Healthy Pregnancy: The Complete Guide From Planning to Birth

Every day, around 700 women die from preventable causes related to pregnancy and childbirth, according to the World Health Organization, most of them in low- and middle-income countries. Most of these deaths could be prevented with good antenatal care, skilled birth attendants and timely emergency care. Whether this is your first pregnancy or your fourth, knowing what to expect, how to look after yourself and which warning signs need urgent attention is one of the most important things you can do for yourself and your baby.

This guide takes you from planning a pregnancy through each trimester to birth and the first weeks afterwards, with practical advice on antenatal care, nutrition, exercise, common discomforts, danger signs and mental health.

Before pregnancy: planning ahead

If you are planning a pregnancy, preparing in advance can reduce risks for you and your baby.

• Folic acid: take 400 micrograms (0.4 milligrams) daily from at least one month before conception (ideally three months) until 12 weeks of pregnancy, to reduce the risk of neural tube defects such as spina bifida. A higher dose, often 5 milligrams, is recommended for women with diabetes, epilepsy, obesity, sickle cell disease, a previous pregnancy affected by a neural tube defect, or taking certain medicines.
• Vaccinations: check you are immune to rubella (German measles) and chickenpox, and get vaccinated before pregnancy if not. These live vaccines should not be given during pregnancy.
• Medicines: review all medicines with a healthcare provider or pharmacist. Do not stop prescribed medicines, such as anti-seizure medicines or antidepressants, without advice.
• Long-term conditions: diabetes, high blood pressure, epilepsy, thyroid disease, HIV, sickle cell disease and other conditions should be well controlled before conception.
• Weight: reaching a healthier weight before pregnancy reduces risks such as gestational diabetes and pre-eclampsia.
• Stop smoking, alcohol and recreational drugs.
• Know your genotype and blood group, particularly where sickle cell disease and thalassaemia are common.
• Screen for infections such as HIV, hepatitis B and syphilis.

Signs of pregnancy

Common early signs include a missed period, nausea or vomiting, tender breasts, tiredness, needing to urinate more often, food cravings or aversions, and a metallic taste. A home pregnancy test detects the hormone hCG in urine and is usually accurate from the first day of a missed period. Contact your healthcare provider or midwife once you have a positive test to start antenatal care.

Antenatal care: why it matters

Antenatal care monitors the health of you and your baby, identifies problems early and prepares you for birth and parenthood. WHO recommends a minimum of eight antenatal contacts, with the first in the first 12 weeks. Many countries offer around 7 to 10 appointments for a first pregnancy.

The booking appointment

Ideally before 10 to 12 weeks, your midwife or nurse will take a detailed history, check your blood pressure, weight and urine, and offer blood tests including:

• Blood group and rhesus status
• Full blood count to check for anaemia
• HIV, hepatitis B and syphilis
• Rubella immunity (in some countries)
• Haemoglobin variants (sickle cell and thalassaemia screening)
• Blood sugar testing if you are at risk of diabetes

Ultrasound scans

• Dating scan (around 8 to 14 weeks): confirms the pregnancy, checks how many babies, and estimates your due date. In many countries, screening for Down syndrome and other conditions is offered at this time, combining the scan (nuchal translucency) with blood tests.
• Anomaly scan (around 18 to 21 weeks): checks the baby’s development in detail, including the heart, brain, spine, kidneys and limbs, and the position of the placenta.
• Additional scans may be offered if there are concerns about growth or other issues.

WHO recommends at least one ultrasound scan before 24 weeks.

Later appointments

At each visit, your blood pressure and urine are checked, and from around 24 weeks, the size of your bump is measured. Your midwife will listen to the baby’s heartbeat and ask about the baby’s movements and how you are feeling.

Glucose tolerance test

Women at higher risk of gestational diabetes, such as those with a BMI over 30, a previous large baby, previous gestational diabetes, a family history of diabetes, or from certain ethnic backgrounds, are usually offered a glucose tolerance test at around 24 to 28 weeks. Some countries test all pregnant women.

Rhesus negative mothers

If your blood group is rhesus negative, you may be offered anti-D injections to prevent your immune system from attacking a rhesus positive baby’s blood in this or future pregnancies.

Nutrition in pregnancy

You do not need to “eat for two”. In the first six months, extra energy needs are small. In the final trimester, you need only around 200 extra calories a day, about a slice of toast with peanut butter and a glass of milk.

Eat a varied diet including

• Plenty of fruit and vegetables
• Starchy foods, preferably wholegrain
• Protein from beans, lentils, fish, eggs, lean meat and nuts
• Dairy foods or calcium-fortified alternatives
• Iron-rich foods such as red meat, beans, dark green leafy vegetables and fortified cereals, with vitamin C to help absorption

Supplements

• Folic acid until 12 weeks (or as advised)
• Vitamin D, 10 micrograms daily, is recommended in many countries
• Iron and folic acid supplements are recommended by WHO for all pregnant women in many settings to prevent anaemia
• Calcium supplements are recommended in populations with low calcium intake to reduce pre-eclampsia risk
• Avoid high-dose vitamin A supplements and liver products, which can harm the baby

Foods to avoid or take care with

• Unpasteurised milk and soft cheeses that may contain listeria, such as some mould-ripened and blue cheeses, unless cooked
• Raw or undercooked meat, eggs (unless from a certified safe source) and fish
• Liver and liver products (high in vitamin A)
• Fish high in mercury, such as shark, swordfish and marlin; limit tuna
• Pâté
• Herbal remedies and supplements without checking with a healthcare provider

Caffeine and alcohol

Limit caffeine to 200 milligrams a day, about two mugs of instant coffee. There is no known safe amount of alcohol in pregnancy; the safest approach is not to drink at all. Alcohol can cause foetal alcohol spectrum disorder, which affects the baby’s brain and development for life.

Weight gain

Healthy weight gain depends on your weight before pregnancy. As a general guide from the US Institute of Medicine, women with a healthy pre-pregnancy BMI typically gain 11.5 to 16 kilograms, less if overweight and more if underweight. Focus on healthy eating and activity rather than dieting in pregnancy.

Physical activity

Unless your healthcare provider advises otherwise, aim for at least 150 minutes of moderate activity a week throughout pregnancy, plus some muscle-strengthening activity. Walking, swimming, stationary cycling, prenatal yoga and pregnancy exercise classes are good choices. Exercise reduces the risk of gestational diabetes, pre-eclampsia and excessive weight gain, improves mood and sleep, and may make labour easier.

• Avoid contact sports, activities with a high risk of falling, scuba diving, and exercising at high altitude if you are not acclimatised
• After about 16 weeks, avoid lying flat on your back for long periods, as the womb can press on a major blood vessel
• Stay hydrated and avoid overheating
• Do pelvic floor exercises daily to reduce the risk of incontinence
• Stop and seek advice if you have chest pain, dizziness, vaginal bleeding, fluid leaking, painful contractions or calf pain

The three trimesters

First trimester (weeks 1 to 12)

The baby’s organs form during these weeks. Many women feel very tired and nauseous. Nausea and vomiting usually improve by 16 to 20 weeks. Eating small, frequent meals, ginger, avoiding triggers and resting help. Severe vomiting where you cannot keep fluids down, called hyperemesis gravidarum, needs medical treatment; do not suffer in silence.

Miscarriage is sadly common, occurring in around one in five recognised pregnancies, mostly in the first trimester and usually due to chromosome problems, not anything the mother did.

Second trimester (weeks 13 to 27)

Many women feel better and more energetic. The bump begins to show, and you will usually feel the baby move between 16 and 24 weeks, often earlier in second pregnancies. The anomaly scan takes place. Heartburn, back pain and leg cramps may begin.

Third trimester (weeks 28 to 40)

The baby grows rapidly. You may feel breathless, uncomfortable, and have trouble sleeping. Braxton Hicks (practice) contractions may occur. Appointments become more frequent, and it is time to prepare for birth.

Common discomforts and what helps

• Nausea: small frequent meals, plain snacks before getting up, ginger, rest. Seek help if vomiting is severe.
• Heartburn: smaller meals, avoid eating late, raise the head of the bed, antacids recommended by a pharmacist.
• Constipation: more fibre and fluids, regular activity; iron supplements can worsen it.
• Back and pelvic pain: good posture, supportive shoes, pelvic support belts, physiotherapy and exercise in water.
• Leg cramps: stretching calves before bed and staying active.
• Swollen ankles: rest with feet raised, avoid standing for long periods, comfortable shoes. Sudden swelling of the face and hands needs checking.
• Varicose veins and haemorrhoids: movement, avoiding constipation, compression stockings.
• Tiredness: rest when you can; check for anaemia.
• Sleep problems: sleep on your side from 28 weeks onwards; using pillows for support helps.

Warning signs: get help immediately

Contact your maternity unit or emergency services straight away if you have:

• Vaginal bleeding at any stage of pregnancy
• Severe headache, blurred vision, flashing lights, or sudden swelling of the face, hands or feet (possible pre-eclampsia)
• Severe or persistent abdominal pain
• Your baby moving less than usual, or a change in the pattern of movements, from about 24 weeks; do not wait until the next day
• Fluid leaking from the vagina (waters breaking) before 37 weeks
• Regular contractions or tightenings before 37 weeks
• Fever, chills or feeling very unwell
• Pain or burning when passing urine
• Persistent itching, especially of the hands and feet, without a rash (possible obstetric cholestasis)
• Pain, swelling and redness in one leg, or chest pain and breathlessness (possible blood clot)
• Fits or convulsions
• Severe vomiting with inability to keep fluids down
• Thoughts of harming yourself or your baby

Never worry about wasting anyone’s time. Maternity staff would always rather check you and find nothing wrong.

Common pregnancy complications

Pre-eclampsia

A condition causing high blood pressure and protein in the urine, usually after 20 weeks. It can affect the liver, kidneys, brain and placenta, and can lead to seizures (eclampsia). Women at higher risk may be advised to take low-dose aspirin from 12 weeks. Regular blood pressure checks are essential.

Gestational diabetes

High blood sugar that develops in pregnancy. It is managed with diet, activity, blood sugar monitoring, and sometimes metformin or insulin. It usually resolves after birth, but increases the risk of type 2 diabetes later, so follow-up testing is important.

Anaemia

Very common, especially in low- and middle-income countries, and treated with iron supplements. Severe anaemia increases the risk of complications, including bleeding after birth.

Placenta praevia

The placenta lies low in the womb, covering the cervix. It can cause bleeding and may require a caesarean birth.

Preterm labour

Labour before 37 weeks. Steroid injections and magnesium sulphate may be given to protect the baby’s lungs and brain if early birth is likely.

Infections in pregnancy

• Wash hands often, especially after handling raw meat, gardening and changing nappies
• Avoid cleaning cat litter trays (toxoplasmosis risk)
• Avoid contact with sheep during lambing
• In malaria areas, sleep under an insecticide-treated net and take preventive treatment offered at antenatal clinics
• Get recommended vaccines: flu, whooping cough (pertussis) from around 16 to 32 weeks, COVID-19, and RSV in some countries from 28 weeks to protect the baby after birth
• Tell your midwife if you have contact with someone with chickenpox or a rash illness

Mental health in pregnancy

Pregnancy can bring joy, but also anxiety, low mood and stress. Around one in five women experience mental health problems during pregnancy or in the year after birth. Previous mental illness, lack of support, relationship difficulties, domestic abuse, financial stress and pregnancy complications increase risk.

Tell your midwife or healthcare provider if you feel persistently low, anxious, unable to cope, have intrusive thoughts, or have a history of mental illness. Treatments, including talking therapies and some medicines, are available and safe in pregnancy. Do not stop any mental health medicine suddenly.

Domestic abuse

Domestic abuse often starts or worsens during pregnancy. You may be asked about it in private at antenatal appointments; this is routine. If you are experiencing abuse, your midwife can help you access support safely. In an emergency, call your local emergency number.

Work and travel

Most women can continue working during pregnancy. Your employer should assess risks such as heavy lifting, long hours standing, shift work, exposure to chemicals or infections. You may have legal rights to paid time off for antenatal care and maternity leave. Air travel is generally safe until around 36 weeks for a single pregnancy (32 weeks for twins), but check airline rules, wear compression stockings on long flights, drink water and move around. Avoid travel to areas with Zika virus and take malaria precautions.

Preparing for birth

• Attend antenatal classes to learn about labour, pain relief, breastfeeding and caring for your baby
• Discuss where you want to give birth: hospital, birth centre or home, depending on your risk and options
• Write a birth plan, while staying flexible
• Learn the signs of labour: regular, strengthening contractions; waters breaking; a “show” (mucus plug)
• Pack a hospital bag by 36 weeks
• Arrange transport and childcare for other children
• Learn about safe sleep and install a rear-facing car seat

Pain relief options

Options include breathing and relaxation techniques, massage, water birth, TENS, gas and air (Entonox), opioid injections and epidural analgesia. Discuss these with your midwife in advance.

When to go to hospital

Your midwife will advise, but usually when contractions are regular and strong (for example, every five minutes for a first baby), if your waters break, if you have bleeding, reduced movements, or if you feel worried.

After birth: the fourth trimester

The weeks after birth are a time of physical recovery and huge adjustment. Bleeding (lochia) lasts several weeks, and your body heals from birth. Rest, nutrition, help with household tasks and support with feeding are important. Most maternal deaths happen around birth and in the first week after, so seek urgent help for:

• Heavy bleeding soaking a pad in an hour or passing large clots
• Fever, chills or foul-smelling discharge
• Severe headache or vision changes
• Chest pain, breathlessness or a painful swollen leg
• Thoughts of harming yourself or your baby

Attend your postnatal checks, discuss contraception (pregnancy is possible within weeks of birth), and continue pelvic floor exercises.

The role of midwives and nurses

Midwives provide most antenatal, birth and postnatal care in many countries, with nurses, obstetricians and other specialists supporting women with additional needs. WHO estimates that midwives, when fully educated, regulated and integrated into health systems, could prevent a large share of maternal and newborn deaths and stillbirths.

Partners and family: how to help

• Come to antenatal appointments and classes when possible
• Learn the warning signs so you can act quickly
• Take on more of the cooking, cleaning and lifting
• Support healthy habits, such as not smoking around the pregnant person
• Listen without judgement to worries and fears
• Help prepare for the baby and plan for the first weeks at home
• Watch for signs of depression or anxiety in both parents

Pregnancy over 35

More women are having babies in their late 30s and 40s, and most have healthy pregnancies. Risks of miscarriage, chromosomal conditions, gestational diabetes, high blood pressure and stillbirth increase with age, so extra monitoring may be offered, sometimes including closer growth scans and discussion about the timing of birth. Screening tests for chromosomal conditions are offered to all women in many countries, regardless of age.

Frequently asked questions

Can I dye my hair in pregnancy?

Most experts consider it low risk, especially after the first trimester, in a well-ventilated room.

Is sex safe in pregnancy?

Yes, for most women. Avoid it if you have bleeding, placenta praevia, waters have broken, or you have been advised against it.

Which painkiller is safe in pregnancy?

Paracetamol is generally considered the safest for short-term use at recommended doses. Avoid ibuprofen and other anti-inflammatories, especially after 20 weeks, unless prescribed. Always check with a pharmacist or healthcare provider.

Which side should I sleep on?

From 28 weeks, going to sleep on your side (either side) rather than your back is linked to a lower risk of stillbirth.

How many kicks should I feel?

There is no set number. Get to know your baby’s pattern, and contact your maternity unit immediately if movements slow down or change.

But my mother and grandmother had babies without all these appointments. Why do I need them?

Many women did, and many also lost babies or their own lives to conditions that are now easily detected and treated, such as pre-eclampsia, anaemia, gestational diabetes and infections. Antenatal care does not replace your family’s wisdom and support; it adds the protection of modern medicine. Every appointment is a chance to catch a problem early.

Related: Folic acid in pregnancy · The 12-week dating scan · Rhesus negative in pregnancy · Newborn care guide

Sources: World Health Organization (recommendations on antenatal care for a positive pregnancy experience; maternal mortality fact sheet), National Institute for Health and Care Excellence (antenatal care NG201), American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, US Institute of Medicine (weight gain during pregnancy).