I was overjoyed when I realized I was pregnant with each of my four beautiful children. I am one of those weirdos who loves pregnancy. Well, at least after the morning sickness finally subsides! Then I felt radiant and excited.

But along with the joy always came these nagging worries about my baby’s health and safety. And an enormous sense of responsibility. Was I eating the right foods? Getting enough nutrients? Was I being exposed to anything that could harm my baby? Too often those anxieties would catch up with me in the middle of the night after a trip to the bathroom to pee (if you’ve been pregnant you know what I mean!) and keep me awake staring at the ceiling until sleep finally won the mental battle…

Some amount of worry during pregnancy is a natural part of the process – pregnant women face a lot of changes and unknowns. As a midwife and physician I have listened to the fears and concerns of countless pregnant mommas – we all have them! I address many of these in my now classic book The Natural Pregnancy Book.

While I admire the inherent wisdom of nature, I think glass bottom bellies would have been a much smarter design so we could actually see our kids while they were in there and feel assured that all the parts were in the right place!

Realistic New Concerns

Unfortunately, these days, pregnant mommas are faced with a whole new set of quite realistic concerns about the harmful things to which most of us are exposed to in our environment. Just yesterday, for example, I received a medical journal article with the title Does Cancer Start in the Womb? Altered Mammary Gland Development and Predisposition to Breast Cancer due to in Utero Exposure to Endocrine Disruptors.

While I’d love to simply reassure you and say don’t worry, the reality is that our environment is filled with so many “new to nature” chemicals – environmental contaminants our bodies have no idea how to use, process, and eliminate, that in fact, sadly, we do need to have a high level of concern for what we are exposed to during pregnancy.

Not too long ago it was believed that the placenta protected babies in the womb from chemicals to which the mom might be exposed. But a study by the Environmental Working Group (EWG) in collaboration with Commonweal, found an average of 200 industrial chemicals and pollutants, including consumer product ingredients, and wastes from burning coal, gasoline, and garbage, in umbilical cord blood from a random selection of babies born in U.S. hospitals.

It is now known that both baby and mom are awash in a sea of chemical exposures. And most frightening is that we have no idea what the impact from this chemical stew is on our bodies. We know that a developing baby’s chemical exposures are greater pound-for-pound than those of adults and that these chemicals have a more profound impact on the developing brain and organs. Further, physiologic systems that naturally detoxify chemicals are still immature in the developing baby, thus toxins may linger longer or have a more detrimental impact than in adults.

There is solid evidence that not only does cancer potentially start in the womb, but so can asthma, birth defects, diabetes, heart disease, depression, and a host of other lifelong chronic medical problems.

The good news is that there are simple and reliable steps you can take to maximize your baby’s health even before birth and avoid as many of these exposures as possible.

Top 5 Midwife-MD recommendations for your baby’s optimal health – starting prenatally:

Take Folate or Folic Acid Daily

Folate, the natural form of the water soluble B-vitamin, and folic acid, the synthetic form, are both effective in preventing what are called neural tube defects (NTD) in babies when taken from the month prior to conception through the first couple of months of pregnancy. This nutrient, in either form, taken throughout pregnancy can also prevent against miscarriage and preeclampsia. Recent data suggests a strong correlation between low maternal folate/folic acid consumption and increased risk of autism.

While it is ideal to get our nutrition from natural sources such as green leafy vegetables rich in folate, unfortunately diet is often not enough to get the amount needed for an optimally healthy baby. Therefore, supplementation is recommended. Though many foods are now fortified with folic acid, which has resulted in a dramatic reduction in NTDs in the general population, many of us eating natural foods diets do not eat those fortified foods and simply do not get an adequate amount.

The standard recommended daily dose for folic acid is 400 mcg, which may be more effective in preventing prenatal problems than folate. However, many women lack an enzyme that allows them to metabolize folic acid and may need to take an activated form. Unless you’ve had testing for this genetic variation in folate metabolism  (MTHFR testing) you won’t know if this applies to you, so I recommend taking 1 mg (1000 mcg) of active folate daily as this is safe for all pregnant women, and bypasses this enzyme problem.

Take a Prenatal Multi Daily

Taking a prenatal vitamin prior to conception and throughout pregnancy improves baby’s health. Because so many of our diets are deficient in one nutritional element or another, taking a prenatal vitamin is like a nutritional “insurance policy.” Many pregnant women find prenatal vitamins very nauseating – I sure did! I recommend trying different brands until you find one that you can tolerate. Take it with food and take it later in the day (but not close to bedtime) to reduce nausea. Sometimes a liquid prenatal vitamin is better tolerated. I prefer natural brands made from whole food sources whenever possible.

Eat Organic and Avoid High Mercury Fish

While the nutritional value of organic foods over conventional has recently been debated, there is no question that organic is better for your body and the environment from a chemical exposures perceptive, and exposure to agricultural chemicals in utero can cause long-term health consequences.

The great news is that studies have clearly demonstrated that even just a few days of eating organic foods significantly reduces the blood levels of harmful chemicals – and staying on organics is likely to keep them lower than eating a conventional foods diet.

Whether to eat organic only is a cost issue for many of us. To learn which foods are organic “musts” visit the Environmental Working Group website and focus on avoiding what are called the “dirty dozen” foods and emphasize eating the “clean 15,” which are products that do not have significant amounts of pesticide residues. Because the fats in dairy and meat are repositories for environmental chemicals, buying these organically (or from antibiotic- and hormone-free sources) is important for protecting baby.

In addition to eating organic, pregnant women will want to avoid fish that are high in mercury, which can cause neurologic problems in the developing fetus. These include tuna, shark, swordfish, King mackerel, tilefish, sea bass, Gulf Coast Oysters, marlin, halibut, pike, walleye, and largemouth bass. I recommend no more than 2 servings of fish per week and no high mercury fish at all during pregnancy (or preferably ever, for that matter!).

 Avoid Endocrine Disruptors and Common Environmental Toxins

Excellent data shows that a pregnant woman’s exposure to a variety of environmental toxins – ranging from bisphenol A (BPA), found in many food packages and plastics, to heavy metals – can have deleterious effects on the baby. We know that environmental chemicals called endocrine disruptors mimic hormones and are associated with problems such as genital birth defects in baby boys, for example, hypospadias, as well as later development of diabetes in children and adults.

I encourage all pregnant women to avoid foods that come in soft plastic wrap, to avoid heating or microwaving foods in plastic containers, and to use glass storage containers and drink only out of glass water bottles rather than plastic ones.

Body products, including many cosmetics, may also contain a variety of toxins and heavy metals. Lead has been found in many brands of lipstick! Household cleaning products can also be sources of toxic exposures. Going green is a sure way to reduce your baby’s prenatal exposures to a host of toxins.

Don’t Eat for Two – Eat for Optimal Health

High blood sugar during pregnancy can lead to gestational diabetes in mom, which increases a baby’s risk of becoming a diabetic adolescent or adult. It also increases the risk of cesarean section and a host of other medical problems for mom and baby. Many of us take food liberties when we are pregnant, thinking it’s ok to give into cravings or eat as many carbs or ice cream as we want – after all, we’re eating for two, right?

Actually, this is not right at all. Caloric needs are really only minimally increased during the first trimester of pregnancy, and even though the need increases as pregnancy continues up until the last trimester, the maximum increased caloric needs are only the equivalent of about a half a sandwich and a glass of milk per day!

Focus on keeping your blood sugar balanced by eating a protein, a good-quality fat, and a healthy carbohydrate (such as a whole grain) at every meal, along with ample amounts of green vegetables daily. Snacks should be high quality and protein-rich. Eat regularly to avoid drastic blood sugar fluctuations, and avoid sugar, white flour products, and excessive intake of starchy foods, as well as all juices, sodas, and other sweetened drinks.

Health is Your Baby’s Birth Rite

We owe it to our kids to give them every chance they can get to start life out with optimal health. It is clear that optimal health begins before birth and sets the template for health throughout life. I know that pregnancy can be an overwhelming time. These 5 steps are actually quite simple when you make them a way of life. And when continued beyond pregnancy you are raising your family with the best kind of insurance policy: good health.

I care deeply – your baby’s health is part of our future! Please stay tuned for much more information and resources on your optimally healthy pregnancy.

Please take a second to LIKE this blog and SHARE it so every woman can optimize her baby’s health.

With love always,









  1. I was wondering 1g of folate? Did you mean 1mg (1000 mcg) of folate? I sell prenatals and folic acid at my vitamin store, the highest we sell is 1000 mcg. I know of an independent brand that sells 1200mcg. (1.2mg)

  2. Question: in your opinion are stainless steel water bottles okay? Glass ones don’t seem readily available or practical.
    Rite or Right? Seems to me a Birth Rite may be more a ritual or procedure than a birthright?

    • Sure are. But I’ll tell ya, the Life Factory ones are AMAZING. I’ve dropped mine several times and it’s still holding water….I take it EVERYWHERE. Even took it to Mexico. I put hot and cold drinks in mine. Took Chai to work in it today. They make kiddie sized ones and sippies, too! I got my grandbaby a cute purple one – she loves it!!!But yes, stainless totally fine.

  3. Awesome post! It’s sad to hear about the poisons in our environments and, consequently, our bodies, but when given information like this, I feel empowered. I’m in the childbearing years right now. I’m 26 and haven’t had any kids yet, but I hope to soon. Knowing what I know about all this toxic crap makes me a little anxious about conceiving and raising a healthy baby, but I also know that my food and lifestyle choices have a significant impact. I have some more work to do in regards to living healthier, but thank God for the internet and the availability of this information. Thanks again, Aviva, for providing great tips and information on how to stay healthy 🙂

  4. Thank you for this wonderful article! I was wondering though if you could repost the links to the dirty and clean foods because they don’t seem to work, thank you!

  5. I read your book, Aviva, during both of my pregnancies and found the information, as in this post, so empowering and useful. It can be so daunting to lead one’s family to good health, but I feel confident that we got the right start during my pregnancies because of your commitment to educating women, Aviva. Yes, you!! Thank you!!!

    • This is possibly due to women’s ability to use the folic acid because of this MTHFR issue – the active form should prevent this.

  6. hi, why do you recommend not taking prenatal vitamins close to bedtime? Is that only intended if taken with food? or is that meant for in general?

    Can you recommend brands of organic prenatal vitamins? Currently taking “Rainbow Light Just Once Prenatal One Advanced Multivitamin”, but get quite nauseous from it.

  7. Aviva:

    Love your articles, as always. They are always so insightful and full of encouragement!

    I was wondering if you could elaborate what you mean by “foods that come in soft plastic wrap”. Do you mean pre-packaged foods like, say, deli meats that aren’t freshly sliced or bread? Am I over-thinking this? 😉

    • Yes, pre-wrapped cheeses and meats where the soft wrap plastic is closely applied to the foods. I know it’s tough to avoid everything– and this is especially tough. Buying in bulk helps, and transferring wrapped foods to glass storage containers minimizes longer term contact. Thank you! 🙂 Aviva

    • I like Thorne because it has methylfolate for moms who need it, and I personally think Rainbow Light is a great product and tolerable to digest in pregnancy.

      • Hi dr Romm, I have been searching for a prenatal suplement, I looked at the two mentioned above, I eat mostly all organic food and was looking at an organic prenatal. Any opinion on whether or not one should aim for organic prenatals?
        Thank you.

  8. Thank you for this post. My first daughter had a tongue tie and we struggled with breastfeeding and her weight until I read a blog about tongue tie. No one could tell me what the problem was, they assumed I had low milk supply, which didn’t make sense. I pretty much nursed on demand, pumped multiple times a day, and supplemented with formula. Finally, I found a blog about tongue tie and it made complete sense. After having it corrected with laser when she was 7 months old, her weight increased and nursing felt 100 percent different. She recently weaned herself at three years old.

    We are actively trying for a second child, and after reading about the difference between folic acid and folate and how it relates to tongue tie, I’m hoping that folate supplementation with prevent a tongue tie in the second baby.

    Is it better to take a b complex with folate or a folate only supplement? I’ve been taking a prenatal with 600mcg of folate and a b complex with 450mcg of folate for a couple of months (b complex in the morning and prenatal in the afternoon).

  9. Our pregnancy was unexpected, so I wasn’t able to hop on a prenatal until five weeks. Before the news, I was consuming a well-balanced, very clean, Weston A Price emphasized diet. Will the prenatals still be effective throughout the pregnancy if started this late? Also, any comments or opinion re: Green Pastures Fermented Cod Liver/Butter Oil? I’ve been taking long before and now during pregnancy. Thanks so much!

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