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Nutrition & Pregnancy

Congratulations, you're pregnant! You feel happy and slightly anxious. Perhaps you're having nausea or strange cravings. It's possible that what used to be your favorite food makes you deathly ill.  Relax, you've been hijacked by your hormones!

A few important ground rules to remember:

  • You can't completely rely on your hunger to determine how many calories you need to eat. Remember that it took our pregnant hunter-gatherer ancestors all day to find the extra calories that we can get in one trip to the refrigerator!
  • The placenta or afterbirth does filter out many harmful substances before they affect the baby but there are some exceptions like alcohol and toxins like mercury and dioxins.
  • Certain food-borne infections like Listeria and some parasites can affect the baby during pregnancy.
  • Adequate hydration, especially in our arid climate, can prevent many problems.
  • Too much or too little weight gain can adversely affect your pregnancy.

Total Pregnancy Recommended Weight Gain

  • Underweight (BMI less than 18.5) - 28 to 40 lbs
  • Normal weight (BMI 18.5 to 24.9) - 25 to 35 lbs
  • Overweight (BMI 25 to 29.9) - 15 to 25 lbs
  • Obese (BMI 30 or greater) - 11 to 20 lbs

Where Does All That Weight Go?

  • Your Baby= 7 to 8 lbs
  • Larger Breasts = 1 to 3 lbs
  • Larger Uterus = 2 lbs
  • Placenta = 1.5 lbs
  • Amniotic Fluid = 2 lbs
  • Body Fat = 5 to 8 lbs
  • Circulating Blood Volume = 3 to 4 lbs
  • Increased Fluid Volume = 6 to 7 lbs
  • Total = 25 to 35 lbs

What are the risks of too much or too little weight gain?

  • Too Much Weight gain
    http://www.nlm.nih.gov/medlineplus/videos/news/pregnancy_and_weight_102209.html
    • Increased risk of gestational diabetes (high blood sugar of pregnancy)
    • Increased risk of high blood pressure of pregnancy
    • Increased risk of an overweight baby
    • Increased risk of Cesarean section
    • Obese women who gain more than 15 pounds during pregnancy tend to retain much of it long after delivery
  • Too Little Weight gain
    • Increased risk of a low birth weight baby
    • Increased risk of premature labor

Weight Gain by Trimester

The 1st Trimester, weeks 0 through 12, is the most important time in your baby's development. All your baby's organs are forming in this first 12 weeks, the placenta is developing (the "afterbirth" that provides your baby's nutrition and oxygen throughout the pregnancy) and your body is creating the reserve needed for a safe pregnancy.

Recommended Weight Gain in the 1st Trimester

  • 6 lbs if you started underweight = about 225 to 300 extra calories per day
  • 4 lbs if you started at a normal weight= about 150 to 200 extra calories per day
  • 2 lbs if you started overweight= about 75 to 100 extra calories per day
  • 0-1 lbs if you started obese= about 40 extra calories per day

The 2nd Trimester weeks 13 through 28 are a time when your baby is growing the most rapidly. It is often the time when weight gain is the most rapid. Weight gain in the 3rd trimester weeks 29 through 40 is a time when your weight gain will start leveling out. In addition it is the time when swelling and fluid retention is the most bothersome.

Recommended Weight Gain in the 2nd and 3rd Trimesters

  • Gain 1 to 2 lbs/week = 400 to 500 extra calories/day if you are Underweight
  • Gain 1/2 to 1 lbs/week = 300 extra calories/day if you are Normal Weight
  • Gain 1/4 to 1/2 lbs/week= 100 to 150 extra calories/day if you are Overweight
  • Gain 0 to 1/4 lbs/week = 50 to 75 extra calories/day if you are Obese

What Should I Avoid?

  • Alcohol
  • Unpasteurized milk or juices
  • Certain Fish like shark, swordfish, king mackerel, grouper, orange roughy, marlin, tilefish (also called white or yellow snapper) due to high levels of mercury (see below)
  • More than 6 oz per week of canned Albacore tuna or tuna steaks
  • More than 2 servings per week of low-mercury fish like cooked shrimp, salmon, canned light tuna, catfish, Pollock, cooked scallops, cooked crab, cooked clam, cooked oysters (see below)
  • Raw or uncooked fish or shellfish such as oysters, clams or scallops (see below)
  • Refrigerated uncooked seafood-labeled Nova-style, lox, kippered, smoked, or jerky
  • Luncheon Meats, unless they are re-heated until steaming hot
  • Soft (unpasteurized) Cheeses, uncooked meat, poultry or shellfish due to an increased risk of Listeria bacterial infection
  • Refrigerated meat spreads
  • Sushi and Sashimi-see above
  • Raw meats-see above. Other risks include toxoplasmosis, E coli, Salmonella
  • Raw eggs, including in those in home-made Cesar dressing, mayo and eggnog and ice cream as they may contain Salmonella
  • Unwashed fresh fruits and vegetables
  • Raw sprouts of any kind including alfalfa, mung bean, radish, clover
  • Store-made salads, such as chicken, egg, or tuna salad
  • Non-food substances like starch, clay, etc.-these prevent absorption of nutrients and may contain toxins

Reduce

  • Artificial sweeteners
  • Caffeinated beverages
  • Table salt
  • Empty calories from junk food, soda pop and candy

What You Should Know About Fish During Pregnancy

Fish and shelfish contain high-quality protein and other essential nutrients, are low in saturated fat and contain omega-3 fatty acids.  However, nearly all fish and shellfish contain traces of mercury.  For most people, the risk from mercury by eating fish and shellfish is not a health concern.  Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child's developing nervous system.

In March 2004, the FDA and EPA revised its advisories on mercury fish.  Here is a summary:

Target - Women who may become pregnant, pregnant women, nursing mothers and young children are to avoid some types of fish and eat fish and shellfish that are low in mercury,

Avoid fish with high levels of mercury - shark, swordfish, king mackeral or tilefish

12 oz. (2 average meals) of low mercury fish per week - shrimp, crab, cod, clams, scallops, canned light tuna, canned salmon, pollock and catfish, etc.  Note:  albacore "white" tuna contains more mercury - limit to 6 oz. (1 average meal) of albacore tuna per week.

So is it safe to eat fish during pregnancy?  Yes, fish offers benefits to both pregnant mothers and their unborn babies.  Therefore, include low mercury fish in your diet 2 times per week.  A cohort study published in October 2005 by the Harvard Medical School found that babies from mothers with higher low-mercury-fish consuption during their second trimester have better scores in mental development.

The above is an excerpt written by Gloria Tsang, R.D., Oct 2005

For further information about the risks of mercury in fish and shellfish call the U.S. Food and Drug Administration's food information line toll-free at 1-888-SAFEFOOD or visit FDA's Food Safety website.

For further information about the safety of locally caught fish and shellfish, visit the Environmental Protection Agency's Fish Advisory website or contact your State or Local Health Department. For information on EPA's actions to control mercury, visit EPA's mercury website.

Suggestions for a Healthy Balance in Your Diet

  • Trade white bread and pasta for the whole-grains
  • Substitute a salad with low-fat dressing or black beans for a burger and fries.
  • Substitute fruits for sweets or a cookie.
  • Choose juices fortified with calcium and other nutrients or better yet substitute water
  • or milk for sugary juices

Baby Building Blocks-Vital Vitamins and Minerals

Nutrient How Much? What Does It Do? Food Sources
Calcium 1000mg/day Build strong bones and teeth Milk, cheese, yogurt, sardines
Iron 27 mg/day Creates red blood cells that deliver oxygen to your baby, prevents fatigue Lean red meat, dried beans and peas, iron-fortified cereals, prune juice, spinach, cooking cast-iron skillet
Vitamin A 770 mcg/day Forms healthy skin, eyesight. Helps with bone growth Carrots, dark, leafy greens, sweet potatoes or yams
Vitamin C 85 mg/day Helps your body absorb iron. Keeps gums healthy. Citrus fruit, broccoli, tomatoes, strawberries
Vitamin B6 Helps form red blood cells. Helps body process protein, fat and carbs. May relieve nausea. Beef, liver, pork, ham, whole grains, bananas
Vitamin B 12 2.6 mcg/day Maintains a healthy nervous system. Needed to form red blood cells Liver, meat, fish, poultry, milk and other animal foods. Vegans need to take a supplement
Folate or Folic Acid 800 mcg/day from meals
+ 400 mcg/day in supplements
Needed to produce blood and proteins. In your baby's early development, prevents brain, spine, heart defects Green leafy vegetables, liver, orange juice, legumes and nuts

 

Omega-3 Fatty Acids during Pregnancy

Omega-3 Fatty Acids are divided into three types called ALA, DHA and EPAs. Omega-3 fatty acids may reduce the risk of premature labor and low birth-weight babies. Some studies also suggest a decreased risk of pre-eclampsia. Infants supplemented with these substances may have better brain and eye function.

Each omega-3 fatty acid performs a different function. ALA is the parent omega-3 and cannot be produced by the body. Walnuts, flaxseed, olive oil and soybeans are excellent plant sources of ALA. However, our bodies are only able to convert small amounts of ALA into the active DHA and EPA fatty acids.

The best way to get enough EPA and DHA is to eat foods that already have them like fatty fish, fish oils, fortified foods and organ meats. These foods do have some downsides (see above) so supplements may be recommended.

DHA is the most common omega-3 in the brain and eyes. It helps to support a baby's brain and eye development and function. Women should get at least 200 milligrams of DHA daily.

If you're not getting enough DHA from food, another option is to take a supplement containing at least 200 mg of DHA. Several prenatal vitamins and supplements include DHA, either from fish oil or other sources.

Fish oil products, however, do have some unique considerations. For example:

  • Taken over many months, fish oils can lead to a deficiency of vitamin E. Consequently vitamin E may be added to the supplement. Prenatal vitamins also may contain vitamin E, so an increased level of vitamin E could occur. So check your labels!
  • Omega-3 fatty acids and fish oil may increase the risk of abnormal bleeding, such as nosebleeds and blood in the urine, if taken in excessively large amounts
  • Fish liver oils, such as cod liver oil, contain lots of vitamins A and which can build dangerously high levels in the body.

What to Eat in Pregnancy-Recommended Daily:

http://www.mypyramidtracker.gov/planner/launch.aspx

Protein: 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards)

  • chicken
  • lean beef
  • lamb
  • pork
  • nuts (1 serving = approximately cup)
  • tofu (1 serving = approximately cup)

Legumes: 2-3 servings of legumes (1 serving = approximately cup)

  • split peas
  • red and white kidney beans
  • black beans
  • navy beans
  • black-eyed peas
  • chick peas (garbanzo beans)

Dairy: 3-4 servings of dairy

  • milk (1 serving = 1 cup)
  • eggs (1 serving = 1 large egg)
  • yogurt (1 serving = 1cup)
  • pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together)
  • tofu (1 serving = cup)
  • white beans (1 serving = approximately cup)
  • almonds (1 serving = approximately cup)
  • salmon (1 serving = approximately 3 ounces)
  • turnip greens (1 serving = approximately 1 cup)
  • cabbage (1 serving = approximately 1 cup)

Vegetables: 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)

  • collard
  • turnip
  • spinach
  • lettuce
  • cabbage

Whole Grains: 3 servings of whole grains (1 serving = approximately. cup or one slice)

  • bread
  • cornmeal
  • cereal
  • oatmeal

Fruits: 2-3 servings of fruit (1 serving = approximately cup)

  • orange
  • strawberry
  • lemon
  • mango
  • tomato
  • grapefruit
  • kiwi
  • melon

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