What’s allowed and what’s not during pregnancy?

Many women who are pregnant, in particular those who are expecting for the first time, question their everyday habits and activities and wonder how these could affect their unborn child. The desire to do what’s best for the baby begins long before the birth.

At a glance

  • Caffeine is allowed in small amounts during pregnancy.
  • Women should completely abstain from alcohol, nicotine, and illegal substances, such as cannabis, even while trying to get pregnant and at latest when they become pregnant.
  • Over-the-counter medications may also have some harmful effects on the baby’s development.
  • Some vaccinations are strongly recommended during pregnancy.
  • Sufficient exercise is important for mother and child, which is why most sporting activities have a positive effect.
  • Sexual intercourse poses no problems in a normal pregnancy.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Eine junge hochschwangere Frau schiebt ihr Fahrrad über die Straße. Sie ist sommerlich gekleidet und die Sonne scheint.

Pregnancy as an exceptional time – are lifestyle changes necessary?

During pregnancy, women are also responsible for their unborn child. Even at this early stage, their focus is on the well-being of the baby, leading many women to make changes to their lifestyle. Coffee in the morning, a glass of wine in the evening, yoga class on the weekend – which cherished habits should pregnant women avoid to prevent harm to the unborn child? And which are still allowed during pregnancy?

Is caffeine allowed during pregnancy?

Coffee or tea are two stimulants that many pregnant women would rather not have to give up. The good news is that small amounts of caffeine are allowed during pregnancy.

The guideline is 200 mg of caffeine per day. This is equivalent to about 1 to 2 cups of coffee or 3 to 4 cups of tea. However, pregnant women should not drink more than this. With tea in particular, the caffeine content of a cup can very greatly, depending on the brewing time and water temperature. This is true for black, green, and white tea.

Important: Caffeine is also in cocoa – depending on the quality of the cocoa, the amount of caffeine it contains may be close to that of green tea.

Although many energy drinks do not contain the maximum amount of 200 milligrams of caffeine, they are still unsuitable during pregnancy. They contain additional ingredients, such as glucuronolactone, taurine, or inositol, and the effects of these on the unborn child have not yet been adequately studied.

Why is alcohol not allowed during pregnancy?

In contrast to the case of caffeine, no amount of alcohol is safe for the unborn child. The recommendation is to avoid alcohol even when planning a pregnancy.

Even small quantities of alcohol can cause deformities, growth abnormalities and damage to tissue, including nerve cells. As the development of the brain, in particular, is very susceptible to damage, alcohol consumption during pregnancy can have a wide range of consequences – some of which only become apparent over the course of childhood. These include, for example, intellectual disabilities, hyperactivity, impulsiveness, or a tendency to be easily distracted. For this reason, expectant mothers should abstain from alcohol at all times.

Even small quantities of alcohol can cause deformities, retarded growth and damage to tissue, including nerve cells.

Why is cannabis not allowed during pregnancy?

The use of cannabis also affects the development of the brain. The THC contained in cannabis passes through the placental barrier. Since the structures to which the THC can bind (endocannabinoid receptors) are already present at an early stage of embryo development, cannabis use can disrupt brain development. Initial study results indicate changes in the brains of children whose mothers used cannabis during pregnancy. These changes differ from those caused by smoking.

Other illegal substances, such as crystal meth, heroin, amphetamines, ecstasy, or LSD, also have harmful effects and must not be consumed during pregnancy.

How harmful is smoking during pregnancy?

Cigarette smoke contains about 250 toxic or carcinogenic substances. Many of these reach the embryo through the umbilical cord. Even passive smoking has effects on the unborn child. The nicotine contained in tobacco is a neurotoxin. It has a vasoconstrictive effect and disturbs the development of the lungs. Babies of smoking mothers therefore suffer more frequently from asthma, allergies, and respiratory diseases

In addition to the toxins in nicotine, carbon monoxide is inhaled when smoking, which generally makes it harder for the unborn child to get oxygen. Smoking during pregnancy not only increases the risk of miscarriage and premature birth, but also impairs embryo development, which is why babies of smokers usually have a lower birth weight.

Since smoking also affects fertility, couples should avoid cigarettes when planning a pregnancy.

Important: Even if the pregnancy is unplanned, it’s never too late to quit smoking; the risk of complications decreases significantly once expectant mothers stop smoking. 

Which types of medication should be avoided during pregnancy?

The short answer is that all medication that can be avoided should be avoided, unless there are health consequences for the mother.

Drugs can harm the unborn child in different ways. Some active ingredients reach the unborn child via the umbilical cord, while others affect the mother’s circulation and can impair blood supply to the fetus. For this reason, expectant mothers should avoid taking medication if possible. 

This also applies to over-the-counter medicines that claim to be completely harmless. These include, for example, some decongestant nasal sprays. If a pregnant woman has a cold, these can be used in the normal dosage for a short period of time. In high doses, however, they constrict the blood vessels and can reduce blood flow to the placenta. In particular, they should be avoided if the cold is a “pregnancy cold”, which is triggered by swelling of the mucous membranes. Even at a normal dosage, there is a risk of developing a dependency. To be on the safe side, pregnant women should use nasal sprays based on saline solutions or chamomile extracts. If these are not sufficient, pregnant women should consult their doctor.

Many types of over-the-counter pain medication should also be avoided during pregnancy or are only safe to use at certain stages of the pregnancy. This applies, for example, to ibuprofen – taking it after the 28th week of pregnancy can lead to damage to the baby’s kidneys and to heart deformities. Paracetamol, on the other hand, is permitted for mild to moderate pain and fever throughout pregnancy. However, pregnant women should still seek medical advice, especially if they are taking it for a long time.

Sleeping pills and sedatives should not be taken without medical consultation. This also applies to herbal preparations.

In general, pregnant women who are dependent on certain medication or who take medication regularly should talk to their doctor about any risks. For critical medications, an alternative can often be found for the duration of the pregnancy.

Important: Medications that have been taken over a long period of time should only be discontinued during pregnancy under medical supervision, regardless of whether they are available over-the-counter or on prescription only.

Vaccinations during pregnancy – which are recommended and which are to be avoided?

It was once believed that the body shuts down the mother’s immune system so that it does not recognize the embryo as foreign and reject it. More recent research suggests that the immune system performs a balancing act. In order to protect the embryo, it must develop what is known as immunological tolerance towards it. Special cells of the immune system even promote attachment to the uterus and growth of the embryo. At the same time, both mother and child need strong protection, which is why the mother’s immune defense against the outside world remains in place.

In fact, the mother’s immune system performs at its highest level during pregnancy. If it is put under additional strain by an infection, the interaction between the mother’s immune system and the cells of the embryo can be disrupted.

Vaccinations with live vaccines, such as those against measles, mumps, rubella, chickenpox, yellow fever, and cholera, should not be taken during pregnancy. Since rubella can cause miscarriages and deformities in the unborn child, vaccination should be given before pregnancy begins.

In contrast, inactivated vaccines are permitted during pregnancy and are sometimes even strongly recommended. Pregnant women, for example, have an increased risk of suffering a severe case of influenza (flu). Therefore, a flu vaccination should be given at the beginning of the second trimester. It should be given as early as the first trimester if the mother is at an increased risk due to an underlying health condition.

The German Standing Committee on Vaccination (Ständige Impfkommission, STIKO) also recommends vaccination against whooping cough at the beginning of the final trimester, so that the baby is protected by the mother’s antibodies at birth. If there is a higher risk of premature birth, this vaccination is recommended as early as the second trimester.

The Standing Committee on Vaccination (STIKO) does not currently recommend vaccination against COVID-19 during pregnancy. However, pregnant women with a high risk of suffering a severe COVID-19 infection can be vaccinated in individual cases following extensive consultation.

Is it okay to play sports and exercise during pregnancy?

Getting sufficient exercise is one of the cornerstones of a healthy lifestyle. This remains true during pregnancy, when many expectant mothers are concerned about harming the unborn child through exercise. In a normal pregnancy, however, this concern is unfounded. In fact, exercise is good for both mother and child. General guidelines recommend at least 30 minutes of physical activity at least 5 days per week, preferably daily. The amount of exertion should be such that conversation is still possible at all times during the activity.

Bewegung ist gut für Mutter und Kind – die allgemeinen Richtlinien empfehlen mindestens 30 Minuten körperliche Aktivität an mindestens 5 Tagen pro Woche.

There are some sports and exercises that are not suitable during pregnancy. For example, pregnant women should avoid sports that involve a high risk of falling or injury, such as horseback riding, downhill skiing, or team sports. Sports that involve frequent jumping, such as volleyball, for example, and activities that put a lot of strain on the abdominal muscles are also unsuitable. For this reason, caution is advised with Pilates. In addition, extreme sports, such as mountain hikes at altitudes above 2,500 meters or scuba diving with an oxygen tank, are not recommended for pregnant women. 

Sports that place equal strain on all large muscle groups, such as cycling, jogging, walking, swimming, or pregnancy yoga, are ideal. Even aerobics or Zumba are allowed, provided that exercises with jumps are omitted. Many studios, gyms, and midwifery practices offer special exercise classes for pregnant women that specifically address the needs of expectant mothers.

Women who are unsure about how much and what type of exercise is appropriate can inquire at one of their routine checkups.

Is sexual intercourse allowed during pregnancy?

If the pregnancy is proceeding normally, there is no reason not to enjoy a fulfilling love life. Caution is only required in the case of multiple pregnancies (twins or more) or complications. For example, if a pregnant woman is experiencing infections, bleeding, or rupture of the membranes, penetration of the penis into the vagina may aggravate the symptoms.

If the expectant mother has ever had an early miscarriage, special care is needed in the first trimester. The same applies in cases of preterm labor or a threatened premature birth in the last trimester. 

Pregnant women who are unsure whether they are at an increased risk should consult their doctor. Midwives can also assess individual pregnancy risks.

Pregnancy is an enormous emotional challenge for both partners. The expectant mother also experiences hormonal and physical changes. In some cases, these lead to her becoming aroused more easily. However, she may also quickly become unpleasantly overstimulated and sensitive to touch. Expectant fathers can be extremely attracted to their partner’s physical changes, but some find them problematic, or feel insecure or alienated at this time. This means that couples should never put themselves under pressure, but rather should pay close attention to each other’s needs and give one another plenty of time.

Further information

IRIS, an online counseling service for pregnant women, provides help with quitting alcohol and cigarettes.

The Germany The Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung) provides information about local addiction counseling centers.

Information about more than 400 drugs and the risks of taking these during pregnancy and breastfeeding can be found at embryotox.de.

Reviewed by the German Midwifery Association (Deutsche Hebammenverband e.V.).

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