The Importance Of DHA For Mom And Baby

The Importance Of DHA For Mom And Baby

by with No Comment Fertility & Women's HealthInfant NutritionMotherhoodToddler Nutrition

When considering the most important nutrients for pregnant moms, many people immediately think of folic acid, iron, and perhaps Vitamin D. Similarly, when it comes to nutrients crucial for babies starting solids, iron often tops the list. While these are indeed essential, there’s another vital nutrient that deserves attention for its role in growth and development: Omega-3s, particularly DHA.

DHA is essential for brain and eye development in babies, and it supports heart health, mood stability, and cognitive function in moms. Let’s dive into why DHA is so important for both mom and baby.

 

OMEGA-3S

Not all omega-3 fatty acids are created equal. Among the 11 types, the three most important are ALA, EPA, and DHA.

  1. Alpha-Linolenic Acid (ALA): ALA is the most common omega-3 fatty acid in the our diet and is primarily found in plant-based sources such as walnuts, seeds (flax, chia, hemp) and oils (canola, soybean, walnut, flaxseed). ALA is a an essential fat because it cannot be made by the body and is needed for normal human growth and development. While ALA can be converted into EPA and DHA, this conversion process is quite inefficient in humans.
  2. Eicosapentaenoic Acid (EPA): EPA is found primarily in fatty fish and seafood. It plays a significant role in reducing inflammation throughout the body, which is crucial for preventing chronic diseases such as heart disease and arthritis. EPA also has benefits mental health, potentially reducing symptoms of depression.
  3. Docosahexaenoic Acid (DHA): DHA is a key structural component of the brain, retina, and many other parts of the body. It is essential for brain development and function, making it particularly important during pregnancy and early childhood. DHA can be obtained either through conversion of ALA or directly from food sources rich in DHA, such as fatty fish, seafood or DHA-fortified foods.

 

THE CONVERSION OF ALA TO DHA

While ALA can be converted into EPA and then DHA, this conversion process, which primarily occurs in the liver, is highly inefficient, with rates reported to be less than 15%.

Additionally, studies have shown that increasing ALA intake during pregnancy does not significantly raise DHA levels in the blood (here, here). Therefore, consuming foods rich in DHA directly (or DHA supplements) is crucial for ensuring an adequate supply of this essential nutrient during pregnancy, supporting both maternal and fetal health effectively.

The active form of DHA found in foods is more beneficial than the converted form from ALA.

 

WHY IS DHA IMPORTANT DURING PREGNANCY?

DHA plays a crucial role in the development of a fetus’s cell membranes, particularly in the brain and retina. Ensuring adequate DHA intake during pregnancy and the first few years following birth is therefore very important. Prior to birth, the DHA required for proper fetal development is provided by placental transfer from the mother. Following birth, babies must receive DHA through breast milk, formulas fortified with DHA, or DHA supplementation (e.g., fish oil).

  1. Brain Development: Throughout pregnancy, DHA requirements increase, especially during the third trimester. As pregnancy progresses, maternal blood volume expands, and both the placenta and the developing baby require more DHA. Therefore, DHA is required to support fetal growth and brain development, especially during the third trimester when the fetus undergoes a rapid “brain growth spurt.”
  2. Eye Development: DHA is also essential for the development of the eyes, as it is the major fatty acid found in the retina, constituting approximately 93% of all omega-3 fatty acids. This high presence of DHA underscores its significance in eye health and visual development.

Studies indicate that during the last trimester, a fetus receives approximately 67 mg of DHA daily from the mother. This requirement increases to 70-80 mg daily during breastfeeding. The substantial demand for DHA during pregnancy and breastfeeding can deplete the mother’s DHA stores to below pre-pregnancy levels by up to 50%, and it can take months to partially replenish these levels. This depletion may pose health risks for the mother, including postpartum depression.

Research has demonstrated that sufficient DHA intake during pregnancy results in several positive outcomes for babies, such as better social behaviour, higher social development scores, enhanced verbal intelligence and reduced risk of pre-term labor, pre-eclampsia, and low birth weight.

 

RECOMMENDATIONS FOR PREGNANT MOMS

When it comes to recommendations for omega-3s, the guidelines can vary depending on the source. To help clarify, I’ve summarized some of the key recommendations below:

The Ministry of Health Malaysia (RNI)

  • 200mg DHA daily

American Pregnancy Association

  • 300 mg DHA daily
The American College of Obstetricians and Gynecologists (ACOG) encourages pregnant women, women who may become pregnant, and breastfeeding mothers to follow the FDA and EPA (US Environmental Protection Agency)’s advice:
  • Consume 2-3 servings of low mercury fish per week, 8-12 ounces of fatty fish in total.

RECOMMENDATIONS FOR MOMS: 

Those who are pregnant or breastfeeding should aim to consume 200 to 300 mg of DHA each day, which means eating 8 to 12 ounces (2 to 3 servings) per week of a variety of fish lower in mercury.

RECOMMENDATIONS FOR BABIES AND TODDLERS

The Institute of Medicine (IOM) has not established specific intake recommendations for EPA and DHA. The current recommendations for total omega-3s intake for babies aged 0-12 months is 0.5g per day, and for toddlers aged 1-3 years old, the recommendation increases to 0.7g ALA per day. These targets can be met if the mother is adhering to her recommended DHA intake and breastfeeding.

American Pregnancy Association

  • Infants (1-18 months & < 15 lbs): 32 mg/lb EPA + DHA
  • Children (1.5-15 years): 15 mg/lb EPA + DHA

FDA

Children should consume two servings of fatty fish per week.

  • A serving size is about:
    • Ages 1-3 years: 1 ounce
    • Ages 4-7 years: 2 ounces
    • Ages 8-10 years: 3 ounces
    • 11 years and older: 4 ounces

RECOMMENDATIONS FOR CHILDREN: 

  • Offer ultra-low mercury fish weekly, aiming for at least 2 x 1 oz. servings of DHA rich options per week.
  • Offer low mercury fish once every two weeks.
  • Offer moderately high mercury fish once every month.
  • Avoid high mercury fish for babies altogether.

 

THE FOOD SOURCE OF DHA

DHA is primarily found in fatty fish and shellfish such as salmon, herring, sardines, and trout. However, it’s important to be mindful of mercury levels, especially for pregnant women and children.

High-mercury fish like fresh/frozen tuna (big eye), tilefish, shark, swordfish, king mackerel, marlin, and orange roughy should be completely AVOIDED  during pregnancy and up to 2 years old for your baby’s safety.

But don’t worry, there are plenty of low-mercury fish options packed with DHA to help you meet your nutritional needs.

ULTRA LOW-MERCURY FISH  

Here are some ultra-low mercury fish (0.06 ppm of mercury or less) and rich in DHA. Offer these fish as often as you like, aiming for at least twice per week.

**The fish in bold are high in DHA with at least 0.4g DHA/100g** (reference)

  • Anchovies 江鱼仔
  • Atlantic mackerel 大西洋鲭鱼
  • Black sea bass 黑鲈鱼
  • Butterfish 奶油鱼
  • Catfish 鲶鱼
  • Clam 蛤蜊
  • Crawfish 小龙虾
  • Flounder 比目鱼
  • Haddock (Atlantic) 黑线鳕
  • Mullet 鲻鱼
  • Oyster 牡蛎/生蚝
  • Plaice 欧蝶鱼
  • Pollock 狭鳕
  • Salmon (Atlantic farmed, fresh, canned) 三文鱼
  • Sardine 沙丁鱼
  • Scallop 扇贝
  • Shad 西鲱
  • Shrimp 虾
  • Smelt 胡瓜鱼
  • Sole 鳎鱼
  • Squid 鱿鱼
  • Tilapia 罗非鱼
  • Trout, freshwater 淡水鳟鱼
  • Whiting 怀廷鱼

LOW MERCURY FISH 

Offer low mercury fish (0.07 and 0.15 ppm of mercury) once every two weeks.

  • Atlantic croaker
  • Cod 鳕鱼
  • Crab 螃蟹
  • Hake 无须鳕
  • Herring 鲱鱼
  • Lobster (American and spiny) 龙虾（美洲和刺龙虾）
  • Pacific chub mackerel 太平洋黑鲭鱼
  • Perch (freshwater and ocean) 鲈鱼（淡水和海洋）
  • Pickerel 狗鱼
  • Skate 鳐鱼
  • Canned light tuna 罐装淡金枪鱼
  • Whitefish 白鱼
  • Buffalo fish 牛鱼
  • Carp 鲤鱼
  • Sheepshead 羊头鱼
  • Tilefish (Atlantic Ocean) 方头鱼（大西洋）

MODERATELY HIGH MERCURY FISH 

Offer moderately high mercury fish (0.16-0.25 ppm) once every month.

  • Halibut 大比目鱼
  • Mahi mahi 鲯鳅鱼
  • Monkfish 安康鱼
  • Snapper 红鲷鱼
  • Spanish mackerel 西班牙鲭鱼
  • Striped bass 条纹鲈鱼
  • Weakfish / sea trout 海鲂鱼

HIGH MERCURY FISH 

The following fish, with mercury levels between 0.25 and 0.45 ppm, are considered very high in mercury and should be completely avoided for babies and pregnant moms.

  • King mackerel 鲭王鱼
  • Marlin 枪鱼
  • Orange roughy 橙鲷
  • Shark 鲨鱼
  • Swordfish 剑鱼
  • Tilefish (from Gulf of Mexico) 方头鱼（墨西哥湾）
  • Big eye tuna 大眼金枪鱼
  • Bluefish (Atlantic) 蓝鱼（大西洋）
  • Chilean sea bass 智利海鲈鱼
  • Grouper 石斑鱼
  • Sablefish 黑鳕鱼
  • Tuna albacore / white tuna, canned 长鳍金枪鱼 / 白金枪鱼，罐装
  • Tuna albacore / white tuna, fresh/frozen 长鳍金枪鱼 / 白金枪鱼，新鲜/冷冻
  • Tuna yellowfin 黄鳍金枪鱼
  • White croaker / Pacific croaker 白石首鱼 / 太平洋石首鱼

 

NOT A FISH EATER OR PICKY EATER

If you find it challenging to consume fish regularly during pregnancy or you have a picky eater at home, consider omega-3 enriched eggs, which typically provide 75-100mg of DHA per serving.

 

FOR FORMULA-FED BABIES 

For babies who haven’t started solids yet, they rely on breastmilk or formula for their DHA needs. If you’re breastfeeding, prioritize consuming DHA-rich foods to benefit both you and your baby. If formula feeding, opt for a formula with approximately 11.5 mg/100 mL of DHA, similar to the average level found in breast milk. This ensures your baby receives adequate DHA for healthy development.

 

EPA+DHA OR DHA ONLY

A common question is whether babies need both EPA and DHA or just DHA. While EPA is important for immune and heart health at any age, it isn’t stored in significant amounts in the brain and retina. DHA, on the other hand, is crucial for early development, especially for the brain and eyes. This is why healthcare professionals often emphasize DHA when talking about omega-3s during pregnancy and early childhood. However, since healthy fats support overall brain health and neural connectivity, it’s beneficial for babies to have adequate levels of both EPA and DHA.

IF YOU EAT FISH, DO YOU STILL NEED DHA SUPPLEMENTS?

You might wonder if consuming fish provides enough DHA, do you still need to take DHA supplements as part of your plan for nutrition during pregnancy.

Pregnant and lactating women should consume 2-3 servings  of a variety of fish weekly. However, even with this recommendation, you may not reach the desired DHA levels. The DHA content varies across fish species, and commonly consumed fish in Malaysia, like Indian mackerel (kembong), anchovies (ikan billis), yellow-tail and yellow-stripe scads (selar kuning), tuna (tongkol), torpedo scads (cincaru), Indian and short-fin scads (selayang), pomfret (bawal), red snapper (merah), king mackerel (tenggiri), merine catfish (jahan) and stingray (pari) have lower DHA levels compared to fish like salmon, herring, or canned white tuna.

In light of this, DHA supplementation offers a convenient solution to ensure you meet your daily DHA requirements. It simplifies monitoring your DHA intake, guaranteeing adequate levels each day, irrespective of variations in fish consumption.

Cod liver oil contains fish oil but because it also contains vitamin A, it should be AVOIDED in pregnancy.

 

WHAT ABOUT VEGAN? 

Since fish is not a part of vegan diets and may also be excluded from certain vegetarian diets, obtaining enough DHA solely through diet can be challenging. While fish remains the best source of DHA, there are plant-based alternatives (ALA) such as walnuts and flax seeds that are rich in Omega-3 fatty acids.

Unfortunately, the conversion of ALA to DHA is inefficient, making it difficult to obtain adequate levels solely from plant-based sources. Therefore, I recommend considering an Omega-3 supplement containing at least 200 mg/day to ensure sufficient DHA intake. Additionally, for those following a vegan lifestyle, there are now vegan-friendly DHA supplements (Microalgae Oils) available, derived from algae rather than fish, providing a reliable source of this essential nutrient without compromising dietary preferences.

 

WHAT ABOUT ALLERGIC TO FISH?

Finned fish and shellfish are considered two different top allergens. Finned fish include species like salmon, cod, and sardines, while shellfish include shrimp, crab, and lobsters.

If your child is allergic to shellfish, it doesn’t necessarily mean they will be allergic to finned fish, as the two are biologically different. Both types of fish should be introduced EARLY and OFTEN when your child shows all signs of developmental readiness for starting solids, typically around six months.

Fish is among the top 9 allergens. For detailed guidance on introducing allergen-containing foods, refer to my post on How to Prevent Food Allergy When Starting Solids.

Also, fish bones can be a choking hazard. Be sure to carefully check for bones when offering fish to your baby!

 

HOW TO CHOOSE AN OMEGA-3 SUPPLEMENT 

There are various omega-3 supplements available on the market, when it comes to choosing an omega-3 supplement for your child, there are several important factors to consider:

1. Quality and Purity

  • Third-Party Testing: Ensure the fish oil manufacturer provides documentation of third-party lab results showing the purity levels of their fish oil, down to the particles per trillion level.
  • Manufacturing Standards: Check the quality standards the manufacturer uses. Reputable standards include the Norwegian Medicinal Standard, the European Pharmacopoeia Standard, and the Council for Responsible Nutrition’s 2006 monograph. These standards guarantee quality by setting maximum allowances for toxins.

2. Form of the Supplement

  • Child-Friendly Forms: Since children often find capsules difficult to swallow, look for omega-3 supplements in the form of jelly, oil, gel capsules, or chewable tablets.
  • Gummies Caution: Fish oil gummies are popular, but the typical dosage required to meet daily omega-3 needs might be high, leading to a high sugar intake and potential cavities. Be cautious of this and try to balance with other low-sugar options.

3. Dosage and Safety

  • Age Appropriateness: Choose a supplement suitable for your child’s age. Always follow the instructions on the package and do not exceed the suggested dosage.
  • Avoid Choking Hazards: For children under 3 years of age, avoid giving capsules as they are a choking hazard. Opt for gummies or liquid forms instead.

4. Source of the Supplement

  • Refined Oils vs. Fish Liver Oils: Purchase supplements made from refined oils from the flesh of fish rather than fish livers. Cod liver oils, which contain fish oil, vitamin D, and pre-formed vitamin A (retinol), can be problematic due to the fat-soluble nature of vitamin A. Excessive intake can cause serious health issues. Different brands contain varying amounts of vitamin A, so be mindful of the Recommended Dietary Allowance (RDA) for your child’s age:
        • 1 to 2 years: 250 mcg
        • 3 to 6 years: 300 mcg
        • 7 to 10 years: 400 mcg
        • 10 to 12 years: 575 mcg

 

BOTTOM LINE

In addition to their well-known benefits for heart health, cholesterol levels, and brain function, omega-3 fatty acids are especially important during pregnancy and infancy. DHA, a type of omega-3, is vital for the development of the fetal brain and eyes, particularly in the third trimester and early childhood.

Omega-3 fatty acids play a crucial role in promoting various aspects of overall health, including heart health, cholesterol levels, and brain function.

 

References: 

  1. https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/chemical-contaminants/environmental-contaminants/mercury/mercury-fish-questions-answers.html
  2. https://www.who.int/news-room/fact-sheets/detail/mercury-and-health
  3. https://seafood.oregonstate.edu/sites/agscid7/files/snic/omega-3-content-in-fish.pdf
  4. https://www.fda.gov/food/consumers/advice-about-eating-fish
  5. https://www.fda.gov/food/environmental-contaminants-food/mercury-levels-commercial-fish-and-shellfish-1990-2012
the-prolonged-breast-milk-jaundice-journey-two-months-photo

The Prolonged Breast Milk Jaundice Journey (Two Months)

by with No Comment Motherhood

经常在社交媒体的群组里看到父母们为了刚出世就全身泛黄的小宝宝在发文求救，寻求最快退黄疸方式。身为父母的我们，每当听到小宝宝扎针抽血时的哭喊声，一定会心如刀割，心急如焚。所以才会到处寻找各种偏方，希望宝宝少受一点扎针之苦。

7年前的第一胎，曾经历长达两个月的母乳性黄疸。所以这一胎，我已提前为肚子里的两个宝宝即将会经历黄疸治疗做好一切的心理准备。

我的双胞胎宝宝终于在5月15日来到了我们的身边。

相信有follow我的 IG 的小伙伴们一定知道，我在过去的两个月里到低经历了什么。我们在COVID-19疫情最严峻的时期频密的往返 KK (Klinik Keshitan)，带宝宝们各种验血验尿，两次进院照灯，最终被refer到了巴生中央医院 (HTAR) 的儿科专科。

新生儿黄疸 (Neonatal Jaundice, NNJ)，正常吗？

新生儿的红血球(Hemoglobin)比成人多，它们的寿命也不长。当新生儿出生后，开始哭泣呼吸，肺循环须提供充分的氧气，这时体内过多的红血球因而被破坏。红血球被分解后，产生未结合胆红素(Unconjugated Bilirubin)。所以这意味着，这时新生儿体内会产生很多的胆红素。一般，胆红素不会引起黄疸，因为肝脏会代谢它并将其排出到肠道中。可是，因为新生儿肝功能尚未成熟，未结合胆红素无法有效经由肝脏代谢排出体外，因此沉积在皮肤表面而导致皮肤甚至巩膜(sclera)变成黄色。所以，黄疸是新生儿时期正常的生理现象。

新生儿黄疸分为生理性及病理性。

生理性黄疸 (Physiological Jaundice)

一般来说，足月宝宝的生理性黄疸通常是在出生后2~3天才出现的，第4天至5天达高峰期，一星期后就会慢慢消退，消退的时间一般不会超过2周。早产儿因为代谢能力差，黄疸消退的时间可能拖比较久，可延长至3周之久。 生理性黄疸通常不需要特殊治疗，除非黄疸出现过早或升高的速度太快、胆红素指数偏高。一般，父母只需在家观察，继续母乳喂养，1-2周后黄疸就会慢慢消退，不会对宝宝造成任何伤害。这就是为什么有些宝宝在满月前黄疸指数就已恢复安全水平，无需天天跑KK验血。

病理性黄疸 (Pathological Jaundice)

如果孩子出生后24小时内出现黄疸，或者黄疸发展迅速、甚至有贫血、体温异常、呕吐、大小便颜色异常（大便颜色是浅灰白，浅黄色，浅绿色；小便颜色是Teh-O色）、不爱喝奶、嗜睡，消退后又复发或者持续时间长，这种多属病理性黄疸，应立即就诊。 因为我曾有GBS positive 的病史，虽然在剖腹产手术前已施打了抗生素，为了安全起见，在出生后，当天晚上弟弟就安排入NICU观察，姐姐则安排在SCN (Special Care Nursery) 观察。第二天一早，弟弟已被transfer回SCN。吃了早餐，我就到SCN探望两个宝宝。  和医生沟通后，宝宝们都很健康，为了排除细菌感染或败血症(sepsis)，需要等待验血报告，另外我特意交代医生一定要观察宝宝们是否有黄疸。 不出我所料，午饭后，我回到SCN 时，宝宝们已经在进行照光治疗(Phototherapy)，所以暂时不能出院。

Audrey
Avery

接着，验血报告显示没有细菌感染，但是宝宝们有黄疸，需要继续照光治疗。在医院呆了4天3夜，医生让我们出院回家，并交代说一定要到住家附近的KK预约回诊，并接受黄疸检查。

Heel Prick Test

在回KK复诊期间，宝宝会被安排做Heel Prick Test。KK 的医生一直会重复的问宝宝的大便和小便的颜色和次数？喝母乳or配方奶？多久喝奶一次？一次喝多少？父母们在家必须把这些给记录好。同时也会检查宝宝的体重， 确保宝宝的体重没有下降

(here)。 

延长性黄疸 (Prolonged Jaundice) 

足月宝宝出生后14天或早产儿出生后21天，黃疸仍旧持续，皮肤和眼白部分比较黄。延长性黄疸通常无害，大多数是因为母乳性黄疸 (Breast Milk Jaundice)，但有些也可能起源于其他病理问题(溶血性黄疸或感染性黄疸)。 两次的入院照光治疗是day 7 和 day 14。需要入院的胆红素水平是257 umol/L以上，而宝宝们的指数也超过了这个level。宝宝们的胆红素水平在照灯治疗后都有显著的下降。可是过后的几天回到KK验血，胆红素水平又往上飙。就这样我们风雨无阻的往返KK验血。 因为持续性黄疸，宝宝们的日龄也已超过了21天，这时KK的医生安排宝宝们采集血液样本和尿液样本来排除其他延迟性黄疸的可能原因，例如泌尿道感染 (UTI)，败血症(Sepsis) ，甲状腺功能低下 ，肝功能衰竭。 引起黄疸的另一个比较严重的原因是肝脏问题：胆道闭锁 (Biliary Atresia) 胆道闭锁 (Biliary Atresia) 是肝脏通向肠道的胆管受到损伤，阻滞了胆汁流出肝脏。若及早发现，可在在60天以内做手术以恢复胆汁引流，以減少死亡或换肝的机率。 这就是为什么 KK 的护士会死缠烂打，穷追不舍，天天打电话来问宝宝的黄疸指数是多少，确定宝宝的黄疸指数下到安全水平才会罢手！

因为延长性黄疸， 所以宝宝们也被refer到了巴生中央医院的儿科专科。来到中央医院也免不了抽血验尿。抽血比在KK 用的Heel Prick Test更加准确。两个宝宝小小的手被无数的针孔扎过，站在门外听到宝宝哭，我只能和老公互相安慰。在排除了以上提到的潜在风险后，两个宝宝体重增加正常，纯母乳喂养，排便次数多，排便量大，尿液清澈，总体情况良好。医生最后告诉我，应该是母乳性黄疸。

母乳性黄疸 (Breast Milk Jaundice) 

一般喝母乳的新生儿，黄疸会持续比较久，这是因为母乳中含有一种女性荷尔蒙，会抑制新生儿肝脏酵素的活性，使其无法代谢处理胆红素，导致持续性的黄疸。 另一方面可能因为新生儿一开始喝母乳，奶量还不是很多，当摄取奶量不足时，可能出现轻微脱水，便便排出延迟，增加肠、肝循环，血液中未结合胆红素增加而出现黄疸。 在这个时候，很多妈妈听到 “母乳性黄疸” 会想要马上停止母乳喂养。

NO! NO! NO!!

事实上，解决母乳性黄疸的方法就是母乳本身！黄疸会随着时间慢慢消退，母乳性黄疸的宝宝应继续母乳喂养。

偏方有用吗？

如今网络媒体资讯发达，在各个群组里，我还是会时不时看到一些完全没有科学根据的 “退黄偏方”。上一胎，因为是新手妈妈，人在国外坐月子，当时宝宝黄，心急如焚的家人到处问人，而以下这几种方式是最多人建议的：

  • 喂宝宝喝羊奶？
  • 喂宝宝喝青葡萄汁？
  • 用黑狗啤酒给宝宝洗澡？
  • 用特制药材包给宝宝洗澡？
  • 坐月子期间不要吃黄色的食物？不要给宝宝穿黄色的衣服？

当然，“退黄偏方” 不只这几种方法而已，只要你在社交媒体的群组里发一个求救贴，底下一定会有很多“我试过了xxx” ”这个对我宝宝有效，黄很快退了” “给宝宝喝XX” 等等的留言。 如果你把前面的文字已读明白了也了解了什么是新生儿黄疸，今天不管你在网上看到，还是听谁谁谁推介超级有效退黄偏方，你都不会随便尝试，因为你知道只有母乳才能解决母乳性黄疸，只是退黄的时间会比较久。

坐月饮食需要戒姜戒中药吗？

在宝宝出生前，我已经和来帮我做月子的老妈说好月子餐要清淡一些，可用姜烹煮，但无需大量使用姜。另外因为需要哺乳+亲喂，暂时也不吃/喝有酒精的食物。在整个做月子期间，不管我是有吃还是没吃姜，酒， 中药，红枣水，宝宝们的胆红素水平还是持续上升，完全不受我的饮食影响。

到目前为止，没有证据表明生姜和黄疸之间存在直接关联；熟食中的酒精本身也不会引起黄疸。红枣水含有丰富的铁和维生素，做月子期间/哺乳都需要大量的摄取水分，所以多补充水分并没有害处。

总而言之，我在整个月子期间吃的均衡适量多样化，红枣水，炒米茶，中药汤，我都有断断续续的喝。姜是适量的用在调味上，也没怎么吃。置于用来炖补的酒，在第一个月里我是完全没有碰，只用了米酒酵素来烹饪。

如果你想在坐月子期间暂时戒姜戒中药，好让宝宝的黄疸退的快一点(有些宝宝是生理性黄疸，两个星期黄疸就渐渐退了)，你也是可以在之后才补上这些食材。

宝宝黄疸指数居高不下，要怎么办？入院照灯须知

不管是生理or 病理性黄疸，只要慢慢增加哺乳次数以及奶量，黄疸自然能改善。总之，多喝奶(每1-2小时)，多排便，多小便，黄疸就会退的很快。如果胆红素超过照光标准(257 or 308 umol/L)，医生就会建议入院进行照光治疗。照光治疗可以安全和有效的迅速降低黄疸，因为蓝光治疗能改变胆红素分子的形状和结构，使它们能随尿液和粪便排出体外。 在治疗期间，宝宝会脱光衣服，只穿上尿布和戴上眼罩，这种光不是紫外线，防护屏会过滤掉可能发出的紫外线，所以爸爸妈妈不需要担心宝宝晒伤。 假如黄疸指数真的非常高，可能需要进行换血(Exchange Transfusion)。因为黄疸指数太高，不及时治疗，胆红素有可能会进入脑细胞，干扰脑细胞的正常活动和功能，伤害到神经系统，造成永久性神经系统损害，脑性麻痹 (Cerebral Palsy) ，听力丧失，智力落后等，更严重的还可能危及生命。

“居家照光治疗服务”可行吗？

在宝宝们第二次入院前，由于疫情逐渐严重，想要减少出入医院的次数，我有尝试询问医生，我们能否租借仪器回家为黄疸宝宝照灯。医生的回答是 “NO”。他认为照光治疗必须在儿科医生和专业护士的观察和指导下进行，不是租借仪器回家照个一两天就当没事了，而且宝宝隔天还是必须回诊与抽血，追踪治疗。因此，他建议如果黄疸指数居高不下，入院治疗才是最快最安全的方式。

宝宝们入院照灯 

因为疫情关系，宝宝们入院照灯，妈妈是不能入院陪同宝宝过夜。一天只有两次探望时间。所以，两个宝宝入院后，我只好在家把母乳挤出来，然后等到探望时间或一大早送过去医院给护士们。 在这里要提醒大家，如果想要宝宝入政府医院进行照灯治疗，一定要带上平时到KK 产检的Pink Book。因为入院时，医生会问很多问题，关于你整个怀孕过程，宝宝在哪家医院出生，宝宝的各种体征，宝宝的喂奶状况等等。 出入医院那么多次，马来语不好的我，都用英语和政府医院的医护人员沟通，不管我问什么问题，他们都很耐心的回答我。

新生儿黄疸可以预防吗？

不能。新生儿黄疸是正常的生理现象，我们无法在怀孕过程预测哪些胎儿出生比较有可能出现黄疸。不管你在怀孕期间，还是坐月子期间，吃什么用过什么都不会把新生儿黄疸的几率降低。想要黄疸退的快，妈妈们在生产后一定要尽早哺乳，初乳有催便效果，胆红素即可迅速排出体外。

总结

新生儿黄疸有哪个新手爸妈不担心的呢？听信坊间流传的没有科学根据的偏方，盲目使用偏方很可能会给宝宝的肝脏带来更多的负担，延迟让宝宝接受应有的治疗，对宝宝的黄疸并不会有帮助。不管你是在政府还是私人诊所follow up， 是生理性黄疸还是病理性黄疸，一定要听从医生护士的建议，准时回诊。 女儿Audrey 在第41天的验血报告里，胆红素已降到56 umol/L；儿子Avery的胆红素在第51天已降到179umol/L。

新手爸妈们，你们是否和新生儿黄疸对抗过呢？请留言分享！

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Things I Learned About My Body and Mindful Eating During Pregnancy

by with No Comment Fertility & Women's HealthMotherhood

While we often view pregnancy as a “glowing” time, for many women the first trimester brings nausea, food aversions, and fatigue. Mom-to-be may also feel anxious during pregnancy, especially if they’ve previously experienced fertility struggles or miscarriage.

Now that you know I’m in the 2nd trimester of my pregnancy with Baby #2 & #3, I thought it would be fun to talk about what I’ve learned about my body and mindful eating during the first trimester.

MY MORNING SICKNESS VS MINDFUL EATING 

People typically think of morning sickness as throwing up in the morning. The truth is that it can happen any time or, for some unfortunate people, like me, ALL DAY. Sometimes you just have constant bouts of nausea without throwing up, I had that and it’s the worst feeling. It stays in the back of my throat and I feel like puking, but I just can’t.

In addition, during the first trimester, foods I didn’t usually crave were suddenly finding their way into my grocery cart, and foods I normally love and want to eat all the time were push to the back of the fridge. My cravings also changed more quickly than I could keep track off. One minute I was cooking lunch for my son, next I can’t even think about eating that right now.

Your body will let you know what it wants.

Pregnancy is a really amazing time to practice mindful eating because your body is going to tell you exactly what it needs. Before getting pregnant, I was in a good routine with my eating where I was still being mindful, but I didn’t have to pay quite as much attention because I generally needed food around the same time most days, and I had learned what types of foods usually felt best for me at certain times.

But things change in pregnancy. In my first trimester, I pretty much couldn’t eat or smell anything.

BUT, why am I hungry all the time?

Getting “hangry” was always something I was susceptible to, but having hangry also come paired with a face smack of nausea.

Not only did I need to eat more often (with small portion size), but it was much more urgent.

I was totally turned off cooked vegetables, difficult to eat foods high in fat like meat, water or soup fill me up and made me nausea. So, I actually lived off bran cereal with milk, crackers, lemon water, fruit smoothie, pao , etc. I was nauseous but hungry all day long, so bland foods like cereal and milk were my BFF. I was probably dehydrated so smoothie and lemon water were my go-tos. I off fatty foods for a while since these are typically harder on body to digest and I constantly burping.

Pregnancy hunger can sometimes feel chaotic and out-of-control. But it doesn’t have to be this way. The truth is mindful eating can be helpful.

Our body is fully capable of doing what it needs to do to keep us and our baby healthy, and most of all, our body can be trusted.

Mindful eating is the practice of learning to pay attention to (and honouring) your body’s natural cues in regards to food. This means nourishing your body when it’s hungry, noticing and stopping when you’re full, and honouring your cravings.

Up until now, when I am feeling hungry, I eat something. When I am getting full, I slow down, take few minutes, and decide if it’s time to stop eating.

No matter what changes your body is going through, you can learn how to dial in to exactly what your body needs and feel confident to give your body just that.

MY BODY WILL GAIN WEIGHT AT ITS OWN PERFECT PACE 

Pregnancy has been a really good lesson in surrendering to my body. Week by week, some weeks subtle and others not, my body has literally changed before my eyes. One day I would worry I was gaining weight too fast, and the next, I would worry I’m not gaining enough and that something was wrong with babies. I’ve spoken with so many of my friends and I came to realize that this is just one of the brutal realities of being a woman, not just in pregnancy when body changes come fast and furious, but pretty much all throughout the life cycle. But as I near the end of my second trimester, I’ve learned to make peace with the chaos. My body will gain weight at its own perfect pace. It may not be the precise 0.5-1 kg each and every week.

I know that for me, some weeks I gain nothing, and others I’ll jump 1 or 2 kg on the scale. But if you’re listening to your body, just know that your body is doing what’s best for you and baby and your weight will find its happy place in the end.

MY BODY DOESN’T JUST CHANGE OVERNIGHT WHEN I SKIP THE EXERCISE ROUTINE 

Before getting pregnant, I work out every day for at least 30 min to an hour. But I was just anxious at the beginning of my pregnancy that I took about 3 months off the exercise routine. Not 3 days or 3 weeks, it is 3 months. Obviously, it was all worth it. But taking that much time off kind of freaked me out. 

Would I lose all of the strength I had worked so hard to build and have to start from scratch again?

Would I gain 20kg?

Would I just fall out of the habit for good and never go back?

After first trimester, I started doing light yoga stretching and leg exercise. I keep telling myself, I have two babies growing inside me, don’t feel guilty because I took 3 months off the exercise routine. It doesn’t have to be all or nothing. Just listen to my body when I’m ready to get back on my yoga mat.

IT’S OKAY TO FEEL EMOTIONAL 

When I found out I was pregnant, I was more terrified than excited. The fear of bleeding, cramping, not hearing heartbeat, it all messes with my head in a way that no one can really understand unless they’ve been there.

Every doctor’s visits are also scary. Every time I have an appointment, I have to take deep breaths to try to stay calm and positive. I find myself constantly thinking about the babies’ movement and heartbeats. To handle fear in the moment, I am taking one day at a time and feel grateful for every day of my pregnancy, allow myself to enjoy things like a positive ultrasound or big kicks.

Now moms and moms-to-be, can you tell me, what are some of the pregnancy lessons you’ve learned along the way that have helped you through your journey? Leave me a comment below and help a fellow mom-to-be out!

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My Infertility, IVF, Miscarriage Journey & Big Announcement

by with No Comment Fertility & Women's HealthMotherhood

今天的文章将会用中文来表达，因为这样比较能诠释我内心的情感。

THE GOOD NEWS 

你喜欢先听坏消息还是好消息呢？我想你在2021年的第一天可能已经在我的社交媒体上看到了我和你们分享的好消息，我也陆续收到很多followers 的祝福，而且还有很多人私信说很期待这篇文章的出炉。是的，你可以从缩图和标题中看出来了，我想告诉大家的好消息就是 – 我怀孕了！

二胎的备孕过程真的是一条艰辛又漫长的路，我无数次幻想着我该如何写这篇文章，和身边所有人分享这份好消息。此外，这篇文章的另一个目的除了是要记录我这5年的备孕心酸过程，我也想和大家谈谈我的不孕症和流产的经历。

看别人分享怀孕，生孩子，坐月子的文章看多了，但是网络上确实很少看到文章分享和谈论不孕和流产的话题。事实上，4-6对夫妇里就会有一对夫妻面对不孕症问题，10-20%的女性曾经有过流产经历，所以我希望此文章能给正在备孕的姐妹们一些希望和正能量 ，you are not alone! 

MY FIRST PREGNANCY 

一直长居加拿大的我在2011 年硕士毕业后，得到了一份很好的 job offer，于是就打包好行李独自一人来到了新的工作和居住环境，一个人生活。一直以来我和现任老公都是远距离恋爱，我过我的自由生活，他过他的忙碌打工日子。直到2012年的 Chinese New Year，他买了机票就这样飞了一天一夜来到了这个冰天雪地的国家，这是他第一次踏入北美洲，也是他第一次看见雪。短短的两个星期的假期，我被求婚了！

2012年12月，我回国，和他举办了一场浪漫的 Beach Wedding。

之后就开始了我们的远距离婚姻。婚后一直觉得自己还很年轻，想要在工作上进修更多，我就尽情玩乐，享受自由自在的日子。而他决定不再做打工仔，想出来创业。他把工作辞了，隔天就直飞加拿大陪伴我两个月半。

就这样，我们的第一个宝宝是在完全无预警没有做任何的planning的情况下就悄悄的来到了我们的身边。

整个孕期，生产过程，哺乳期也可以写成一篇文章！

Anyway, 2014年5月，我当妈妈啦！

MY INFERTILITY TREATMENT

一直以来，我和老公都是处在远距离婚姻，我们一年见面2次，半年一次，我们只能各自拿最多3个星期的有薪假期。一般正常夫妻，即使什么问题也没有，在自然不避孕的状态下，每个月自然怀孕的几率也大约仅为 15-25% (here, here)。所以，一年只有两次机会的我们想怀第二胎的几率是非常小的。因为第一胎是在没有任何计划的情况下怀上的，而产后的我，身体状况，体力，经期，饮食，生活作息，比任何一个人都还要正常。所以 “不孕不育” “试管婴儿” 这些字眼从来都没在我的脑海闪过。

同时，我决定哺乳儿子至少3年，把最好的和花更多时间在陪伴儿子身上，所以就算没有怀上，我们也没放在心上。

不过，当时身边许多家人朋友都陆续结婚怀孕生子。经常都被念叨：

“什么时候要生多一个女儿呀？”

“你儿子那么可爱，可以再生多一个？”

“你还不赶快趁年轻的时候，快点生，有人帮你照顾？”

“赶快戒奶，喂母乳很难怀孕的？”

“一次过生完，你就可以收工了！”

因为哺乳了将近两年多，而我似乎开始有些介意这些 “好心人” 的叮咛，有没有可能是因为哺乳的关系导致不孕？自己本身曾有贫血症状，每年都会做一次比较详细的 full body check-up。结果不出乎意料，我的 TSH level 显示异常的底，Thyroid peroxidase antibody (TPOAb) 偏高，幸好的是T3和T4, 都属于正常。见了内分泌科，抽了一瓶又一瓶的血，做了 thyroid ultrasound，最后医生说，有可能是 Hashimoto’s disease? 等孩子戒奶了，这些指数可能会慢慢回归正常。但是，我的家庭医生为了安全起见，我每一个月都要抽血monitor我的TSH level。另外，她也建议我去咨询 fertility doctor。

就这样，我半只脚踏入了 infertility treatment 的圈子。我开始上网阅读每一间 fertility centre 的文章，技术，关于IUI，IVF，ICSI 的疗程。原来这圈子的水很深，当你研究的越多，懂得越多，你就知道能够 “自然受孕”，还一年生一个的人，是有多么的幸运呀。

子宫腔内人工受精（intrauterine insemination, IUI）是指将男性精液经过人工筛选之后，选出健康的精子直接注入女性子宫颈或宫腔内，以协助受孕。此一技术使用细小的管道插入子宫颈内，在排卵时注入精子，以便让精子更容易与卵子结合而受精，增加受孕成功率。过程不需手术和麻醉。

体外人工受精（In vitro fertilization，IVF）则是指分别将精子与卵子带到体外，在试管内进行受精和发育成为胚胎后再移植回母体子宫内。通常使用小盘状的培养皿，在适宜的环境下受精。当把卵子和精子均放入到同一培养皿中之后，让精子自由游动与卵子结合，并发育成为小型的胚胎，胚胎在培养箱中一段时间后，则移回母体子宫内着床怀孕。

卵细胞浆内单精子显微注射（Intra Cytoplasmic Sperm Injection, ICSI）是一种人工辅助受精技术，将精子直接注入卵子中以形成受精卵，也是人工辅助受孕的一项科技，特别是有助于男方精子缺陷或精子不够活跃所造成的不孕症，或者曾经使用过IVF技术辅助受孕却不成功的案例。因为透过IVF技术治疗时发现，虽然将精子与卵子放在同一培养皿中，仍存在精子无法穿破卵子外壳而实现受精的情况，可能是精子本身不够有力或质量偏低，精子前冲力道不足，也可能来自女方卵子外壳过厚，导致精子无法穿破。因此使用ICSI能辅助精子穿透卵子外壳。首先在显微镜下选出最健康优质的单精子，并使用非常细小的玻璃管刺穿卵子外壳，将单精子注射进入卵子中。这一辅助受精技术可大幅度提升受精率，也使试管婴儿受孕方式的成功率获得提升。

除了low TSH level 的问题之外，我也做了HSG X-Ray，检查结果显示我右边的输卵管 “好像” 堵塞了，因为无法在X-Ray里看到造影剂流入到右边的输卵管。最后，医生给的建议是既然你之前能够自然受孕，经期正常，身体状态良好，左边的输卵管运作正常，那么就尝试吃排卵药。

子宫输卵管造影（hysterosalpingography，HSG）是针对输卵管和子宫的一种特殊X光检查。医生会将细导管穿过子宫颈插入子宫，然后注射特殊的对人体无害的不透射线造影剂染料，通过这种造影剂医生可以看出整个输卵管的通畅程度、堵塞的部位和宫腔的形态。

想要怀孕是两夫妻的事。当然，我老公也误打误撞的和我一起踏入了这个圈子，他也去做了精子检查。报告显示精子浓度正常 (concentration)，只是精子异常 (morphology) 和活动力不足 (mortility), 属于中度弱精症。因此，Dr. A (Fertility Doctor) 建议我们可以尝试吃排卵药，打排卵针或尝试人工受精。我们接受了医生的建议，我一共吃了4个cycle 的 FEMARA® (letrozole) 5mg。

大部分患有弱畸形精子症的原因不明确，需要多个方向 (生活作息，药物，饮食) 综合治疗。老公的生活作息一项良好，不烟不酒，不熬夜，不挑食，只是偶尔中午没吃 (工作太忙)。经过一番饮食调理，2018年夏天，我们选择了IUI疗程。在疗程进行前，我也去了当地来自中国的中医师做针灸。

IUI对年龄在35岁以下的女性平均成功率为每周期的10至20%。 35岁至40岁的女性为10%成功率，40岁以上的女性则有 2％至 5％的几率。但是，成功率主要取决于精子质量和受孕女性的子宫健康状况，许多研究证实接受大约三到四个周期IUI疗程有更高的成功率。

护士帮忙施打排卵针

很可惜，第一次的IUI疗程没有成功。

由于 Dr. A 只负责 IUI treatment。于是，家庭医生又refer 我到另外一家fertility centre 做咨询。疗程讲解，抽血，ultrasound，可以做的都做了。这次的fertility doctor – Dr. S 在验血检测里多加了一样就是 AMH (anti-mullerian hormone) (here)。

抗苗勒管激素 AMH浓度是评估女性的卵巢储备和受孕能力的重要指标，这项检测对计划怀孕或继续治疗不孕的女性非常重要。AMH是女性卵巢卵泡产生的荷尔蒙，分泌於卵泡初成形之时；若卵巢卵泡数目越多，血清中的AMH值越高；反之，若卵巢卵泡越少，AMH值就越低，因此透过AMH值可评估卵巢的卵泡库存量。

AMH值低于5属于低水平，数值超过15为高水平，数值落在两者之间则属于中等 (here)。

我的AMH 指数是 13.2 pmol/L，医生说如果要进行 IVF疗程，她希望AMH可以在14 以上。同样的，由于老公本人不在加拿大，要 sign up IVF 疗程，必须两人同行，还要报名上一些辅导课程。医生还是给了同样的建议，先尝试排卵药，于是我又吃了4 个cycle的 Clomid。

半只脚在这个飞也看不到尽头的不孕圈，感觉很孤单，很无奈，很无助，很沮丧。在此时，我已经把自己和不孕症画上了等号。从一开始天真的以为 “自然受孕” 是那么的简单，到今天经历了那么多的打针吃药，检查的轮回，大姨妈还是每个月都准时到访。那种失落感无人问津。

当一个极度想要怀孕却总是每个月看到白板的人，这个时候只要一打开自己的社交媒体账号，朋友圈里的所有朋友都好像同一时间怀孕；只要一走在shopping mall一定会看到经过你身边的每一个人都是大肚婆；在工作上每个星期都会接到关于prenatal and postnatal care 的referral cases；就连身边已年过40岁的两个朋友本来就不打算怀孕生小孩的也怀孕了！这个时候，我的世界只有我一个人，天天都在问自己到底那里出错了！

MY IVF JOURNEY

可能因为自己是理科生，看过无数关于卵子+精子受精的影片，所以一直以为吃一吃排卵药，把卵子养大，打个排卵针，再来把精子处理一下，那么一定会中的！

但是，我和老公从来没有中大奖的命，就连安慰奖也没份儿。

2019年2月，我拿了2个月半的假期回国。在决定回国前，老公已经到几间 fertility centre 去听课也 survey 了费用。回来后，我带着一份份厚厚的体检报告来到了 fertility centre 见 Dr. H。医生给我的诊断结果是 “unexplained infertility”。因为一边的输卵管堵塞了，如果真的要自然怀孕，有可能需要靠点运气和漫长的等待。又抽了一瓶又一瓶的血，所有的指数，子宫内膜厚度，卵子的成长大小都很理想，医生建议不如这个cycle再试试看吃排卵药，打排卵针和直接进入IUI 疗程。

中医VS西医

中医和西医在 infertility treatment上的差别挺大的，中医讲求的是将体质调好，辅助血液循环，提高卵泡的质量以及改善子宫内膜的环境。西医的强项是诊断不孕的原因，能在各种仪器的辅助之下，提供不同的方式协助女性怀孕 (服用排卵药，打促排卵针，调理荷尔蒙失调问题等)。

做了一些 research 后，我决定在进入IUI 疗程前，再尝试多一次针灸疗法来增加受孕几率。毕竟，当时在加拿大咨询的中医师并不是专注于助孕疗程。

针灸真的有用吗？我有吃中药吗？

首先，我咨询过 Dr. S 和 Dr. H，两个医生都没有明确的说不建议或不鼓励，他们处于中立态度，完全取决于我的budget和我的时间。我也翻阅了一些研究报告，在临床研究上，针灸确实能辅助子宫血液循环。不过，我也曾听过一些国内的 fertility doctor 是不鼓励中医疗法也会督促在进行疗程的女性不要乱吃中药以免影响疗程效果。

但是，我还是想要做最后的尝试，毕竟在国内确实有几间不错的助孕中医诊所。为了配合IUI 疗程，我几乎天天到中医馆针灸和服用中医师给的药粉。只要你和中医师说明自己正在疗程中，中医师都会配合西医的疗法。由于我对国内的交通路线不熟悉，所以不管到什么地方都是由老公亲自接送。老公没有任何怨言也很愿意配合我的时间。医师人很亲切，整个针灸过程都让人很放松。

第二次的IUI疗程，我们还是没有成功。

2019年3月正式踏上试管之路

 

 

 

 

 

 

 

 

IUI失败之后，我们回到诊所咨询 Dr.H 后，决定要选择IVF 疗程。回家的路上，我问老公：“你觉得我需不需要再回到中医馆去针灸呢？老公给我的回答是：“如果你觉得压力很大，每天要这样赶上赶下，就不要回去了，我们就听医生的指示，该休息就休息，该打针就打针”。于是，我没有回去接受针灸调理。

促排+取卵

打了10天的针。我对针筒并不会感到害怕，所以全程都是自己打针，儿子在一旁鼓励和观看，老公则躲的远远的。

药物：吃的，塞的，打针的。
取卵前
取卵后

 

 

 

 

 

 

 

 

 

取卵手术需要全身麻醉，晚餐后就要 fasting 了。当天一早梳洗完毕，就出发到诊所去了。Dr.H 在取卵过程中也顺便帮我子宫里小小的息肉 (polyp) 也一起割走了。

通常取卵手术后，会容易有卵巢过度刺激综合症（OHSS），具体表现为腹胀，腹水，严重的会全身水肿。因此在术后，护士会建议患者多喝运动饮料 (如100Plus)，多吃高蛋白的食物等，避免辛辣，油炸和甜食。我的 OHSS 的症状不是很明显。休息了几天，等待诊所的电话。

卵巢过度刺激综合症 OHSS (Ovarian Hyperstimulation Syndrome) 是IVF 的主要并发症之一，因为排卵药物促使过多卵泡发育，但这并发症是可以治疗的。

一共取了21颗卵，有19颗mature eggs同时也做了ICSI。一共有9颗成功受精，能成功让胚胎师决定留下来的只有4颗胚胎。

Day3: 2颗 8 cells grade 2

Day 5: 1颗2BB，1颗3BB

我们决定下一个cycle 就做 FET (Frozen Embryo Transfer)。我选择植入2颗Day 3 的胚胎。植入后的四天，我就直接飞回加拿大工作了。一个星期后的验孕结果是：

隔天我马上到家里附近的 walk-in clinic 见医生，要求做HCG test, 为了确保HCG 有翻倍，放工后，我都到验血中心报道，我一共抽了3次血：

Test 1: 2366 IU/L

Test 2: 3261 IU/L

Test 3: 6596 IU/L

从看见验孕棒 positive 的那一刻起头脑就涌现出许许多多的画面和计划，心里是又兴奋又紧张，感觉像是在做梦一样。

验了3次HCG test，一星期后又用了另一支验孕棒验多一次，确保这一次是真的成功，不是在做梦。指数那么高，会不会是双胞胎呢？内心其实很不踏实，因为真的太久没有看过 positive result了。

MY MISCARRIAGE STORY 

到了大约8-9 weeks 时，我带着忐忑不安和期待的心情去做 dating ultrasound。在房间里sonographer 照了很久很久，我不敢发出任何声音但又很想知道到底有没有双胞胎。结果 sonographer 让我去上厕所，要做阴超。上厕所时，我心里一直在祈祷。在做阴超的时候sonographer 还是一样的安静，照了很久很久，整个房间的气氛很奇怪很凝重，我开始有点不安。结束后，她让我换上衣物，然后对我说：“对不起，我们没有听到宝宝的心跳，胚胎的大小刚好停留在8 week 3 days (正是我做ultrasound 的前一天)，你需要尽快咨询你的家庭医生”。

当下，我的脑袋是一片空白的，一时之间不知道如何反应过来，“没有心跳” 是什么意思？验孕棒不是 positive了吗？HCG 很高呀？在回家的路上，我一面开着车，一面留着眼泪，一直不断的回想，前一天我做了什么，吃了什么，是因为什么原因导致宝宝没有心跳？回到家我整个人瘫坐在床边，一面哭，一面上网查询 “when can we hear baby’s heartbeat?”

接下来的一个星期，只能用 “煎熬” “痛苦” 来形容。我需要一面装着若无其事的样子上班，一面要坚信一个星期后能听到宝宝的心跳声。每一次上厕所都一定检查有没有出血症状，有没有肚子痛。日子过的非常模糊，就这样昏昏噩噩的过了一个星期。

第二次的ultrasound 结果还是显示宝宝没有心跳。Sonographer 完全没有让我看影像，之后radiologist 进来和我解释检查结果。接着到诊所会见家庭医生，医生向我解释了流产迹象和几种不同的流产程序。我强忍着泪水离开诊所，一个人呆坐在车里，眼泪一直流。因为我完全没有任何流产的迹象，医生说我可以等宝宝自然排出体外 (可能需要1-2星期) 或可以尝试用药，暂时先不需要入院做人工流产。这时我的整个世界是崩溃和黑暗的。

老公知道消息后，马上定了机票飞过来加拿大。而我也和老板说了自己的情况，请了两个星期的小产假。因为只有两个星期的病假，我只能选择用药，但在用药的前一天，已经有一些些出血现象。两个星期的小产假，我除了哭，一直都在回忆着这两个月的所有画面，我做了什么，吃了什么。我的心情就好像坐过山车一样，上上下下，突然被狠狠的抛出车外，这一摔，很痛很伤。

2nd TRANSFER & 2 WEEKS WAITING PERIOD 

我曾经天真的以为只要验孕棒出现两条线，就代表你成功了！经历过这次的流产事故，我深深体会到女人能够从孕育一个新生命开始到把一个健康的宝宝带到这个世界上来，是多么的不容易。许多研究发现，流产其实并不罕见；每100名怀孕的女性，就有15人有过流产的经验 (here)。

根据统计，流产发生几率大约在12%～15%之间，其中又以妊娠13周前发生的早期流产最常见 (here)。

休息几个月后，我要求再做多一次 HSG X-Ray。这次 HSG X-Ray 显示，我两边的输卵管是通的。这让我又燃起了 “自然受孕” 的期望。

2019年12月，我决定把事业的中心放在 Simple Balance Nutrition，于是我把工作辞了，回到马来西亚，想给自己一个假期，同时多陪伴家人。结果遇上COVID-19 疫情大爆发，全世界都在抗疫，锁国封城。我们也只能乖乖呆在家。没错，我和很多人想的一样，这是不是上天给我的安排呢？多了和老公相处的机会，那么受孕几率也会大大增加。结果还是一样，每一个月都是失望收场。

2020 年突如其来的疫情，打乱了许多计划，但却给了我很多工作上的新挑战和机会。我本身的性格很执着而且还是个完美主义者，只要我想做的事我一定会做到101%！但是对怀孕这件事，不是我一个人可以控制的。流产后，我用了15个月的时间平抚情绪，调整自己的心态和身心，听到看到别人怀孕，脸上总是挂着一副羡慕的表情，尤其是我特别热爱自己的工作，想在 childhood nutrition，prenatal/postnatal nutrition，儿童挑食，育儿方面多做些深入的研究。

终于，2020年9月，在疫情似乎控制下来时，同时工作上的几项大project 也告一段落，儿子也回校上课了，我和老公讨论后，决定再次鼓起勇气回到 fertility centre 见 Dr. H。

备孕饮食+生活作息

在饮食调理上，我对 fertility diet 做了很多的研究，读了很多论文，该吃的备孕 supplement 照样吃。在平时的饮食上，身为饮食治疗师，一切讲究均衡，多样化，适量为主。有在follow 我 IG 的朋友们，一定知道我热爱瑜伽，我天天都一定会抽至少半小时的时间运动。

自制滴鸡精

在移植前，我也吃了至少3个月的 homemade 滴鸡精直到开奖。

这次采用的FET 疗程是以 natural cycle 进行，所以在移植前是完全不需要吃/塞任何药物。移植当天，由于疫情关系，老公完全不能进入手术室，我一个人换好衣服，躺在手术台上等待时，我看见在电脑萤幕里的两颗健康的胚胎，心里一直在默念祈祷，希望今天我可以把你们两个宝贝一起带回家。

这次我们一共移植了最后仅有的两颗 Day 5 的胚胎。移植后，开始服用Duphastan，一天两次。

为什么移植两颗胚胎呢？

其实这是我的决定。努力了那么多年，年纪也越来越大，每一个月最煎熬的就是等待验孕开奖的那两个星期，一次又一次的失望，压力大到无法形容。

上次移植了两颗胚胎没有成功，research 了很多流产和 IVF 不成功的原因，医生无法给出任何解释，有可能是精卵质量不好，染色体异常，高龄，又或者是自己没有足够的休息而导致流产的。

这一次，因为不想明年再交 freezing fee，也不想再为了生育这个问题搞得我们夫妻压力重重。干脆直接移植最后两颗胚胎。如果不成功，可能我们会从新开始新的 IVF 疗程，或认命。既然上天给了我一位那么可爱，乖巧，暖心的男孩儿，我不应该要求那么多。所以直接拼了！Dr. H 很随和，她不会给任何太过主观的意见（除非是她真的觉得不适合，她会直接和我说），她也知道我的专业，我在做任何决定前，一定是已经 research 好了，才来告诉她。当时，我和她说想要移植最后两颗胚胎的时候，她给了我很正能量的鼓励同时叮咛我有可能是双胞胎，也告知了怀双胞胎的风险！

再来说说移植后的事情，之前老是听别人说移植胚胎到子宫后不敢立马上厕所，连洗澡都不可以，怕胚胎流出来，其实这个真的不用担心。我移植完后直接就在手术台上问护士我能不能在这里躺一下，躺了大概15-20分钟，我害怕下一个要移植的妈妈要进来了，就慢动作的去上厕所排尿换衣回家。回家后在家前3天基本都是躺着多，但是吃饭会起床到楼下餐桌吃饭，不时的在客厅走走坐坐，我个人观点是没有必要一直躺着，不时起床走一下，可以促进子宫血液循环，帮助宝宝着床，3天后我就开始做一些文书处理工作，写写文章。

第二次移植和第一次移植的心态和心境有所不同。可能第一次移植时，时间太赶，压力太大，没有足够的休息，而且我还长途跋涉的飞回加拿大。这一次，一切放慢脚步，看书，写文章，看连续剧，写计划书，吃饭，睡觉，和儿子读绘本等。

就这样等到了第十天。我十分明白这两个星期对期待受孕的夫妻而言，是最难熬的过程。

在开奖的前一天，我心血来潮，因为家里多了一支普通的验孕棒，我就想说，那不然来验一下吧。其实心里很清楚，如果是白板，也不要伤心太久。老公天天都对我说：“不管结果是什么，我们只要秉持着一颗平常心就好”。我们已经尽力了，一定要放松心情。这天早上，老公和儿子已起床吃早餐，准备要去上学上班，儿子上来看一看我是不是睡醒了，顺便和我道别。而我，告诉儿子：“来，我们来做一个 scientist 的实验好不好，你帮妈咪把这个stick放入这个有尿尿的杯子里，看看会不会变颜色”。

因为有太多太多次的失败和失望。我这次真的很怕看到“白板”。一面刷牙洗脸一面等成绩，很快的，试纸显示两条线，我立马再看一下说明书，确实是有很清楚的第二条线，我告诉儿子说：“mommy 的肚子很像有baby了，不过这个是 secret，不可以告诉任何一个人哦！”

第二天，也是一样趁老公在楼下吃早餐，我又叫了儿子上来再做一次 scientist 的实验，这次用的是 ClearBlue 的 pregnancy test。看到positive的那一刻我简直难以按耐内心的兴奋，但是心里还是很害怕，拿着验孕棒下楼告诉老公后，他的第一个反应是：“怎么办，现在是怎样，等下快点打电话给诊所，看看下一步要做什么，你不要再做家务了，饭也不用煮了，你快去楼上躺着”。

发了简讯给诊所的 nurse，他们要我马上回诊所验血。下午护士打电话告诉我成绩，这次的HCG 成绩是 623.4 IU/L。指数没有上一次移植的高，我问了问护士姐姐，她说，只要是超过600 IU/L，医生就很高兴了。于是，她要我继续吃药 – Duphastan 同时开始吃 Aspirin。

MY RAINBOW BABIES 

在 week 7 day 1 时，我和老公带着很忐忑的心情回到诊所见Dr. H。我们一路上都没怎么说话，紧张的情绪完全都写在我们的脸上了。在躺上要照 ultrasound 的那张床上时，脑袋是一片空白的，我只乞求胚胎可以成功着床，可以听到宝宝的心跳。因为周数太小，所以我们照的是阴超。眼前的电视荧幕出现了子宫内有小小的一粒黑点，然后 Dr.H 就说：“爸爸要不要进来看一下”。老公走过来，在我身后，看着黑白银幕里的宝宝 (其实我知道他看不懂)，接着我很紧张的问 Dr. H有心跳吗？她播放心跳的声音给我们听，她说：“有心跳呀，而且很好。Eh….我是不是放两颗呀？好像有两个胚胎哦，两个都有心跳，周数也差不多”。当下她移过去看到第二个胚胎的时候，我眼眶泛泪，内心激动不已，很想跳起来抱着她 (反而不是自己的老公)，但是因为 social distancing 的问题，加上她是全副武装的穿着PPE，我也只好掩饰内心的激动和兴奋。

My rainbow babies

MY THOUGHT

为了结束这个冗长的文章，我想只有亲生经历过这一切的姐妹们才能真正的体会到，我们到底经历了些什么。相比之下，我的个人经历和故事并没有其他姐妹们来的坎坷。在 infertility 这个圈子，我属于 secondary infertility (续发性不孕症) 。

通常不孕症又可分为原发性不孕症 (primary infertility)和继发性不孕症(secondary infertility)。所谓原发性不孕症就是指从来没有怀孕过的病人，称为原发性不孕症；而继发性不孕症就是指过去曾经怀孕过，但是结果是流产，子宫外孕、死胎、死产，或是正常生产之后，而再也没有怀孕的病人，都称为继发性不孕症。

踏入这个圈子后，我才发现好多姐妹们都比我坚强，勇敢和更加努力，有些经历了7-8次的IVF 疗程，2-3次的流产事故，花了大笔的积蓄只为了生下一个健康的宝宝。

我十分可以理解不易受孕的女性往往为生育问题而整日忧心忡忡，心情随着每月的月经来潮而跌入低谷，看到别人或亲友怀孕，享受当妈妈的甜蜜滋味，有些还说是意外怀孕的，自己就会莫名奇妙的变得很沮丧，甚至开始埋怨自己的肚皮不争气。长期累计的压力很容易造成忧郁症，忧虑过多，反而降低受孕几率。如果身边的人对你心理和情绪上造成了极大的压力和反感，那么请暂时远离他们吧！

如果你看到这里，我也谢谢你的耐心，希望你对 “生殖医学” “不孕不育” ”试管宝宝” “人工受孕” 这些字眼不要有太多的避讳。如果你是家婆，岳母，七大姑八大姨，或是同事，闺蜜，千万千万不要追问身边已婚女性 “什么时候要生？” ，“什么时候要生二胎/三胎/收工？”，也不要给一堆不正确的助孕资讯，推销一些不需要又昂贵的保健品。如果一对夫妻在无避孕的情况下已经尝试12个月或更长的时间，我强烈建议你们尽早咨询妇科或助孕科进行生育评估检验，一定要相信科学，相信你的医生。

最后，姐妹们，如果你有任何关于不孕症饮食，试管婴儿，流产，怀孕，孕期保健品等问题，请留言。 在接下来的一段时间内，我将做更多的这些帖子和更新，因此请务必继续关注我的文章。

Have you or someone you known struggled with miscarriage or infertility? Let’s keep the comments respectful and support one another here!

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Tips to Lose Baby Weight After Pregnancy

by with No Comment MotherhoodWeight Management

A common concern of new mothers is losing the weight gained during pregnancy.

How much weight to lose after the birth of your baby is associated with how much weight you gained during pregnancy. If you gained more weight than recommended, it may take longer to lose it. That weight did not get put on overnight (it took 9 months to get there, remember!!) and time will be needed for the weight to be lost. So, patience is important. This is one reason it is advised that women do not exceed the recommended pregnancy weight gain.

The longer you keep extra weight on, the less likely you are to lose it.

To help you achieve a gradual, healthy weight loss, make small changes to your eating and physical activity habits. Here are 10 simple and easy ways to shed your baby weight while taking care of your new bundle of joy.

DON’T SKIP MEALS ESPECIALLY BREAKFAST 

You’re busy with your new baby and lack of sleep. So, it’s understandable if it seems easier to skip breakfast or lunch and eat large portion in long intervals of time. Don’t make it a habit.

Eating a healthy breakfast containing protein can help you to control your appetites and cravings all day, and prevents unhealthy snacking later in the day and into the evening. It also gives your metabolisms a kick-start first thing in the morning. I know how easy it is to get caught up in morning survival-mode with babies and toddlers, so having something quick and easy to grab like a overnight oat that was made the night before or smoothie, may come in handy.

My confinement meal.

CHOOSE & EAT RIGHT

You’ll need around an extra 350 kcal a day to have the energy to produce milk. Choosing the right foods – vegetables, fruits, whole grains, lean protein and dairy, focusing on eating foods that are rich in iron, protein and calcium for energy and milk stimulation.

  • Iron rich foods include lean meats, eggs, beans, lentils, dark-leafy green vegetables, whole grain products. The best way for a body to absorb iron is by combining foods high in iron with foods high in vitamin C (like citrus fruits).
  • Include protein at each meal, such as lean meat, eggs, dairy, beans, lentils, and seafood low in mercury.
  • Calcium is found in dairy products (milk, yogurt, and cheese), as well as tofu, leafy-green vegetables and calcium-fortified or enriched cereals, soy milk and soy yogurt.
  • Eat foods high in fibre. Consume at least 2 cups of fruits and 2 – 3 cups of vegetables per day.
  • Continue taking your prenatal multivitamins.

PLAN HEALTHY SNACKS

Six months postpartum, I eat  small portion but frequent meals to keep my energy intake up. The goal is to stop buying all the junk food (empty calorie foods). I listen to my hunger cues and choose healthy snacks, such as fresh fruit, nuts, greek yogurt with granola, hummus with vegetables or a protein bar/ball (recipe, recipe), lactation cookies.

BREASTFEEDING

If you’re able to breastfeed, it will definitely help you in the postpartum weight loss. Aside from the many benefits of breastfeeding, you will also burn up to 500 extra calories per day, some of which comes from the body’s fat that built up during pregnancy.

Wait until breastfeeding is going really well (baby is 4 months old) before trying to lose weight. A weight loss between 0.5 kg and 1 kg (~ 1 – 2 lbs) a week is safe and shouldn’t impact your milk supply. If you notice a change in your milk supply, talk to your doctor or dietitian.

A diet that is too low in calories and nutrients can affect the quality of your breastmilk. 

UP THE FLUIDS

During labor, a woman loses an incredible amount of fluids and blood. Drinking enough water is not only crucial for maintaining your milk supply, for proper digestion and for staying hydrated, but it’s also important for losing weight.

Drink at least 8 glasses of water per day. 

EAT MINDFULLY 

I know, you are trying to get your chores done – washing dishes/bottles, laundry, pumping breastmilk, cleaning the house, cooking etc. I remember my first 3 months postpartum life was breastfeeding, eating and sleeping, even though my mom provided help. I was so easy to get distracted, I wolfed my meals down without chewing, and ran to my crying baby.

Distracted eaters tend to eat more food in one sitting than people who are paying attention to their food.

This study shows mindful eating approach may encourage postpartum weight loss without weighing, measuring, recording and assessing dietary intake. Here are my mindful eating tips:

  • Relax before eating. Breathe deeply for one minute, or bless your food before picking up your fork. This time will allow you to become aware of how hungry you actually are.
  • Put food on a plate and sit down at the table.
  • Try to place your eating utensil down with each bite. Take at least 20 minutes to eat your meal.
  • Avoid distractions when eating, such as phone calls, radio, TV, and reading. These diminish the experience of eating. Pay attention to the texture, color, flavor, and temperature of your food. You will be more aware of your hunger level if you pay attention as you eat.
  • Use smaller plates. By using smaller plates and bowls, you will automatically serve yourself less, but still feel like you’re having a satisfying amount of food.

BE ACTIVE 

Exercise can help tackle postpartum depression, improve the mood, reduce stress and boost the confidence. Finding time to exercise is one of the biggest issues new moms face when losing weight after childbirth.

After recovering from delivery (which may take a couple month or you doctor says it’s ok), find a perfect workout plan that suits your schedule and personality. There are so many options when it comes to exercising but the best option is the one that YOU will enjoy the most.

Walking may be the perfect postpartum activity because it’s easy to do, not strenuous and can include baby (in a stroller). You can incorporate weigh lifting or a resistance routine (such as yoga or using exerics bands) once you regain your strength and your baby is a little older. The goal should be to enjoy your alone time and get your body moving for at least 10-30 minutes, 3 times a week. That is only 30-90 minutes for the whole week!

AVOID WEIGHT LOSS FADS

Educate yourself about nutrition, not diets. It is easy slip into the “I want to lose weight fast” mentality. Most fad diets restrict certain food groups and portions, which result in quick weight loss but impossible to sustain. This is the main reason why people on fad diets end up regaining the weight they lost. This also damage health in the long run and your self-esteem.

This is why I really recommend seeing a dietitian. As much as you can Google nutrition tips, the guidance of a dietitian can help provide you with personalized nutrition information that is right for YOU.

SLEEP , SLEEP, SLEEP

This study found that mums who slept five or less hours per night were more likely to hold onto their extra baby weight – This is because when you’re sleep deprived, your body releases the stress hormone cortisol, which can promote weight gain around your belly.

LOVE YOURSELF

If you are a new mom or a mom of two or three, that doesn’t mean that you can neglect your own health. Your well-being is just as important as your child’s well-being. I truly believe that part of being a good mom or new mom means taking care of myself, and slowly getting back to my healthy and comfortable weight is part of that. Don’t beat yourself up if you’re not bouncing back as quickly as you’d like.

BOTTOM LINE

Having a baby not only changes your life but also bring about many changes in your body including the weight gain. It is not easy to take care of yourself with a new baby. Having a Chinese culture background, I view the first 3 months postpartum as recovery. The focus should be on eating for energy, physical and emotional recovery, rather than weight loss.

Need help losing weight after your pregnancy? Check out the 3 months TRANSFORM Program.

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How to Prevent Food Allergy When Starting Solids

by with No Comment Infant NutritionMotherhoodToddler Nutrition

Food allergies are on the rise. In the past, some expert recommended that dairy products and other common food allergens like eggs, peanuts and fish not be introduced until after an infant’s first birthday. More recently, evidence has shown that there is no reason to delay introduction of these foods beyond 6 months of age. In fact, delaying the introduction of these foods may increase your baby’s risk of developing allergies (here).

Current recommendations for solid food introductions are to wait until around 6 months of age. Look for your child’s readiness cues and provide only breast milk or formula until that time. There are no hard and fast rules as to what order or exactly what age to introduce certain foods to a baby. Babies really can go to town and eat what the rest of the family are eating (making sure the foods are an appropriate texture to avoid choking).

Read my article on When to Start Solids and How to  Start Solids for more info.

What Is a Food Allergy? 

A food allergy is when the body’s immune system mistakes a food as harmful and this cause a reaction. A food allergic reaction appear after a few minutes of giving a food and often will happen within two hours of having the food. Signs can also show up hours or days later. They can be mild (flushed face, abdominal pain, rash/hives, stuffy/runny nose) to severe (vomiting, diarrhea, blood in stools). The most extreme allergic reaction is anaphylaxis, where the throat starts to close and there is difficulty breathing.

Which Foods are Most Likely to Cause an Allergic Reaction? 

The most common food allergens are:

  • Eggs
  • Fish
  • Milk
  • Tree Nuts (Walnuts, Almonds, Cashew, Pecan, etc)
  • Peanuts
  • Sesame
  • Shellfish
  • Soy
  • Wheat

So should you feed your baby these foods? or avoid it? As of now, here’s what you need to know…

Risk of Developing Food Allergies? 

Your baby may be at high risk for developing food allergies if a parent, sister or brother has an allergic condition such as: food allergies, eczema, asthma or hay fever. Your baby is at lower risk if no parent, sister or brother has an allergic condition.

What to Eat When Pregnant and Breastfeeding

When you are pregnant or breastfeeding, good nutrition is extremely important, and you should continue to eat all of the nutritious foods that you usually eat. You do not need to avoid common food allergens while pregnant or breastfeeding. Go ahead and eat peanuts or drink a milkshake. Avoiding potential allergens will not decrease your baby’s chance of having an allergy to these foods. Breastfeeding itself maybe protective against food allergies.

If you choose to avoid certain foods while pregnant or breastfeeding, speak with a Registered Dietitian or your health care provider to make sure you are getting all the nutrients you and your baby need.

When Can You Feed Babies Highly Allergenic Foods

For low risk baby, there is no benefit to delaying common food allergens past 6 months.

For high risk baby, there is no reason to wait until the baby is older before introducing highly allergenic foods, and some studies suggest that it may even be helpful to introduce foods early. Talk to your allergist about whether it would be help to do a food allergy test before feeding these foods to your baby or speak with your dietitian about a personalized plan for food introduction.

The goal is to choose foods that provide the most nutrition. 

Here are a few steps that you could follow:

    Try other food first

The first foods that you give your baby should not be the most allergenic ones. Start with other single ingredient foods, such as rice or oat cereal, yellow and orange vegetables (sweet potato, squash and carrots), fruits (pears, banana, apples) and green vegetables (peas, broccoli, spinach), tender meat. Once things are going well with these other foods you can then start to introduce the common food allergens.

    Go slowly

Introduce just one food at a time, and then wait 3-5 days before trying the next new food (whether it is a highly allergenic food or not).

    Choose the right time

When you are ready to introduce a highly allergenic food, pick a time when you’ll be at home and you will be able to watch your baby closely for any signs of reaction. Along these lines, it may be better to do this earlier in the day and not right before a nap or bedtime. Do not try these foods right before you need to leave the house to go somewhere, such as to drop the baby off at day care or take your other children to school. Although many babies react the first time they eat a food, you should be cautious for the first two or three times that your baby tries an allergenic food. After that you can relax knowing the chances of a reaction are extremely small.

    Start with a small quantity

Don’t give your baby a full serving of a highly allergenic food on the first feeding. Start with a just a little. If there does not appear to be a reaction, then you can gradually increase the quantity during the next few feedings.

    Use nut butters, not nuts

Never feed nuts to a baby. Babies can choke on nuts. To introduce nuts into your baby’s diet, use nut butters or pastes.

You can do so in small amounts and can even try rubbing some of the food on their chick and then lip to see if it produces a rash, before giving/feeding that food.

Bottom Line

If your baby has severe allergic reaction, carry an epi pen. Make sure your baby is on a balanced diet, if it is quite restricted, please talk to your dietitian. Also, you will need to become an expert on reading food label and searching for all of the various names for the food you are avoiding.

If the allergies are mild, you can always try re-introducing the food after a few months.

If you have questions about food allergies. Contact Me about starting a nutritional counselling program.

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Caffeine and Pregnancy

by with No Comment Fertility & Women's HealthMotherhood

We want to do what’s best for our growing baby inside of us. Once we get that positive pregnancy result, we clean up every bit of our lives to be sure our babies have the healthiest start possible. And so many of us wonder: is it safe to drink coffee while pregnant?

I’m not a coffee drinker, but I’ve seen the love, devotion, and urgency many mamas have around their morning Joe. We can give up a lot when we’re pregnant, but please don’t touch our caffeine!

Caffeine is a drug and it will cross the placenta. It can limit blood flow to the placenta, as well as increase blood pressure and blood sugar levels. It also puts additional strain on the liver, which is already busy processing the increased hormonal demands related to pregnancy.

Caffeine should be limited since some studies have linked high intake of caffeine may be associated with growth restriction, reduced birth weight, preterm birth or stillbirth.

WHO advises all women of reproductive age to consume no more than 300 milligrams of caffeine per day.

One small (8 ounce) cup of coffee has 80 to 179 milligrams; the same serving size of weakly brewed tea has 25 to 45 milligrams.

Other sources of caffeine include chocolate milk, cola drinks, and energy drinks.

WHAT ABOUT HERBAL TEA?

Be careful if you’re planning to switch from coffee to herbal tea. Not all herbal teas are safe during pregnancy.

In general, tea with Ginger, Orange Peel, Red Raspberry Leaf, Peppermint Leaf and Rose Hip are considered safe during pregnancy, if taken in moderation (no more than 2 to 3 cups per day).

NOTE: Pregnant women should ask their physician before consuming any natural/complementary health product or herbal therapy.

Are you pregnant? Not sure what to eat or drink? You want to learn more about healthy eating during pregnancy? Contact Me , I can help you meet the nutrition needs of both you and your growing baby. 

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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) occurs when blood sugar levels become high during pregnancy. It means the body cannot produce enough insulin (胰岛素), a hormone made by pancreases (胰腺), an organ located behind the stomach. Without sufficient insulin, the body cannot properly use and store carbohydrate (碳水化合物 or sugar) from the foods you eat.

During pregnancy, hormonal changes and weight gain can cause the body’s cell to use insulin less effectively, a condition knowns as Insulin Resistance. This resistance increases the body’s need for insulin. If the pancreases cannot produce enough insulin to meet this increased demand, gestational diabetes can develop.

All pregnant women experience some degree of insulin resistance in late pregnancy. However, some women have insulin resistance even before pregnancy, often due to being overweight. These women start pregnancy with a higher insulin need and are more likely to develop gestational diabetes.

 

RISK FACTORS FOR GDM 

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

  • Age over 35 years
  • Previous pregnancy with GDM
  • Previously delivery of a large baby over 4 kg or 9 lbs
  • Family history with diabetes (parent, sibling with Type 2 Diabetes)
  • Previous stillbirth
  • Being overweight before pregnancy or gaining excessive weight during pregnancy
  • Belonging to a high-risk ethnic group (e.g., Aboriginal, Hispanic, South Asian, Asian or African descent)
  • Having multiple babies in this pregnancy (twins or triplets)
  • Having Polycystic Ovary Syndrome (PCOS), a hormonal disorder

HOW WILL GDM AFFECT MY BABY? 

If your GDM is not well controlled, high blood glucose levels can affect your baby. Your baby’s pancreas will produce extra insulin to manage this high glucose, and the excess glucose is stored as fat.

Untreated or uncontrolled GDM can lead to several issues for your baby, such as

  • Being born larger than normal (macrosomia), which can complicate delivery and pose risks
  • Experiencing low blood glucose (hypoglycemia) immediately after birth
  • Developing breathing problems (respiratory distress syndrome)
  • Facing a higher risk of dying before or shortly after birth
  • Your baby may be more likely to become overweight and develop Type II Diabetes later in life

HOW WILL GDM AFFECT ME? 

GDM can increase your chances of:

  • Developing high blood pressure (pre-eclampsia) and protein in the urine 
  • Needing a C-section due to large baby
  • Experiencing GDM in future pregnancies
  • Having a higher risk of developing Type II Diabetes later in life

Finding out you have Gestational Diabetes can be overwhelming. As a mother-to-be, following your management plan will help ensure 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 you earlier than 24 weeks and again later if the initial test is negative.

Tests for GDM

To determine if you have GDM, one or more of the following tests may be conducted:

(A) Screening Test for GDM

A 1-hour blood sugar measurement after consuming a 50-gram carbohydrate drink, done 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 treatment is needed.
  3. If your blood sugar is between 7.8 and11 mmol/L, your MAY have GDM and will need a 75-gram Oral Glucose Tolerance Test (OGTT 75 g).

(B) 75-gram OGTT

This test measures fasting blood sugar after 10 hours of fasting. Blood sugar is tested again 1 and 2 hours after a 75-gram carbohydrate drink.

There are 2 possible results:

1. GDM Diagnosis: if two or more of the following values are are 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

2. Impaired Glucose Tolerance: if one value is met or exceeded.

If diagnosed with either conditions, a management plan is essential to ensure a healthy pregnancy.

MANAGEMENT PLAN 

Blood Sugar Target

You’ll meet with a 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 daily
  2. Spread carbohydrates throughout the day
  3. Limit foods and drinks with added sugar
  4. Choose higher-fibre foods more often
  5. Include protein-rich foods in each meal and evening snack
  6. Ensure adequate calcium and vitamin D intake daily
  7. Take multivitamin every day
  8. Use sugar substitutes sparingly

Lifestyle Management 

  1. Aim for healthy weight gain
  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 No 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.