Overview

Staying hydrated is crucial to help your overall health. Water makes up around 60% of your total body weight, and every cell in your body needs water to function. Staying hydrated helps you regulate body temperature, aids in digestion, transporting nutrients and oxygen to cells, absorbing nutrients, and eliminating waste. These processes are also crucial during pregnancy for your baby, and you have increased water requirements when you are pregnant. Plus, if you are not drinking enough water, you can exacerbate many common pregnancy symptoms.

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Function of Water

Staying hydrated is crucial to help your overall health. Water makes up around 60% of your total body weight, and every cell in your body needs water to function. Staying hydrated helps you regulate body temperature, aids in digestion, transporting nutrients and oxygen to cells, absorbing nutrients, and eliminating waste. Without water, you could only survive for about three to four days.

The Function of Water During Pregnancy

You can imagine that these processes are also crucial during pregnancy for your baby. Since you have increased nutrient requirements, you also need additional water for digestion and transport additional nutrients. You are building a human, which requires a lot of energy and, in turn, requires more water. You also need water to make amniotic fluid and produce additional blood. Your blood volume increases by around 45% when pregnant, and 83% of blood is composed of water.

You also lose more water during pregnancy through urination and increased respiration. You lose more water through sweat from changes to your adrenal and thyroid functions, increased metabolism, and additional blood circulation.

How Water Can Help With Common Pregnancy Symptoms

If you are not drinking enough water, you can exacerbate many common pregnancy symptoms.

Constipation

Many changes during pregnancy contribute to constipation. Increased progesterone slows down food digestion, you are likely increasing your iron consumption, and your uterus puts additional pressure on your digestive tract. Drinking water aids in digestion. Increasing your fiber intake to help combat constipation will require extra water because fiber draws water into your bowel. For more information on constipation during pregnancy, see this episode.

Braxton Hicks

Braxton Hicks or “practice contractions” are thought to prepare you for actual labor. These are sporadic uterine contractions that are unpredictable and irregular in intensity. They do not cause labor, but many expecting mothers may mistake them for labor. See this episode for more information on Braxton Hicks and distinguishing this from actual labor. Dehydration is thought to be a significant factor in extended Braxton Hicks contractions. Dehydration can cause your muscles to spasm, which can trigger a contraction. If you experience Braxton Hicks, you may want to drink some water and see if that helps. A full bladder may trigger contractions, so make sure you don’t put off going to the bathroom. 

Edema

Edema is swelling that occurs in about 80% of all pregnancies. This is most common in the third trimester and happens in your legs and feet. Edema can also cause numbness, tingling, or aches. It may seem counterintuitive, but staying hydrated will help your body retain less fluid. If you are dehydrated, your body wants to hang on to as much liquid as possible, contributing to edema. To learn more about edema and evidence-based treatments, see this episode.

Migraines

Dehydration can also cause migraines and headaches. If you go to the hospital for a severe migraine, one of the first things they will do is give you IV fluids to rule out dehydration as a cause. There is an episode on migraines and headaches with evidence on treating headaches during pregnancy.

Skin Health

Your skin is your body’s largest organ, and like everything in your body, it requires water. Evidence shows that consuming higher amounts of water correlates with positively impacting skin physiology. Simply put, staying hydrated is a simple thing you can do to help keep your skin healthy. There are additional episodes on how pregnancy changes your skin and safe pregnancy skincare.

Research

There is a lot of research showing the adverse effects of dehydration during pregnancy. A study based on data from the National Birth Defect Prevention Study found decreases in risks of congenital disabilities when pregnant mothers increased their water consumption. This included neural tube defects, oral clefts, musculoskeletal defects, and congenital heart defects. One study found dehydration in mothers resulted in lower weight, height, head circumference, and chest circumference of their babies. There is a study taking place now to fill many of the gaps in the research on water intake and maternal health and birth outcomes. This study aims to provide data for updating recommendations on adequate water intake among pregnant women. Although the registration date for this clinical trial is 2018, results are not yet available.

How Much Water Do You Need During Pregnancy and Breastfeeding

The American College of Obstetricians and Gynecologists recommends drinking 64-96 ounces (1.9-2.8 liters) of water every day. Like the Dietary Reference Intake, many other sources have a lower recommendation. The Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, creates the Dietary Reference Intakes (DRI). The DRI states adequate intake for water in pregnancy is 101 ounces (3.0 liters) per day of total water. This includes approximately 78 ounces (2.3 liters) as total beverages, including drinking water.

For breastfeeding mothers, the adequate intake is increased to 128 ounces (3.8 liters) per day of total water. This includes approximately 101 ounces (3.1 liters) as total beverages, including drinking water. Although water is the main ingredient in breastmilk, increasing your water intake may not directly increase your milk supply. A Cochrane review found not enough evidence to support advising breastfeeding mothers to increase fluid intake beyond what they are likely to require for comfort. No evidence shows increasing fluid intake increases milk supply.

Intake of Water

Since our bodies do not produce water on their own, we need to get it from fluids and diet. While water is the ideal source, other food and drinks count towards your daily intake of fluids.

The basis for any beverage is water, and even milk contains about 87% water. If you rely on other liquids to stay hydrated, pay attention to other content, like sugar, artificial sweeteners, or caffeine. See this episode if you want to know more about drinks to be cautious about during pregnancy, like coffee, tea, kombucha, juice, soda, or alcohol. Even if you enjoy other beverages, the ideal drink is always water.

Your diet may provide up to 20%-30% of your daily fluid needs. This largely depends on what you are eating and will be higher in diets high in fruits and vegetables. Lettuce and cucumber are 96% water. Fluids in food can also come from sources like eggs, which are 75% water. Even a chocolate chip cookie is about 7% water.

Elimination and Output of Water

The primary way our bodies regulate hydration is by excreting water in urine. You can also lose water through sweat, breathing, and through your digestive system in feces. There are acute situations that can increase your water requirements because they cause additional output. Increased output usually relates to heat exposure. If you are exercising or are in a hot climate, you require extra fluids. If you experience a fever, you lose water through sweat as your body tries to cool down. Diarrhea and vomiting also cause you to lose water. Some expecting mothers who experience extreme morning sickness may have trouble keeping fluids down and, as a result, will be dehydrated.

Signs of Dehydration

Our bodies give us a lot of clues that can tell us whether we are drinking enough fluids. These may seem obvious, but these are some signs that you are not drinking enough water. The first is that your mouth is dry or you are thirsty. This is your body’s way of telling you that you need fluids. Urinating less frequently, headaches, fatigue, and dizziness can show you need to drink more water.

According to ACOG, you should call your care provider if you have the following signs and symptoms of dehydration:

  • You have a small amount of urine that is dark in color.
  • You are unable to urinate.
  • You cannot keep down liquids.
  • You are dizzy or faint when standing up.
  • You have a racing or pounding heartbeat.

Urine Color as an Indicator of Hydration

Research examining markers for hydration often measures urine osmolality or specific gravity. These measurements require specialized equipment and training to determine them. You can use a color scale to assess the level of hydration by matching the color of your urine to the corresponding color on the scale. The original studies establishing this color chart do not include a picture of the color chart. I tracked down another study that does have a couple of color charts.

There is evidence that urine color was a valid marker of urine concentration, specifically in pregnant or lactating mothers. Variables can affect the color like taking vitamins, whether you are urinating into a cup or a toilet, the lighting in the bathroom, etc. Don’t overthink this. Comparing the color of your urine to a color chart is not an exact science. You are looking for the color of your urine to be within the top 3 colors, which are all shades of light yellow.

Can You Drink Too Much Water?

It is possible to drink too much water. The problem is consuming too much water can decrease the sodium in your blood to dangerously low levels. Water toxicity presents symptoms like altered mental status, disorientation, nausea, and vomiting. Since these symptoms are vague, they can be challenging to diagnose. Our bodies have a system to regulate hydration, and water toxicity is uncommon. When it does happen, it is often due to overhydration after prolonged exercise without correcting electrolyte losses or when people drink large quantities of water for some type of competition.

Types of Water

In developed countries, we have a lot of choices when it comes to where we get our water, and we are fortunate to have access to safe drinking water. While we can drink tap water, we also have endless choices to purchase different types of water.

Safety of Tap Water

In the United States, about 90% of the population gets their tap water from community water systems. The Environmental Protection Agency regulates these systems through the Safe Water Drinking Act. Individual states can enforce more stringent standards as long as they meet the EPAs standards. The EPA sets legal limits on over 90 contaminants in drinking water. These can include organic and inorganic chemicals, heavy metals, microorganisms, disinfectants and disinfectant byproducts, and radionuclides which are atoms that emit radiation. Some of these contaminants are not permitted at all. Others need to be under set limits.

You should receive an annual consumer confidence report with information on water quality, source, and contaminants for the drinking water where you live. Quality and even the taste of tap water can vary greatly depending on where you live. Some people are comfortable drinking tap water, and others prefer to send it through an additional filtration process or purchase water from another source. Where you get your drinking water from primarily comes down to personal preference.

Bottled Water

The FDA regulates bottled water based on the EPA standards for tap water. Within the bottled water category are many different types of water, each that has specific guidelines outlined by the FDA.

Artesian water comes from a confined aquifer.

Springwater comes from a natural spring.

Mineral water contains no less than 250 ppm (parts per million) of total dissolved solid minerals naturally present.

Purified water goes through a process to remove dissolved solids. Processing can be reverse osmosis, deionization, distilling, or demineralizing.

Sparkling water contains carbon dioxide, which gives it bubbles.

Alkaline water has dissolved solids that give it a higher ph level (8 or 9) than typical drinking water, with a pH of 7. Alkaline water can naturally occur from water passing over rocks or through a manufacturing process that removes the more acidic molecules. The idea behind drinking alkaline water is to lower the pH in your body to be less acidic. Other reported benefits range from increased energy to reducing signs of aging. There is mixed evidence on whether alkaline water is genuinely healthier than water with a neutral pH.

Comparing Different Sources of Water

From a hydration standpoint, all types of water will help you stay hydrated. If you are looking for other health benefits, you may want to look at the minerals you get from the water you drink. One study examined mineral content in tap and bottled water. The researchers found mineral content, especially calcium, magnesium, and sodium levels in tap and bottled water, vary greatly depending on the source and processing method. Compared to the recommended daily intakes of calcium, magnesium, and sodium, mineral intake from tap water is generally low but may be important when drinking from mineral-rich sources. European bottled waters contain higher mineral levels than North American tap and bottled waters. This study recommends that individuals choose bottled water with an optimal mineral profile but notes that few of the bottled waters examined have an optimal mineral profile.

Electrolytes

Essential minerals like calcium, potassium, magnesium, chloride, and sodium have a positive or negative electrical charge when dissolved in water, hence the name electrolytes. One way to ensure you are getting enough of these essential minerals is to add electrolytes to your water. Electrolytes play many roles in your body, including chemical reactions, your nervous system’s functioning, muscle function, regulating pH levels, and maintaining hydration. An imbalance in electrolytes can negatively affect your health and body’s ability to function. You gain electrolytes from the food and drinks you consume and lose electrolytes when you eliminate water.

It has become increasingly popular to supplement with electrolytes. There are several options for packets of electrolytes you can add to water. These add flavor and electrolytes. Typically these powders contain a small amount of sugar to help hydrate you quicker because glucose helps you absorb sodium, chloride, and water. While sports drinks, like Gatorade, also have electrolytes, they are very high in sugar.

It is even more important to replace electrolytes when you exercise, in hot weather, or experiencing vomiting or diarrhea. I am a huge fan of adding electrolytes to my water every day. The hydration mix from Basis is my favorite. It isn’t overly sweet and has the perfect hint of flavor. You can save 20% off with the code PREGNANCYPODCAST. Drinking water with electrolytes added has increased the amount of water I drink, made it more enjoyable to stay hydrated, and I know I am getting an adequate amount of electrolytes.

Plastic Water Bottles

There are a couple of challenges with single-use plastic water bottles. The first is that they can contain chemicals that leech into the water. The second is that they are not environmentally friendly.

Chemicals in Plastics

BPA (bisphenol A) is an industrial chemical used in plastics. Exposure to BPA is a concern because it is an endocrine disruptor. Your endocrine system is your hormone system. Endocrine disruptors can work in a few ways. They can increase or decrease hormone levels, mimic your body’s natural hormones, or they can alter the production of hormones or receptors. BPA is a xenoestrogen, which means that it mimics estrogen. Specifically, it mimics estradiol, the strongest of the four main types of estrogen hormones in your body. You know hormones are a big deal, especially for pregnancy, and hormones drive practically every process in your body. Endocrine disruptors have the potential to cause developmental malformations, interfere with reproduction, increase risks for cancer, and disturb the proper functioning of your immune and nervous system. 

If you buy single-use bottles of water, the good news is that these do not typically contain BPA. Most single-use water bottles are plastic called polyethylene terephthalate (PET). If you want to know if a plastic bottle contains BPA, you can look at the recycling code on the bottom, and if it has a 1, 2, 4, 5, or 6, it does not contain BPA. Although most water bottles don’t contain BPA, they can contain other endocrine-disrupting chemicals, like phthalates.

Even if you avoid single-use water bottles, you are unlikely to avoid all exposure to plastics from your environment. Like anything, the dose makes the poison. There is a difference between plastic water bottles here and there and drinking from them all day, every day. It would not be worth being thirsty or dehydrated just to avoid drinking from a plastic water bottle.

The Environmental Impact of Single-Use Water Bottles

From an environmental standpoint, single-use plastic bottles are devastating for the environment. Every year more than 17 million barrels of oil are required to produce enough plastic water bottles just in the U.S. Worldwide, bottling water uses some 2.7 million tons of plastic. Bottled water requires using fossil fuels, contributes to global warming, and causes pollution.

If you want to avoid single-use water bottles, you can get a refillable bottle. A stainless steel insulated water bottle can keep water cold for up to 24 hours and conveniently take anywhere. Hydroflask and Yeti are my favorite brands. Ironflask is also a good option and is much less expensive. 

What is the Best Water to Drink?

You have many options when it comes to the water you drink daily. The best water comes down to your goal and your personal preference. If the goal is to stay hydrated, the best water is the water you enjoy drinking. If you are trying to force yourself to drink something you do not enjoy, you are less likely to drink it consistently. You can compare mineral content, taste test different waters, or add ingredients like electrolytes to your water. Your primary focus should be to ensure you are drinking enough.

Tips to Increase Water Intake

Even when you know the importance of staying hydrated, it can be challenging to drink enough water consistently. Here are some tips to increase how much water you drink. It may seem like a chore now, but with consistency, you can make staying hydrated a habit that doesn’t take a lot of effort.

Keep track of how much water you drink to know where you stand. You can do this with an app, in a note on your phone, or even on a sticky note.

Fill up your water bottles at the start of your day. Better yet, fill them up the night before. If you have three 32 ounce water bottles at the beginning of the day, you know exactly how much you should be drinking before you go to bed. To prevent chugging a large amount of water just before going to sleep, you should be pacing yourself throughout the day.

You can set an alarm or a reminder on your phone to drink water throughout the day. You can also use existing habits to anchor a new habit. You eat multiple meals per day; make sure you drink a glass of water with each meal.

If you want to add some flavor to your water, you can add fresh fruit, a squeeze of lemon or any citrus, cucumber slices, even a sprig of mint. There are flavors or enhancers you can add to water. Some contain caffeine, sugar, artificial sweeteners, or artificial colors. If you purchase a flavor enhancer to add to your water, you may want to check the ingredient label.

Keep water next to you at all times. It may help to have water bottles in a few places around the house, so you always have water next to you. Anytime you leave the house, take a bottle of water with you.

The water temperature may make a difference in how much you drink, depending on the time of year or time of day. Add ice or use an insulated water bottle to keep it cold if you prefer cold water. If you want something hot try herbal tea.

Some people find having a straw helps them drink more water.

Hydration During Labor

You want to go into your birth well hydrated. This should not be an issue if you stay hydrated throughout your pregnancy. In the past, birthing mothers were prohibited from drinking during labor, except for ice chips. Thankfully, those archaic policies have evolved to encourage mothers to hydrate during labor.

The American College of Obstetricians and Gynecologists state that oral hydration can be encouraged to meet hydration and caloric needs. Current guidance supports the oral intake of moderate amounts of clear liquids by women in labor who do not have complications. However, laboring mothers should avoid particulate-containing fluids and solid food. For the evidence on eating and drinking during labor, see this episode.

One study showed that drinking isotonic drinks during labor reduced an increase in ketone production when compared to water. Isotonic drinks have similar water, salt, and carbohydrate concentration as your blood. When your body needs energy, the first place it pulls from is your glycogen stores. This comes from glucose, which comes from carbohydrates. Once you deplete carbohydrate stores, your body may go into ketosis. This is a metabolic state in which some of your energy supply comes from ketone bodies in the blood. A mild state of ketosis during labor is normal. Your care provider may be monitoring your ketone levels to make sure that you are staying adequately hydrated.

It is standard practice to routinely use IV fluids during labor, especially in a hospital setting in the U.S. Although IV Fluids are not routine at a home birth or a birth center, a midwife can administer them if needed. It is worth noting that most IV fluids are isotonic.

Water and Your Baby

Infants under six months do not need water and get the fluids from breastmilk or infant formula. If you use infant formula, follow the water to formula ratio instructions. Never water down the formula more than the instructed amount on the label. Too much water for a baby can cause water intoxication. With powdered formula, you want to use the scoop that came with that particular container, don’t use another scoop or measurement from another brand.

The American Academy of Pediatrics suggests you can give infants between 6-12 months 4-8 ounces of water per day. While there is bottled water marketing specifically for infant formula, it is not necessary. As long as the water is safe to drink, it is safe to mix it with formula. The American Academy of Pediatrics has criticized the mixed messaging on formula packaging about boiling water then letting it cool. If you have any concerns about the safety of tap water, you can always use filtered water. If your baby is born prematurely or has other health concerns, please ask your pediatrician about the water you mix with formula. 

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