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Prenatal Care

Prenatal care

【Before Pregnancy】

Improve the lifestyle to avoid premature birth Such as quitting alcohol, tobacco and drugs, improve the nutritional status and health habits, avoid overwork, maintain a good mood, try the best to get pregnant in the appropriate age, avoid the damage of the reproductive system, such as infection, abortion and so on.


【Dietary principles for pregnant and breastfeeding women】

1.Women who are preparing for pregnancy should adjust to be healthy and maintain ideal body weight. If there are any questions during pregnancy or breastfeeding, please contact a doctor or a dietitian for consultation.

2.Body weight: During pregnancy, the weight of pregnant women should be adjusted according to the pregnancy. The most suitable situation is a weight increase iof between 10 to 14 kilograms. Pay attention to the speed of the weight gain, and during pregnancy weight loss is not suitable.

3. Calories
(1) According to the recommendation of the Dietary Reference Intakes (DRIs), the daily calories intake during pregnancy needs to increase by 300 kcal, starting from second trimester. However, the total calories for each day should be adjusted depending on the pregnant woman's age, level of activity, pre-pregnancy health condition, and the degree of weight increase. 
(2) According to the recommendation of the DRIs, the daily calories required for a breastfeeding woman is best increased by 500 kcal.
4. Protein
(1) According to the recommendation of the DRIs, starting in the first trimester, 10 grams of extra protein should be added because the fetus has started to develop. More than half of the protein source should come from high biological value (HBV) protein, such as low-fat dairy products, soy products (including soy milk), tofu and dried tofu, fish, meat, and eggs. 
(2) During breastfeeding, the daily secretion volume of breast milk should increase to an average of 850 milliliters 2 to 3 months after giving birth. Because breast milk contains 1.1% protein, it provides about 10 grams of protein to an infant, so it is recommended that a breastfeeding woman should increase daily protein intake by about 15 grams, and half of the protein source should come from  high biological value (HBV) protein.
5. During pregnancy and breastfeeding, the requirement for many vitamins and minerals increases. Pregnant women should have a balanced intake of food from all food groups, have more dark-colored vegetables, and whole-grain cereals. The sources of vitamins and minerals should mainly be natural foods and not from a single nutrient or mineral supplement; however, pregnant women can choose a multivitamin supplement recommended by a doctor to supplement minerals and vitamins during pregnancy.
6. Minerals
(1) Calcium: Pregnant or breastfeeding women should take in enough calcium. It is recommended that pregnant and breastfeeding women take in 1,000 milligrams of calcium per day to satisfy the growth of fetus/infant and the needs of the parent. Foods that are high in calcium: low-fat milk, dairy products, tofu, leafy dark green vegetables.
(2) Iron: During pregnancy the need for iron increases, and the recommended intake volume of iron during the first and second trimester is 15 milligrams per day. The intake volume of iron for women in their third trimester or who are breastfeeding should increase to 45 milligrams per day. Supplement of iron is not only provided for the needs of the pregnant woman and the fetus, it is also largely stored in the fetus body to provide for infants for 4 months after birth. Iron insufficiency during pregnancy may results in negatively affecting the brain and psychological symptoms of fetus. Foods that are high in iron: leafy dark green vegetables, red meat, organ meat such as liver and kidney, and shellfish.
(3) Iodine: If a pregnant woman's iodine intake during pregnancy is severely insufficient, it may affect fetus' brain development, resulting in slow growth and insufficient development of the newborn nervous system and even increase the mortality rate of infants. It is recommended that pregnant women take in 200 micrograms of iodine per day and that breastfeeding women take in 250 micrograms per day. Foods that are high in iodine: Seaweed, kelp, shellfish, green vegetables, eggs, dairy, cereals, etc., of which, seaweed and kelp have the highest iodine content. Pregnant women can also use iodized salt to increase the intake of iodine.
(4) Sodium: If there are symptoms of hypertension or edema during pregnancy, the intake volume of sodium should be limited.
(5) Magnesium: Increasing magnesium intake during pregnancy can reduce the chance of pre-eclampsia and poor fetal growth. It is recommended that pregnant women take in 355 milligrams of magnesium per day and that breastfeeding women take in 320 milligrams per day. Magnesium can be found in vegetables rich in chlorophyll, such as spinach, red spinach, cabbage, and other foods such as cereal germ, whole grain wheat bran, stone fruits, seeds, and bananas.
(6) Zinc: Zinc insufficiency for pregnant women may result slow fetal growth and neural tube defects. It is recommended for pregnant and breastfeeding women to take in 15 milligrams of zinc per day. Animal food sources for zinc include liver, lean meat, oyster, and crustaceans, which have the highest zinc content.
(7) Other: Mineral intake volume for Taiwanese citizens should meet and not exceed the DRIs.
7. Vitamins
During pregnancy and breastfeeding, the requirements for most vitamins are increased.

  1. The required amount for Vitamin B1, B2, B6, and niacin are increased as the intake of calories and protein increases. Wheat germ has the richest content of Vitamin B1, but nuts, lean meat, liver, soybeans and their products are also main sources of Vitamin B1. Vitamin B2 is stored in most plant and animal tissues, of which, milk, dairy products, and fortified grains have the richest content. Vitamin B6 is found in various types of meat and whole grains. Foods that are rich in niacin include liver, beef, pork, chicken, fish and shellfish, eggs and dairy, cheese, brown rice, germ rice, yeast, mushroom, seaweed, etc.
  2. Vitamin B12: Vitamin B12 deficiency or inadequate Vitamin B12 status might cause fetal neural tube defects. Vegetarians should pay special attention to the supplement of Vitamin B12. Foods that are high in Vitamin B12: Mainly comes from animal food sources, of which liver has the richest Vitamin B12 content.
  3. Other: Vitamin intake volumes for Taiwanese citizens should meet and not exceed the DRIs.

8. The importance of folic acid
(1) According to research on records of newborns reported with neural tube defects between 1993 to 2002, the rate of neural tube defects is between 0.4‰ to 1‰, an average of 7 in every 10,000 pregnancies. sAccording to American studies, pregnant women who take in enough folic acid can prevent a majority of neural tube defects in the fetal brain and spinal cord, avoiding about 50% to 70% of the defects. According to the DRIs, it is recommended that women of childbearing age take in 400 micrograms of folic acid per day, increasing to 600 micrograms from one month prior to conception and during pregnancy to provide for the mother and the fetus.
Folic acid is commonly found in many foods, such as  green vegetables, lean meat, liver, yeast, and soybean products. It is recommended that the volume of folic acid intake should come from diverse natural foods first. If daily diet is not providing a sufficient amount of folic acid, then it is recommended to supplement with folic acid supplementation under the guidelines of a doctor's prescription.
9. Selection of foods needs to be balanced, and pregnant and breastfeeding women should reduce or avoid the following:
(1) Tobacco, alcohol, coffee and strong tea.
(2) Foods that are high in fat, such as fatty meat, fried food, etc.
(3) Smoked and processed food, such as cured meats, salted duck eggs, salted fish, ham, fermented bean curd, etc.
(4) High-calorie foods such as candy, cola, and other soft drinks.
10. If a pregnant woman experiences nausea and vomiting during early pregnancy, the pregnant woman should have smaller but more frequent meals and choose low-fat and non-irritating foods. Cereal foods such as cookies and steamed buns can be eaten in the morning to reduce vomiting. Avoid eating too much carbohydrates and fats during the end of the pregnancy, to prevent increase of body fat.
11. Herbal medicine from unknown sources without a licensed traditional Chinese practitioner confirming dosage and administration should be avoided.
12. Pregnant women should have an appropriate amount of daily exercise and pay attention to relevant exercise safety precautions.

(
Information source: Maternal Health Booklet issued by the Health Promotion Administration, Ministry of Health and Welfare)

【Hereditary disease prevention
There are an estimated 25,000 genes in the human genome, and by DNA replication genes are passed on from generation to generation. Each person carries about 5 to 10 defective recessive genes,and as a result, many couples who appear to be healthy may give birth to babies with genetic disorders because one or both person caries defective recessive genes.

● Prenatal diagnosis focus
For the mother-to-be that does not have a family health history of diseases and is under the age of 34, the 10 prenatal diagnosis provided by National Health Insurance is enough for doctors and the mother-to-be to understand the changes and fetal condition of the entire pregnancy. However, if the financial condition permits, it is recommended that few more self-paid diagnoses be carried out, after consulting with a doctor.
As of now, although private clinics have already developed many self-paid diagnosis services, non-invasive screenings can be the initial focus. It is especially recommended that pregnant women also have a spinal muscular atrophy (SMA) screening between 12th and 20th week of pregnancy. Because SMA is a fatal genetic disorder, if both parents are carriers, then every fetus has a 1/4 chance of becoming a patient, so it is recommended that every fetus be screened.
Down syndrome is a common disorder caused by chromosomal abnormalities, women over the age of 35 will have a higher chance of having babies with Down syndrome; however, approximately 80% of babies with Down syndrome were born from mothers that are 34 years old or younger. Hence, it is recommended for pregnant women under the age 34 to receive blood tests for Down syndrome and decide whether to receive amniocentesis to reduce the risk of giving birth to babies.with Down syndrome.
If the mother-to-be had given birth to children with rare diseases or has a family history of hereditary diseases, the mother-to-be should discuss with the doctor as early as possible and receive chorionic villus sampling (CVS) between the 10th and 12th week of pregnancy, amniocentesis between the 16th and 20th week of pregnancy, level 2 ultrasound and other screening between 20th and 24th week of pregnancy for chromosome analysis, and relevant prenatal diagnosis.
Everyone has the risk of genetic diseases, so the mother-to-be must receive prenatal screening on time and cooperate with doctors.

(Information source: Taiwan Foundation for Rare Disorders)

【Premature birth】
A premature birth is a birth that takes place after the 20th week of pregnancy and before the start of the 37th week of pregnancy. It is difficult to take care of premature babies, and improper care is the main cause of death for newborn infants. 50% of the causes for premature births are still unknown. Known risk factors include:

Lifestyle

Before pregnancy

During pregnancy

Yes/No
□□ Malnutrition
□□ Use tobacco and alcohol
□□ Use addictive drugs
□□ Overworked
□□ Poor hygiene habits
□□ Emotionally restless
□□ Anemia, etc.

Yes/No
□□ Younger than 18 years old or older than 40 years old
□□ Premarital pregnancy
□□ Underweight before pregnancy
□□ Spacing of pregnancies is too close together
□□ Had premature birth, premature labor, first or second trimester miscarriage
□□ Suffered from pyelonephritis
□□ Experienced cervical incompetence in a previous pregnancy
□□ Has a negative obstetrical history
□□ Uterus has received surgery (i.e. artificial abortion)

Yes/No
□□ Infection or fever
□□ Urinary tract infection or a cold
□□ Multiple births
□□ Placenta previa
□□ pre-eclampsia or hypertension
□□ Abruptio placenta
□□ Premature rupture of membranes
□□ Hydramnios or oligohydramnios
□□ Uterine malformation
□□ Bleeding occurred 12 weeks after pregnancy
□□ Had abdominal surgery
□□ Suffered physical or emotional trauma
□□ Fetal chromosomal abnormalities or congenital malformations

Most of these factors can be resolved before pregnancy. If you have one of the following symptoms, be sure to see a doctor as soon as possible.


Yes/No
□□ Experience more than six uterine contractions within one hour or one uterine contraction every 10 to 15 minutes, and the condition does not improve after resting for 30 minutes. Uterine contractions do not necessarily result in pain; however, the abdomen will harden or you like feel like the baby is pushing down.
□□ Menstrual-like cramps or throbbing pain like that experienced before menstruation
□□ Feels like the fetus is dropping and there is uterine and vaginal pressure
□□ Low backache that cannot be improved by any method
□□ Continuous diarrhea or constant abdominal pain
□□ Increase of vaginal discharge, vaginal mucus, and blood-like secretion
□□ Fetal movement reduced by more than half
(If you have checked any of the symptoms above, your pregnancy might be a high risk pregnancy. Remember to tell your doctor about the symptoms to ensure your and baby's safety. To contact the Premature Baby Foundation of Taiwan)

(Information source: Maternal Health Booklet issued by the Health Promotion Administration, Ministry of Health and Welfare)

【Signs of labor
Births that occur two weeks prior to and after the expected date of delivery are considered to be normal. When approaching the expected date of delivery, the following signs will appear:
1. Feeling relaxed
Few weeks prior to the expected date of delivery, baby's head will settle into the pelvis, and pregnant women will feel lighter, usually will have a better appetite, and smoother breathing.
2. Red discharges or bleeding
The cervix dilates, and cervical mucus mixed with small amounts of blood discharges from the vagina.
3. Cramps and increased back pain
(1) At the beginning, the pain you experience is irregular, gradually falls into regular pattern, and then the pain increases as the time progresses.
(2) The pain is in the entire abdomen and back, especially around the tail bone area.
(3) When contraction pain occurs, the uterus hardens, and when the pain ceases, the uterus softens.
(4) Pain does not ease with massage or walking around.
4. Rupture of membranes
The amniotic membrane that protects the fetus ruptures, and amniotic fluid leaks from the vagina. When this happens, regardless of whether there is pain or not, you should try not to walk around, and go to a hospital as soon as possible.

★ When should a pregnant woman go to a delivery room to prepare for childbirth?
If any of the following signs of labor occur, the pregnant woman should go to a delivery room as soon as possible.

  1. Regular contractions: The contractions for the first childbirth are approximately 7 to 8 minutes apart; however, for the second childbirth, the pregnant woman is ready to enter the delivery room when experiencing regular contractions.
  2. Red discharge and regular contractions.
  3. Rupture of membranes

(Information source: Maternal Health Booklet issued by the Health Promotion Administration, Ministry of Health and Welfare)