Twins & Triplets — Exercise & Nutrition Tips

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A detour: We received a ques­tion about nutri­tion and exer­cise for mul­ti­ples. So, here is some infor­ma­tion for those with twins and triplets. Add a com­ment if you have a ques­tion or expe­ri­ence to share on this top­ic! Next comes birth, we promise!!

If one is a girl and one is a boy, they're fraternal!

If one is a girl and one is a boy, they’re fra­ter­nal!

Nutri­tion for Mul­ti­ples:

The pri­ma­ry thing we tell peo­ple with twins or more is that the pro­tein needs rise about 30 grams/baby/day above the 70 — 90 grams/day need­ed for a sin­gle­ton. Water intake also needs to rise. Avoid thirst and as much as pos­si­ble, drink until urine runs clear rather than yel­low (as best as you can).

Mul­ti­ples is con­sid­ered a risk fac­tor, and for each risk fac­tor (mul­ti­ples, under­weight, teenage mom, inter-preg­nan­cy peri­od less than a year) an addi­tion­al 200 calo­ries is often rec­om­mend­ed, with 400 extra calo­ries the upper lim­it.

Exer­cise with Mul­ti­ples:

A crit­i­cal fac­tor in suc­cess­ful implan­ta­tion and growth of the pla­cen­ta appears to be aer­o­bic fit­ness in the six months pri­or to and the first half of preg­nan­cy. Once bio­me­chan­ics become dif­fi­cult in mid-preg­nan­cy, women with mul­ti­ples can con­tin­ue activ­i­ty safe­ly as long as mon­i­tor­ing show the babies are grow­ing appro­pri­ate­ly. A bel­ly sup­port can be extreme­ly help­ful when exer­cis­ing.

Con­traindi­ca­tions for exer­cise include the dis­cov­ery that one fetus is grow­ing at a sig­nif­i­cant­ly slow­er rate than the other(s), that both/all are too small, that the placenta(s) is/are mal­func­tion­ing, or some oth­er con­di­tion occurs, such as an incom­pe­tent cervix or pla­cen­ta pre­via, that would be a fac­tor in any case.

Absolute size dif­fer­ence does not nec­es­sar­i­ly mean that one baby is grow­ing more slow­ly, as some fetus­es may be a cou­ple weeks younger than their uterus-mate(s) if the moth­er ovu­lat­ed twice in the fer­til­i­ty cycle. Or, s/he might be small­er if genet­i­cal­ly des­tined to be a small­er infant at birth. Thus, growth rate is the mea­sur­able fac­tor that helps deter­mine if a fetus is at risk of not receiv­ing ade­quate ener­gy. This can hap­pen when there are two pla­cen­tas and one pla­cen­ta is work­ing more poor­ly than the oth­er, or for some rea­son there is a flaw in the umbil­i­cal cord of an iden­ti­cal. The com­pe­ti­tion for ener­gy places a slow­er grow­ing baby at risk.

Pro­tect­ing Mom and Baby:

The pla­cen­ta is designed to nour­ish the baby and will do so at a cost to the moth­er first if there is inad­e­quate nutri­tion. Thus, activ­i­ty to the lev­el the moth­er can tol­er­ate and fol­low­ing nutri­tion­al guide­lines above — in the absence of med­ical com­pli­ca­tions — pro­duces healthy off­spring. Mul­ti­ples will gar­ner all the same ben­e­fits a sin­gle­ton does.

Note about images:  we strive to use images we own or that are adver­tised as free on the inter­net. We want to thank google, bing and yahoo for mak­ing free images avail­able.

Pregnancy Pathway, Pregnancy — Behavior: Avoiding Risks

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Some­times it seems like preg­nan­cy is a time of restric­tions. Avoid­ing risks can be one thing that makes it seem that way. But, bear with us here in an inter­est­ing trip through dan­ger and find­ing you find ways of enhanc­ing your preg­nan­cy!

Risk Fac­tor #1:

Lack of pre­na­tal care. More than any­thing else, be sure you have care. Hav­ing some­one mon­i­tor your health and that of your baby dur­ing preg­nan­cy is vital to a good out­come.

Risk Fac­tor #2:

Not exer­cis­ing. Seden­tary behav­ior increas­es the risk for meta­bol­ic, car­dio­vas­cu­lar and immune dis­or­ders.

I know, I know, you don’t have time to exer­cise. Well, pay now or pay lat­er, as they say. Make time to go to a class (make sure it includes 20 -30 min­utes of aer­o­bics) a cou­ple times a week. A class will also pro­vide social sup­port, anoth­er fac­tor that enhances your preg­nan­cy. Take a walk at lunch time. Prac­tice relax­ation tech­niques.

Risk Fac­tor #3:

Breath­ing dan­ger­ous fumes. Yes, this includes smok­ing and sec­ond-hand smoke. But, it also means avoid­ing envi­ron­ments where there is a lot smog (near high­ways), liv­ing with mold or dust, and fan­cy cleansers that may have dan­ger­ous chem­i­cals in them. Stick with vine­gar, ammo­nia or bleach as cleansers.

Smog can endanger your fetus!

Smog can endan­ger your fetus!

We are learn­ing that com­bus­tion exhaust from cars and trucks can neg­a­tive­ly affect birth weight and pre­ma­tu­ri­ty. If you live or work near a high­way or in an area where smog is preva­lent, what are your options? Can you trans­fer or move? Can you wear a mask? Talk to your care provider and fig­ure out the best pro­tec­tion for you and your fetus.

Risk Fac­tor #4:

Poor Nutri­tion. Yup, just go back one entry and find out how food affects preg­nan­cy. If you don’t eat enough pro­tein and drink enough water, you don’t make suf­fi­cient blood vol­ume to nour­ish your pla­cen­ta and thus your fetus.

Read labels!

Read labels!

Eat whole foods and learn to read labels when you buy processed foods. What is a “processed” food? Any­thing with more than one ingre­di­ent!

Some pro­cess­ing (ex: home­made soup) takes lit­tle nutri­tion away, but some pro­cess­ing (ex: pota­to chips) takes every­thing good away and replaces it with unsafe sub­stances. Look for low sodi­um, low sug­ar, high vit­a­min and min­er­al con­tent items with no sat­u­rat­ed or trans fats.

Read the ingre­di­ents; if you don’t know what the words mean, maybe you want to pass it up.

Risk Fac­tor #5:

Alco­hol and Drugs. Com­mon items can be as dan­ger­ous as street drugs, which

There is plenty of time in life for a glass of wine...later.

There is plen­ty of time in life for a glass of wine…later.

No. No. No. Only meds from your prenatal care provider are okay.

No. No. No. Only meds from your pre­na­tal care provider are okay.

Caffeine? Only one cup & only if you must.

Caf­feine? Only one cup & only if you must.

can severe­ly com­pro­mise you baby’s future. If you have a drug or alco­hol habit, get help.

Risk Fac­tor #6:

Genet­ics. You can have genet­ic pre­dis­po­si­tions for many preg­nan­cy issues. How­ev­er, that does not nec­es­sar­i­ly mean you will devel­op a giv­en dis­or­der. For exam­ple, nutri­tion and exer­cise great­ly reduce the risk and sever­i­ty of meta­bol­ic issues. Some genet­ic issues are unavoid­able how­ev­er, and your care provider will alert you to these, if they are rel­e­vant.

Risk Fac­tor #7:

Social issues — iso­la­tion, lack of sup­port, abuse, pover­ty. All of these fac­tors can have neg­a­tive effects.

If iso­la­tion is a sim­ple mat­ter of need­ing to meet oth­er moms-to-be, join an exer­cise pro­gram. That way, you get both sup­port and exer­cise; just be sure it includes aer­o­bics, along with cen­ter­ing, relax­ation and appro­pri­ate strength.

If your sit­u­a­tion is more dire, seek the help of a care provider or social work­er at your local hos­pi­tal or clin­ic. Safe­ty and sup­port are crit­i­cal for you at this time. Get the help you need. There are peo­ple who care. And, if you know of some­one who needs help, help them.

If you have oth­er risk fac­tors to offer, please post them in the com­ments. Thanks!

What’s next?  BIRTH!!

Pregnancy Pathway, Pregnancy — Nutrition

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Fresh fruit = vitamins & minerals!!

Fresh fruit = vit­a­mins & min­er­als!!

Ques­tion:

How many extra calo­ries do you need in each trimester to off­set the meta­bol­ic cost of preg­nan­cy?

Answer:

First trimester — 0; Sec­ond trimester — 300; Third trimester — 500 (source: Insti­tute of Med­i­cine).

Keep in mind that you may also need calo­ries for any fit­ness pro­gram you are doing. If you are con­tin­u­ing a pro­gram, the only change is due to the preg­nan­cy.

If you begin or increase your activ­i­ty, you need to take that into account. One yoga class = 100 — 150 calo­ries. One aer­o­bics class = 200–400 calo­ries. Walk one mile = 100 calo­ries.

1 slice whole grain bread = 50-100 calories

1 slice whole grain bread = 50–100 calo­ries

Be sure you read food labels so that you can bal­ance your food intake and your calo­rie out­put. A small woman (under 5′3″ & 130 lbs.) prob­a­bly needs about 1200 calo­ries per day as a base. A medi­um sized woman needs about 1400, and a large woman (over 5′9″ & 160 lbs.) prob­a­bly needs 1600 to 1800 calo­ries. Add your activ­i­ty and preg­nan­cy needs to your base amount.

Ques­tion:

What foods are nec­es­sary for a healthy preg­nan­cy?

Answer, part A:

PROTEIN. Lean pro­teins like turkey and those with omega 3 fats like ocean fish and eggs.…yes! EGGS!

Turkey is a good protein

Turkey is a good pro­tein

Ocean fish 1 or 2 times/wk = good protein & omega 3 fat

Ocean fish 1 or 2 times/wk = good pro­tein & omega 3 fat

Eggs are a perfect pregnancy food!

Eggs are a per­fect preg­nan­cy food!

70–90 grams of pro­tein are nec­es­sary each day, along with  ade­quate water.  These are need­ed to make an extra 40% blood vol­ume required to sup­port the pla­cen­ta.

Answer, part B:

WATER. Two (2) quarts of water…more if you are very active…are need­ed to make extra blood and to pre­vent dehy­dra­tion.

Ques­tion: What else?

Fresh vegetables also provide fiber

Fresh veg­eta­bles also pro­vide fiber

Answer: CARBS. Fresh, col­or­ful fruits & veg­gies pro­vide nec­es­sary vit­a­mins and min­er­als, as well as fiber. Eat 5 serv­ings a day from all the col­ors:  yel­low, orange, red, pur­ple and green, and you will get live vit­a­mins all day long that help your baby devel­op prop­er­ly! Fruits, veg­eta­bles and whole grains are low glycemic index car­bo­hy­drates — the good ones!

Dairy provides calcium

Dairy pro­vides cal­ci­um

Ques­tion:

Do I need dairy prod­ucts and red meat? Can I get the need­ed min­er­als in oth­er ways?

Answer:

Cal­ci­um is need­ed in ade­quate amounts for bones and teeth. It is most eas­i­ly obtained by drink­ing milk or eat­ing cheese, yogurt or cot­tage cheese. Soy, dark green leafy veg­eta­bles and cal­ci­um for­ti­fied juice are alter­na­tives.

Iron is nec­es­sary for red blood cells to take up oxy­gen. It is found in high amounts in beef,  and less­er amounts in raisins, spinach, and prune juice. Pre­na­tal vit­a­mins are your insur­ance against defi­cien­cies of these essen­tial min­er­als.

Ques­tion:

Any­thing else that’s essen­tial?

Answer:

Yes! Healthy FAT!!

Avocado is an excellent source of omega 6 fat

Avo­ca­do is an excel­lent source of omega 6 fat

In addi­tion to omega 3 fats found in fish, wal­nuts and flax seeds, you need also need omega 6 fats, which are found in avo­ca­dos, olive oil and oth­er veg­etable oils. Healthy fats help bal­ance car­dio­vas­cu­lar con­stric­tion and dila­tion, reduc­ing the risk for hyper­ten­sion.

Last Ques­tion:

What is a healthy weight gain?

Answer:

In 2009, the Nation­al Acad­e­my of Sci­ences revised its rec­om­men­da­tions. It now bases desir­able weight gain on pre-preg­nan­cy BMI (Body Mass Index…google this!).

BMI less than 18.5 (low) — 28 to 40 lbs.; BMI between 18.5–24.9 (nor­mal) — 25 to 35 lbs.; BMI 25.0 to 29.9 (high) — 15 to 25 lbs.; obese women (BMI over 30.0) — 11 to 20 lbs.

Com­ing Next: Avoid­ing Risks.

Pregnancy Pathway — Exercise cont’d

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MORE?!! You didn’t think that was it? Only a few com­ments on evi­dence as to WHY mov­ing around, burn­ing calo­ries, being strong and learn­ing to relax while preg­nant is ben­e­fi­cial? No, of course not. You know there is more to it, like WHAT move­ment is safe and effec­tive dur­ing preg­nan­cy?

So, what is safe? Well, first, unless you have a very few con­di­tions that your health care provider con­sid­ers unsafe, every woman — fit, cur­rent­ly seden­tary, young or a lit­tle old­er — can exer­cise safe­ly in preg­nan­cy. How much of what kind depends on your fit­ness lev­el and exer­cise his­to­ry. Get med­ical screen­ing first.

If you are fit, you can do vigorous exercise

If you are fit, you can do vig­or­ous exer­cise

If you are fit, you just need to learn how to mod­i­fy some move­ments to accom­mo­date your bio­me­chan­ics. As your body changes, stress on the joints and tis­sues means a lit­tle less jump­ing or bal­lis­tic motion will be more com­fort­able and safer. If you are fit, you can con­tin­ue with vig­or­ous exer­cise and it will be of ben­e­fit to you and your baby.

If you are not so fit or are seden­tary, find a cer­ti­fied pre/postnatal instruc­tor and join a group where you will have fun, get some guid­ance and be mon­i­tored for safe­ty. How do you find such a per­son? Try our Find A Class or Train­er page.

What is effec­tive? Don’t spend your time on things that may be nice to do but don’t help you focus and pre­pare for birth, relieve dis­com­forts or have the sta­mi­na for birth and par­ent­ing. There is sub­stan­tial sci­en­tif­ic evi­dence and infor­ma­tion from large sur­veys that these things are help­ful.

Car­dio­vas­cu­lar or aer­o­bic activ­i­ty is the most impor­tant activ­i­ty you can do. Already fit? Keep work­ing out; join a class if you want sup­port or new friends. If you are seden­tary or some­what active, you can improve your fit­ness by doing at least 20 — 30 min­utes of aer­o­bic activ­i­ty 3 times a week. Work at a mod­er­ate pace — some­what hard to hard — so that you can talk, but not sing an aria! If you are more than 26 weeks and have not been doing car­dio, you can walk at a com­fort­able pace. Aer­o­bics is key because it gives you endurance to tol­er­ate labor and pro­motes recov­ery.

Strength and flex­i­bil­i­ty exer­cis­es that do not hurt and are done cor­rect­ly are also safe. There are some spe­cial preg­nan­cy exer­cis­es that actu­al­ly help you pre­pare for birth. Essen­tial exer­cis­es that aid your com­fort, align­ment and birth prepa­ra­tion include:

Kegels (squeez­ing and relax­ing pelvic floor mus­cles) — squeez­ing strength­ens them and thus sup­ports the con­tents of the abdomen, and learn­ing to release these mus­cles is nec­es­sary for push­ing and birth.

Abdom­i­nal hiss/compress and C-Curve® - con­tract­ing the trans­verse abdom­i­nal mus­cles reduces low back dis­com­fort and strength­ens the mus­cle used to push and lat­er to recov­er abdom­i­nal integri­ty after birth.

Squatting

Squat­ting

Squat­ting — get­ting into this posi­tion strength­ens the entire leg in a deeply flexed posi­tion; start seat­ed and use arms for sup­port, sta­bil­i­ty and safe­ty. Leg strength improves mobil­i­ty and com­fort in preg­nan­cy and post­par­tum; plus, deep flex­ion is a com­po­nent of push­ing in almost all posi­tions.

Strength­en­ing for bio­me­chan­i­cal safe­ty — strength­en­ing some parts of the body helps pre­vent injury to bone sur­faces, nerves and blood ves­sels with­in joints re-aligned in preg­nan­cy. This can be done using resis­tance rep­e­ti­tions (weights, bands, cal­is­then­tics or pilates) or iso­met­rics (yoga or bal­let). A respon­si­ble class will focus on upper back (row­ing), push-ups, abdom­i­nals, gluteals, ham­strings, and mus­cles of the low­er leg.

Stretch­ing of areas that tend to get tight — reliev­ing some dis­com­forts through flex­i­bil­i­ty helps you main­tain a full range of motion. Sta­t­ic stretch­es, used in com­bi­na­tion with strength exer­cis­es or fol­low­ing aer­o­bics, is most effec­tive. Stretch­ing pri­or to exer­cise tends to pro­duce more injuries than not stretch­ing. Areas need­ing stretch­ing include the chest, low back, ham­strings and hip flex­ors (psoas).

Mind/Body skills are very impor­tant. There are two activ­i­ties that exer­cis­ers con­stant­ly tell us are a big help in preg­nan­cy, birth and par­ent­ing.

• Cen­ter­ing employs a bal­anced or neu­tral pos­ture, deep breath­ing and mind­ful­ness to help you work in a relaxed way. Ath­letes and dancers call this “the zone.” Start­ing your work­out in asso­ci­a­tion with your body estab­lish­es econ­o­my of motion, some­thing very use­ful in birth and par­ent­ing, and reduces risk of injury.

• Relax­ation is anoth­er key activ­i­ty; it relieves stress, pro­motes labor in the ear­ly stages and helps you enter the zone!

Remem­ber: Birth is a Motor Skill™

Pregnancy Pathway — Exercise

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How lucky is this? Just a few days ago, yet anoth­er study was released and has been cir­cu­lat­ing on Med­scape and oth­er med­ical sites that indi­cates exer­cise is ben­e­fi­cial in preg­nan­cy, whether the moth­er is a pre­vi­ous exer­cis­er or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behav­ior Affects Preg­nan­cy Out­come

Phys­i­cal exer­tion (we call it “exer­cise” nowa­days) is a nor­mal state for healthy humans. Only in the last cen­tu­ry has the desire to rest or the need to store extra calo­ries as fat become more pos­si­ble to achieve than our need to move about to sur­vive.

Preg­nan­cy is a state in which both of these fac­tors (rest­ing and stor­ing calo­ries) are enhanced through organ­ic changes in body chem­istry, adap­ta­tions that favor fetal sur­vival. The cur­rent seden­tary lifestyle exag­ger­ates these meta­bol­ic changes and results in syn­dromes that increase the risk for a num­ber of meta­bol­ic, car­dio­vas­cu­lar and immuno­log­i­cal dis­or­ders of preg­nan­cy.

When con­front­ed by the idea that it is coun­ter­in­tu­itive to think exer­cise in preg­nan­cy might be safe (let alone ben­e­fi­cial) I am dumb­found­ed. To me, it is coun­ter­in­tu­itive to think that a seden­tary lifestyle in preg­nan­cy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burn­ing Calo­ries in Preg­nan­cy Improves Out­comes!

What is the evi­dence that exer­cise in preg­nan­cy is ben­e­fi­cial? Keep in mind that some stud­ies have been exe­cut­ed more expert­ly than oth­ers. But, what is com­pelling is that numer­ous well-respect­ed researchers have sought to test the hypoth­e­sis that exer­cise is not safe, but come away with results that indi­cate the oppo­site!

Here are some of the major find­ings:

• The pla­cen­ta is larg­er and has more trans­port sur­face in exer­cis­ers than seden­tary women

• The fetus­es of (aer­o­bic) exer­cis­ing moth­ers make ben­e­fi­cial car­dio­vas­cu­lar adap­ta­tions

• Women who do aer­o­bic exer­cise are less like­ly to devel­op severe preeclamp­sia or ges­ta­tion­al dia­betes, and the long term health prob­lems that accom­pa­ny these dis­or­ders

• Women who are aer­o­bi­cal­ly fit recov­er from birth 10 times faster than seden­tary women (as mea­sured by time need­ed to metab­o­lize free rad­i­cals pro­duced in labor)

• Women who exer­cise in preg­nan­cy are more like­ly to be phys­i­cal­ly fit in midlife

• Babies of aer­o­bi­cal­ly fit women are at reduced risk for pre­ma­tu­ri­ty and low birth weight
DTP_mover2
So, we have arrived at the take-home mes­sage: MOVE!! Preg­nan­cy works best when you move and burn calo­ries in a mod­er­ate to vig­or­ous fash­ion. But, alter­nate this activ­i­ty with rest and good nutri­tion, and be sure to stay well hydrat­ed.
If you want more specifics and resources on this top­ic, try these:
“Women and Exer­cise” in Varney’s Mid­wifery.

Pregnancy Pathway, Pregnancy – Exposure to Toxins and Infection

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Hot top­ic for today: Tox­ins and infec­tions in preg­nan­cy.

Pregnancy Exposure to Toxins and Infections

Preg­nan­cy Expo­sure to Tox­ins and Infec­tions

A moth­er-to-be needs to be aware of items that can have adverse effects on the health and devel­op­ment of her fetus, as well as her own health. Two of these fac­tors are tox­ins and infec­tions.

1. Tox­ins can be food, envi­ron­men­tal fac­tors, and med­ica­tions, alco­hol or drugs. Let’s start with food. Inter­est­ing­ly, many plants have slight tox­ins in them that can have a small neg­a­tive impact dur­ing ear­ly fetal devel­op­ment. One the­o­ry of nau­sea and vom­it­ing in ear­ly preg­nan­cy is that this helps the mother’s body pre­vent these tox­ins from inter­fer­ing with nor­mal devel­op­ment. Pica — espe­cial­ly eat­ing dirt that is large­ly clay — may be anoth­er man­i­fes­ta­tion of how the body strives to counter plant tox­ins, as clay can coun­ter­act some of the effects of these tox­ins. So, plant tox­ins can be one food source in ear­ly preg­nan­cy.

Anoth­er source is food addi­tives (things you can­not pro­nounce, so read the ingre­di­ents!). We have no idea how many chem­i­cals and hor­mones added to foods affect fetal devel­op­ment.

NIH illustration of reading food label

NIH illus­tra­tion of read­ing food label

Risk-aver­sion involves avoid­ing items that are risky. If you are not sure, don’t eat it. For up to date infor­ma­tion, look at the FDA site on food safe­ty or the NIH site on read­ing food labels.

Envi­ron­men­tal fac­tors that may affect fetal devel­op­ment can include air pol­lu­tion, house­hold cleansers, mold and oth­er items encoun­tered any­where one goes. Things we breathe can be par­tic­u­lar­ly dan­ger­ous, so be sure to keep cleanser use to sim­ple items such as vine­gar, ammo­nia or chlo­rine bleach. Wear­ing a mask while clean­ing is also a good idea.

Med­ica­tions, drugs or alco­hol that might nor­mal­ly be con­sid­ered safe for a non-preg­nant per­son — some­thing as sim­ple as aspirin — can be dan­ger­ous as they affect blood clot­ting fac­tors and threat­en the pla­cen­ta. Or, because they cross the pla­cen­tal bar­ri­er but can­not be metab­o­lized by the imma­ture fetal liv­er, they are tox­ic and induce dam­age to the fetus.

2. Infec­tions are of con­cern, as well. It is pos­si­ble that an active infec­tion at the time of fer­til­iza­tion and implan­ta­tion can con­tribute to dys­func­tion in preg­nan­cy because it inter­feres with the nor­mal immune respons­es of ear­ly preg­nan­cy. Hyper­ten­sion in preg­nan­cy may be relat­ed to infec­tion in the ear­ly days of preg­nan­cy. Some infec­tions — par­tic­u­lary sex­u­al­ly trans­mit­ted infec­tions — are known to have detri­men­tal effects on the baby’s health. Preterm pre­ma­ture rup­ture of mem­branes (P-PROM) almost always reflects active infec­tion.

Tak­ing Pre­cau­tions: First, be sure to let your health care provider know about any ill­ness or infec­tion. Sec­ond, take care of your­self. Fol­low rec­om­men­da­tions for fre­quent hand­wash­ing and car­ry ster­ile hand gel in your purse or back­pack. Avoid places where hygiene might be com­pro­mised. Prac­tice safe sex.