When your nutrient intake falls below the optimal levels, the baby’s growth and development are compromised more than your health.  Again, the nutrients that you intake will be used first for your health and physiological changes, and then for placental development. 

Here are some examples:

• Underweight women who gain the same amount of weight as normal weight women tend to deliver smaller infants and retain more of the weight gained at the expense of fetal growth
• Fetal growth tends to be reduced in pregnant teens who gain height compared to fetal growth in teens who do not grow during pregnancy

• Vitamin and mineral deficiencies and toxicities in newborns have been observed in women who showed no signs of deficiency or toxicity diseases during pregnancy

It is important to know that the fetus is harmed more by poor maternal nutritional status than is the mother.  Please make sure you eat enough calories during pregnancy, because the fetus will be harmed if you do not.  Of course you have to make sure you do not consume too many calories to avoid unnecessary weight gain and health complications.

This is my last post on my blog.  I hope everyone learned a lot and enjoyed my site.  Thanks for your comments everyone

Back Pain Is A Major Problem In Pregnancy

Some women believe that exercising may complicate their pregnancy, and that pregnancy is a time to relax and take it easy.  Physical exercise is beneficial no matter what age you are or what conditions you may be under.  There is no evidence that moderate or vigorous exercise undertaken by healthy women consuming high-quality diets and gaining appropriate amounts of weight is harmful to the mother or the fetus. 

“Body size and gestational age, as well as other health parameters, were similar in the group of women who followed the exercise regime compared to those who did no form of physical activity during pregnancy, which indicates that exercise poses no threat to the health of the fetus,” co-author Jonathan R. Ruiz explains

 There are many benefits to the mother and fetus concerning exercise during pregnancy and they include:

• Feeling healthier
• Improved sense of well-being
• Shorter labours
• Reduce the risk of developing gestational diabetes
• Reduce the risk of developing pregnancy-induced hypertension
• Reduced lower back pain
• Decreased chance of excessive weight gain
• Decreased chance of blood clots

However, in women who are malnourished, exercise may be a bad thing in that exercise may reduce fetal growth. 

Drink Plenty of Water During Exercise

It is considered safe to begin an exercise program during pregnancy.  Actually, it is recommended!  Starting an exercise program may improve fetal growth.  You just have to make sure that you stay hydrated and drink plenty of fluids.  It is also important to make sure you don’t become overheated and exert yourself too much!   

What Kind of Exercise?  How Long For?

The types of exercise that pregnant women can engage in includes:

Walking Is A Great Form Of Exercise

• Walking
• Cycling
• Swimming
• Jogging
• Dancing

The types of activities better saved for after pregnancy include:

• Water skiing
• Snow skiing and snowboarding
• Surfing
• Mountain climbing
• Scuba diving
• Horseback riding

It is advised that pregant women engage in exercise three to five times per week for about 30 minutes.  Yes, you did read correctly.  It is the same recommendation for the general public.  Remember: exercising during pregnancy is recommended as well as eating a balanced diet from all food groups.

Sources

Brown, J.  (2008).  Nutrition through the lifecycle.  Belmont, USA: Thomson Wadsworth

R Barakat, A Lucia, J R Ruiz, ‘Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial’, International Journal of Obesity, 2009, doi:10.1038/ijo.2009.150

Ginseng

The use of herbal remedies during pregnancy is becoming increasingly common.  This is scary because there is little evidence on the safety and effectiveness of these herbal remedies.  Natural herbs do not go through the same evaluation process by the FDA.  The quality and strength of a herbal supplement may vary between two batches of the same product and between products from different manufacturers.  There is no way of knowing how safe the product is.  If you become pregnant, it is advised that you avoid herbs during pregnancy because they are rarely tested in pregnant women.  There are concerns that testing may damage the fetus. 

Unsafe Herbs

Blue Cohosh

It is estimated that one third of herbal remedies are deemed unsafe for use by pregnant women.  Blue cohosh was once thought to safely induce uterine contractions, but now it is learned that it may increase the risk of heart failure in the baby.  It can also induce labour.  Ginseng, which is the most commonly used herb in the world is now found to cause malformations in rat embryos.  If it causes malformations in rat’s embryos, human embryos could be affected as well.  Gingko may promote excessive bleeding.  Other unsafe herbs during pregnancy include:

• Aloe vera
• Anise
• Black cohosh
• Black haw
• Borage
• Buckthorn
• Comfrey
• Cotton root
• Dandelion leaf
• Dong Quai – uterine stimulant and relaxant effects
• Ephedra, ma huang
• Ergot
• Feverfew
• Goldenseal – may cross the placenta
• Juniper
• Kava
• Licorice
• Pennyroyal
• Saw palmetto – has hormonal activity
• Senna

Safe Herbs

Not all herbs are considered unsafe.  Although the list is shorter, there are some herbs (if taken in small amounts) that can be taken during pregnancy without harm to you or your baby.  Peppermint tea and ginger root are considered safe and are taken for nausea.  One gram oral doses of ginger for four days was found to decrease the severity of nausea and vomiting in the majority of women.  Rosemary is considered safe when taken is small amounts (eg. sprinkled on your tomato sauce).  Other herbs considered safe in small amounts are:

• Garlic
• Sage
• Tumeric
• Red raspberry leaf – rich in iron, helped tone the uterus, increase milk production, decrease nausea, ease labour pains
• Slippery Elm Bark – help relieve nausea and heartburn
• Oats and Oat Straw – rich in calcium and magnesium; helps relieve anxiety, restlessness and irritated skin

Red Raspberry Leaf

As you can see, there are many different herbs available to pregnant women.  It is advised that pregnant women stay away from them because they are not evaluated by the FDA.  However, there are some herbs that are considered safe, but not many.  You may end up taking some herbal supplements to decrease nausea and vomiting and become interested to take different ones, that may risk your baby’s health.

Sources

Brown, J.  (2008).  Nutrition through the lifecycle.  Belmont, USA: Thomson Wadsworth

Women’s Health Series: Herbs of Special Interest to Women. J Am Pharm Assoc 40(2):234-242, 2000.

Around 30 years ago, it was thought that sodium increased water retention and blood pressure, and limiting sodium would prevent edema (swelling) and high blood pressure.  We now know that this is not the case, and if you decide to restrict your sodium intake, you could complicate the course and outcome of your pregnancy.  Restriction may exhaust sodium conservation mechanisms and lead to excessive sodium loss.

Thirty years later, we know that sodium restriction is not recommended during pregnancy for the control of high blood pressure or edema.  You can be given no advice concerning your sodium intake during pregnancy, and just remember to salt to taste.  Make sure you check your blood pressure when you visit your doctor just in case, and eat a balanced diet.      

Hypertension

Check Your Blood Pressure When Visiting The Doctor

The causes of most cases of hypertension during pregnancy remains unknown.  Chronic hypertension is diagnosed prior to pregnancy or before 20 weeks after conception.  It is more likely to occur in African Americans, obese women, women over 35 years of age, and women who experienced high blood pressure in a previous pregnancy.  To avoid hypertension during pregnancy, consume an adequate and balanced diet before and during pregnancy.  If you are worried about consuming too much salt and want to restrict it, remember that limiting salt may impair fetal growth. 

Edema

Edema is a normal physiological change during pregnancy and occurs in 60-75% of women.  Edema is swelling (usually in the legs and feet, but can extend throughout the body) due to the accumulation of extracellular fluid.  High gains of water is associated with increasing degress of edema and weight gain.  Edema generally reflects a healthy expansion of plasma volume.  The greater the expansion of plasma volume, the greater the newborn size.  Edema is normal and do not try to prevent edema because it may impair the growth of your newborn.

 Sources

Brown, J.  (2008).  Nutrition through the lifecycle.  Belmont, USA: Thomson Wadsworth

There are many foods and beverages that contain caffeine (not just coffee and tea), which include:

• 1 cup drip coffee: 137-153 mg caffeine
• 1 cup percolated coffee: 97-125 mg
• 1 cup instant coffee: 61-70 mg
• 1 cup decaff coffee: 0.5- 4.0 mg
• 1 cup tea brewed for 5 minutes: 32-176 mg
• 1 cup instant tea: 40-80 mg
• 12 oz Mountain Dew: 54 mg
• 12 oz Coca-Cola: 46 mg
• 12 oz Diet Coca-Cola: 46 mg
• 12 oz Dr. Pepper: 40 mg
• 12 oz Pepsi: 38 mg
• 12 oz Diet Pepsi: 37 mg
• 1 cup chocolate milk: 10-17 mg
• 1 oz milk chocolate: 1-15 mg
• 2 tb chocolate syrup: 4 mg
  

  Chocolate Contains Caffeine

Although some pregnant women may think they should avoid consuming coffee and tea because of the caffeine intake, they may need to think about if they are consuming chocolate and pop as well.  Pregnant women consume on average 170 mg caffeine from coffee per day.  One study found that pregnant women consume an average of 58 mg of caffeine per day, compared to a mean consumption of 106- 170 mg per day in adults.  About 62% of the caffeine ingested by pregnant women was from tea. Other sources were coffee (14%), cola drinks (12%), chocolate (8%), and soft drinks (2%). Hot chocolate, energy drinks, and alcoholic drinks contributed 2%, 1%, and <1% respectively. 

Caffeine and coffee intake during pregnancy has not been related to an increased risk of fetal malformations, reduced fetal growth, labour or delivery complications, preterm delivery, or developmental problems in offspring, if taken in small amounts.  One study showed that a caffeine consumption of more than 200 mg/day during pregnancy was associated with a reduction in birth weight of about 60-70 grams.  There is a greater reduction in birth weight with a higher caffeine intake, and these relationships were consistent among all three trimesters.  There are conflicting results regarding caffeine during pregnancy, and it seems like small amounts of caffeine is safe (less than 200 mg) no matter what, but the higher the caffeine intake, the greater the risks to the baby.

Children of women who drank coffee during pregnancy have been found to have similar levels of intellectual and neuromotor development when compared to non-coffee drinkers. 

High levels of coffee and caffeine intake (over 500 mg per day), have been related to miscarriage.  One study shows that a consumption of 200 mg/day of caffeine or greater is associated with an 80% miscarriage risk.  However, this study was not statistically significant because of reduced sample size.      

Like I said before, alcohol and caffeine are both blurry subjects when it comes to pregnant women.  My advice would be to consume caffeine if you want to, but only in small amounts.  Like alcohol, large amounts of caffeine may have serious effects on the baby.

Sources

Brown, J.  (2008).  Nutrition through the lifecycle.  Belmont, USA: Thomson Wadsworth

Konje, J.C. (2008). Maternal caffeine intake during pregnancy and the risk of fetal growth restriction: a large prospective observational study. Centre for Epidemiology and Biostatistics, 337, 1-8

Weng, X, Odouli, R. & Li, D. (2008). Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J Obstet Gynecol, 198, 279.e1- 279.e8

Foods High In Folate

Folate is a water soluble vitamin and is a natural source of vitamin B9.  Folate is involved in embryonic and fetal development, cell division, nuclei acid synthesis, cellular growth and replication.  It is found in many foods such as:

• Legumes
• Leafy green vegetables
• Fortified cereals
• Liver
• Citrus fruits
• Whole-wheat bread

The Recommended Dietary Allowance (RDA) for folate in women that are not pregnant is 400 ug/per day.  A significant proportion of women of reproductive age have low dietary folate intake and do not use folic acid-containing supplements or eat fortified cereals.  The Recommended Dietary Allowance (RDA) for folate in women who are pregnant is 600 ug/day.   

Why Should I Worry About My Folate Intake Now?

All women of child-bearing age should meet the recommendation of folate to prevent neural tube defects.  This is important because the central nervous system develops in the fetus during the first weeks of gestation.  By day 23 the neural tube that will become the spinal cord has closed.  Neural tube development is complete before most women are aware that they are pregnant.  It is strongly recommended that folate supplementation should begin one month before conception. 

A Neural Tube Defect

Risks To You and Your Baby With Compromised Folate Intake

Adequate folate intake is extremely important before and during pregnancy.  There are multiple consequences to the baby and mother with inadequate folate intake, which include:

• Neural tube defects
• Preterm delivery (leading cause of infant mortality)
• Infant low birth weight
• Fetal growth retardation
• Increased spontaneous abortion
• Pregnancy complications (placental abruption and preeclampsia)
• Respiratory distress syndrome
• Bronchopulmonary dysplasia
• Intraventricular hemorrhage
• Necrotizing enterocolitis
• Hypoglycemia 
• Hypertension
• Developmental disorders (learning disabilities, childhood psychiatric disorders, mental retardation, child growth and development disruptions)
• May play a role in Down’s Syndrome

It is clear to see that you should definitely consume the recommended amount of folate before pregnancy to prevent neural tube defects.  Consuming the recommended amount during pregnancy is also extremely important, as seen above.  All women of child-bearing age should consume foods high in folate, and also take a supplement if they are planning on becoming pregnant. 

Sources

Kaiser LL, Allen L. Nutrition and lifestyle for a healthy pregnancy outcome. J AM Diet Assoc 2002;102:1470-1490

Stay Away From the Martini While Pregnant

One day my friend asked me if she could drink alcohol while pregnant, and of course I immediately said “no way!”  Her other friend (which is a nurse by the way), was also over at the same time and she told her that one drink is completely safe.  I was actually shocked.  Ok, if one drink is considered safe then what kind of drink is it?  Beer?  Wine?  Rum?  Vodka?  And how much is a drink exactly?  I was confused and I started to doubt my own knowledge and what we had been taught in class.  She is a nurse, maybe she was right?  No, I realized.  I was right, and any amount of alcohol can be dangerous to your unborn baby.  It seemed like my friend was favouring having a drink while pregnant, and I told her I wouldn’t risk it!

It just goes to show you that if you are pregnant, you are going to get many people of all expertise telling you what you can and cannot do.  Alcohol in any amount is unsafe to your baby because the alcohol passes through the placenta to the fetus where it can interrupt normal growth and development.  Would you actually risk having a drink for your baby?  I know I wouldn’t.  Drinking does not mean that much to me and it should not mean that much to you.

Adverse Effects of High Amounts of Alcohol

High amounts of alcohol is classified as several drinks per day or more, and is strongly related to these possible characteristics in your baby: 

• Abnormal mental development and growth
• Behavioural problems
• Mental retardation
• Aggressiveness
• Nervousness
• Short attention span
• Growth-stunting
• Birth defects
• Impaired organ development
• Development of Fetal Alcohol Syndrome

The consumption of four or more drinks per day, or occasional episodes of consumption of five or more drinks in a row is considered to be heavy alcohol intake during pregnancy.  This will increase the risk of:

• Miscarriage
• Stillbirth
• Infant death within the first month after delivery

Low Intakes of Alcohol

Adverse effects of alcohol are mild or undetectable when intakes are low, or if intake exists but are infrequent.  However, it is still wise to avoid alcohol altogether when pregnant or if you may become pregnant. 

I do realize this is a glum topic, but I felt like it needed to be addressed.  I do realize a lot of people know the risks of alcohol intake during pregnancy, but there are some people out there (unfortunately my friend is one of them), that do not completely understand the risks involved.  NO amount of alcohol is safe, and your baby is worth more than a drink!

Sources

Brown, J.  (2008).  Nutrition through the lifecycle.  Belmont, USA: Thomson Wadsworth

Should Pregnant Women Eat Fish?

Some women are concerned about eating fish during pregnancy because of fears of food poisoning and high mercury levels.  Mercury can harm your baby’s developing nervous system.  There are fish that do not contain high levels of mercury that can be eaten safely, and some fish that contain high amounts of mercury that should not be consumed.  Here are some examples of fish that can be eaten without any risk to you or your baby during pregnancy.

Haddock

Haddock is a mild, white fish from the Atlantic ocean that contains low levels of mercury.  Haddock is high in vitamin B6 and is a great choice for fish and chips.  Vitamin B6 is often given as a supplement because it can help you feel less nauseous during the first few months of your pregnancy.  So start eating haddock!

Tilapia

Tilapia is another mild, white fish that tastes best when cooked with spices and savoury vegetables.  Tilapia is a good source of niacin, which helps your baby’s brain development. 

Salmon

Salmon is a red-fleshed, flavourful fish that contains very low levels of mercury, and can therefore be enjoyed two times per week during pregnancy.  Salmon also contains healthy omega-3 fatty acids, and is a great low fat alternative. 

Trout

Trout is a red-fleshed freshwater fish that has a rich, but mild flavour.  Enjoy it baked or grilled with a squeeze of lemon and a generous sprinkle of pepper.  Do not eat more than two portions per week. 

Sardines

Sardines are salty little fish which are low in mercury and are usually purchased in small tin cans.  If you love sardines, you can safely eat two 6-oz servings per week.  They are also an excellent source of calcium, which will help support your bone health during pregnancy.  If you do not consume enough calcium during pregnancy, there is a risk of osteoporosis later in life.

Tuna

Mercury is found in tuna (tuna is a large fish and large fish contain more mercury than smaller fish), but there is a recommendation that you must follow if you would like to eat tuna during the course of your pregnancy.  The recommendations are to eat no more than four medium-sized cans (dry weight of 140g per can) of tuna or two fresh tuna steaks (weighing about 170g raw or 140g when cooked) per week.

Fish that should be avoided are shark, swordfish and marlin.  These fish contain high amounts of mercury and should be avoided during the course of pregnancy. 

Fish High In Mercury Should Be Avoided, Such As Swordfish

Fish should not be avoided altogether because it contains high amounts of omega-3 fatty acids, protein, vitamin D and minerals.  New evidence shows that the benefits of eating fish outweigh the cons of the mercury and pollutants that some fish may contain.  The current recommendation for the consumption of fish during pregnancy is a minimum of 12 ounces per week of the low mercury fish. 

Omega-3 Fatty Acids

You are probably wondering what the big deal is about these omega-3 fatty acids.  I am going to assume you all know what they are (we are all nutrition students here), but what does it have to do with pregnancy?  Omega-3 fatty acids enhance the development of the baby’s brain, improve the baby’s IQ, make the baby a better sleeper after birth, prevent premature contractions and premature labour, prevent high blood pressure during pregnancy, and acts as an anti-inflammatory that prevents infection.  Fish supplements are also available at a health food store if you are uncomfortable with eating fish.  

Foods That Contain Omega-3 Fatty Acids

I hope I have convinced everyone that eating fish during pregnancy is a great choice.  Yes, there are some precautions, such as high mercury levels, pollutants and food poisoning, however all foods have some pros and cons associated with them.  It must be said again that eating fish during pregnancy is a must, because the pros associated with fish definitely outweigh the cons.

Sources

Brown, J.  (2008).  Nutrition through the life cycle.  Belmont, USA: Thomson Wadsworth

American Pregnancy Association.  (2007). Mercury levels in fish.