives (artificial colors/flavors/sweeteners/preservatives)
Hydrogenated fats, partially hydrogenated fats, trans fats
Highly-processed foods – instead, cook with whole foods (whole grains, vegetables, etc.)
B. Reduce Toxic Exposures
Common Toxins to Avoid:
Smoking
Alcohol
Over-the-counter medications (discuss all with your physician and reduce/avoid if possible)
Avoid acetaminophen (in Tylenol and other products). It has been linked to increased risk of having
a child with ADHD, developmental problems (communication, gross motor skills, behavior
issues), and possibly linked to an increased risk of having a child with autism. Ibuprofen has
NOT associated with those risks, so NHF recommends using Ibuprofen instead but in
moderation.
Recreational drugs
Mercury dental amalgams
No placement or removal of mercury amalgam fillings or root canals with mercury during six
months prior to conception and during pregnancy and nursing; avoid anesthesia if possible;
Check household for:
Water quality –
1. Use tap water purified by reverse osmosis with a charcoal filter.
2. Store water in glass, stainless steel, or BPA-free plastic bottles.
3. Tap water (regulated by the EPA) is usually safer than bottled water (regulated by the
FDA).
4. Compare the quality of your local water to national averages by entering your zip code
at: http://www.ewg.org/tap-water/home . This information is compiled by the
Environmental Working Group (EWG).
Clean Air - Fresh air is important. Air out your home at least one time per week. Indoor air quality
is generally much worse than outside. Use a HEPA filter to remove particulates
Cleaning products – check the EWG website (www.ewg.org) for safe suggestions.
Dust - Keep dust levels to a minimum by cleaning weekly, preferably with a wet mop and HEPAfilter vacuum cleaner. Many toxicants, such as flame retardants, accumulate in dust;
and regular vacuums often blow some of the dust back into the air where it may be
inhaled.
Pesticides in home or outside – use only natural products
For homes, see: http://www.beyondpesticides.org/alternatives/factsheets/
For personal use, see EWG report on bug repellents http://www.ewg.org/research/ewgs-guide-bug-repellents
Paint/stain/varnish –
Pre-1978 paint contains lead, so do not scrape or sand (dust is very dangerous).
If painting, use paint with low VOC (volatile organic compounds) and limit exposure
(have someone else paint, air out the house, stay away until paint odor is gone)
Avoid brilliantly colored or fluorescent paints because they often contain PCBs.
New sources of plastics – New plastics emit small chemicals that are hazardous, including new
carpet, plastic/vinyl flooring, glue for carpet/flooring, furniture (especially foam cushions),
plastic shower curtains, Styrofoam, etc.). For safer options, see
www.greenhomeguide.com
Other chemical exposures, including:
Artificial fragrances – use natural/organic ones instead, including essential oils and
plant-derived fragrances
Stainguards on furniture
EMF - Consider reducing exposure to electromagnetic fields (EMF). . Research at this time is
unclear, but it may be helpful to reduce exposure to EMF. This is easy to do at night,
when electronics including wifi can be turned off. For cell phones, use speaker mode or
headset.
Personal Care
Cosmetics – Use natural cosmetics because many cosmetics are a major source of phthalates,
bisphenol A, parabens, toxic metals, and other toxins – see www.ewg.org for safe ones
Sunscreen – some sunscreens are much safer than others; avoid nano particle zinc oxide (regular
zinc oxide is ok) - see recommendations at www.ewg.org
Antiperspirants – use aluminum-free, paraben-free
Drycleaning –Find local dry cleaners that do not use PERC to clean your clothes. This is a toxic
substance that stays in your clothes for days. If you cannot avoid PERC, air the clothing out
with the plastic bag removed, outside the house for 24-48 hours
Hair Treatments/Nail treatments – reduce or avoid additional chemical exposures
Cooking
Avoid microwaving/heating food in plastic (chemicals in plastic then leach into food) – instead,
microwave foods on ceramic plates
Avoid Teflon/Non-stick coatings – use stainless steel and cast iron cookware instead
Avoid/reduce canned food. BPA is used in most canned food and leaches into the food.
Cookware – use steel, stainless, steel or cast iron – avoid aluminum
Pet care
Flea collars – use only natural products
Avoid contact with cat litter or dog’s stool
Toxic metals
Lead: A major source is paint (pre 1978). Other common lead-based products include: lead
pipes, some ceramic cookware from Mexico/South America, imported toys, and some
cosmetics, especially lipstick
Mercury – Primarily from mercury dental fillings, root canals, and high-mercury fish
Arsenic –Arsenic is injected into most chicken, except for organically-raised chickens. Wood
decks with pressure-treated lumber often contain arsenic.
Aluminum – A major source is cookware. We recommend steel or cast iron pots and pans.
Aluminum is also found in many anti-perspirants, antacids, and anti-diarrheals. It is
often added to the water supply, and it can be absorbed by inhalation during
showering.
C. Individualized Evaluation, Metabolic Testing and Treatment – We recommend you ask your
physician to conduct the following tests to check for hidden health problems. Also ask your physician
about relevant tests for the father based on his health status.
Complete gynecological exam
Check all medications, over-the-counter medications, and supplements with your Ob/Gyn
Blood tests
CBC (anemia)
Blood type and Rh
Blood Chemistry panel
Sexually-transmitted diseases, toxoplasmosis, HIV
Immunity to Rubella and Chicken Pox
CRP (C-Reactive Protein)
Glucose and HbA1C
Vitamin D as 25(OH)D
Iron panel (serum iron, IBC, % saturation and serum ferritin)
Thyroid (TSH or more extensive thyroid panel)
Homocysteine (total fasting plasma; give extra vitamin B12 and folinic acid if indicated)
Toxic metals (urine recommended, but hair can be done if hair is untreated by chemicals)
Visual check of stool – should be medium/dark brown, formed, at least 1x/day – if not, discuss with
your physician
Group B Streptococcus (usually at 36 weeks)
Additional tests to consider for high-risk groups
Referral to genetic counselor, medical geneticist, or biochemical genetics specialist
Oxidative Stress Panel (white cell count, urinary isoprostanes, ratio of reduced:oxidized
glutathione)
Essential Fatty Acids (especially if low seafood/fish oil consumption)
Organic Acids (urine)
Plasma quantitative acyl-carnitine panel
Plasma Amino Acids (esp. if low protein consumption and pre-albumin is low)
Methylmalonic acid in urine (for vitamin B12)
Formimino-glutaric acid (FIGLU) in urine (for folate status)
D. Stress Reduction and Mood Improvement
Promote
i. Strong support systems
ii. Healthy relationships without violence
iii. Lifestyle behaviors that decrease stress (e.g., walking, yoga, meditation, prayer)
Daily walking will help to decrease stress, increase Vitamin D, and maintain appropriate
exercise and weight gain
iv. Regular sleep habits: get at least 8 hours per night if possible
E. Appropriate Exercise
F. Wait – After a previous birth, wait at least 18 months before conceiving. This significantly reduces
the risk of pregnancy complications including pre-term birth and infant mortality, probably
because it gives your body time to recover and replenish its nutritional stores.
Wait 3 months after stopping oral contraceptives before conceiving. This allows time for
hormone levels to normalize.
2. Pregnancy
A. Attend all prenatal care visits
i. Collect personal and family medical history data
ii. Discuss risk vs. benefits of prescribed medications (e.g., antidepressants, acne medications
with retinoic acid (Accutane))
iii. Attend childbirth classes
iv. Preparing for Breastfeeding
B. Additional Tests that may be Recommended
i. Amniocentesis (Down syndrome, Cystic Fibrosis, Spina Bifida)
ii. Biophysical Profile
iii. Chorionic Villus Sampling (Down syndrome, Cystic Fibrosis)
iv. First trimester screen (Chromosomal abnormalities)
v. Quad Screen (maternal)
C. Continue Healthy Diet (see Nutrition handout)
Promote:
i. WIC registration during pregnancy, if needed (for low-income families)
ii. Eat frequent small to moderate meals throughout the day, to stabilize glucose levels of
fetus. Foods with a low glycemic index (low sugar) are preferred.
iii. Avoid heavy meals before bed to avoid reflux-triggered waking
iv. Balanced diet to facilitate appropriate weight gain based on BMI at start of pregnancy
v. Anticipate gaining approximately 25-35 pounds during the pregnancy if normal weight
(About 28-40 pounds if underweight, or 20 pounds if you are a little overweight before
pregnancy)
vi. Organic foods as much as possible, to reduce exposure to toxic pesticides
D. Continue to Reduce Toxic Exposures (see above)
Although not conclusive, there is growing concern about receiving ultrasounds during
pregnancy. We recommend minimizing the number and duration of ultrasound testing.
E. Continue Stress Reduction/Mood Improvement Activities
F. Appropriate Exercise (see Exercise During Pregnanacy handout)
Get fit. Pregnancy is a work out, and labor can be a marathon. Prenatal yoga can be very helpful
with learning to open the pelvis and birth canal. Also daily walking enhances fitness and reduces
venous congestion.
G. 40 Weeks of Pregnancy – Do not schedule C-sections prior to 40 weeks unless necessary
Special Cases:
Gestational Diabetes: If you had gestational diabetes in previous pregnancies, the following may
help:
 Aim to keep your carbohydrate intake under 60 grams per day
 Fill up on low starch vegetables, meats, eggs, nuts, and oils
 Sample diets include modified Atkins diet, Protein Power, Southbeach, the Zone, and
Rosedale
Recommended Reading for Parents:
Websites
EWGs Guide to a Healthy Pregnancy - http://static.ewg.org/pdf/pregnancy_awareness.pdf
US Building Council’s Green Home Guide - www.greenhomeguide.com
Physicians for Social Responsibility – www.psr.org
Toxic Chemicals in Food - http://www.psr.org/assets/pdfs/toxic-chemicals-in-our-food.pdf
In Harm’s Way – Toxic Threats to Child Development http://action.psr.org/site/DocServer/execsumm.pdf?docID=5122
Books:
Strategies for Protecting Your Child's Immune System :Tools for Parents and Parents-To-Be – Rodney
Dietert, Janice Dietert
Preventing Autism & ADHD: Controlling Risk Factors Before, During & After Pregnancy - Debby
Hamilton
Preliminary List of Suggested References to Integrate:
Baiz, N., Dargent-Molina, P., Wark, J.D., et al. (2012). Gestational Exposure to Urban Air Pollution Related to a
Decrease in Cord Blood Vitamin D Levels. Journal of Clinical Endocrinology & Metabolism, 97(11),
4087-4095.
de Jonge, L.L., Harris, H.R., Rich-Edwards, J.W., et al. (2013). Parental Smoking in Pregnancy and the Risks
of Adult-Onset Hypertension. Hypertension, 61(2), 494-+.
O'Connor, T.G., Bergman, K., Sarkar, P., et al. (2013). Prenatal cortisol exposure predicts infant cortisol
response to acute stress. Developmental Psychobiology, 55(2), 145-155.
Pereira, G., Haggar, F., Shand, A.W., et al. (2013), Association between pre-eclampsia and locally derived
traffic-related air pollution: A retrospective cohort study. Journal of Epidemiology and Community
Health, 67(2), 147-152.
Pike, K.C., Inskip, H.M., Robinson, S., et al. (2012). Maternal late-pregnancy serum 25-hydroxyvitamin D in
relation to childhood wheeze and atopic outcomes. Thorax, 67(11), 950-956.
Power, M.L., & Schulkin, J. (2012). Maternal obesity, metabolic disease, and allostatic load. Physiol Behav,
106(1), 22-8.
Various publications/committee opinions from the American College of Obstetricians and Gynecologists, such
as “Obesity in Pregnancy” (2013) or “Lead Screening during Pregnancy and Lactation” (2012).