Understanding prenatal nutrition key to healthier pregnancy
BC Women's dietitians work with hundreds of women each year to help them nurture their unborn babies. They also help patients address complications of pregnancy, such as gestational diabetes, that require special nutrition strategies.
Dietitian Carllee Thiessen explains that while nutrition needs and preferences vary from woman to woman, some basic advice applies to all. For example, some women do not realize that it's important to take vitamin supplements early on. Dietitians, maternity care providers and Health Canada recommend you start taking a prenatal or other multi-vitamin that contains folic acid when you are planning to conceive or as soon as you find out you are pregnant.To help you navigate the food groups and portions that you need for nutrition and healthy weight gain, dietitians recommend that you follow the Canada Food Guide throughout your pregnancy. In the first trimester, you can follow the food guide's recommended number of servings per day, but more servings will be needed as your pregnancy progresses and more weight gain is needed.
“Your caloric needs increase in the second and third trimester," Thiessen says. "It's also important that you understand how much weight you need to gain during the different stages of your pregnancy."We asked Thiessen to answer some of questions that come up frequently when dietitians are counselling women on prenatal nutrition.
Do I need to take vitamins?
We advise women to take a multi-vitamin supplement that contains 400 mcg of folic acid and 16 to 20 mg of iron. Some women may need higher amounts or other supplements. For example, if you are already anemic, you may need a higher dose of iron, and some women need additional calcium and vitamin D. Your maternity care provider can advise you on what's right for your own situation.
I'm planning a pregnancy - how much folic acid do I need to take?
Start at least three months before you plan to conceive and take a prenatal vitamin supplement containing at least 400 mcg of folic acid. (Women at higher risk of certain birth defects, such as spina bifida may be advised to take a higher dose.)
Talk to your family doctor or other primary health care provider if you have any questions.
How do I lose weight before I get pregnant?
Aim for a healthy weight before you are pregnant. A healthy lifestyle that includes regular exercise and a good diet is a good start to your pregnancy. If you are active before and during your pregnancy, you will likely have more energy during your pregnancy.
What is the right weight gain for me?
Most women assume they should gain about 30 lbs in pregnancy, when in fact the total recommended weight gain is very individual and depends on the woman’s weight before pregnancy.
If you are having twins or triplets, you will need to gain more weight than a woman expecting one baby.
One of the biggest misconceptions that first time moms have is when the weight gain should happen. In the first trimester, only a one- to four-lb gain is recommended, followed by steady weight gain during the second and third trimester.
If you are overweight or obese, it's not a good idea to try to lose weight when you are already pregnant, but your maternity care provider will advise you to gain less weight during your pregnancy than a woman of normal weight.
How do I know if I am eating enough?
Eating for two is a misconception! We advise women to eat twice as healthily rather than twice as much. Look at the Canada Food Guide servings tracker to make sure your diet is balanced and understand how many servings of different types of food that you need during the day. Once you reach the second trimester, it's time to add an additional two to three servings a day.
How often should I eat during the day?
Everyone is different! You may prefer to eat three meals a day with no snacks, but women often find that eating the same amount of food divided into three smaller meals and regular snacks helps to prevent heartburn and nausea in pregnancy. It's useful to think ahead and prepare healthy snacks that you can have in the kitchen ready to go or take to work.
I need more iron, which foods have lots of iron?
We recommend that all women take a multi-vitamin that contains 16 to 20 mg of iron. Check with your maternity care provider if that's enough for you. No matter what type of diet you prefer, there are many foods to choose from that are rich in iron. For example: beef; lamb; chicken; fish; seeds, such as pumpkin, cashews or hazelnuts; legumes, including dried beans, peas or lentils; whole grain cereals; and dark leafy greens like kale, Swiss chard and spinach. “Eat these iron rich foods with foods that are sources of vitamin C, such as kiwi fruit, citrus fruit or bell peppers, to help with iron absorption,” Thiessen notes.
How much more do I have to eat for twins/triplets?
Healthy weight gain helps your babies have a healthy birth weight and ensures you have adequate energy stored for breastfeeding. When you are having more than one baby, your energy needs are even greater. Speak with a dietitian or your maternity care provider to find out the right weight gain for you.
I don't drink milk. How can I get enough calcium?
Calcium is important for the development of your baby's bones, as well as maintaining the density of your own, so it's important to pay attention to your calcium intake in pregnancy. It's a good idea to get what you need from your diet, but some women will need an extra supplement. To ensure you have enough calcium, aim for three servings of milk or alternatives every day. If you don't drink cows' milk, other great alternatives include almond, soy or rice milk, but be sure it's fortified with calcium. Cheese, yoghurt and kefir are also high in calcium. If you are looking for non-dairy sources, try tofu, legumes, almonds or salmon with bones (e.g. canned salmon containing small, soft bones).
What foods should I avoid during pregnancy?
Some foods can be a higher risk for pregnant women due to the way they are produced and stored. By avoiding certain foods, your chances of getting food poisoning can be significantly lower.
To reduce your risk of food borne illness, avoid foods such as deli meats, hot dogs, raw or undercooked meat, poultry, fish, seafood or eggs, soft cheeses (e.g. Brie), and raw sprouts. For more details, please see the HealthLink BC guidelines for food safety during pregnancy.
I avoid several foods due to allergies - am I missing anything my baby needs?
This really depends on the types of foods you are unable to eat due to your allergies. Check in with your maternity care provider or ask a dietitian for help.
What can I do about my morning sickness or heartburn or constipation?
For morning sickness, many women experience nausea with or without vomiting during early pregnancy. Even though you may not be able to eat your usual diet, your baby will still receive nutrients from you. Here are some suggestions that may help morning sickness:
• Eat small amounts of food every one to two hours during the day. Try not to eat too much at one time or leave your stomach too empty as this may make your symptoms worse.
• Include a protein food at meals and snacks if possible
• Ensure you are drinking enough fluids. Aim for at least two litres (eight cups) of fluids daily in small amounts taken frequently.
• Try drinking fluids on their own rather than with food. Mixing food and drinks can increase nausea and vomiting.
• If your prenatal vitamin is making you feel sick, try taking it at bedtime with food instead of in the morning.
If you are experiencing heartburn, smaller, more frequent meals or snacks are also a good idea, and try not to lie down right after you eat. You will learn what types of foods trigger heartburn. Often, pregnant women develop heartburn from consuming acidic or spicy foods, or having too much food at one time.Constipation can usually be managed with your diet and fluid intake. Try to drink at least eight cups of fluid a day and choose foods high in fibre such as whole grain cereals, breads, beans and lentils, fruits, and vegetables. Incorporating flax and chia seeds in your meals can also be easy ways to increase your fibre.
If these strategies don't help, talk to your maternity care provider before you reach for an over-the-counter constipation remedy.
I am breastfeeding and pregnant with a new baby - how do I know that I'm getting enough to eat?
It's important that you are well-nourished and hydrated so that you can continue to produce enough milk for breastfeeding and ensure that your unborn baby is getting the necessary nutrients for healthy growth. To achieve both, it's good idea to seek advice from your maternity care provider or consult a dietitian.
Seeking advice from a dietitian
If you have any questions about healthy eating during pregnancy and breastfeeding, seek professional advice from a dietitian. To speak to a dietitian at BC Women’s hospital, call 604-875-2330. The HealthLink BC dietitians can also provide advice and information if you dial 811, or use the Motherisk Helpline at 1-800-436-8477.
Prenatal nutrition counselling - BC Women's Hospital + Health Centre
Get primed for pregnancy with extra folic acid - BC Women's Foundation eNews article
Postpartum nutrition advice from the experts: eating well, getting enough fluids impacts you and your baby - BC Women's Foundation eNews article
Motherisk information about the safety of various medications, herbs and supplements in pregnancy and for breastfeeding along with information about infectious diseases and other conditions in pregnancy
Healthlink BC information for food safety and nutition in pregnancy. Website has a searchable database for information on all sorts of topics
Thanks to your support, the BC Women’s Newborn ICU was there to help baby Avery through a life-threatening condition
One-year-old Avery Wilson looks just like any other healthy, pink-cheeked baby. “She’s eating like a champ and gaining weight,” says mom, Alisen, from her North Vancouver home. But the picture was not always so rosy.
Just 20 weeks into her pregnancy, Alisen was referred to BC Women’s Hospital, where tests revealed that her unborn daughter had a rare physical disorder called a congenital diaphragmatic hernia – an opening in the diaphragm that allows the internal organs to enter the chest cavity, preventing normal lung growth and displacing the heart.
Alisen and her husband were told that the condition would cause their baby to be born with severe breathing problems and would require immediate surgery. Their priority was to get Avery to full-term, allowing her lungs to develop as much as possible to improve the post-surgical prognosis.
“My husband and I tried hard that day to keep it together,” says Alisen, “but when we left the hospital, we just hugged each other and cried. I remember it was raining and it really fit the mood.”
Alisen’s pregnancy went full-term, and when Avery was born she weighed in at a healthy eight pounds, one ounce. She also had BC Women’s Newborn ICU (NICU) on her side at delivery, with a first-rate team of specialists ready to address the problem and provide the complex care needed for her journey to recovery.
“Not only did the NICU staff provide us with the best-possible care, it’s obvious that they hold all of these babies close to their hearts, and that they make the parents part of the team,” says Alisen. “They made an extremely stressful situation tolerable for us.”
In gratitude for the care their granddaughter received, Avery’s grandparents purchased a Baby Tile commemorating her birth. It hangs among the others on a special wall just outside the Newborn ICU, a poignant reminder of the very real difference the unit makes in the lives of BC families.
By Helena Bryan, Photography by Claudette Carracedo
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