Staying healthy during pregnancy is vital for mother and baby

Research shows that the health of the mother during pregnancy impacts the health of the baby as well as the long-term health outcomes of both mother and baby.

In this month’s “Ask the Specialist” forum, Dr Manisha Mathur, Deputy Head and Senior Consultant from the Department of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group, will be addressing your questions on optimising health during pregnancy.

This As​k The Specialist forum has closed. Thank you for your interest and participation.

1. Question by Reenes
I'm about 6-7 weeks pregnant, above 35years old, has mild endometrosis, and a history of miscarriage which stop growth around 5-6th weeks. anything that i can take note? eg., diet, exercises etc. 

Any specific doctor that you can recommend?. previously tried IVF at KKH but the doctor stopped see me as this time round is natural pregnancy.

Answered by Dr Manisha:
Dear Reenes,
Firstly, congratulations on your pregnancy! It is not uncommon for women to conceive naturally and have a successful pregnancy after stopping IVF (invitro-fertilisation) treatments, so keep your spirits high.

One prior early miscarriage does not significantly increase your risk of another miscarriage so odds are in your favour to have a good outcome. Also, once you are pregnant, endometriosis should not affect the pregnancy in any way.

At this early stage of your pregnancy, I would recommend that you start taking folic acid supplement, which are available over the counter at any pharmacy. 

Make lifestyle modifications such as adopting a healthy and wholesome balanced diet; avoiding smoking and intake of alcohol and caffeine; have 20 to 30 minutes of light exercise such as walking; and minimising stress in life. Remember not to take any medications while pregnant without the advice of your doctor. As far as recommendations for an obstetrician is concerned, any good specialist should be able to help you manage your pregnancy. I suggest you seek an appointment in the coming few weeks. Good luck!

Follow up question by Reenes
I put on quite abit of weight even though i'm in my first trimester. I tend to overeat when i'm hungry or when i'm feeling nauseous. any suggestions to help with diet?

Answered by Dr Manisha:
Dear Reenes,
Pregnancy is a time of weight gain. On average, a pregnant woman with a normal body mass index is expected to gain 11 to 15 kilogrammes of weight during her entire pregnancy. In addition, the saying "eating for two", during pregnancy is a myth.

Some general tips that may help you with optimising your weight gain during pregnancy include watching your intake of high-fat or sugary foods, resisting the urge to snack on pastries or fried foods, swapping full fat milk and cheese with low-fat versions, consuming steamed or grilled dishes instead of stir-frying and avoiding high-sugar teas or coffees, and fruit juices. Finally do not forget that a healthy diet should be supported by regular exercise, so try to stay active with 20 to 30 minutes of light activities every day, such as brisk walking, swimming, yoga or Pilates.


2. Question by Anonymous 
I had one miscarriage and one ectopic pregnancy in this year. I want to know whether next planning is good or i need to take any precautions before planning and how to avoid both miscarriage and ectopic

Answered by Dr Manisha:
Dear Anonymous,
I am sorry to hear of your miscarriage and ectopic pregnancy this year. I hope the outcome would be better next time. If you feel you have physically and mentally recovered, you can start planning and trying for your next pregnancy soon. I would recommend you to take folic acid supplement (5mg) daily as soon as you have decided, as this helps reduce the risk of a subsequent miscarriage. In view of your history of an ectopic pregnancy I would suggest you see your obstetrician for an early scan soon to check for the pregnancy site and well-being, as your risk of another ectopic pregnancy is slightly higher this time. If you have any difficulty conceiving, you must also seek help early. 


3. Question by bernicism
If my first pregnancy was preterm, does it mean my 2nd pregnancy would be preterm? How do I prevent preterm labour?

Answered by Dr Manisha:
Dear bemicism,
The cause for preterm labour is not exactly known. However, several risk factors such as advanced maternal age during childbirth, use of fertility treatments, a history of a premature baby previously, pregnancy with multiples, have underlying medical conditions with the womb or cervix, along with smoking have all been known to increase the likelihood of preterm labour. 

In view of your previous history of a preterm delivery you would be a slightly higher risk of another preterm delivery and hence it would be advisable for you to work with your obstetrician to optimise your pregnancy and reduce your risks. Adopting a healthy lifestyle such as avoiding alcohol and smoking, managing stress levels well, eating a healthy and balanced diet as well as exercising regularly, will help optimise general health and pregnancy.


4. Question by Nade
How does a woman with depression and reaching her 30s, reach her dreams of having children without letting her mental health affect the baby?

Answered by Dr Manisha:
Dear Nade,
It is common for women in their thirties to get pregnant and deliver healthy babies. Hence, do not fret, as we just need to take certain measures to make your pregnancy safer. It is a good idea however to optimise your mental health by symptom control prior to embarking on your pregnancy journey, and this is entirely possible with safe medications as well as counselling. If you do need to take medications for your condition, your psychiatrist will be able to advise you with regards to medications which are safe to use during pregnancy. If your symptoms are well-controlled, there is no reason why you cannot consider a pregnancy in the near future.

We (at KKH) are also able to provide emotional support to our pregnant mother with the help of our multidisciplinary team from the Department of Psychological Medicine. Stay positive, and seek help and advice! 


5. Question by Karishma
Dear Dr Mathur, 
Greetings of the day!

After my 1st child who has turned 13 years old this year, I have had 2 miscarriages. Now I am 44 years old and I do not want to give up any hope. Seek your advice and guidance whether it is fine to keep trying until nature allows. For your easy reference, I do not have any prior medical conditions and lab tests of my miscarriages have shown no negative results too. Please advise. Thank you.

Answered by Dr Manisha:
Dear Karishma,
Times have changed and women are pushing boundaries, with more women having successful pregnancies at an older age as compared to the past. However it is also established that pregnancy in older women (>35 years) is associated with higher health risks and the risks rise with increasing age. 

Some of the risks include having a higher chance of having a baby with Down’s syndrome and lower-weight babies. Mothers who are pregnant at an advanced age are also at higher risk of having pregnancy-induced diabetes (known as gestational diabetes) and hypertensive disorders. 

Having said that, as along you understand and accept the risks involved, an experienced obstetrician should be able to minimise your risks and optimise your pregnancy by adopting certain measures and interventions. You should seek a consultation with an obstetrician to fully understand the risks involved before deciding to conceive.


6. Question by SophieLove
Hello Dr Manisha,
I'm 29 years old, with a weight of 80kg at 156cm. I would like to plan for a 2nd child. During my 1st pregnancy, my pre-pregnancy weight was 56kg. It's been almost 4 years and it's hard for me to lose the extra kilos and get back my pre-pregnancy weight. I have started being active again the past few months, thus shedding a few kilos. In these 4 years, I was afraid to conceive due to these concerns: 

1) Am I still able to get pregnant even though I'm categorised under "obese" now? Losing weight healthily seems to take time, but I don't want to be conceiving in my 30s, as I'm afraid of further complications (diabetes, DS, hypertension etc). I have no medical problems prior to this.

2) If I am still able to get pregnant with this weight, could you please advise how I should care for the pregnancy? What are the complications would there be, should I get pregnant with this weight? Or is it best and advisable to lose weight first?

3) Do obese women have a chance of delivering through a normal/vaginal birth, or they definitely have to go through C-sect?

Looking forward to your reply. Thank you Dr!

Answered by Dr Manisha:
Dear SophieLove,
Thank you for asking very relevant and pertinent questions related to obesity and pregnancy. I will try to answer your queries to the best of my ability. As per your weight and height, your BMI (body mass index) is 32.9, which falls under the obese category. Please continue with your efforts to lose weight through making lifestyle modifications. Your first priority is to focus on optimising your BMI for not just a healthier pregnancy outcome, but also to have a more positive impact on your overall health.

In response to the query regarding your ability to get pregnant in your current condition, some women with a high BMI may experience difficulty conceiving; majority will be able to get pregnant if they have regular menses and have regular sexual intercourse during the mid-cycle or the fertile period. Should they continue with these measures, on an average it might take up to one year for a couple to conceive. Do remember during the preconception period, it is important to consume folic acid supplement. 

Having advised as above, it would still be most ideal if you can optimise your weight prior to conceiving, to achieve a healthier outcome for both mother and baby. Evidence has shown that obesity during pregnancy is linked to an increased risk of having a bigger baby, a caesarean delivery and medical complications such as high blood pressure and diabetes in pregnancy. It is therefore important to optimise your weight prior to the pregnancy when possible. It is a good idea to set achievable goals over a period of a few weeks in terms of weight loss, and also perhaps consider consulting a dietitian, joining a gym, or participating in group activities that encourages you to engage in physical activities. As mentioned above, I feel you do have the motivation to lose weight, so as to achieve a healthier pregnancy and health outcome. The risks associated with advanced maternal age during pregnancy are more relevant after the age of 35 years. At your current age of 29 years, coupled with a normal or a near-normal BMI, your risks will be lower during a pregnancy.

To address your next query simply - yes you can get pregnant if you have regular menses, which means you produce an egg every cycle, increasing your chances of a pregnancy. However if you have irregular menses, it would be advisable to seek help early as this may sometimes delay your chances of conceiving. Losing weight or having a normal or near-normal BMI usually normalises the menses cycle, thus increasing the chances of a pregnancy. Women who are overweight during their pregnancy are advised to gain less weight during the pregnancy by staying active and also focusing on a diet that is protein-rich with less carbohydrates and fats. It is also important to follow your obstetrician’s advice and attend regular antenatal follow-ups to monitor for medical complications. 

As obstetricians, we aim to promote a safe vaginal delivery for all our pregnant patients as the recovery is much faster following a normal delivery. Hence, even for women who are overweight or obese, our priority is to encourage and achieve a normal vaginal delivery. However, evidence has also shown that women who are obese, are at an increased risk of undergoing a caesarean delivery due to having bigger-sized babies, a challenging labour, or sometimes due to medical complications. 

In summary, my advice would be to continue your current endeavours in optimising your weight prior to pregnancy for the best outcome. It is indeed possible, and I would like to wish you all the best for your efforts. Please do seek advice from a doctor should you need any further clarifications.


7. Question by Gen Haw
Dear Dr Mathur,

Kindly please give personal advice for first time pregnancy on how to maintain the healthy lifestyle and pre partum and post partum to ensure that pregnancy will be just a breeze and lifestyle from when I was still not pregnant vs pregnant is not that much affected.

I am currently on my 5th week and have already gained 9 lbs. I would like to ask for your advice on how can I ensure myself and the baby will be healthy with needed complete nutrients. Thank you!

Answered by Dr Manisha:
Dear Gen,
Congratulations on your pregnancy, and entering this new phase in life! While pregnancy is possibly the most exhilarating period in any woman’s life, there are much to learn and discover as the body undergo many changes. 

In general, the strategies to optimise your health during pregnancy are as follows:
◦Eat a balanced and healthy diet, mainly protein-based
◦Exercise regularly, approximately 20 to 30 minutes daily
◦Take prenatal supplements especially folic acid
◦Keep your stress levels low
◦Make an appointment with an obstetrician for assessment and planning for your pregnancy 
◦If there is any pain in your tummy or any bleeding below please seek help early 

If you would like to have more information on the above strategies, access credible online resources from this website (HealthXchange.sg), KKH website, Health Hub and the Baby Bonus - Parent Portal.

Should you require further information or more practical tips, consider attending an antenatal programme or class.

About Dr Manisha Mathur

Dr Manisha Mathur is the Head of Ambulatory Service as well as Deputy Head and Senior Consultant with the Department of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH).

Her main clinical areas of interest are in antenatal and peri-partum care, gynaecological conditions and women’s health. Passionate about medical education, Dr Mathur is also the Programme Director of the SingHealth OBGYN Residency Programme.

Dr Mathur graduated with a Bachelor of Medicine and Surgery and a Master of Surgery (Obstetrics and Gynaecology) from the Sawai Man Singh Medical College in India. She subsequently trained in the United Kingdom (UK) and advanced herself with a Certificate of Completion of Training for Specialist from the General Medical Council, UK, in 2010. Dr Mathur has been a member of the Royal College of Obstetricians and Gynaecologists, London, UK, since 2004, and she obtained a Fellowship of the Royal College of Obstetricians and Gynaecologists, London, UK, in 2017. She has also been a fellow of the American Congress of Obstetricians and Gynaecologists since 2016.

In recognition of Dr Mathur’s service to patients at KKH throughout the years, she was awarded the SingHealth Quality Service Award - Gold in 2014, the SingHealth Quality Service Award - Star in 2015 as well as the SingHealth Quality Service Award - Superstar Finalist Winner in 2017. She was also awarded the AM.EI Golden Apple Award in 2019, that recognises and honours outstanding educators from SingHealth and Duke-NUS.

Because #healthiswealth #healthforgood

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