Nutrition & Exercise During

Pregnancy

Why is This Relevant to Me?

Everyone knows someone who is pregnant/going to become pregnant

Diet and Exercise are important for people who are not pregnant.

Health problems are on the rise

Weight Gain During PregnancyWeight gain depends on many factors:

Rate of weight gainMaternal ageAppetitePre-pregnancy body mass index

Where the weight goes?Baby-7.5 lbsBreast growth- 2lbsMaternal stores- 7lbsPlacenta 1.5 lbsUterus growth- 2lbsAmniotic fluid- 2 lbsBlood – 4 lbsBody fluids- 4 lbs

What is a BMI?

BMI- Body Mass Index(Weight/Height2) x 703

Applies to adult men and women

Classification BMI

Underweight <18.5

Normal weight 18.5-24.9

Overweight 25-29.9

Obesity >30

Weight Gain During Pregnancy

Weight should be gained graduallyFirst trimester

1-4 lbs total during the first 3 months

Second & Third Trimester2 to 4 pounds per month during the 4th to 9th months

Most weight gained in last three monthsAvoid weight loss during pregnancy even if obese Weight gain during the 2nd trimester predicts birth weightSeek proper weight before pregnancy

Effects of Starting BMI

Underweight (BMI <18.5)Increased risk of preterm deliveryLow birth weight babyIron deficiency anemiaNutritional requirements low

Overweight (BMI ≥25)Gestational diabetesGestational hypertensionC-Section DeliveryBirth defects (neural tube defects)Fetal death or miscarriagePostpartum effects (hemorrhage, wound infection, depression)Increase chance of childhood obesity

Nutrition During PregnancyMost pregnant women need 2,200-2,900 caloriesEnergy Requirements

No different than non- pregnant women until the 2nd trimester

340 kcal in the 2nd trimester452 kcal in the 3rd trimester

Variety of foodsChoose nutrient-dense foods/ limit energy-dense foodswww.mypryamid.gov

How much is that increase?340 Calories

8oz low-fat plain yogurt mixed with 1/2 cup raspberries and 1 tbs honey (205 cals) One hard-boiled egg with a slice whole grain toast (130 cals)

452 Calories2 oz turkey burger, 1/4 cup avocado, 1/4 cup grilled onions on one slice whole-grain bread (240 cals) 1/2 whole grain English muffin, toasted; 2 tbs pizza sauce, 2 oz low-fat mozzarella (190 cals)

Dietary Guidelines for Non-Pregnant Individuals

USDA 2005 Dietary GuidelineNew one set for 2010Based on 2,000 calorie dietFruit Group

2 cups(4 servings)Vegetable Group

2.5 cups (5 servings)Grain Group

6 ouncesMeat and Beans Group

5.5 ouncesMilk Group

3 cupsOils

24 grams (6tsp)

Nutrition During PregnancyWhole grains

Bread, cereals, pasta, brown riceWhole/Canned/Frozen Fruits

Apples, pears, peaches, nectarines, melonStay away from acidic fruits such as oranges, pineapples, lemons, and limes

VegetablesLeafy greens, bell pepper, eggplant, squash, and mushrooms

Lean protein from plant and animal sourcesTofu, nuts, seeds, lentils, beans, red meat, chicken, turkey, fish and pork

Low-fat dairyMilk, cheese and yogurt

Healthful fatsCanola oil, walnuts, almonds, avocadoes, and fish

SupplementationPrenatal multivitamin is advised before pregnancy for

Women with multiple birthsWomen with HIVWomen taking drugsWomen eating little/no animal products

Multivitamin used to complement not to substitute for a good dietEarly supplementation has shown to decrease risk for preeclampsia

Foods to Avoid During PregnancyMinimize beverages/sports drinks or foods with:

High sugar contentHigh Sodium

Raw EggsUnpasteurized juices or dairy productsUndercooked meat, poultry, and fishDeli meatsRaw vegetable sproutsSoft Cheeses

Fish

MercuryControversial topicHigh amount in large predatory fish (<100g per week)

King MackerelPikeSharkWalleyeBarracudaLarge Tuna

Tuna

No more than twice per week

Potential Pathogen/Food SafetyPathogens:

ListeriaAirborne pathogenCan grow at refrigeration temperaturesDeli meats, unpasteurized milk, refrigerated and ready to eat products

Toxoplasma gondiiCan pass through placentaFeces of catsContaminated/undercooked meat, unwashed fruits, unpasteurized milk, contaminated water

Food safety tips:Wash fruits and vegetablesHeat meat to steaming

Omega 3-Fatty Acids/DHAEssential fatty acids

Needs to come from dietBody cannot make them

Child growth, development, & healthVisual & Cognitive Development

Present in breast milk200 milligrams/daySources

FishFish oilCanola OilFlax

DHA Recommendation StudyGoal:

Develop recommendations on dietary fat intake in pregnancy and lactation

ResultsDietary fat intake during pregnancy and lactation same as the general populationOmega-3 PUFA deposited in brain/other tissues during fetal and postnatal lifeMaternal intake of omega-3 PUFA have visual and cognitive development outcomes for the infant

ConclusionDietary intake of 200 milligrams/ day1-2 portions of sea fish/week or consumption of flaxseed or canola oils

Calcium & Vitamin DCalcium

Development of baby’s teeth, bones, heart, nerves, and muscles1,000 milligrams/day Calcium before and during pregnancySources

Low-fat or fat-free milkYogurtCheeseCalcium-fortified cerealsCalcium-fortified juices

Vitamin DReduce infection in pregnancyReduce preeclampsiaIncrease absorption of Calcium

Maternal Vitamin D Deficiency and Risk for Preeclampsia

MethodsCase study of Vitamin D levels in preeclamptic women >16 wks compared to non-preeclamptic women

ResultsAs maternal serum vitamin D

concentrations increased, risk of preeclampsia decreased.

Neonates born to preeclamptic mothers more likely to have poor Vitamin D status than neonates of controls

ConclusionMaternal Vitamin D deficiency at

less than 22 weeks was a risk factor for preeclampsia

FolateReduces risk of birth defects affecting the spinal cordNeeded to produce blood and protein for the baby.Advised to increase intake when planning or capable of pregnancy. 400 micrograms/day for non-pregnant women600 micrograms/day for pregnant womenSources

CerealsPastaBreadSupplements

Folic Acid Fortification and Neural Birth Defects

IntroductionMandatory fortificationIncrease by 30–70% of folic acid87% due to Spina Bifida

ResultsBefore fortification

Neural tube defects was 1.85 per 1000 live births

Introduction of fortificationNeural tube defects was 1.07 per 1000 live birth

After fortificationNeural tube defects was .95 per 1000 live births

ConclusionSignificant decline of 49% in incidence of neural tube defects

IronPregnant women are at high risk for anemia

Iron deficiency

Helps red blood cells deliver oxygen to the babyNon-pregnant women: 15-18 milligrams/dayPregnant women 27 milligrams/daySources

SpinachKaleLeafy greensBeansFortified CerealsRed MeatChickenFish

PICAPICA

Ingestion of non-food items are foods in higher amountsAssociated with Iron deficiencyCravings for taste, smell, or texture

ComplicationsDepend on substance eaten

GI disturbanceExcess weight gainHyperglycemiaHigh Blood PressureMetabolic Alkalosis

Exercise During PregnancyRequirements

Then ACOGShould not exceed 140 beats/minuteStrenuous exercise ≤15 minutes

Now ACOGModerate exercise ≥30 minutesMost days of the week

Changes in body:BalanceJointsHeart Rate

Seek Healthcare professional

Benefits of ExercisingMother

Improved cardiovascular functionLimited pregnancy weight gainDecreased musculoskeletal discomfortReduced muscle crampsReduced lower limb swellingMood stability

FetusDecreased fat massImproved stress toleranceAdvanced neurobehavioral maturation

Types of ExerciseBeginners

WalkingCyclingSwimmingAerobics

ExercisersRunningStrength training

Exercises to Avoid

Downhill snow skiingContact sport

FootballBasketballIce HockeySoccer

Scuba DivingGymnasticsHorseback ridingStanding for long periods of time

ConclusionProper weight gain is important in maintaining the health and well being of both the mother and the fetusIron, Vitamin D, omega 3 fatty acids, and Folic Acid are important to supplement during pregnancyExercise during pregnancy is beneficial not only for the mother but for the fetusThese nutrition and exercise recommendations are important for pregnant women but can be maintained after pregnancy for a healthy lifestyle