Pregnancy

Nutrition before pregnancy

Becoming healthy before becoming pregnant

Pre-conception nutrition, is a vital part of preparing for pregnancy. Factors such as, a woman's weight compared with her height, and what she eats, can play an important role in a mother's health during pregnancy, as well the health of her developing foetus.

Pre-pregnancy weight

A mother's pre-pregnancy weight has a direct influence on her baby's birth-weight. Studies show that, underweight women are more likely to give birth to small babies, even though they may gain the same amount in pregnancy as normal weight women. Overweight women have increased risks for complications in pregnancy, such as gestational diabetes or high blood pressure. Consult your health care provider, about whether you need to lose or gain weight, before becoming pregnant.

Pre-pregnancy nutrition

Many women do not eat a well-balanced diet before pregnancy, and may not have the proper nutritional status for the demands of pregnancy. Generally, a pregnant woman needs to add about 300 extra calories to meet the needs of her body and her developing foetus. However, those calories, as well as her entire diet, need to be healthy, balanced, and nutritious.

The Choose My Plate icon is a guideline to help you select a healthy diet. My Plate can help you choose a variety of foods, while encouraging the right amount of calories and fat. The USDA and the U.S. Department of Health and Human Services have prepared the following food plate to guide you in selecting foods.

The My Plate icon is divided into five food group categories, emphasizing the nutritional intake of the following:

  • Grains. Foods that are made from wheat, rice, oats, cornmeal, barley, or another cereal grain are grain products. Examples include whole wheat, brown rice, and oatmeal.
  • Vegetables. Vary your vegetables. Choose a variety of vegetables, including dark green, red, and orange vegetables, legumes (peas and beans), and starchy vegetables.
  • Fruits. Any fruit, or 100 percent fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed.
  • Dairy. Milk products and many foods made from milk, are considered part of this food group. Focus on fat-free or low-fat products, as well as those that are high in calcium.
  • Protein. Go lean on protein. Choose low-fat or lean meats and poultry. Vary your protein routine by choosing more fish, nuts, seeds, peas, and beans.

eatwell-plate

Oils are not a food group, yet some, such as nut oils, contain essential nutrients and can be included in the diet. Others, such as animal fats, are solid and should be avoided.

Exercise and everyday physical activity, should also be included with a healthy dietary plan.

To find more information about the Dietary Guidelines for Americans 2010, and to determine the appropriate dietary recommendations for your age, sex, and physical activity level, visit the Online Resources page for the links to the ChooseMyPlate.gov and 2010 Dietary Guidelines sites. Please note that the My Plate plan is designed for people over the age of 2, who do not have chronic health conditions.

In addition to the My Plate food groups, the following nutrients should be included in a woman's pre-conception diet, and continued into pregnancy:

  • Folic Acid. The U.S. Public Health Service recommends that all women of childbearing age consume 400 micrograms (0.4 mg) of folic acid each day. Folic acid, a nutrient found in some green leafy vegetables, most berries, nuts, beans, citrus fruits, fortified breakfast cereals, and some vitamin supplements, can help reduce the risk of birth defects of the brain and spinal cord (called neural tube defects). The most common neural tube defect is spina bifida, in which the vertebrae do not fuse together properly, causing the spinal cord to be exposed. This can lead to varying degrees of paralysis, incontinence, and, sometimes, mental retardation.

    Folic acid is most beneficial during the first 28 days after conception, when most neural tube defects occur. Unfortunately, many women do not realize they are pregnant before 28 days. Therefore, folic acid intake should begin prior to conception and continue through pregnancy. Your health care provider will recommend the appropriate amount of folic acid to meet your individual needs.

    Most health care providers will prescribe a prenatal supplement before conception, or shortly afterward, to ensure all of the woman's nutritional needs are met. However, a pre-natal supplement does not replace a healthy diet.

  • Iron. Many women have low iron stores as a result of monthly menstruation and diets low in iron. Building iron stores helps prepare a mother's body for the needs of the foetus during pregnancy. Good sources of iron include the following:

    • Meats, such as beef, pork, lamb, liver, and other organ meats.
    • Poultry, such as chicken, duck, turkey, and liver (especially dark meat).
    • Fish and shellfish including clams, mussels, oysters, sardines, and anchovies.
    • Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards.
    • Legumes, such as lima beans and green peas, and dry beans and peas such as pinto beans, black-eyed peas, and canned baked beans.
    • Yeast-leavened whole-wheat bread and rolls.
    • Iron-enriched white bread, pasta, rice, and cereals.

  • Calcium. Preparing for pregnancy includes building healthy bones. If there is not enough calcium in the pregnancy diet, the fetus may draw calcium from the mother's bones, which can put women at risk for osteoporosis later in life. The recommended calcium intake for most non-pregnant women, is 1,000 milligrams and an additional 400 milligrams is needed during pregnancy. Three or more servings of milk or other dairy products each day, equals about 1,200 milligrams of calcium.

Pregnancy symptoms:
Top ten signs you might be pregnant

Could you be pregnant? Most likely you won't notice any symptoms until about the time you've missed a period – or a week or two later. If you're not keeping track of your menstrual cycle, or if it varies widely from one month to the next, you may not be sure when to expect your period. But if you start to experience some of the symptoms below - not all women get them all – and you haven't had a period for a while, you may very well be pregnant. Take a home pregnancy test to find out for sure!

Abdominal bloating

Hormonal changes in early pregnancy may leave you feeling bloated, similar to the feeling some women have just before their period arrives. That's why your clothes may feel more snug than usual at the waistline, even early on when your uterus is still quite small.

Heightened sensitivity to odours

If you're newly pregnant, it's not uncommon to feel repelled by the smell of a bologna sandwich or a cup of coffee, and for certain aromas to trigger your gag reflex. Though no one knows for sure, this may be a side effect of rapidly increasing amounts of oestrogen in your system. You may also find that certain foods you used to enjoy are suddenly completely repulsive to you.

Nausea or vomiting

For some women, morning sickness doesn't hit until about a month after conception, though for others it may start a week or two earlier. And not just in the morning, either – pregnancy-related nausea and vomiting can be a problem morning, noon, or night. (A lucky few escape it altogether.) About half of women with nausea, feel complete relief by the beginning of the second trimester. For most others, it takes another month or so for the queasiness to ease up.

Frequent urination

Shortly after you become pregnant, hormonal changes prompt a chain of events that raise the rate of blood flow through your kidneys. This causes your bladder to fill more quickly, so you need to pee more often. This symptom may start as early as six weeks into your first trimester. Frequent urination will continue – or intensify – as your pregnancy progresses. Your blood volume rises dramatically during pregnancy, which leads to extra fluid being processed and ending up in your bladder. The problem is compounded as your growing baby exerts more pressure on your bladder.

Fatigue

Feeling tired all of a sudden? No, make that exhausted. No one knows for sure what causes early pregnancy fatigue, but it's possible that rapidly increasing levels of the hormone progesterone are contributing to your sleepiness. (Of course, morning sickness and having to urinate frequently during the night can add to your sluggishness, too.)

You should start to feel more energetic once you hit your second trimester, although fatigue usually returns late in pregnancy when you're carrying around a lot more weight, and some of the common discomforts of pregnancy make it more difficult to get a good night's sleep.

Depression can contribute to fatigue and sleeplessness, too. If you've been feeling sad or hopeless, or unable to cope with your daily responsibilities, or you're having thoughts of harming yourself, call your healthcare provider or a mental health professional right away.

Tender, swollen breasts

One of the early signs of pregnancy is sensitive, sore breasts caused by rising levels of hormones. The soreness and swelling may feel like an exaggerated version of how your breasts feel before your period. Your discomfort should diminish significantly after the first trimester, as your body adjusts to the hormonal changes.

A missed period

If you're usually pretty regular and your period doesn't arrive on time, you may decide to do a pregnancy test before you notice any of the above symptoms. But if you're not regular or you're not keeping track of your cycle, nausea and breast tenderness and extra trips to the bathroom may signal pregnancy before you realize you didn't get your period.

Implantation bleeding

Very early in pregnancy, even before you realize you're pregnant, you may have some spotting that lasts for only a day or two. There's no way of knowing for sure why this happens, but it may be caused by the fertilized egg burrowing into the wall of your uterus – a process that starts just six to seven days after fertilization.

Your basal body temperature stays high

If you've been charting your basal body temperature, and you see that your temperature has stayed elevated for 18 days in a row, you're probably pregnant.

And finally ...

The proof: A positive home pregnancy test

In spite of what you might read on the box, many home pregnancy tests are not sensitive enough to reliably detect pregnancy until about a week after a missed period. So if you decide to take a test earlier than that and get a negative result, try again in a few days.

Once you've gotten a positive result, make an appointment with your practitioner.

Eating well in pregnancy

Eating a nutritious and varied diet in pregnancy is the best way of caring for yourself and your baby. This topic outlines what is meant by a nutritious and varied diet, and is suitable for most pregnant women. There are some women who may need to make some special changes when they are pregnant. They include:

  • very young women (adolescents who are still growing)
  • women who are underweight, or overweight, when becoming pregnant
  • women who have had more than three pregnancies in two years
  • women who eat a restricted diet (eg, macrobiotics, vegans)
  • women who have been eating a diet which they consider has been unhealthy
  • women who have been eating a diet which they consider has been unhealthy

If you fit within any of these categories, you may need special nutritional advice. Talk with your lead maternity carer or doctor, about whether you would benefit from visiting a registered dietitian.

What foods are ideal in pregnancy?

The following food groups provide you with the necessary vitamins, minerals and protein for a healthy pregnancy and baby.

  • Vegetables and fruits. Eat at least seven different types per day.
  • Breads, cereals, pasta and rice (wholegrain is best). Eat at least six servings per day.
  • Milk products like milk, yoghurt, cheese or cottage cheese. Eat two servings a day.
  • Lean protein sources like fish, chicken, eggs, meat, nuts and pulses. Eat at least one serving a day.

Be aware that, if you are only eating nuts and pulses for protein, you will not be getting the iron, vitamin B12 or zinc, which are required for good health. You will need to ensure that these nutrients come from other parts of your diet. A serving corresponds roughly to the size of the palm of your hand.

What foods are best avoided in pregnancy?

Chilled or uncooked fish or seafood products can be infected with the bacterium Listeria. Infection with Listeria can cause listeriosis, a flu-like illness that can harm your baby. Other foods which can cause listeriosis are: pate, precooked chicken or ham and other chilled, precooked meat products. Stored salads and coleslaws, and unpasteurised milk products, should also be avoided.

  • all fresh foods should be washed thoroughly before eating
  • alcohol should not be drunk in pregnancy. There is no known 'safe' amount to drink, and as such it is wise to avoid it completely
  • foods that are high in sugar (like fizzy drinks or undiluted fruit juices), fats (french fries, cakes or chocolate) and salt (potato chips or pre-packaged noodles or stock) should be moderated for occasional treats only.

Can't wait to feel your baby move?

When most people think of babies moving, they imagine little feet prodding pregnant tummies or being able to see their baby kicking. But of course, at the beginning, babies are still really tiny and have plenty of room to move around, without bumping into your sides. In fact, you may not even notice your baby's movement in the early stages of pregnancy!

The first flutterings

When you feel your baby move for the first time, usually at around 16 – 20 weeks, it's very exciting – personal proof that your baby is really there and growing healthily. Of course, all pregnancies are slightly different, so yours won't run to an exact timetable, but there are cycles of baby movement you can expect.

Later baby movements

  • 24 to 28 weeks – it's not unusual to feel your baby hiccup, and while sudden loud noises won't do them any harm, they might make them 'jump'!
  • Around 29 weeks – it starts getting a bit more cramped inside your womb, so your baby will make smaller movements but they might feel stronger.
  • Around 32 weeks – they'll probably get even more active before starting to get into their final position (hopefully head down!), at around 36 weeks. Because space will be tighter and your baby will be stronger, that's when you might find baby movements a little less comfortable – particularly those baby kicks to the ribs!
  • 36 to 40 weeks – it's usual to experience less kicking towards the end, so don't worry when movements slow down. But it's still very important that you feel your baby move – about 10 movements in any 24-hour period is considered normal.

Still worried about your baby's movements?

If you're worried that your baby isn't moving, or is moving too much, don't hesitate to ask your healthcare professional/midwife for a check-up.

Causes of pregnancy back pain

Pre-pregnancy weight

Lots of women experience some sort of back pain during pregnancy, especially in the third trimester. Usually, it's due to the weight of your bump pulling forward on the muscles in your lower back. Also, as your body prepares itself for birth, your ligaments become softer than usual. This can make your pelvis ache, which you might also feel at the bottom of your spine.

Preventing backache in pregnancy

  • Posture - your posture is really important and can make all the difference; when standing, imagine there's a piece of string tied to the top of your head and it's pulling you upwards, and try to keep your stomach and bum tucked in.
  • Sitting - posture is important when you're sitting and lying down, too; try not to slouch when you're sitting. Supporting your back with a cushion should help.
  • Sleeping - at night, lie on your side with a pillow between your knees to keep you in the right position. Also, use your arms to help push yourself up and support your bump – this will take a lot of strain off your back and help keep backache at bay.
  • Shoes - comfy shoes are also essential; some women prefer flat shoes, while others feel better with a bit of a heel. Just go with whatever's comfortable for you.
  • Keeping yourself fit - can also help ease pregnancy backache. See if you can join any antenatal exercise classes in your area, such as aqua-natal or antenatal yoga classes. Even regular gentle swimming and walking can help.
  • Avoid lifting anything heavy - you're already carrying a growing baby, so any extra loads will put even more strain on your body. If you really have to pick something up, always remember to bend from your knees, not your back, and use your thighs to help you stand.

Treating backache

  • Support your bump – ease the strain on your back by sleeping on your side with a wedge-shaped pillow under your bump. If you're really suffering, try wearing a special support belt during the day, and speak to your doctor/midwife.
  • Hot or cold relief – a warm bath or hot water bottle, can also help soothe backache, though some women prefer the cool relief of an ice pack (or a bag of frozen peas!).
  • Massage –a gentle massage can do wonders for aching muscles, but your normal massage oils may not be suitable for pregnant women, so check with an aromatherapist or your midwife first.

Constipation

Why you get blocked up

  • During pregnancy, constipation isn't just linked to your diet, it's also down to your hormones. Your body produces extra progesterone, which cleverly makes your muscles relax so your baby can grow inside you. However, this also affects your intestines, meaning food moves through more slowly.
  • Constipation during pregnancy can also be caused by the extra pressure the uterus puts on the bowel and rectum, slowing down bowel movements.

Moving things along

  • When bowel movements need speeding up, diet and exercise can help set things in motion!
  • Getting plenty of fibre like fruit, veg and whole grains is important. Liquid will also help to soften your stools and make them easier to pass, so drink lots too. Aim for at least 8 glasses of water a day, and try fruit juices (particularly prune juice).
  • When you're bloated and blocked up, you may not feel like exercising but, about 20 to 30 minutes a day of swimming, walking, or another gentle exercise you enjoy, can help kick -tart your system.
  • You might also want to review any pregnancy vitamin supplements or iron tablets you're taking, as they can slow your bowels down too, but double check with your midwife before making any changes. And while you're doing so, ask them which type of laxative is safe to take during pregnancy. Hopefully you won't need any, but they'll be useful to have on stand-by as a last resort!
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