healthy pregnancy essay

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What can I do to promote a healthy pregnancy?

Once you're pregnant, early and regular prenatal care is important to keep yourself and your developing infant healthy.

During your first prenatal visit, your health care provider may talk to you about the following ways to help have a healthy pregnancy: 1

Take folic acid.

Begin or continue to get at least 400 micrograms of folic acid by taking vitamin supplements every day to reduce your child's risk of neural tube defects . In the United States, enriched grain products such as bread, cereal, pasta, and other grain-based foods are fortified with folic acid. A related form, called folate, occurs naturally in leafy, green vegetables and orange juice, but folate is not absorbed as well as folic acid. 2 Also, it can be difficult to get all the folic acid you need from food alone. 3 Most prenatal vitamins contain 400 micrograms of folic acid. 4 If you have had a child with an NTD before, taking a larger daily dose of folic acid (4 mg) before and during early pregnancy can reduce the risk for recurrence in a subsequent pregnancy.

Do not use alcohol, tobacco, or drugs.

FASDs are a variety of effects on the fetus that result from the mother drinking alcohol during pregnancy. The effects range from mild to severe, and they include intellectual and developmental disabilities ; behavior problems; abnormal facial features; and disorders of the heart, kidneys, bones, and hearing. FASDs last a lifetime although early intervention services can help improve a child's development. FASDs are completely preventable: If a woman does not drink alcohol while she is pregnant, her child will not have an FASD. 7 Currently, research shows that there is no safe amount of alcohol to drink while pregnant. According to one recent study supported by the NIH, infants can suffer long-term developmental problems even with low levels of prenatal alcohol exposure. 8

Other research shows that smoking tobacco, smoking marijuana, exposure to second-hand smoke, and taking drugs during pregnancy can also harm the fetus and affect infant health. One study showed that smoking tobacco or marijuana and using illegal drugs doubled or even tripled the risk of stillbirth , fetal death after 20 weeks of pregnancy. 9 Likewise, drinking alcohol, smoking tobacco, and exposure to second-hand smoke during pregnancy increases the risk of SIDS, the sudden, unexplained death of an infant younger than 1 year old. 10 Research also shows that smoking marijuana during pregnancy can interfere with normal brain development in the fetus, possibly causing long-term problems. 11 For more information, visit https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/ substance-use-while-pregnant-breastfeeding .

Your health care provider can be a source of help if you find it hard to quit smoking or drinking on your own. You can also visit http://smokefree.gov/ for plans and information about quitting smoking. The Rethinking Drinking website provides resources and information related to quitting alcohol use. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a services locator through its website at https://findtreatment.samhsa.gov/ . SAMHSA also has a confidential hotline through which people can find assistance: 1-800-662-HELP (4357).

Talk to your health care provider about medications.

According to the CDC, most women take at least one medication during pregnancy. 12 The majority of medications have not been specifically studied for use in pregnancy. Talk to your health care provider about over-the-counter and prescription medications and herbal and vitamin supplements. Certain medications to treat acne and epilepsy and some dietary or herbal supplements can harm the fetus during pregnancy.

Taking prescription pain medications, specifically opioids, during pregnancy can pose serious risks to the fetus. Taking these medications during pregnancy doubles or even triples the risk for stillbirth. 9 If taken regularly during pregnancy, the baby may go through withdrawal after birth, a situation called neonatal abstinence syndrome (NAS). Babies with NAS face a variety of symptoms and problems, some of them severe. 13 The best way to protect your baby from these problems is to stop taking these medications during pregnancy.

Avoid exposure to toxic substances.

During pregnancy, exposure to radiation, pesticides, some metals, and certain chemicals can cause birth defects, premature birth, and miscarriage. 14 If you're not sure if something might be harmful to you or your fetus, avoid contact with it until you check with your health care provider.

If you work in a job on a farm, a dry cleaner, a factory, a nail or hair salon, you might be around or come into contact with potentially harmful substances. Talk to your health care provider and your employer about how you can protect yourself before and during pregnancy. You may need extra protection at work or a change in your job duties to stay safe. 14

A few examples of exposures that are known to be toxic to the developing fetus are:

Lead: Lead is a metal that may be present in house paint, dust, and garden soil. Any home built before 1978 may have lead paint. Exposure can occur when removing paint in old buildings (or if the paint is peeling) and working in some jobs (for example, manufacturing automotive batteries). Lead is also present in some well water and in water that travels through lead pipes. High levels of lead during pregnancy can cause miscarriage, stillbirth, low birth weight, and premature delivery, as well as learning and behavior problems for the child. 15 Women who had exposure to lead in the past should have1 their blood levels checked before and during pregnancy. 15 Call the National Lead Information Center for information about how to prevent exposure to lead at: 800-424-LEAD.

Radiation: Radiation is energy that travels through space. It can be in the form of X-rays, radio waves, heat, or light, or it can come from "radioactive" materials like dust, metals, or liquids that give off energy called radioactivity. Low exposures to radiation from natural sources (such as from the sun) or from microwave ovens or routine medical X-rays are generally not harmful. Because the fetus is inside the mother, it is partially protected from radiation's effects. 14 , 16 Pregnant women or women who might be pregnant should make sure their dentists and doctors are aware of this so appropriate precautions can be taken with medical scans (X-rays or CT scans) or treatments that involve radiation. 14 Pregnant women who may be exposed to radiation in the workplace should speak with their employer and health care provider to make sure the environment is safe during their pregnancy. Nuclear or radiation accidents, while rare, can cause high radiation exposures that are extremely dangerous, especially to the developing fetus.

Solvents: Solvents are chemicals that dissolve other substances. Solvents include alcohols, degreasers, and paint thinners. Some solvents give off fumes or can be absorbed through the skin and can cause severe health problems. During pregnancy, being in contact with solvents, especially if you work with them, can be harmful. Solvents may lead to miscarriage, slow the growth of the fetus, or cause preterm birth and birth defects. 14 Pregnant women who may be exposed to solvents in the workplace should speak with their employer and health care provider to make sure the environment is safe during their pregnancy. 17 Whenever you use solvents, be sure to do so in a well-ventilated area, wear safety clothes (such as gloves and a face mask), and avoid eating and drinking in the work area. 14

Many chemicals are commonly found in the blood and body fluids of pregnant women and their infants. However, much remains unknown about the effects of fetal exposure to chemicals. 18 It's best to be cautious about chemical exposure when you are planning to get pregnant or if you are pregnant. Talk to your health care provider if you live or work in or near a toxic environment. 17

Follow a healthy diet.

Choose a variety of fruits, vegetables, whole grains, and low-fat dairy products to help ensure the developing fetus gets all the nutrients it needs. Make sure you also drink plenty of water. An online tool called the Daily Checklist for Moms can help you plan your meals so that you get the right foods in the right amounts according to your personal characteristics and your stage of pregnancy.

Eat a safe diet.

Avoid certain foods such as raw fish, undercooked meat, deli meat, and unpasteurized cheeses (for example, certain types of feta, bleu cheese, and Mexican-style soft cheeses). 19 Always check the label to make sure the cheese is pasteurized.

Some pregnant women are concerned about the amount of fish they can safely consume. Certain fish contain methylmercury, when certain bacteria cause a chemical change in metallic mercury. Methylmercury is found in foods that fish eat, and it remains in the fish's body after it is eaten. Methylmercury in fish eaten by pregnant women can harm a fetus's developing nervous system.

According to the U.S. Food and Drug Administration (FDA), pregnant women can eat up to 12 ounces a week of fish and shellfish that have low levels of methylmercury (salmon, canned light tuna, and shrimp). Albacore ("white") tuna has more methylmercury than canned light tuna; pregnant women should consume 6 ounces or less in a week. Avoid fish with high levels of methylmercury (swordfish, king mackerel, and shark). For more information on methylmercury and pregnancy, see the FDA Food Safety for Moms-to-Be . 19

Limit caffeine intake.

Some studies suggest that too much caffeine can increase the risk of miscarriage. Talk to your health care provider about the amount of caffeine you get from coffee, tea, or soda. Your health care provider might suggest a limit of 200 milligrams (the amount in about one 12-ounce cup of coffee) per day. Keep in mind, though, that some of the foods you eat, including chocolate, also contain caffeine and contribute to the total amount you consume each day. 20

Talk to your health care provider about physical activity.

Most women can continue regular levels of physical activity throughout pregnancy. Regular physical activity can help you feel better, sleep better, and prepare your body for birth. After your child is born, it can help get you back to your pre-pregnancy shape more quickly. 21 Talk to your health care provider about the amount and type of physical activity that is right for you.

Maintain a healthy weight.

Gaining too much or too little weight during pregnancy increases the risk of problems for both the mother and the infant. Following a healthy diet and getting regular physical activity can help you stay within the recommended weight gain guidelines set by the Institute of Medicine.

The amount of weight you should gain during pregnancy depends on your pre-pregnancy weight and body mass index (BMI) , which is your weight in kilograms divided by the square of your height in meters (kg/m 2 ). The following guidelines are for women who are pregnant with one fetus. The recommendations are different if you are pregnant with more than one fetus (such as twins). 22 , 23

• Women who are underweight (BMI less than 18.5) should gain between 28 and 40 pounds.
• Women at a normal weight (BMI between 18.5 and 24.9) should gain between 25 and 35 pounds.
• Overweight women (BMI 25 to 29.9) should gain between 15 and 25 pounds.
• Obese women (BMI more than 30) should gain between 11 and 20 pounds.

In a recent NICHD study of more than 8,000 pregnant women, 73% gained more than the recommended amount of weight. The study found that excessive weight gain during pregnancy increases the risk for gestational high blood pressure, cesarean section, and large-for-gestational-age infants. 24

Talk to your health care provider about the right amount of weight gain for you based on your pre-pregnancy weight.

Talk to your health care provider about your nutrition status, including vitamin B12 and iron levels.

Iron-deficiency anemia—when the body doesn't have enough iron—is common during pregnancy and is associated with preterm birth and low birth weight. Your health care provider may screen you for iron-deficiency anemia and, if you have it, may recommend iron supplements. 25 Your health care provider may also recommend a vitamin B12 supplement if you are a vegan. 26 , 27 (Vegetarians normally get enough vitamin B12 by eating eggs and dairy products.)

Get regular dental checkups.

Your gums are more likely to become inflamed or infected because of hormonal changes and increased blood flow during pregnancy. 28 Make sure you tell your dentist if you think you could be pregnant, but keeping up your regularly scheduled checkups is important. Some women may fear getting dental work during pregnancy, but a 2006 study and 2011 follow-up study showed no increase in preterm births or other adverse outcomes for pregnant women who received dental care. 29

Prevent infections that can affect your pregnancy.

Certain infections can affect pregnancy or the developing fetus. It's important to take steps to prevent such infections or get medical treatment before or during pregnancy.

Vaccinations can protect against many infections that can affect the mother's health, the pregnancy, the fetus, and even her newborn child. Some vaccines need to be given before pregnancy, so it's a good idea to review your vaccination history with your health care provider as part of your pre-pregnancy care. The Centers for Disease Control and Prevention provides recommendations about timing of vaccinations to help ensure a healthy pregnancy.

Learn more about how infections can affect pregnancy and which infections can cause problems during pregnancy .

• NIH Office of Dietary Supplements. (2016). Dietary supplement fact sheet: Folate. Retrieved January 5, 2016, from http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
• Womenshealth.gov. (2012). e Publications: Prenatal care fact sheet. Retrieved June 27,2017, from https://www.womenshealth.gov/a-z-topics/prenatal-care
• Centers for Disease Control and Prevention. (2015). Preconception health and health care: Planning for pregnancy. Retrieved January 5, 2016, from http://www.cdc.gov/preconception/planning.html
• Centers for Disease Control and Prevention. (2015). Fetal alcohol spectrum disorders (FASDs): Facts about FASDs. Retrieved January 5, 2016, from http://www.cdc.gov/ncbddd/fasd/facts.html
• Eckstrand, K. L., Ding, Z., Dodge, N. C., Cowan, R. L., Jacobson, J. L., Jacobson, S.W., et al. (2012). Persistent dose-dependent changes in brain structure in young adults with low-to-moderate alcohol exposure in utero. Alcoholism: Clinical and Experimental Research, 36 (11), 1892–1902. PMID: 22594302
• NICHD.(2013). Tobacco, drug use in pregnancy can double risk of stillbirth. Retrieved November 9, 2016, from https://www.nichd.nih.gov/news/releases/Pages/ 121113-stillbirth-drug-use.aspx
• NICHD.(2016). Ways to reduce the risk of SIDS and other sleep-related causes of infant death . Retrieved June 2, 2016, from https://www.nichd.nih.gov/sts/about/risk/Pages/reduce.aspx
• NICHD.(2016). Prenatal exposure to marijuana may disrupt fetal brain development, mouse study suggests. Retrieved November 9, 2016, from https://www.nichd.nih.gov/news/releases/Pages/ 031516-prenatal-exposure-marijuana.aspx
• Centers for Disease Control and Prevention. (2018). Treating for Two: Medicine and Pregnancy. Retrieved May 16, 2018, from https://www.cdc.gov/pregnancy/meds/treatingfortwo/index.html
• Centers for Disease Control and Prevention. (2014). Cancer and long-term health effects of radiation exposure and contamination. Retrieved January 5, 2016, from https://www.cdc.gov/nceh/radiation/emergencies/cancer.htm
• Lanphear, B. P., Vorhees, C. V., & Bellinger, D. C. (2005). Protecting children from environmental toxins. PLOS Medicine, 2 (3), e61.
• U.S. Food and Drug Administration. (2014). Food safety for moms-to-be: While you're pregnant—methylmercury. Retrieved January 6, 2016, from https://www.fda.gov/food/people-risk-foodborne-illness/food-safety-moms-be
• Johnson, J., Clifton, R. G., Roberts, J. M., Myatt. L., Hauth, J. C., Spong, C. Y., et al. (2013). Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstetrics and Gynecology, 121 (5), 969–975. PMID: 23635732
• U.S.Department of Agriculture & U.S. Department of Health and Human Services. (2010). Dietary guidelines for Americans 2010. Retrieved May 21, 2012, from https://health.gov/sites/default/files/2020-01/DietaryGuidelines2010.pdf  (PDF 2.89 MB)
• NICHD. (2010). Pregnancy and healthy weight. Retrieved April 10, 2012, from http://www.nichd.nih.gov/news/resources/spotlight/Pages/040710-pregnancy-healthy-weight.aspx
• National Child and Maternal Oral Health Resource Center. (n.d.) Oral Health Care During Pregnancy: A Consensus Statement. Retrieved June 24, 2020, from https://www.mchoralhealth.org/materials/consensus_statement.php .

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Pregnancy diet: Focus on these essential nutrients

A healthy pregnancy diet will promote your baby's growth and development. Understand which nutrients you need most and where to find them.

During pregnancy, the basic principles of healthy eating remain the same — get plenty of fruits, vegetables, whole grains, lean protein and healthy fats. However, a few nutrients in a pregnancy diet deserve special attention. Here's what tops the list.

Folate and folic acid — Prevent brain and spinal cord birth problems

Folate is a B vitamin that helps prevent serious problems with the developing brain and spinal cord (neural tube defects). The synthetic form of folate found in supplements and fortified foods is known as folic acid. Folic acid supplementation has been shown to decrease the risk of premature birth and having a low birth weight baby.

How much you need: 400 micrograms (mcg) a day of folate or folic acid before conception and 600 to 1,000 micrograms of folate or folic acid a day throughout pregnancy

Good sources: Fortified cereals are great sources of folic acid. Dark green, leafy vegetables, citrus fruits, and dried beans, peas and lentils are good sources of naturally occurring folate.

In addition to making healthy food choices, taking a daily prenatal vitamin — ideally starting at least three months before conception — can help ensure you're getting enough of this essential nutrient. Anyone who might become pregnant should take a daily vitamin supplement containing folic acid.

Calcium — Strengthen bones

You and your baby need calcium for strong bones and teeth. Calcium also supports healthy functioning of the circulatory, muscular and nervous systems.

How much you need: 1,000 milligrams (mg) a day; pregnant teenagers need 1,300 milligrams a day

Good sources: Dairy products are the best absorbed sources of calcium. Nondairy sources include broccoli and kale. Many fruit juices and breakfast cereals are fortified with calcium, too.

Vitamin D — Promote bone strength

Vitamin D works with calcium to help build your baby's bones and teeth.

How much you need: 600 international units (IU) a day

Good sources: Fatty fish, such as salmon, is a great source of vitamin D. Other options include fortified milk and orange juice.

Protein — Promote growth

Protein is crucial for your baby's growth throughout pregnancy.

How much you need: 71 grams (g) a day

Good sources: Lean meat, poultry, seafood and eggs are great sources of protein. Other options include beans and peas, nuts, seeds, and soy products.

Iron — Prevent iron deficiency anemia

The body uses iron to make hemoglobin. Hemoglobin is a protein in the red blood cells that carries oxygen to the body's tissues. During pregnancy, you need double the amount of iron that nonpregnant women need. Your body needs this iron to make more blood to supply oxygen to your baby.

If you don't have enough iron stores or get enough iron during pregnancy, you could develop iron deficiency anemia. You might develop headaches or become fatigued. Severe iron deficiency anemia during pregnancy also increases the risk of premature birth, having a low birth weight baby and postpartum depression.

How much you need: 27 milligrams a day

Good sources: Lean red meat, poultry and fish are good sources of iron. Other options include iron-fortified breakfast cereals, beans and vegetables.

Prenatal vitamins typically contain iron. In some cases, your health care provider might recommend a separate iron supplement.

The iron from animal products, such as meat, is most easily absorbed. To enhance the absorption of iron from plant sources and supplements, pair them with a food or drink high in vitamin C — such as orange juice, tomato juice or strawberries. If you take iron supplements with orange juice, avoid the calcium-fortified variety. Although calcium is an essential nutrient during pregnancy, it can decrease iron absorption.

Supplements — Ask your health care provider

Even if you eat a healthy diet, you can miss out on key nutrients. Taking a daily prenatal vitamin — ideally starting at least three months before conception — can help fill any gaps. Your health care provider might recommend special supplements if you follow a strict vegetarian diet or have a chronic health condition. If you're considering taking an herbal supplement during pregnancy, consult your health care provider first. Some herbal supplements might be harmful to your pregnancy.

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• Landon MB, et al., eds. Nutrition during pregnancy. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Jan. 19, 2022.
• Fact sheet for health professionals: Folate. National Institutes of Health. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/. Accessed Jan. 19, 2022.
• Fact sheet for health professionals: Iron. National Institutes of Health. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed Jan. 19, 2022.
• Fact sheet for health professionals: Calcium. National Institutes of Health. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Accessed Jan. 19, 2022.
• FAQs: Nutrition during pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy. Accessed Jan. 19, 2022.
• Staying healthy and safe. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/staying-healthy-and-safe. Accessed Jan. 19, 2022.
• Garner CD. Nutrition in pregnancy: Dietary requirements and supplements. https://www.uptodate.com/content/search. Accessed Jan. 19, 2022.
• 2020-2025 Dietary Guidelines and Online Materials: Food sources of vitamin D. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials/food-sources-select-nutrients/food-sources. Accessed Jan. 19, 2022.
• 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov. Accessed Jan. 19, 2022.
• Fact sheet for health professionals: Vitamin D. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed Jan. 19, 2022.
• American College of Obstetricians and Gynecologists. Practice Bulletin No. 233: Anemia in pregnancy. Obstetrics & Gynecology. 2001; doi:10.1097/AOG.00000000000004477. Reaffirmed 2015.
• AskMayoExpert. Preconception care. Mayo Clinic; 2021.

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Staying Healthy During Pregnancy

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Now that you're pregnant , taking care of yourself has never been more important. Here's how to keep you and your baby as healthy as possible.

Prenatal Health Care

To protect the health of your baby, be sure to get regular prenatal care . If you think you're pregnant, call your health care provider to schedule your first prenatal appointment. Often, the first visit will happen after 8 weeks of pregnancy unless there is a problem before then.

Medical Care and Testing During Pregnancy

At this first visit, your health care provider will probably do a pregnancy test, then figure out how many weeks pregnant you are based on a physical exam and the date of your last period. They'll also use this information to predict your delivery date (an ultrasound  later in your pregnancy will help confirm that date).

If you're healthy and have no complicating risk factors, most health care providers will want to see you:

• every 4 weeks until the 28th week of pregnancy
• then every 2 weeks until 36 weeks
• then once a week until delivery

Your health care provider will regularly check your weight and blood pressure, and check the growth and development of your baby (by doing things like feeling your abdomen, listening for the fetal heartbeat starting during the second trimester, and measuring your belly). You'll also have prenatal tests  and probably at least one ultrasound.

When choosing a health care provider to counsel and treat you during your pregnancy, your options include:

• obstetricians: doctors who specialize in pregnancy and childbirth
• obstetricians/gynecologists (OB/GYNs) : doctors who specialize in pregnancy and childbirth, as well as women's health care
• family practitioners: doctors who provide a range of services for patients of all ages — in some cases, this includes obstetrical care
• certified nurse-midwives:  advanced practice nurses  specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for pregnancies without problems. There are other types of midwives, too, with different levels of training. Midwives often work together with doctors, but in some states they might work independently.

Nutrition and Supplements During Pregnancy

Now that you're eating for two (or more!), don't cut calories or go on a diet. Women who are pregnant with one baby need about 300–400 extra calories a day in the second trimester, and a little more in the third trimester. If you're very thin, very active, or  carrying  multiples , you'll need even more. But if you're overweight, your health care provider may advise you to take in fewer extra calories.

Healthy eating is always important, but especially when you're pregnant. So, make sure your calories come from nutritious foods that will boost your baby's growth and development, such as:

• whole-grain breads
• low-fat dairy products

Eating a healthy, balanced diet helps you get the nutrients you need . But you will need more of the essential nutrients — especially calcium, iron, and folic acid — than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.

How Can I Get Enough Calcium During Pregnancy?

Women 19 and older need 1,000 mg of calcium a day for healthy bones and teeth. During pregnancy, your growing baby's calcium demands are high, so you'll need to get even more of it to prevent losing the mineral from your own bones.

Most prenatal vitamins contain some extra calcium, but dietary sources are also important. Good food sources of calcium include:

• low-fat dairy products including milk, pasteurized cheese, and yogurt
• calcium-fortified products, including orange juice, soy milk, and cereals
• dark green vegetables including spinach, kale, and broccoli
• dried beans

How Can I Get Enough Iron During Pregnancy?

Pregnant women need about 30 mg of iron every day. Iron is needed to make hemoglobin, the oxygen-carrying component of red blood cells. Red blood cells circulate throughout the body to deliver oxygen to all its cells.

Without enough iron, the body can't make enough red blood cells and the body's tissues and organs won't get the oxygen they need to work well. So it's especially important for pregnant women to get enough iron in their daily diets — for themselves and their growing babies.

Although the nutrient can be found in various kinds of foods, iron from meat sources is more easily absorbed by the body than iron found in plant foods. Iron-rich foods include:

• dark poultry
• enriched grains
• dried beans and peas
• dried fruits
• dark leafy green vegetables
• blackstrap molasses
• iron-fortified breakfast cereals

How Can I Get Enough Folate (Folic Acid) During Pregnancy?

The Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age — and especially those who are planning a pregnancy — get about 400 micrograms (0.4 milligrams) of folic acid supplements every day. Pregnant women should bump that up to 600 micrograms (0.6 milligrams).

So, why is folic acid so important? Studies have shown that taking folic acid supplements 1 month prior to and throughout the first 3 months of pregnancy decrease the risk of neural tube defects.

The neural tube forms during the first several weeks of pregnancy, sometimes before a woman knows she's pregnant. It goes on to become the baby's developing brain and spinal cord. If it doesn't form properly, it can lead to a neural tube defect such as spina bifida .

Your health care provider can prescribe a prenatal vitamin that contains the right amount of folic acid. Some women may need more than 600 micrograms per day (for example, if they've previously had a child with a neural tube defect).

If you're buying an over-the-counter supplement, remember that most multivitamins contain folic acid, but not all of them have enough to meet the nutritional needs of pregnant women. Check labels carefully before choosing one and talk to your health care provider.

Staying Hydrated During Pregnancy

It's important to drink plenty of liquids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy. Drinking enough water each day not only helps prevent  dehydration , but also constipation, a common problem during pregnancy.

What Else Should I Know?

To take great care of yourself and your baby during your pregnancy, follow these basics:

• Don't  smoke ,  drink alcohol , or  use drugs .
• Get enough  rest .
• Eat a healthy  diet .

It's also important to take  precautions  and know about:

• medicine safety
• food safety
• exercise safety

Even though you have to stay aware of how what you do — and don't do — may affect your baby, many women say they've never felt healthier than during pregnancy.

How to have a healthy pregnancy

F or most women, pregnancy is a rollercoaster ride of joy punctuated by crippling doubt, countless Google searches and perpetual risk assessment.

Suddenly everything is measured in weeks (or fruit – the baby is compared to everything from a blueberry to a mango), a whole host of anatomical words enter the vernacular, and a woman’s entire lifestyle comes under scrutiny. 

Unsurprisingly, a survey conducted by pregnancy charity Tommy’s found that 86 per cent of women felt overwhelmed by the amount of pregnancy information available, not helped by the fact that guidelines and rhetoric seem to change by the year. 

To ease confusion, we’ve compiled a comprehensive guide to having a healthy pregnancy with the most up-to-date advice on foods to avoid , safe exercise and how to sleep better. Here’s what we cover:

Eating for two?

What to eat when you’re pregnant, prenatal vitamins and supplements, foods to avoid when pregnant, how to sleep better when pregnant, is it safe to exercise when you’re pregnant.

This is one myth the NHS is keen to overturn as even by the third trimester, women only need an additional 200 calories a day (that’s two slices of wholemeal toast and margarine). The NHS website says most women gain between 10 and 12.5kg (22-28lb), mainly after week 20, but given those gains vary greatly, the focus should be on adopting healthy eating habits and staying active .

Foods women are encouraged to eat in order to help their baby develop and grow are fairly straightforward, but it’s those to avoid that cause confusion. “We know women receive a great deal of health-related information during their pregnancies ,” says Dr Caroline Taylor, associate professor in nutrition at the University of Bristol, who runs The Pear Study, which aims to find out how guidance on diet in pregnancy affects what women eat. “Even in the last 15 years, protocol has changed with certain foods. For example, before 2009 the advice was to avoid peanuts if there was a history of allergies, now it’s to avoid them only if you have a nut allergy. Before 2019, all uncooked or partially cooked eggs were to be avoided, but now it’s okay if they are hen’s eggs stamped with the British Lion mark or produced under the Laid in Britain scheme. And before September 2022 smoked fish was fine and sushi was okay if the fish had previously been frozen. Nowadays raw fish should be avoided and smoked fish cooked thoroughly.”

During pregnancy, women in England are urged to follow a healthy diet broadly similar to the general population with the exception of specific foods and drinks.

“A baby’s rapid growth and development during pregnancy puts many metabolic demands on a mother’s body, which requires plenty of nutritional fuel,” says nutritionist and hormonal health specialist Lola Ross. “A healthy pregnancy diet should be based around diverse wholefoods: colourful vegetables, fruit, legumes, wholegrains, small amounts of dairy and organic animal produce that provide you with protein, healthy fats , insoluble/soluble fibre and micronutrients needed to support both mum and baby during pregnancy.”

The NHS recommends eating at least two portions of fish a week, one oily – such as salmon, sardines or mackerel – but also instructs women to avoid eating more than two portions of oily fish a week. Taylor warns that this puts some women off eating fish altogether: “The advice on fish requires women to keep a tally of weekly intakes and determine what a portion looks like, as well as to be able to identify oily versus white fish. Our research finds this to have a negative effect on the amount of fish eaten, meaning pregnant women and their babies are missing out on the many beneficial effects.” 

According to Taylor’s research, most women say NHS information on eating fish is light on positive messaging, and she points out that while the mercury and pollutant content of oily fish is of concern, the benefits (despite increased levels of maternal blood or hair mercury) may outweigh any adverse effects and are now well established. 

The jury may still be out on the benefits of additional prenatal vitamin supplementation while following a healthy, varied diet, but official guidance dictates pregnant women should be taking 400mg of folic acid every day until the 12-week mark to help avoid neural tube birth defects such as spina bifida. It also states that supplements containing vitamin A, such as cod liver oil, should be avoided.

It’s recommended that pregnant and breastfeeding women take a vitamin D supplement between September and March when skin is less exposed to sunlight, with Ross advising that this is particularly important for black and brown women living in the Global North who have a higher risk of vitamin D deficiency, which can pose pregnancy or birth complications.

“It’s important to get your vitamin D levels checked via your GP or a nutritionist so they can prescribe tailored, safe supplement doses.” Because nutrient status can be compromised by stress and by eating nutrient-depleted crops and animal products as a result of industrialised farming, some people, adds Ross, may still want to consider supplementation. 

Official guidance on foods to be avoided in pregnancy is based on several factors, including reduction of teratogens (substances that can cause birth defects) and microbiological and toxicological hazards. But while advice on alcohol, cigarettes and foods high in saturated fat or sugar is unequivocal (namely to avoid the former altogether and limit the latter), foods such as cheeses and fish are a little murkier. According to preliminary findings by The Pear Study, fish guidance was cited as the “most complicated” with all research participants significantly underestimating the amount of tuna they could eat, while only 32 per cent of midwives correctly recalled the overall advice on eating fish.

Current recommendations are to avoid eating shark, swordfish and marlin due to high levels of mercury, which can damage a developing baby’s nervous system, and to eat no more than two tuna steaks (or four tins) per week as tuna can also contain higher mercury levels. Raw shellfish and cold-smoked or cured fish such as smoked salmon and gravlax are also off the menu to minimise the risk of contracting listeriosis, which can lead to miscarriage or stillbirth. Oily fish such as mackerel and sardines, which can contain pollutants, should be limited to two portions a week. 

“Aside from fish, much of the public health guidance during pregnancy is based on avoiding foods that may harbour harmful bacteria such as listeria,” says Ross. “ This bacteria can be found in soft cheeses with rinds, like brie, undercooked eggs and unpasteurised dairy products. Undercooked or raw meats are also best avoided, as they may contain the toxoplasmosis parasite, which can harm foetal development.”

And when it comes to your daily brew? “Caffeine has been shown to produce adverse effects on foetal development and is also an anti-nutrient – a substance that can interfere with the metabolism of nutrients such as iron and magnesium that we take in from our diet, so avoid as much as possible,” Ross explains.

One of the biggest ironies of pregnancy is that while we are urged to bank as much shut-eye as possible, and are well-versed in the benefits of rest to mother and baby, it’s often a time when women experience poor sleep. “Sleep disturbance and insomnia are common in pregnancy, and up to 80 per cent of pregnant women will suffer from this at some point,” says Shazia Malik, consultant obstetrician and gynaecologist. 

“In the first trimester, it is common to feel hotter at night due to hormonal changes, pass urine more frequently and have sore breasts and nipples. In the third trimester, backache and hip discomfort become more common, as well as the frequent trips to the bathroom at night,” Malik says. “Some women may also find that as the birth approaches , they feel more anxious which can affect sleep too. Leg cramps are not uncommon, and as your baby grows, the kicks become stronger and can sometimes wake you too.” 

Unsurprisingly, a survey into pregnant women’s attitudes and behaviour towards sleep and exercise found that almost all (95 per cent) experienced “barriers” to that elusive eight hours, whether it be 3am bathroom breaks or all-night baby gymnastics, although the same study also found that positive attitudes to sleep were associated with longer sleep duration and better sleep hygiene.

On a more worrying note, a review published by the University of Oxford found that sleep disturbances were significantly associated with adverse maternal and foetal health outcomes such as pre-eclampsia and gestational diabetes. 

So how can you sleep better when you’re pregnant? According to Malik, ensure that your bed is comfortable, your room temperature is cool and that you have pillows to support your back and hips. 

“Magnesium supplements can help with leg cramps, and staying fit and active as well as doing stretches can really help to keep stiff and sore muscles at bay. Avoiding caffeine, especially after lunchtime, can help, and seeking help for anxiety and sharing any worries or concerns is crucial at any point of pregnancy.” Malik also advises resisting your phone or tablet if you wake up. Instead, get up for half an hour in low light, do some breathing exercises or listen to sleep music.

Most experts (including the NHS and Tommy’s) advise that pregnant women should sleep on their sides, especially from 28 weeks onwards, after several reliable research trials found that sleeping on your back doubles the risk of stillbirth (don’t worry if you do wake up on your back, as it’s the position you go to sleep in that you hold for the longest time – simply settle back to sleep on your side).

Despite the benefits of staying active during pregnancy, research suggests that most pregnant women are not meeting recommended levels of exercise. Almost all pointed to physical symptoms such as nausea , back pain and tiredness, as well as psychosocial factors such as lack of time or misguided beliefs about the safety of moderate to vigorous exercise, as things that negatively impacted their ability to hit the gym. 

“I’m always asked, ‘Is it safe to exercise when you’re pregnant?’ and the answer is a resounding yes,” says leading performance coach, personal trainer and nutritional expert Dalton Wong, who has trained many of his celebrity clients throughout pregnancy. “Aside from the mental health benefits that exercise provides, it is a great way to counter bad posture and reduce pain as the weight of your belly, breasts and curvature of the spine changes. Exercising during each trimester will allow your spine, hips and knees to become stronger , which will help support your changing body.” 

• Try pregnancy yoga or Pilates classes which are a great form of exercise and tailored to your specific needs. “I would always suggest that you start by getting professional guidance in order to practise safe prenatal yoga,” says Wong. “Once you have a plan, you can proceed to doing it by yourself. If you currently do yoga, you can of course modify your plan to suit your pregnancy, just avoid doing deep closed twists, intense backbends or obviously prone poses.”
• Choose low-impact exercises such as swimming . “If you do cardio, I would suggest you go for a lower-impact version so you can continue training throughout your pregnancy,” says Wong.
• Do “specific exercises for your glutes/core as they will help stabilise your lower back”, according to Wong. “Focusing on the muscles around your middle back and stretching out your chest can help strengthen the spine. When we make an effort to work on muscles around a joint, it helps improve its stability.”
• Don’t start a new exercise plan unless it’s under professional guidance and avoid exercises you haven’t done before or those where there is a risk of falling, such as skiing or horse riding.
• “Abdominal exercises should only be prescribed by a professional and tailored to your specific needs,” says Wong. “Avoid crunches as they can cause your upper abs to separate. Post-pregnancy, our aim is to close or reduce muscle separation with exercises that strengthen the core, such as hip extensions/bridges, bird dogs and side planks. As the core gets stronger, planks and crunches can be added in.”
• “Avoid rotational exercises where your hips move one way and the shoulders the other. This could cause back pain due to your spinal muscles being weaker,” says Wong.
• Don’t push yourself. “Relaxin is a hormone that helps loosen your muscles, joints and ligaments during pregnancy in preparation for birth . When you exercise, this hormone could allow your muscles, joints and ligaments to go further than your normal range, which can lead to strains or muscle and ligament pulls,” warns Wong.
• Tommy’s advises against lying flat on your back for long periods of time, especially after 16 weeks, as the weight of the baby puts pressure on the major blood vessels, which can cause low blood pressure and dizziness and reduce blood flow to the baby.

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Laws Punishing Drug Use During Pregnancy Likely Worsen Health Outcomes

Contrary to some claims, laws that criminalize or otherwise punish drug use during pregnancy are more likely to worsen rather than improve health outcomes, according to a paper by researchers at Columbia University Mailman School of Public Health. The study is the first to systematically review the literature on punitive prenatal drug laws—an increasingly common state policy strategy for addressing rising rates of prenatal drug use. The findings are published in the International Journal of Drug Policy .

The authors collected data on the number of states with laws that explicitly allow criminal prosecution, involuntary commitment, or revoke custody rights following allegations of drug use during pregnancy. They then evaluated existing studies testing whether the enactment of such laws was associated with health improvements, either for pregnant people themselves or their babies.

The authors reviewed four studies tested whether the adoption of punitive laws was associated with reductions in neonatal drug withdrawal syndrome (NDWS)—a condition that can occur after exposure to opioids and other drugs in utero. Two of the studies found little change, while the two others found increased NWDS after a punitive law was adopted. 

“There has been considerable concern from within legal, medical, and public health communities that punitive prenatal drug policies might increase potential harms. Our findings support this premise and suggest that such approaches constitute ineffective policy,” said lead author Emilie Bruzelius , PhD, a postdoctoral research fellow in the Department of Epidemiology .

“Identifying effective policy strategies to support pregnant people with drug use disorder outside of the criminal-legal system is an important priority,” noted Silvia S. Martins , MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author.

Co-authors include Melanie S. Askari, Sandhya Kajeepta, Lisa Bates, Seth J. Prins, Columbia Mailman School of Public Health; Kristen Underhill, Cornell University Law School; and Marian Jarlenski, Pittsburgh School of Public Health.

The study was supported by the National Institutes on Drug Abuse (DA045872, DA053745, DA031099).

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Meet our team, silvia martins, md, phd.

• Director, Substance Use Epidemiology Unit
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Miscarriages linked to health risks in later pregnancies

New Curtin University research has revealed a link between miscarriage and the increased risk of developing complications of gestational diabetes and high blood pressure-related disorders in later pregnancies.

Researchers from the Curtin School of Population Health analysed 52 studies involving more than 4 million pregnancies across 22 countries to investigate the health impacts of miscarriage, abortion and recurrent pregnancy loss (more than two miscarriages in succession) on subsequent pregnancies.

The study found different health risks for each group.

People who had experienced a miscarriage were 44 per cent more likely to develop gestational diabetes during later pregnancies but only 6 per cent more likely to develop high blood pressure in subsequent pregnancies.

Conversely, people who had experienced recurrent pregnancy loss showed no increased risk of gestational diabetes but were 37 per cent more likely to develop pre-eclampsia, a potentially dangerous complication characterised by high blood pressure, in later pregnancies.

There was no evidence linking abortion to diabetic or hypertensive related issues, either during or outside of pregnancy.

Lead study author Dr Jennifer Dunne said establishing the links between pregnancy loss, diabetes and high blood pressure could have a far reaching impact.

"Miscarriages occur in 15-25 per cent of all pregnancies -- which is around 23 million per year, globally," Dr Dunne said.

"Gestational diabetes and high blood pressure disorders in pregnancy can cause a variety of significant health problems; understanding the relationship between pregnancy loss and later pregnancy complications could reveal new ways to mitigate risks or possibly prevent these conditions from progressing.

"Further research into the biological links between pregnancy loss and later health issues might reveal new targets for developing treatments."

Dr Dunne said the study added to what was already known about pregnancy complications and health later in life, even beyond pregnancy.

"Knowing miscarriage can lead to these pregnancy complications later on is important, as these conditions during pregnancy have previously been linked to a higher risk of people developing heart disease later in life," Dr Dunne said.

"By shedding light on the long-term health effects of miscarriages and repeated pregnancy losses, this study paves the way for improved healthcare strategies, research, and support for those affected -- hopefully enhancing the outcomes for parents and babies in future pregnancies."

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Story Source:

Materials provided by Curtin University . Original written by Samuel Jeremic. Note: Content may be edited for style and length.

Journal Reference :

• Jennifer Dunne, Damien Foo, Berihun A. Dachew, Bereket Duko, Amanuel T. Gebremedhin, Sylvester D. Nyadanu, Gavin Pereira, Gizachew A. Tessema. Diabetic and hypertensive disorders following early pregnancy loss: a systematic review and meta-analysis . eClinicalMedicine , 2024; 102560 DOI: 10.1016/j.eclinm.2024.102560

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Reduce the proportion of unintended pregnancies — FP‑01 Data

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Unintended pregnancy , 2013   ◊ (percent) Decrease desired

Data Sources:  National Survey of Family Growth (NSFG), CDC/NCHS ; National Vital Statistics System - Natality (NVSS-N), CDC/NCHS ; Surveillance Data for Abortion, CDC/NCCDPHP ; Guttmacher Institute Abortion Provider Census (APC), Guttmacher Institute ; Guttmacher Institute Abortion Patient Survey (APS), Guttmacher Institute

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Health Reporting in the States

Standard pregnancy care is now dangerously disrupted in louisiana, report reveals.

Rosemary Westwood

Under Louisiana's abortion ban, doctors face penalties of up to 15 years in prison, $200,000 in fines and loss of their medical license. Dr. Neelima Sukhavasi, a Baton Rouge OB-GYN, says that doctors are scared. Here, Dr. Sukhavasi poses for a portrait in Baton Rouge, La., on Monday, March 18, 2024. Christiana Botic hide caption

Under Louisiana's abortion ban, doctors face penalties of up to 15 years in prison, $200,000 in fines and loss of their medical license. Dr. Neelima Sukhavasi, a Baton Rouge OB-GYN, says that doctors are scared. Here, Dr. Sukhavasi poses for a portrait in Baton Rouge, La., on Monday, March 18, 2024.

In the wake of Louisiana's abortion ban, pregnant women have been given risky, unnecessary surgeries, denied swift treatment for miscarriages and ectopic pregnancies, and forced to wait until their life is at risk before getting an abortion, according to a new report first made available to NPR.

It found doctors are using extreme caution to avoid even the appearance of providing an abortion procedure.

"We were stunned by just how much regular medical practice for pregnant people has been disrupted," said Michele Heisler, the medical director of Physicians for Human Rights and one of the report's authors.

The report is titled " Criminalized Care: How Louisiana's Abortion Bans Endanger Patients and Clinicians ."

It draws on interviews with 30 health care providers and 13 patients conducted in 2023, and was jointly supported by four groups that support abortion access: Physicians for Human Rights, the Center for Reproductive Rights , Lift Louisiana and Reproductive Health Impact .

It's among the most comprehensive research to date showing abortion bans are changing pregnancy care and worsening maternal health. It concludes that Louisiana's ban is impeding a federal law that regulates the provision of emergency health care, and is infringing on reproductive and human rights.

"There are going to be deaths that didn't have to happen. There are going to be severe complications that didn't have to happen," said Dr. Nicole Freehill, a New Orleans OB-GYN interviewed for the report.

Unnecessary C-sections raise alarms

In one of the most extreme examples of how pregnancy care has changed, doctors described cases of women who experienced preterm premature rupture of membranes (when the "water breaks" early in pregnancy, before the fetus is viable). Some of these women were forced to undergo Cesarean section surgeries to empty their uterus and avoid infection, instead of receiving an abortion procedure or medication.

"Which is ludicrous, absolutely ludicrous," said Freehill. "The least safe thing that we do, no matter if it's early in pregnancy or full-term at your due date, is a C-section."

Describing one of these cases, Dr. Michele Heisler with Physicians for Human Rights explained that the C-section was done "to preserve the appearance of not doing an abortion."

The patient wasn't given a choice, she added.

A C-section is major abdominal surgery. NPR consulted three OB-GYNs who were not interviewed for the report, all of whom said a C-section in a case like this is not standard care. Compared to an abortion procedure or an induction, it carries far greater risks for increased hemorrhaging, compromised future fertility, and other complications.

The doctors also added that patients undergoing a C-section in that circumstance would be told that in future pregnancies they couldn't deliver vaginally and risked a ruptured uterus.

"I want to emphasize that this is not what's in the best interest of the patient," said one New Orleans OB-GYN who didn't want her name used because she feared talking publicly could cause her trouble with her employer. "This is what's in the best interest of...the physician in protecting themselves from criminal prosecution."

Doctors face penalties under Louisiana's abortion ban of up to 15 years in prison and $200,000 in fines.

Prenatal care appointments pushed back

In what doctors described as another serious deviation from standard medical practice, OB-GYNs in Louisiana are now delaying routine prenatal care until patients reach 12 weeks of pregnancy — the point at which the risk of miscarriage drops significantly .

One patient interviewed in the report said several different doctors' offices wouldn't see her before 12 weeks. One office told her the abortion ban was "something that's new" and that doctors wanted "to eliminate some of the spontaneous abortions, or miscarriages, that may happen up until that 12-week mark," the patient recounted.

Pins on Dr. Neelima Sukhavasi's coat pocket show her support for women's reproductive health, Baton Rouge, La., on Monday, March 18, 2024. Christiana Botic hide caption

Pins on Dr. Neelima Sukhavasi's coat pocket show her support for women's reproductive health, Baton Rouge, La., on Monday, March 18, 2024.

"I think physicians are scared, and so what can we do to decrease our risk that the attorney general is going to come after us?" said Dr. Neelima Sukhavasi, a Baton Rouge OB-GYN interviewed in the report. "And that is probably one of the things that they saw would be easiest."

Delaying pregnancy care into the second trimester can be dangerous for people who might have complications, such as a history of blood clots or an ectopic pregnancy that goes undiagnosed, doctors told NPR. Without treatment, some pregnancy-related problems can lead to birth defects, stroke, heart attack, or even death.

Delays, transfers, waits for illness to get worse

Physicians are also delaying treatment of miscarriage and ectopic pregnancy out of fear of breaking the law, the report found — as previously reported in news stories from states operating under abortion bans. Ectopic pregnancies — when the embryo implants outside of the uterus — are never viable, and they can even be deadly.

One patient with an ectopic pregnancy said her care was delayed so long that her fallopian tubes ruptured.

"I could have died," she said in the report. "I really could have died."

In another case, Sukhavasi had a patient in her first trimester who came to the hospital bleeding and in pain. The patient wanted an abortion procedure called dilation and curettage, or D&C, which uses suction to empty the contents of the uterus and stop the pain and bleeding.

"I know this pregnancy is not going to make it anywhere near survival. And I was stopped from taking her to the operating room," Sukhavasi said.

The woman waited for hours while hospital officials decided if her abortion was allowed. Sukahavasi said it all goes back to fear.

"Institutions don't want the government coming down on them, accusing us of doing something wrong when what we're doing is just providing essential health care that people are coming to us for," she said.

Sukhavasi, photographed in Baton Rouge, La. Monday, March 18, 2024, had a patient in her first trimester who came to the hospital bleeding and in pain. The patient wanted an abortion procedure called dilation and curettage, or D&C. "I know this pregnancy is not going to make it anywhere near survival. And I was stopped from taking her to the operating room," Sukhavasi said. Christiana Botic hide caption

Sukhavasi, photographed in Baton Rouge, La. Monday, March 18, 2024, had a patient in her first trimester who came to the hospital bleeding and in pain. The patient wanted an abortion procedure called dilation and curettage, or D&C. "I know this pregnancy is not going to make it anywhere near survival. And I was stopped from taking her to the operating room," Sukhavasi said.

When miscarrying women arrive at ERs in rural areas, those rural hospitals are increasingly transferring patients to urban, specialty hospitals, the report found, to avoid having to treat those patients altogether. But refusing miscarriage treatment could be a violation of the Emergency Medical Treatment and Labor Act , or EMTALA — a federal law requiring emergency medical care.

The doctors described numerous cases in the report in which seriously ill patients were denied abortions until they became so sick that their lives were irrefutably at risk.

These included pregnant women with cancer; patients with heart problems and kidney failure, who were on dialysis and hospitalized; and women who'd experienced life-threatening complications from previous pregnancies and found themselves pregnant again.

In one case, an OB-GYN treating a patient with severe heart failure was first required to prescribe multiple cardiac medicines before being allowed to offer an abortion.

"And I'm thinking, but what if she doesn't want to wait that long because she could have a heart attack and die?" the OB-GYN said. "At what point can you act? How many cardiac meds have to fail?"

Another physician in the report couldn't get their colleagues to agree to an abortion for a patient with a history of multiple C-sections, hemorrhaging and infections in past pregnancies.

"It was a risk" to require the patient to stay pregnant, the physician said, but the woman wasn't yet "at the brink of death."

Some hospitals have even told physicians that they can't give patients any information on how to get an abortion outside of Louisiana — because that advice could be construed as "providing" an abortion.

Louisiana's ban allows for abortion in cases of severe fetal anomalies – but only if those anomalies are on a list of conditions published by the state's health department . Women whose fetuses are diagnosed with severe and even fatal conditions that don't appear on that list are also being told they can't get an abortion, the report found. Doctors said patients who can afford to are traveling out of state for abortions, while those who can't remain pregnant.

Louisiana's maternal health outcomes might get worse

Physicians interviewed in the report and those interviewed separately by NPR agreed that women's health and their lives were being put at risk because of the abortion ban, especially Black and low-income women.

Louisiana already suffers from some of the highest rates of maternal mortality and morbidity in the nation. Black women in the state are more than twice as likely to die as a result of their pregnancy as white women .

Nearly two-thirds of maternal deaths in Louisiana are among low-income women on Medicaid.

Some doctors in the report said they have considered leaving Louisiana. Others warned that a possible exodus of OB-GYNs would exacerbate the state's existing shortage of obstetricians.

Louisiana Right to Life , which helped author Louisiana's ban, declined to comment on the report's conclusions, without being able to read it before its public release on Tuesday afternoon

Its executive director, Benjamin Clapper, told NPR that the law clearly allows for the treatment of miscarriages and that OB-GYNs contacted by his organization have seen no change in miscarriage care as a result of the ban.

Clapper has said previously , in response to claims that the law is harming women's health, that these concerns have been "manufactured" by abortion rights supporters.

The report's authors said they have simply documented the facts on the ground.

" The anti-abortion movement in Louisiana has for decades created a culture of harassment and intimidation of people providing abortion care," said Michelle Erenberg , the executive director of Lift Louisiana. "And so for folks in that movement to now say, well, providers are just overcomplying with the law, or they're misunderstanding the law, no. They are terrified."

Beyond going to prison, she said, doctors fear being harassed or ostracized from the institutions where they work, and the communities in which they live.

"And all of that is a legitimate fear," she said.

Clarification March 19, 2024

A previous version of this web story did not explain that Benjamin Clapper declined to comment on some of the findings in the report because it had not yet been publicly released and he had not read it himself.

• miscarriage care
• Lousiana abortion ban
• maternal mortality
• Center for Reproductive Rights

What does the mifepristone case mean for Plan B? The difference between the two explained.

Emergency contraception is not the same thing as the abortion pill, but these medications are often confused. While both involve reproductive health, emergency contraception ‒ often called Plan B ‒ is meant to stop a pregnancy from happening , and the abortion pill mifepristone ends an existing pregnancy, medical experts say .

Delineating the two medications is more important than ever as the Supreme Court heard arguments Tuesday on a case that could sharply limit access to mifepristone and diminish the independence of the Food and Drug Administration.

An anti-abortion organization is challenging mifepristone's FDA approval, claiming the agency bypassed standard protocols to bring the medication to market.

Abortion advocates say the pill should not lose its FDA approval, citing decades of safety and efficacy in patients across the nation .

Mifepristone remains FDA-approved at the moment and available to many Americans from reproductive health clinics or telemedicine services, although full access to the pill is restricted in 15 states . The "Plan B" pill is legal in all 50 states without age restrictions.

The court's decision in the mifepristone case, expected this summer, could have a long-term impact on the FDA’s ability to make decisions about the safety of all drugs. This means that while neither pill's approval changes today, there could be ramifications for all medications and the future of reproductive health systems nationally.

"Regardless of the result, it will not have an immediate impact on emergency contraception," Dana Singiser, co-founder of the Contraceptive Access Initiative, said of Tuesday's case.

How we got here

Last April,  U.S. District Judge Matthew Kacsmaryk in Texas  effectively  invalidated the FDA's 23-year-old approval for mifepristone .

The Biden administration appealed, but the New Orleans-based 5th U.S. Circuit Court of Appeals affirmed Kacsmaryk's ruling that the FDA was wrong for approving changes in 2016 and 2021 that let women take the drug three weeks longer into a pregnancy and allowed the drugs to be dispensed through the mail without in-person visits with a doctor.

“In loosening mifepristone’s safety restrictions, FDA failed to address several important concerns about whether the drug would be safe for the women who use it," the court wrote. “It failed to gather evidence that affirmatively showed that mifepristone could be used safely without being prescribed and dispensed in person."

The case marks the first time a court has restricted access to an FDA-approved drug by second-guessing the agency’s expert judgement, according to the Biden administration.

A decision against the FDA could open the "barn doors" for future similar claims against a slew of medications if the court sides with the plaintiff, particularly emergency contraception, Singiser and others argued.

Ongoing coverage: Supreme Court hears abortion pill Mifepristone case, nation watches anxiously: Live updates

"If the Supreme Court undermines FDA's authority that could threaten any drug that's ever been approved by the FDA," Singiser said. "That threat is is particularly posed to reproductive health products because there is such an organized advocacy movement against abortion, contraception and IVF."

What is mifepristone?

Mifepristone is one of two pills commonly used in medication abortion , accounting for more than half of all U.S. abortions. according to the Guttmacher Institute, which researches reproductive health policy. Patients take mifepristone with another medication called misoprostol to end a pregnancy that is less than 70 days developed. The pills are taken about two days apart.  

The abortion drug has been used in the United States since 2000. The drug accounted for 63% of all U.S. abortions in 2023, an increase from 53% in 2020.

Some insurers and Medicaid plans cover abortion pills, according to Plan C , which hosts a guide to accesses abortion pills per state with financial information. Cost of the pill can range from $150 from online clinics that mail pills, to $500 or more at in-person clinics. Several online providers, such as Hey Jane , offer financial assistance, if needed.

Many medical organizations have rushed to defend mifepristone as "the most studied medication" and "overwhelmingly" safe, with a better track record than commonly used drugs such as Tylenol and Viagra, according to legal briefs filed in support of the FDA by the American Medical Association, the American College of Obstetricians and Gynecologists, American Academy of Family Physicians and several other organizations.

What about Plan B?

Emergency contraception is a type of birth control that should be taken within 72 hours of unprotected sex or birth control failure . The single pill is sold for about $50 at drug stores such as CVS and Walgreens.

It works by delaying ovulation with a hormone called levonorgestrel, according to Planned Parenthood . It's recommended to take Plan B as soon as possible after unprotected sex, but it can be taken up to five days later.

Emergency contraception is not abortion . The morning-after pill can be  up to 95% effective in preventing pregnancy , but does not terminate an existing pregnancy. Plan B is designed to prevent ovulation , holding back an egg so that it won't be fertilized by sperm and an embryo formed.

Many Americans confuse Plan B with the abortion pill. Some Americans began hoarding Plan B after Roe v. Wade fell in 2022 , causing confusion and panic that emergency contraception was the next best thing, or would be next to be restricted. Even Olivia Rodrigo's current "Guts" Tour had to clarify that it was handing out emergency contraception, not abortion pills , at the pop star's concerts.

This conflation between the two medications is by "design," said Singiser, who said the anti-abortion movement has intentionally framed contraception as an "abortifacient" and worked to codify laws that state life begins at immediate conception, paving the way for legal battles on contraception and IVF , such as the recent attack on IVF in Alabama after the state's high court determined frozen embryos could be considered children.

This has all lead to fears that mifepristone's federal approval changing would cause a ripple effect for Plan B. And this confusion is even worse for people in states where abortion care is already restricted, the independent Kaiser Family Foundation found in a 2023 study . But Americans' access to emergency contraception remains unchanged for now.

Contributed: Maureen Groppe