Do you know how important physical activities, dietary habits, stress, and other factors during pregnancy are for pregnant women's health? Pregnant women's health is a sensitive and important process for problems that may occur after childbirth. Daily routines, changing hormone levels, mood swings, etc. affect the health of the pregnant woman. Medications used during pregnancy, food supplements, oral care, pregnancy monitoring and education are important priorities. Let's take a more detailed look at the pregnancy process together.

An ideal pregnancy is on average 40 weeks or 280 days. Premature birth is when the baby is born before the 37th week of pregnancy. We can divide the pregnancy process into 3 equal periods of 3 months. These 3-month periods are called trimesters. As the trimester progresses, the risk and side effects of the drugs used may change. The risk of teratogenicity is highest during the embryonic period (between the 4th and 8th week). This risk is lower in the first 3 weeks and fetal period (from the 9th week until birth). Teratogenicity refers to abnormal conditions and defects in the fetus caused by chemical or environmental agents.

The main purpose of pregnancy monitoring is to determine the health status of the pregnant woman and the baby and to create an appropriate care plan. Pregnancy follow-up consists of 4 stages. 1st follow-up is performed at 0-14 weeks, 2nd follow-up at 18-24 weeks, 3rd follow-up at 30-32 weeks, 4th follow-up at 36-38 weeks. General condition is evaluated. Monitoring includes height-weight measurement, blood pressure monitoring, control of anemia findings, evaluation of the appropriateness of the gestational week and uterus size, risk assessment for risky pregnancies, various laboratory tests, information and counseling, nutrition, and supplementation recommendations. As a result of these follow-ups, complications that may occur in the pregnant woman and the baby during pregnancy can be prevented or detected. In addition, women who want to become pregnant can be provided with pre-pregnancy counseling services to have a healthier pregnancy process.

• Beta-HCG test
• Determination of blood groups
• Complete blood count
• HbA1c
• TIT (Complete urinalysis)
• Urine culture
• Thyroid functions

• Toxoplasma, Cytomegalovirus (CMV), Rubella IgG and IgM antibodies
• Hepatitis B and C
• Binary test
• First trimester detailed USG examination
• Triple test 
• Quadruple test
• Maternal plasma cell-free DNA testing 
• Second trimester Doppler USG
• PPG and OGTT tests

Another important issue is education in pregnant health. By educating the pregnant woman, many factors that can threaten her health can be prevented. Comprehensive education on nutrition, supplements and weight gain can be provided. Pregnant women can be made more conscious by providing information on avoiding smoking, alcohol, and substances with high risk of addiction, light exercises, vaccinations, oral care and protection against infections. In terms of protection from infections, sexually transmitted diseases can be prevented by using condoms, toxoplasma can be prevented by limiting the consumption of raw meat, vegetables and fruits contaminated with soil, cytomegalovirus (CMV) can be prevented by paying attention to hand hygiene and reducing the use of common objects with young children, varicella can be prevented by stopping contact with people who have varicella and Zika virus can be prevented and protected by limiting travel to risky areas.

One study examined "Knowledge, Awareness and Behaviors of Postpartum Mothers Regarding Oral and Dental Health and Periodontal Disease during Pregnancy" and concluded that women reported changes in periodontal health status during pregnancy compared to the pre-pregnancy period and that most women had inadequate knowledge and awareness of periodontal disease, pregnancy and birth outcomes. Pregnant women need more information on oral disease prevention and oral health education programs. Intensification of oral hygiene practice instructions may play an important role in reducing the symptoms of gingivitis during pregnancy. It has been reported that oral health education programs to be implemented in pregnancy follow-up and maternity care centers can change the effects on the behavior of pregnant women, but further studies are needed to evaluate the long-term effects. As a result of this study, we can see that pregnant women do not have adequate education on oral and dental health. Pregnant women should be reminded that oral and dental care is important in pregnant women's health, the use of medication in any dental disease that may occur during pregnancy should be minimized for the health of the mother and the baby and the importance of education on this issue should be emphasized.

Although nausea and vomiting, I mean morning sickness, may not seem very serious, severe pregnancy vomiting can cause fluid and electrolyte loss in pregnant women and cause related health problems. Ginger can be used as a non-drug treatment to prevent nausea. Constipation can be prevented by exercising. Hypertension in pregnant women can cause premature birth. Hypertension occurs in 2 forms. Hypertension that occurs in the first 3 months of pregnancy (chronic hypertension) and gestational hypertension due to pregnancy that develops after the 20th week. As a result of gestational hypertension, successive contractions called preeclampsia may occur in pregnant women. Severe contractions may cause placental insufficiency because of increased blood pressure and may lead to the death of the baby. Therefore, medication is strongly recommended in high-risk patients. Major depression and bipolar disorders can also occur in pregnant women. In the treatment of these diseases, medication is generally not recommended, electroconvulsive therapy is safe and effective. Another disease that threatens the health of pregnant women is diabetes. Let's examine diabetes in detail.

There are 2 types of diabetes risk in pregnant women. These are diabetes that can occur at the beginning of pregnancy and gestational diabetes that occurs due to pregnancy. The first choice and safe drug in diabetes is insulin. In a study conducted in Norway for gestational diabetes, the prevalence of GDM in pregnancy increased from 2.6% in 2010 to 6.0% in 2016 and then stabilized, reaching 6.3% in 2020. A similar pattern was seen across BMI, age and education strata. In general, prevalence increased with higher BMI, higher age and lower education, and prevalence also increased in parallel with the rise in obesity and Type 2 Diabetes. In recent years, maternal vitamin D deficiency has also been recognized as an important risk factor for GDM. The risk of congenital anomaly in gestational diabetes is lower than in normal diabetic pregnant women, but pregnant women with gestational diabetes have a high risk of developing type 2 diabetes later in pregnancy. Therefore, it is recommended that they be tested at least every 3 years for life. In conclusion, gestational diabetes may be associated with adverse pregnancy outcomes such as having a large-for-gestational-age baby, cesarean delivery, preterm delivery, low apgar score and macrosomia.

Pregnant women may be exposed to medication during pregnancy for the treatment of long-term conditions or acute illnesses. Drug safety is therefore a major concern for the fetus and mother. Non-steroidal anti-inflammatory drugs (NSAIDs) should not be used in the last 3 months of pregnancy, i.e. in the 3rd trimester. Patent ductus arteriosus (PDA) is a vessel between the anterior left pulmonary artery and the aorta that should close after birth. However, PDA may close early or not close at all because of NSAID use in the last trimester of pregnancy. Antidepressants and antipsychotics are considered first-line drugs in the treatment of depression and are second line after psychotherapy in pregnancy. Up to 20% of women experience depression during pregnancy and pregnant women with untreated depression are at high risk of poor obstetric and neonatal outcomes. Symptoms of depression during pregnancy can occur in any trimester. The use of antipsychotic drugs in the last trimester of pregnancy can be dangerous and their safety at this stage is controversial. The use of antiepileptics, antihypertensives, antidiabetic drugs and antibiotics during pregnancy may cause side effects and adverse outcomes.

Tetanus and diphtheria vaccines can be administered if the pregnant woman has not been vaccinated in the last 10 years. ACOG recommends that all pregnant patients receive a Tdap vaccine during each pregnancy to prevent pertussis in infants, as the pertussis vaccine series doesn’t start until 2 months of age. Hepatitis A and B vaccine can be given if necessary. Flu (influenza) vaccine is also recommended. Vaccines not recommended during pregnancy are mumps, measles, rubella, and varicella vaccines. In a study, a large group of pregnant patients were followed up after inactivated influenza vaccination. It found no link between vaccination and adverse pregnancy outcomes, including caesarean section, preterm birth or medical conditions of infants up to 6 months of age. In addition, influenza vaccination during pregnancy was associated with a reduced risk of preterm birth and low birth weight babies. Despite the importance of vaccination, rates of influenza vaccination in pregnant women are low. Environmental factors and people can influence the decisions of patients considering influenza vaccination. Vaccination can play an important role in protecting pregnant women and infants from the disease and should be emphasized.

• Pay attention to a healthy and balanced diet.
• Supplements recommended by a doctor or pharmacist should be used regularly.
• Do not stay sedentary for a long time, exercise regularly.
• Daily caffeine consumption should be within a certain limit.
• Addictive substances such as smoking and alcohol should be avoided.
• Pay attention to weight gain to prevent the risk of diabetes.
• The use of medication should be within the doctor's advice and knowledge. 
• Fiber foods can be consumed against constipation and hemorrhoids.
• Necessary oral and dental care should be done before conception.
• Before conception, pregnancy education should be carried out for the health of both the baby and the pregnant woman.