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How to Solve the Biggest Problem During Pregnancy: Weight Gain

by with No Comment Fertility & Women's HealthMotherhoodWeight Management

Weight gain during pregnancy is a hot topic and commonly discussed in parenting or women’s health magazines. Most women who are planning to conceive or pregnant are unsure as to how much weight they should safely gain during this period. Today, I am going to give you some nutrition tips and guidance to reduce your stress.

Weight gain is an important part of pregnancy. The recommended amount of weight gain during pregnancy depends on your Body Mass Index (BMI) before pregnancy. Knowing the range of weight gain that’s right for you will help you gain enough weight without gaining too much.

You can find out your pre-pregnancy BMI by:

  • Using an online calculator
  • Using the following formula: BMI = weight (kg) / height (m2)
  • Talking to your healthcare provider or Dietitian

The table below will help you find out how much weight gain will be healthy for you and your baby.

If you were overweight, you need to gain less weight. If you were underweight or you are having twins or triplets, you need to gain more weight. Talk to your doctor, dietitian or nurse about the right weight gain for you.

WHERE IS THE WEIGHT GOING? 

Most women need to gain about 11.5 – 16 kg in pregnancy. It’s common to gain very little weight in the first trimester. In second and third trimesters a gradual increase of about 0.5 kg a week is normal since the baby and supporting tissues continue to grow.

IF YOU GAIN TOO MUCH WEIGHT 

Women who gain too much weight tend to have:

  • More difficulty giving birth
  • Babies who are born large for their age or who have a high birth weight (more than 4.1 kg)
  • Babies who have problems with being overweight or obese later in childhood
  • More troubles losing weight after pregnancy
  • Increased risk of high blood sugar and high blood pressure during pregnancy

IF YOU GAIN TOO LITTLE WEIGHT 

Women who don’t gain enough weight tend to have:

  • Babies who are born early
  • Babies who are born small for their age or who have a low birth weight (less than 2.5 kg)

HEALTHY EATING TIPS DURING PREGNANCY

Consuming a well balanced and varied diet will help ensure you consume food sources of folic acid, iron and calcium, which are especially important nutrient during pregnancy.

Eat “twice as healthy”, not “twice as much”

  • Eating every 2-4 hours while awake gives your growing baby a steady supply of nutrients. It may also help you feel better if you’re having trouble with nausea.
  • Avoid skipping meal. Skipping meals makes it hard for you and your baby to get all of the nutrients you both need.
  • Take a prenatal multivitamin every day.
  • Avoid foods which may be contaminated by bacteria.
  • Aim for 3 meals a day with healthy snacks in between.
  • First trimester: No extra calories. Normal healthy eating.
  • Second trimester: About 350 extra calories per day.
  • Third trimester: About 450 extra calories per day.
  • Breastfeeding: 350-400 extra calories per day.

Here are some examples of snacks that contain about 350 kcal:

  • Yogurt parfait – 3/4 cup yogurt, 1/2 cup berries, 1/2 cup granola

 

Here are some example of snacks that contain about 450 kcal:

  • 1 slice of whole wheat toast with 1 tbsp of natural peanut butter,  1 banana and 1 cup of milk

It is not recommended to lose weight or follow a weight loss diet during pregnancy.

BOTTOM LINE

Eating a healthy diet and staying active when pregnant ensures you and your baby receive the nutrients you need while maintaining healthy weight gain. If you look and feel healthy, just give yourself a break. One of the joys of pregnancy is be able to unbeaten those jeans and glory in the elastic waistband. There is no point in sucking in your stomach, or squeezing into a cocktail dress, or trying to look good in a bathing suit. You’ve got a bump, and that’s just how it is.

So, You’re having a baby? Contact Me, I can help you meet the nutrition needs of both you and your growing baby. 

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Things You Should Know about Gestational Diabetes (妊娠期糖尿病)

by with No Comment DiabetesFertility & Women's HealthMotherhood

Gestational Diabetes Mellitus (GDM 妊娠期糖尿病) is when you have high blood sugar during pregnancy. It means you are not able to make enough of a hormone called insulin (胰岛素). Insulin is made in your pancreases (胰腺), an organ located behind your stomach. Without enough insulin, your body can not properly use and store carbohydrate (碳水化合物 or sugar) from foods that you eat.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called Insulin Resistance. Insulin Resistance increases your body’s need for insulin. If your pancreases can’t make enough insulin, you will have gestational diabetes.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant, usually because they are overweight. These women start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

RISK FACTORS FOR GDM 

You are more likely to have GDM if you have one or more of the risk factors below:

  • Age over 35 years
  • Previous pregnancy with GDM
  • Previously delivery of large baby over 4 kg or 9 lbs
  • Someone in your family with diabetes (Parent, brother, sister with Type 2 Diabetes)
  • A previous stillbirth
  • Being overweight before pregnancy or gaining too much weight during your pregnancy
  • Being from a high risk ethnic group (Aboriginal, Hispanic, South Asian, Asian or African descent)
  • More than one baby in this pregnancy (twins, triplets)
  • Have a hormonal disorder called PCOS (Polycystic Ovary Syndrome)

HOW WILL GDM AFFECT MY BABY? 

If you have high blood glucose levels because your GDM is not under control, your baby will also have high blood glucose. Your baby’s pancreases will have to make extra insulin to control the high blood glucose. The extra glucose in your baby’s blood is stored as fat.

Untreated or uncontrolled GDM can cause problems for your baby, such as

  • Being born with a larger than normal body (a condition called macrosomia), which can make delivery difficult and more dangerous for your baby
  • Having low blood glucose (called hypoglycemia), right after birth
  • Having breathing problems (called respiratory distress syndrome)
  • Having a higher chance of dying before or soon after birth
  • Your baby will be more likely to become overweight and develop Type II Diabetes as he or she grows up

HOW WILL GDM AFFECT ME? 

GDM may increase your chances of:

  • Having high blood pressure and too much protein in the urine (a condition called preeclampsia) 
  • Have C-section due to large baby
  • May have gestational diabetes in your next pregnancy
  • Higher risk of having Type II Diabetes later in your life

Finding out that you have Gestational Diabetes can be scary. As a mother-to-be, following your management plan will help make sure you have a healthy pregnancy.

HOW IS GDM DIAGNOSED? 

Screening for GDM

Most pregnant women are screened between the 24th to 28th week of pregnancy. If you are at a high risk of GDM your doctor may screen earlier than 24 weeks, and again later if that test is negative.

Tests for GDM

At least one of the following tests are done to determine if you have gestational diabetes:

a) Screening test for GDM: is a 1 hour blood sugar measurement following a 50 gram carbohydrate drink, given at any time of day.

  1. If your blood sugar is less than 7.8 mmol/L, you DO NOT have GDM and no further testing is required.
  2. If your blood sugar is over 11.1 mmol/L, GDM is diagnosed and you will need treatment.
  3. If your blood sugar is 7.8-11 mmol/L, your MAY have GDM. Your will need a 75 gram Oral Glucose Tolerance Test (OGTT 75 g) to diagnose GDM.

b) 75 gram OGTT: measures fasting blood sugar after nothing to eat for 10 hour. Blood sugar is tested again 1 and 2 hours after you have been given a 75 gram carbohydrate drink. There are 2 possible results:

  1. You have GDM is two or more values below are met or exceeded
  2. You have Impaired Glucose Tolerance if one value below is met or exceeded.
  • Fasting blood sugar over 5.3 mmol/L
  • 1 hour blood sugar over 10.6 mmol/L
  • 2 hour blood sugar over 9 mmol/L

If you are diagnosed with either or these conditions you will need a management plan to help you have a healthy pregnancy.

MANAGEMENT PLAN 

Blood Sugar Target

You will be meeting with your team of dietitians, nurses, and doctor to discuss your management plan. You blood sugar targets are:

  • Fasting blood sugar (before breakfast): less than 5.3 mmol/L
  • 1 hour after meals: less than 7.8 mmol/L
  • 2 hour after meals: less than 6.7 mmol/L

Nutrition Management 

  1. Eat 3 meals and 3 snacks every day
  2. Spread carbohydrates over the day
  3. Limit sweet foods and drinks with added sugar
  4. Choose higher fibre foods more often
  5. Eat foods higher in protein at each meal and evening snack
  6. Get enough Calcium and Vitamin D from the foods and drinks you have every day
  7. Take multivitamin pill every day
  8. You can use sugar substitutes and foods with sugar substitutes in small amounts

Lifestyle Management 

  1. Gain a healthy amount of weight
  2. Be active every day

Are you having trouble to keep your blood sugar down during pregnancy? Contact Me, I can help you meet your blood sugar goal. 

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How to Choose a Prenatal Multivitamin?

by with One Comment Fertility & Women's HealthMotherhoodSupplementation

Thinking about getting pregnant? Since many pregnancies are not planned, all women who could become pregnant should take a daily prenatal multivitamin.

It is recommended to start taking your supplement at least 3 months before you get pregnant.

Your nutrient requirements are much higher during pregnancy, it is important that you start taking a prenatal multivitamin before you become pregnant to fill any nutritional gaps. You may say “I eat very healthy and balanced”, however, it’s impossible to meet all of your requirements with food alone. This doesn’t mean that you have to spend a lot of money on buying branded supplements from the health food store .

In fact, I often recommend generic brands from local pharmacies or supermarkets as long as the supplement is government regulated and it contains what it says it contains. So I will give you some tips and what to look for when buying a prenatal multivitamin.

FOLIC ACID 

Folic acid is super important to help prevent Neural Tube Defects (e.g., spinal bifida – when nerves in the spinal cord are exposed and damaged) in your baby. Choose a prenatal multivitamin that has 0.4-1.0 mg (400-1000 mcg) of folic acid.

Food High in Folic Acid: whole grain breads, leafy green vegetables, legumes (beans and lentils), citrus fruits and juices and most cereals (fortified with folic acid).

IRON

Your iron requirements increase during pregnancy. Your body makes an extra 2kg of blood during pregnancy. In your third trimester of pregnancy, your baby is building iron stores for the first six months of his or her life. Therefore, you need more iron to make the extra blood and to help your baby store enough iron.

When you’re pregnant, it is very difficult to get the amount of iron you need just from diet alone, so choose foods high in iron and take a prenatal multivitamin containing iron (16-20 mg). Your body absorbs iron from meat, poultry, and fish better than iron in other foods. To increase iron absorption, eat a food containing Vitamin C (e.g., strawberries or oranges) and food containing iron at the same time. For example, have vegetables with meat (e.g., chicken stir-fry) or have an orange with a bowl of oatmeal. Coffee and tea can interfere with iron absorption. Limit these drinks and have them between meals rather than at meals.

Best Sources of Iron: beef, pork, chicken, lamb, fish, sardines, shrimp, oysters, mussels.

Good Sources of Iron: legumes (lentils, beans, chickpeas), tofu, whole grain and enriched cereals.

Anemia during pregnancy has been linked to decreased weight gain, preterm birth and babies with a low birth weight. If you become anemic during pregnancy (which is very common), your doctor or dietitian may recommend an additional iron supplement. Iron supplements can make you constipated, so be sure to increase your intake of fibre and fluids.

CALCIUM

Your calcium needs are very high during pregnancy. Calcium helps keep your bones strong. It also helps your muscles and nerves to work properly and helps your blood to clot. During pregnancy, calcium helps your baby build strong bones and teeth.

Most prenatal multivitamins contain about 300 mg of calcium. A prenatal multivitamin will not support all of your calcium needs, so it is important that you’re including calcium rich foods in your diet.

Food High in Calcium: milk, yogurt, calcium-fortified beverages such as soy, rice or orange juice.

Other Food Sources of Calcium: cheese, canned salmon or sardines with bones, tofu made with calcium.

VITAMIN D

Vitamin D is important in pregnancy. It helps keep your bones strong and builds strong bones in your baby (enhance calcium absorption). It also helps your baby build vitamin D stores to use during his or her first few months.

If you have a dark skin, cover most of your skin with clothing or sunscreen, don’t go outside very often or don’t eat very many vitamin D rich foods (see below) you may need to take extra vitamin D supplement.

Food High in Vitamin D: milk, fortified soy beverages, fish such as salmon, trout, herring, Atlantic mackerel, sardines, and Vitamin D fortified orange juice.

Not all milk products are high in vitamin D. In Canada, milk, margarine and some yogurts have vitamin D added to them. In Malaysia, please check you nutrition fact label.

VITAMIN A

Too much Vitamin A can cause birth defects in your baby. If you are taking a prenatal multivitamin (which has vitamin A included), do not take any additional vitamin A supplements. You will get enough Vitamin A from a combination of your food (e.g., carrots, broccoli and squash) and your prenatal multivitamin.

BOTTOM LINE

Healthy eating and taking a prenatal multivitamin helps you prepare a healthy pregnancy. Do not take more than 1 daily dose of a prenatal multivitamin. Supplement do not take the place of food and healthy eating. If you are vegan, on a restricted diet, food allergies or you avoid certain foods, you may be missing important nutrients you and your baby need. Talk to you doctor or dietitian.

So, You’re having a baby? Contact Me, I can help you meet the nutrition needs of both you and your growing baby. 

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Foods to Avoid During Pregnancy

by with One Comment Fertility & Women's HealthMotherhood

A healthy, well-balanced diet is important during pregnancy. Most fresh foods are completely safe for pregnant women, however, some foods should be avoided during pregnancy or if you’re trying to conceive, because most pregnancies are unplanned. I’ve compiled a list of foods to avoid during pregnancy to serve as a quick guide.

WHY WE SHOULD AVOID THESE FOODS DURING PREGNANCY? 

Food may carry germs that can make you sick. Your ability to fight off infections is decreased when you’re pregnant. Food poisoning (Food-Borne Illness) can also affect your unborn baby, such as listeriosis (李斯特菌病), salmonellosis (沙门氏菌病), toxoplasmosis (弓形虫病), campylobacteriosis (弯曲杆菌病). Handling, preparing and storing food properly can reduce the chance of getting sick from food poisoning.

Pregnant women are 10 times more likely than other people to get Listeria infection. Listeria infection can cause miscarriage, stillbirths, and preterm labor (here).  

Raw or Undercooked Meat

Raw or Undercooked Meat

All meat needs to be thoroughly cooked during pregnancy because of the risk of infection from several bacteria or parasites, including, Salmonella (沙门氏菌), E.Coli  (大肠杆菌), Listeria (李斯特菌) and Toxoplasma (弓形虫).

Try to cook meat, poultry and fish to a safe internal temperature and avoid contamination through cutting boards and cooking utensils as well.

  • ground beef 71°C (160°F )
  • poultry 74°C (165°F)
  • Fish 70°C (158°F)

Raw or Undercooked Seafood and Raw Shellfish

Raw or Undercooked Seafood and Shellfish 

Raw or undercooked fish (including sushi, sashimi), especially raw shellfish (raw oysters, mussels and clams), should be avoided during pregnancy because of potentially harmful bacteria (Listeria) and parasites.

Smoked seafoods are safe to eat when they are an ingredient in a cooked meal such as casserole (as it reaches an internal temperature of 74°C (165°F) to kill harmful germs). So, it is safe to eat smoked seafood during pregnancy if it is canned, shelf-stable or an ingredient in a casserole or other cooked dish.

A cooked sushi is fine.

Deli Meats and Hotdogs

Deli Meats and Hotdogs

It’s advised to avoid all deli meats and hotdogs, if possible, due to potentially contaminate with Listeria. This bacteria can be killed through heat, so if you still want to eat deli meat during pregnancy, be sure to heat the meat until it’s steaming hot, at least 74°C (165°F).

The middle of the hot dog should be steaming hot or 74°C.

Another reason to avoid these foods is the effects of nitrites on a developing fetus are still unknown (deli meats and hotdogs often contain these ingredients).

Raw or Undercooked Eggs

Raw or Undercooked Eggs

Eating raw or undercooked eggs can put pregnant women at an increased risk of Salmonella poisoning. Make sure both the yolk and white are cooked through. Certain sauces, spreads and drinks such as homemade Caesar salad dressing, hollandaise sauce, homemade mayonnaise, unpasteurized eggnog, Tiramisu,  custards and homemade ice cream may contain raw eggs.

It is recommended the use of pasteurized egg products when a recipe calls for raw eggs. 

Unpasteurized Dairy Products and Juices

Unpasteurized Dairy Products and Juices

Raw (unpasteurized) milk is milk from any animal (goat, cow, etc) and has not been pasteurized to kill harmful bacteria. Raw milk may contain bacteria such as Campylobacter, E.coli, Listeria, Salmonella, or Toxoplasma. To avoid getting these food borne illnesses, only consume pasteurized milk.

Avoid unpasteurized soft semi-soft, blue-veined cheese such as Feta, Brie, Camembert, havarti, Queso blanco, Queso fresco and Panela unless they’re made with pasteurized milk. These cheese made with unpasteurized milk may contain Campylobacter and Listeria. It is important to read labels carefully, to make sure that the milk being used in these products has been pasteurized. Instead of eating soft cheese, eat hard cheese such as Parmesan, cheddar or Swiss.

Homemade ice cream are made with an egg-based custard that isn’t completely cooked. If you are using pasteurized eggs are okay. Commercially manufactured ice cream is typically fine.

Also, avoid unpasteurized juices such as unpasteurized apple cider. Double check fresh pressed juice and cold pressed juice to be sure. Home-squeezed juices are safe if the vegetables and fruits are washed in cold, running water. I’m a bigger fan of smoothie during pregnancy because you can pack so much more nutrition into them, and you can get the fibre part of the fruits and veggies, not just the juice.

If the cheese is coming in from another country, it may not be pasteurized. 

Low Mercury Fish

High Mercury Fish

Fish offers many health benefits to both pregnant mothers and their unborn babies. Fish is a good source of protein and healthy fats that help the development of your baby’s brain and eyes.

Eat at least 2 servings of fish per week. 

Mercury is toxic to a developing fetus and can linger in a woman’s blood stream for over a year.

Check out FDA Chart

High Mercury Fish:

  • swordfish (旗鱼)
  • tilefish (方头鱼)
  • king mackerel (鲭鱼)
  • shark (鲨鱼)
  • marlin (马林鱼)
  • orange roughy
  • canned white tuna (Albacore) (大眼金枪鱼)

Low Mercury Fish:

  • salmon (三文鱼)
  • trout
  • herring (鲱鱼)
  • sardines (沙丁鱼)
  • pollock (Boston bluefish)
  • sole (鳎目鱼)
  • flounder
  • anchovy (凤尾鱼)
  • char
  • hake
  • mullet
  • smelt
  • Atlantic mackerel (大西洋马鲛鱼)
  • cod
  • catfish
  • tuna (light canned)/skipjack tuna (罐装金枪鱼)

Raw Sprouts 

Raw sprouts including alfalfa, clover, radish or mung bean sprouts may be contaminated with Salmonella or E.coli. According to FDA, cook sprouts thoroughly can kill harmful bacteria and reduce the risk of illness.

Unwashed Vegetables and Fruit

Unwashed Vegetables and Fruit 

It’s important to make sure that your vegetables are thoroughly washed to avoid any risk of Toxoplasmosis, because the soil in which vegetables are grown may be contaminated with E.coli or Salmonella.

Eat at least 4-5 servings of vegetables per day and 2-3 servings of fruit per day while pregnant (as well as when you aren’t pregnant). Keep cut vegetables and fruit in the fridge.

Flax Seeds and Flaxseed Oil

Flax seed may adversely affect pregnancy due to its mild extrogenic effects but there is insufficient reliable clinical evidence about the effects of flax seed on pregnancy outcomes (here). There is some evidence about the flaxseed oil is associated with an increased risk of preterm birth. Due to the insufficient evidence, flax seed should be avoided in very large quantities and flaxseed oil should be completely avoided during pregnancy, but it is still safe to consume flax seed in the amounts commonly found in foods, such as flax seed bread.

Artificial Sweeteners 

Artificial sweeteners are ingredients that add sweetness to foods. Sweeteners are ingredients in soft drinks, desserts, candies, and pastries. Moderate use of artificial sweeteners during pregnancy is considered safe. It is recommended that pregnant women avoid excessive consumption of products containing artificial sweeteners as such food could replace nutrient dense, energy-yielding foods. So far, Saccharin (Hermesetas®) and Cylamate (Sugar Twin®, Sweet N’Low®) are not safe to use during pregnancy (here).

Pregnancy and Liver

Liver

Liver is rich source of iron. However, it contains a high level of Vitamin A. Large amounts of Vitamin A can be harmful to the baby (here).

Limit liver to 75g (2.5 oz) every two weeks. 

Pregnancy and Alcohol

Alcohol

Drinking alcohol can be harmful to the baby. No one knows what level of alcohol is safe for an unborn baby.

While you’re pregnant, or thinking about becoming pregnant, it’s safest not to drink any alcohol. 

Alcohol is passed from the mom through the placenta to the growing baby. Baby’s liver is not capable of breaking down alcohol, increasing the risk of miscarriage, preterm labor, low birth weight, and Fetal Alcohol Spectrum Disorder (FASD) that can lead to growth problems, development delays, learning disabilities, and deformed facial features.

Alcohol used in cooking, such as Chinese rice wine, may be safe to consume if the food has been simmered or baked for at least an hour.

Caffeine

Caffeine has been associated with miscarriage, especially during the first trimester. However, small amounts of caffeine during pregnancy are fine for most people.

Limit your caffeine intake to about 300 mg per day or less (no more than 500 mL or 2 cups).

High caffeine intake during pregnancy has been shown to increase the risk of low birth weight and impaired fetal growth. Caffeine is also found in tea (green and black teas contain about 30-50 mg per 250 mL or 1 cup), cola (23-40 mg per 250 mL or 1 cup), and chocolate (3-50 mg per 1 bar).

Herbal Teas 

You may be thinking you should switch to herbal tea if you’re trying to cut back on caffeine, but that may not necessarily be your best pregnancy drink. Herbal teas can be made with fresh or dried flowers, leaves, seeds and/or roots.

Even though tea is all “natural”, the research on herbal tea is sparse and in some cases, there is concern that if consumed in excess, it could be problematic for a wide range of reasons. Some herbal products may stimulate uterine contractions, or increase the risk of birth defects. Again, it’s likely just a concern if you’re drinking large amounts daily, but always speak to your doctor first before making anything a regular part of your routine. (here, here).

BOTTOM LINE

Although there are foods to limit or avoid during pregnancy, the most important consideration is providing a nutritious prenatal diet.

Information adapted from Food Safety for Pregnant Women

Did you know that I provide one-on-one nutrition counselling services? If this is something you’d like to learn more about, check out my service.