How to Have a Healthy Baby: Everything I Tell My Patients Before and During Pregnancy
Of all the questions I receive in my clinic and in online consultations, this one carries the most weight: how do I make sure my baby is healthy? It is the question behind almost every other concern a pregnant woman brings to me — about what she is eating, what she should be taking, whether a particular symptom is dangerous, and whether she is doing enough.
I want to answer it properly. Not with a list of generic advice copied from a pamphlet, but with the same guidance I give to my patients sitting across from me at South East Hospital — honest, practical, and grounded in more than 20 years of obstetric experience.
The truth is that having a healthy baby is rarely about doing one big thing right. It is about doing many small things consistently — before pregnancy, during each trimester, and right through to delivery. None of it is complicated. But all of it matters.
Start Before You Are Pregnant: The Preconception Window
Most women only begin thinking about their health when they discover they are pregnant. By that point, the baby’s neural tube — the structure that develops into the brain and spinal cord — has already begun forming. It closes by around the 28th day after conception, often before a woman even knows she has conceived.
This is why preconception care matters so much. The three to six months before you try to conceive are, in my view, as important as the pregnancy itself. What you do in that window directly shapes the environment your baby develops in from the very first days.
The most important preconception steps I advise are:
Start Folic Acid Before Conception
Folic acid is not optional — it is the single most evidence-based supplement in pregnancy care. Taking 400 micrograms of folic acid daily, starting at least one month before conception and continuing through the first trimester, significantly reduces the risk of neural tube defects such as spina bifida.
In Pakistan, folic acid deficiency is a real concern, partly because of dietary patterns and partly because many women do not begin supplementation until they discover they are pregnant — by which time the critical window has already passed. If you are planning a pregnancy, start folic acid today. Do not wait for a positive test.
Women with a history of a previous pregnancy affected by a neural tube defect, or those with certain medical conditions, may need a higher dose. I assess this individually in preconception consultations.
Get a Preconception Health Check
I encourage every woman who is planning a pregnancy to come and see me — or any gynaecologist — for a preconception assessment before she starts trying. This visit allows us to review your medical history, check for any conditions that could affect pregnancy, update vaccinations if needed, and establish a baseline.
Conditions such as thyroid disease, diabetes, high blood pressure, and anaemia all need to be well controlled before pregnancy begins, because they carry risks for both mother and baby when they are poorly managed during the first trimester. Discovering and addressing them before conception is always better than managing them in the middle of an established pregnancy.
If you have been struggling to conceive and are looking for guidance before your pregnancy even begins, please visit our Infertility Treatment page for information on how we approach pre-pregnancy evaluation.
Review Any Medications You Are Taking
Some medications that are safe in normal life are not safe during pregnancy. Some supplements people take without much thought — high-dose vitamin A, for example — can be harmful to the developing foetus in large amounts. Conversely, some medications used for chronic conditions need to be continued but perhaps adjusted for pregnancy safety.
If you take any regular medication prescribed or over the counter bring the list to a preconception appointment so we can review it before you conceive. This is not the conversation to have after a positive pregnancy test.
Achieve a Healthy Weight Before Trying to Conceive
Both underweight and overweight status carry risks in pregnancy. Being significantly underweight increases the risk of low birth weight and preterm delivery. Obesity increases the risk of gestational diabetes, pre-eclampsia, caesarean delivery, and complications for the baby. Neither extreme is ideal, and both are better addressed before pregnancy rather than during it.
I do not expect perfection. I do not tell patients they must reach a particular number on a scale before they are allowed to have a baby. What I do ask is that they are moving in the right direction — eating reasonably, being active, and not carrying significant unmanaged weight-related health risks when they conceive.
Stop Smoking, Alcohol, and Any Harmful Substances
There is no safe amount of alcohol in pregnancy. I say this plainly because I still encounter patients who have read that a small occasional drink is harmless. The evidence does not support this position. Alcohol can affect foetal brain development at any stage of pregnancy, and the safest approach is none at all — ideally beginning before conception.
Smoking reduces fertility, increases the risk of miscarriage, and restricts the blood supply to the placenta, causing reduced oxygen and nutrient delivery to the growing baby. Babies born to mothers who smoke have higher rates of low birth weight and respiratory problems. If you smoke, stopping before conception is one of the most powerful things you can do for your baby’s health.
Nutrition During Pregnancy: What I Actually Tell My Patients to Eat
Nutrition in pregnancy is one of the most discussed and most misunderstood topics I deal with. There is a great deal of noise — conflicting advice from relatives, social media, and well-meaning friends and underneath it, a simple clinical reality: a varied, balanced diet built on real food gives your baby the nutrients it needs to develop well.
I do not give my patients a rigid meal plan. What I give them is a framework.
Iron and Folate — The Two I Insist On
Anaemia in pregnancy is extremely common in Pakistan — studies estimate that more than half of pregnant Pakistani women are anaemic at some point during their pregnancy. This is not a minor concern. Anaemia reduces the oxygen delivered to the baby, increases the risk of preterm birth and low birth weight, and leaves the mother exhausted and vulnerable during labour.
Iron-rich foods include red meat, chicken, fish, lentils, spinach, and beans. However, dietary iron alone is often insufficient during pregnancy, particularly in the second and third trimesters when the baby’s demand is highest. This is why I prescribe iron supplementation for most of my pregnant patients, not as an optional addition but as a standard part of antenatal care.
Folic acid continues to be important throughout the first trimester and beyond, both for neural tube protection and for supporting the rapid cell division of early development.
Calcium and Vitamin D
The baby needs calcium to build its bones and teeth — and it will take what it needs from the mother’s body if the dietary supply is insufficient, which is why pregnant women who do not consume enough calcium can lose bone density over the course of a pregnancy.
Good calcium sources include milk, yoghurt, cheese, leafy greens, and sesame seeds — all readily available in Pakistani diets. Vitamin D is needed to absorb and use calcium properly, but vitamin D deficiency is extremely common in Pakistani women, even in our sunny climate, because of limited sun exposure and dietary gaps. I check vitamin D levels routinely in my antenatal patients and supplement where needed.
Protein for Baby's Growth
Protein is the building block for every tissue and organ the baby develops. Adequate protein intake — from eggs, meat, fish, chicken, lentils, beans, and dairy — is essential throughout pregnancy, but particularly in the second and third trimesters when foetal growth accelerates.
I tell patients not to underestimate how much protein they need. It is not enough to eat a little daal once a day. Pregnancy increases protein requirements significantly, and most women need to deliberately increase their intake.
Foods to Limit or Avoid
I keep this list focused and practical:
- Raw or undercooked meat and eggs — risk of bacterial infection that can harm the baby
- Unpasteurised dairy products — risk of listeria
- High-mercury fish such as shark, swordfish, and king mackerel — mercury affects foetal brain development
- Excess caffeine — keep it under 200mg per day (roughly one cup of coffee or two to three cups of tea)
- Alcohol — none at all, as discussed above
- Raw sprouts, unwashed vegetables, and street food with uncertain hygiene — risk of foodborne illness
Beyond these, my advice to most patients is: eat real food, eat regularly, and do not skip meals. Nausea in early pregnancy sometimes makes this difficult, but small frequent meals tend to help both nausea and blood sugar stability.
Supplements I Recommend During Pregnancy
I prescribe supplements based on each patient’s blood results and dietary history, not as a blanket protocol. That said, there are supplements that the vast majority of my pregnant patients need:
- Folic acid (400mcg daily) — from before conception through at least the first trimester, and often continued throughout pregnancy
- Iron — dose adjusted based on blood results; most women need supplemental iron from the second trimester at the latest
- Calcium — particularly if dairy intake is low
- Vitamin D — I check levels and supplement accordingly; deficiency is very common
- Iodine — important for foetal thyroid and brain development; often overlooked
I do not automatically prescribe expensive branded prenatal vitamins unless there is a specific reason. Many of my patients do well with straightforward folic acid and iron prescribed alongside a good diet. More important than the brand is consistency — taking supplements every day, as prescribed, for the duration of the pregnancy.
Why Antenatal Care Is Not Optional
Antenatal care is the system through which we monitor the health of both mother and baby throughout pregnancy. In my clinic I see patients who have managed three or four pregnancies with minimal antenatal visits, assuming that because previous pregnancies went well, this one will too. I understand the thinking — but it is not how obstetrics works.
Every pregnancy is different. A woman who sailed through previous pregnancies can develop gestational diabetes, pre-eclampsia, or placenta problems in a subsequent one. These conditions can progress silently, causing significant harm to the baby before any dramatic symptom appears. Antenatal visits are how we catch them early.
What I Check at Each Antenatal Visit
My antenatal assessments are not simply a quick listen to the baby’s heartbeat. At each visit I am monitoring:
- Blood pressure — to detect pre-eclampsia early, which is one of the most dangerous pregnancy complications
- Urine — for signs of protein (pre-eclampsia) or infection
- Fundal height — to ensure the uterus is growing appropriately for the gestational age
- Foetal heartbeat and movement patterns
- Blood results — checking haemoglobin, blood sugar, thyroid function, and other markers at appropriate intervals
- Ultrasound scans — to monitor foetal growth, position, amniotic fluid levels, and placental location
Each of these checks serves a purpose. Missing antenatal appointments is not saving time — it is missing early warning signs.
When to Book Your First Antenatal Appointment
I recommend booking within the first eight weeks of pregnancy as soon as you have a positive pregnancy test and have recovered from the initial surprise. This first appointment is the most comprehensive: we confirm the pregnancy, perform a dating ultrasound, take a full medical history, order baseline blood tests, and establish your care plan for the rest of the pregnancy.
For information on how I approach normal pregnancy monitoring and delivery planning, please visit our Normal Delivery and Pregnancy Care page.
Exercise During Pregnancy: Move - But Move Wisely
I am sometimes asked by patients whether they should rest completely during pregnancy to protect the baby. My answer is almost always no. For women with uncomplicated pregnancies, regular moderate exercise benefits both mother and baby significantly.
Exercise during pregnancy improves circulation, reduces the risk of gestational diabetes, helps manage weight gain, supports better sleep, and reduces the risk of pre-eclampsia. It also genuinely improves labour outcomes — women who remain active during pregnancy tend to have shorter active labours and recover faster after delivery.
What I recommend for most of my patients:
- Walking — 30 minutes most days. It requires no equipment, no gym membership, and carries negligible risk in a normal pregnancy.
- Swimming — gentle on the joints, excellent cardiovascular exercise, and very comfortable as the abdomen grows.
- Antenatal yoga or stretching — builds the strength and flexibility that support a more comfortable late pregnancy and labour.
- Pelvic floor exercises — I teach these at every first antenatal appointment. A strong pelvic floor supports the weight of the growing uterus and reduces the risk of incontinence after delivery.
What I ask patients to avoid: contact sports, exercises with a high risk of falling, heavy lifting, lying flat on the back after the first trimester for prolonged periods, and anything that causes pain, shortness of breath, or dizziness.
If you have a high-risk pregnancy, placenta praevia, a history of premature labour, or other specific conditions, I will advise you individually on what is safe. The general guidance above does not apply to every woman.
Managing Stress in Pregnancy — This Matters More Than Most Women Realise
Stress is one of the most underappreciated risks in pregnancy, and I say this based on both the evidence and on what I observe in my clinic. Women under chronic, significant stress during pregnancy have higher rates of preterm birth, low birth weight babies, and gestational complications including elevated blood pressure.
The mechanism is not mysterious. When the body is under sustained stress, it produces elevated levels of cortisol. Cortisol crosses the placenta. High cortisol in the foetal environment affects brain development, immune function, and growth. This is not theoretical — it is documented in research consistently.
I am not saying that everyday pregnancy worry is dangerous. Some anxiety during pregnancy is normal and understandable. What I am concerned about is chronic, unmanaged stress — financial pressure, relationship problems, family conflict, workplace stress, or untreated anxiety and depression — that persists throughout pregnancy without support.
What I advise my patients:
- Identify the sources of your stress and address what can be addressed. Some stressors can be reduced; others simply need to be managed.
- Rest matters. Sleep in pregnancy is not a luxury — it is when the body repairs, the baby grows, and cortisol levels reset. Aim for seven to nine hours, and rest when you need to during the day.
- Whether to a trusted family member, a friend, or a counsellor, not carrying stress silently is important.
- Gentle exercise, breathing practice, and time outside all have a measurable effect on cortisol levels.
- If you have persistent low mood, significant anxiety, or symptoms of depression during pregnancy, please tell me. Antenatal depression is real, treatable, and not something you should simply endure.
In Pakistani families, there is often enormous social pressure placed on pregnant women — expectations about gender of the baby, pressure from in-laws, financial concerns, or unrealistic demands on a woman who is growing a human being while managing a household. I see the toll this takes. If this is your situation, you are not alone, and there are ways to make it more manageable.
Avoid Infections That Can Harm Your Baby
Certain infections during pregnancy carry a disproportionate risk to the developing baby, and some of them can be prevented with simple precautions. I discuss the most important ones with my patients early in pregnancy:
Rubella (German Measles)
Rubella infection in the first trimester can cause serious birth defects including deafness, heart problems, and developmental delay. Most women are protected through childhood vaccination, but I check immunity at the preconception stage or early in pregnancy. If you are not immune and not yet pregnant, vaccination before conception is the answer.
Toxoplasmosis
This infection, caused by a parasite found in raw or undercooked meat and in cat faeces, can cause serious problems for the developing baby including brain damage and vision loss. I advise pregnant women to avoid handling cat litter, to wash hands thoroughly after handling raw meat, and to eat meat that is well cooked.
Listeria
Listeria is a bacterial infection associated with unpasteurised dairy products, soft cheeses, deli meats, and foods that have not been stored or reheated properly. Pregnant women are significantly more susceptible to listeria than the general population, and the infection can cause miscarriage, stillbirth, or serious illness in the newborn.
Group B Streptococcus (GBS)
GBS is a bacterium that some women carry in the vagina and bowel without any symptoms. In most situations it causes no problem, but if passed to the baby during delivery it can cause a serious newborn infection. I screen for GBS in late pregnancy and, if it is present, administer antibiotics during labour as a precaution.
Urinary Tract Infections
UTIs are more common in pregnancy and, unlike in non-pregnant women, they are more likely to ascend to the kidneys and cause serious complications including preterm labour. I screen for asymptomatic UTI at antenatal visits because women often have no obvious symptoms. Staying hydrated and seeking treatment promptly for any urinary symptoms are important habits throughout pregnancy.
Warning Signs During Pregnancy That Need Immediate Attention
I want every pregnant patient to know which symptoms require urgent medical attention — not a wait-and-see approach, not a message to the clinic the next morning. These require immediate assessment:
- Heavy vaginal bleeding at any stage of pregnancy
- Severe abdominal pain or persistent cramping
- Reduced or absent foetal movements after 28 weeks of pregnancy
- Severe headache, particularly with blurred vision or swelling of the face and hands — possible pre-eclampsia
- Sudden swelling of the face, hands, or feet — possible pre-eclampsia
- High fever
- Difficulty breathing
- Signs of urinary infection with fever
- Fluid leaking from the vagina before the expected due date
I tell all my patients: if something feels seriously wrong during your pregnancy, do not wait for your next scheduled appointment. Contact the clinic or go to the nearest emergency facility. A good outcome depends on early recognition of problems, not on tolerating symptoms and hoping they resolve.
For information on how complications in early pregnancy are managed, please visit our Miscarriage Management page. For information on caesarean delivery in complicated cases, our Caesarean Section page provides a clear overview.
The Role of the Father in a Healthy Pregnancy
Pregnancy is not a solo effort, and I say this in my clinic to couples as well as to women who come alone. The health of the father matters — not just emotionally, but biologically. Sperm quality is affected by smoking, alcohol, obesity, nutritional deficiencies, and chronic stress. A father who addresses these factors before conception gives his half of the baby’s genetic material the best possible start.
During pregnancy, the father’s role in creating a calm, supportive, low-stress home environment directly affects the mother’s wellbeing — and as I discussed earlier, the mother’s stress levels directly affect the baby. A husband who takes over household responsibilities, accompanies his wife to antenatal appointments, and responds to her physical and emotional needs during pregnancy is contributing to his baby’s health in a very real way.
I encourage husbands to attend at least the major antenatal appointments. Hearing the baby’s heartbeat, seeing the ultrasound, and understanding what their partner is experiencing physically changes the nature of the support they offer. It also allows them to ask their own questions and to be part of the plan.
Planning for Delivery: Part of Having a Healthy Baby
A healthy pregnancy does not automatically result in a healthy delivery. Planning where and how you will deliver your baby is part of the overall strategy, not an afterthought.
I discuss delivery preferences with my patients in the third trimester, taking into account their medical history, the baby’s position and growth, the progress of the pregnancy, and any conditions that have developed during the antenatal period. For most women with uncomplicated pregnancies, normal vaginal delivery remains the safest option for both mother and baby.
If you have concerns about delivery options or are wondering about the difference between normal delivery and caesarean section, our Normal Delivery page and Caesarean Section page explain both pathways clearly.
Delivering in a facility with proper monitoring, skilled staff, and the ability to respond to emergencies is non-negotiable. I say this particularly to patients who are considering delivering at home or in inadequately equipped settings: the complications that kill mothers and babies during delivery are unpredictable and rapid. Skilled, equipped attendance at delivery is not a luxury it is the standard.
Special Considerations for Women With Hormonal or Fertility Conditions
Women who conceived after treatment for PCOS, thyroid disease, hormonal imbalance, or infertility carry different risk profiles in pregnancy and need more attentive antenatal monitoring. I want to address this group specifically because they sometimes assume that once they are pregnant, the hard part is over.
In reality, the underlying conditions that affected conception can also affect how the pregnancy progresses. Women with PCOS have higher rates of gestational diabetes and pregnancy-induced hypertension. Women with thyroid disease need their thyroid function monitored throughout pregnancy because requirements change. Women who conceived through fertility treatment may have specific risks based on their treatment history.
If you have a hormonal condition such as PCOS or thyroid imbalance, please make sure your gynaecologist knows this from the very first antenatal visit. You can also visit our PCOS Treatment page or our Hormonal Imbalance Treatment page for more background on how I manage these conditions.
FAQs
When should I start preparing for a healthy pregnancy?
Ideally, three to six months before you begin trying to conceive. Start folic acid, have a preconception health check, address any medical conditions that need managing, stop smoking and alcohol, and move toward a healthy weight. The earlier the preparation, the better the starting point for the pregnancy itself.
What is the most important supplement during pregnancy?
Folic acid is the one I insist on above all others, because its protective effect against neural tube defects depends on it being taken before and during the earliest weeks of pregnancy — before most women even know they are pregnant. After that, iron and vitamin D are the two I most commonly need to prescribe based on blood results in Pakistani patients.
Is it safe to exercise during pregnancy?
For most women with uncomplicated pregnancies, yes — and I actively encourage it. Walking, swimming, gentle yoga, and pelvic floor exercises are all safe and beneficial. Exercise reduces the risk of gestational diabetes and pre-eclampsia, improves sleep, and supports better labour outcomes. I tailor activity guidance for women with high-risk pregnancies individually.
What I Want Every Patient to Remember
Having a healthy baby is not about following a perfect set of rules. It is about making consistently good choices across a period of several months — before conception, during each trimester, and right through delivery. None of the steps I have described are complicated. Most of them are within every woman’s reach.
What I have learned from 20 years of practice is that the women who have the best pregnancy outcomes are not necessarily the wealthiest or the most medically sophisticated. They are the ones who come for their antenatal appointments, who communicate openly with their doctor when something does not feel right, who eat reasonably well and rest when they need to, and who have someone beside them — a husband, a mother, a sister — providing steady support.
You do not need to be perfect. You need to be present, informed, and cared for. That is what I am here to help with.
Medical Review: This page has been thoroughly reviewed and medically verified by Dr. Sajida Guftaar to ensure clinical accuracy and reliability.