Nutrition & Exercise During
Pregnancy
Why is This Relevant to Me?
Everyone knows someone who is pregnant/going to become pregnant
Diet and Exercise are important for people who are not pregnant.
Health problems are on the rise
Weight Gain During PregnancyWeight gain depends on many factors:
Rate of weight gainMaternal ageAppetitePre-pregnancy body mass index
Where the weight goes?Baby-7.5 lbsBreast growth- 2lbsMaternal stores- 7lbsPlacenta 1.5 lbsUterus growth- 2lbsAmniotic fluid- 2 lbsBlood – 4 lbsBody fluids- 4 lbs
What is a BMI?
BMI- Body Mass Index(Weight/Height2) x 703
Applies to adult men and women
Classification BMI
Underweight <18.5
Normal weight 18.5-24.9
Overweight 25-29.9
Obesity >30
Weight Gain During Pregnancy
Weight should be gained graduallyFirst trimester
1-4 lbs total during the first 3 months
Second & Third Trimester2 to 4 pounds per month during the 4th to 9th months
Most weight gained in last three monthsAvoid weight loss during pregnancy even if obese Weight gain during the 2nd trimester predicts birth weightSeek proper weight before pregnancy
Effects of Starting BMI
Underweight (BMI <18.5)Increased risk of preterm deliveryLow birth weight babyIron deficiency anemiaNutritional requirements low
Overweight (BMI ≥25)Gestational diabetesGestational hypertensionC-Section DeliveryBirth defects (neural tube defects)Fetal death or miscarriagePostpartum effects (hemorrhage, wound infection, depression)Increase chance of childhood obesity
Nutrition During PregnancyMost pregnant women need 2,200-2,900 caloriesEnergy Requirements
No different than non- pregnant women until the 2nd trimester
340 kcal in the 2nd trimester452 kcal in the 3rd trimester
Variety of foodsChoose nutrient-dense foods/ limit energy-dense foodswww.mypryamid.gov
How much is that increase?340 Calories
8oz low-fat plain yogurt mixed with 1/2 cup raspberries and 1 tbs honey (205 cals) One hard-boiled egg with a slice whole grain toast (130 cals)
452 Calories2 oz turkey burger, 1/4 cup avocado, 1/4 cup grilled onions on one slice whole-grain bread (240 cals) 1/2 whole grain English muffin, toasted; 2 tbs pizza sauce, 2 oz low-fat mozzarella (190 cals)
Dietary Guidelines for Non-Pregnant Individuals
USDA 2005 Dietary GuidelineNew one set for 2010Based on 2,000 calorie dietFruit Group
2 cups(4 servings)Vegetable Group
2.5 cups (5 servings)Grain Group
6 ouncesMeat and Beans Group
5.5 ouncesMilk Group
3 cupsOils
24 grams (6tsp)
Nutrition During PregnancyWhole grains
Bread, cereals, pasta, brown riceWhole/Canned/Frozen Fruits
Apples, pears, peaches, nectarines, melonStay away from acidic fruits such as oranges, pineapples, lemons, and limes
VegetablesLeafy greens, bell pepper, eggplant, squash, and mushrooms
Lean protein from plant and animal sourcesTofu, nuts, seeds, lentils, beans, red meat, chicken, turkey, fish and pork
Low-fat dairyMilk, cheese and yogurt
Healthful fatsCanola oil, walnuts, almonds, avocadoes, and fish
SupplementationPrenatal multivitamin is advised before pregnancy for
Women with multiple birthsWomen with HIVWomen taking drugsWomen eating little/no animal products
Multivitamin used to complement not to substitute for a good dietEarly supplementation has shown to decrease risk for preeclampsia
Foods to Avoid During PregnancyMinimize beverages/sports drinks or foods with:
High sugar contentHigh Sodium
Raw EggsUnpasteurized juices or dairy productsUndercooked meat, poultry, and fishDeli meatsRaw vegetable sproutsSoft Cheeses
Fish
MercuryControversial topicHigh amount in large predatory fish (<100g per week)
King MackerelPikeSharkWalleyeBarracudaLarge Tuna
Tuna
No more than twice per week
Potential Pathogen/Food SafetyPathogens:
ListeriaAirborne pathogenCan grow at refrigeration temperaturesDeli meats, unpasteurized milk, refrigerated and ready to eat products
Toxoplasma gondiiCan pass through placentaFeces of catsContaminated/undercooked meat, unwashed fruits, unpasteurized milk, contaminated water
Food safety tips:Wash fruits and vegetablesHeat meat to steaming
Omega 3-Fatty Acids/DHAEssential fatty acids
Needs to come from dietBody cannot make them
Child growth, development, & healthVisual & Cognitive Development
Present in breast milk200 milligrams/daySources
FishFish oilCanola OilFlax
DHA Recommendation StudyGoal:
Develop recommendations on dietary fat intake in pregnancy and lactation
ResultsDietary fat intake during pregnancy and lactation same as the general populationOmega-3 PUFA deposited in brain/other tissues during fetal and postnatal lifeMaternal intake of omega-3 PUFA have visual and cognitive development outcomes for the infant
ConclusionDietary intake of 200 milligrams/ day1-2 portions of sea fish/week or consumption of flaxseed or canola oils
Calcium & Vitamin DCalcium
Development of baby’s teeth, bones, heart, nerves, and muscles1,000 milligrams/day Calcium before and during pregnancySources
Low-fat or fat-free milkYogurtCheeseCalcium-fortified cerealsCalcium-fortified juices
Vitamin DReduce infection in pregnancyReduce preeclampsiaIncrease absorption of Calcium
Maternal Vitamin D Deficiency and Risk for Preeclampsia
MethodsCase study of Vitamin D levels in preeclamptic women >16 wks compared to non-preeclamptic women
ResultsAs maternal serum vitamin D
concentrations increased, risk of preeclampsia decreased.
Neonates born to preeclamptic mothers more likely to have poor Vitamin D status than neonates of controls
ConclusionMaternal Vitamin D deficiency at
less than 22 weeks was a risk factor for preeclampsia
FolateReduces risk of birth defects affecting the spinal cordNeeded to produce blood and protein for the baby.Advised to increase intake when planning or capable of pregnancy. 400 micrograms/day for non-pregnant women600 micrograms/day for pregnant womenSources
CerealsPastaBreadSupplements
Folic Acid Fortification and Neural Birth Defects
IntroductionMandatory fortificationIncrease by 30–70% of folic acid87% due to Spina Bifida
ResultsBefore fortification
Neural tube defects was 1.85 per 1000 live births
Introduction of fortificationNeural tube defects was 1.07 per 1000 live birth
After fortificationNeural tube defects was .95 per 1000 live births
ConclusionSignificant decline of 49% in incidence of neural tube defects
IronPregnant women are at high risk for anemia
Iron deficiency
Helps red blood cells deliver oxygen to the babyNon-pregnant women: 15-18 milligrams/dayPregnant women 27 milligrams/daySources
SpinachKaleLeafy greensBeansFortified CerealsRed MeatChickenFish
PICAPICA
Ingestion of non-food items are foods in higher amountsAssociated with Iron deficiencyCravings for taste, smell, or texture
ComplicationsDepend on substance eaten
GI disturbanceExcess weight gainHyperglycemiaHigh Blood PressureMetabolic Alkalosis
Exercise During PregnancyRequirements
Then ACOGShould not exceed 140 beats/minuteStrenuous exercise ≤15 minutes
Now ACOGModerate exercise ≥30 minutesMost days of the week
Changes in body:BalanceJointsHeart Rate
Seek Healthcare professional
Benefits of ExercisingMother
Improved cardiovascular functionLimited pregnancy weight gainDecreased musculoskeletal discomfortReduced muscle crampsReduced lower limb swellingMood stability
FetusDecreased fat massImproved stress toleranceAdvanced neurobehavioral maturation
Types of ExerciseBeginners
WalkingCyclingSwimmingAerobics
ExercisersRunningStrength training
Exercises to Avoid
Downhill snow skiingContact sport
FootballBasketballIce HockeySoccer
Scuba DivingGymnasticsHorseback ridingStanding for long periods of time
ConclusionProper weight gain is important in maintaining the health and well being of both the mother and the fetusIron, Vitamin D, omega 3 fatty acids, and Folic Acid are important to supplement during pregnancyExercise during pregnancy is beneficial not only for the mother but for the fetusThese nutrition and exercise recommendations are important for pregnant women but can be maintained after pregnancy for a healthy lifestyle