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Friday, July 4, 2014

Pregnancy & Breastfeeding Nutrition Guide

Do you know what your body needs for calories and nutrients when you're pregnant or nursing?
If you're planning a family, have a baby on the way, or are nursing, it's important to know and understand what your body needs. Adding calories isn't an excuse to meet more chips (sorry ladies!) or chow down on your favourite naughty snacks 'just because'. To help you learn what to eat to encourage a healthy pregnancy, a healthy baby, & a healthy mama, we spoke to dietician, Kristy Pemberton. Here's what she had to say...

Calorie requirements increase in pregnancy by about 10 - 15 percent. If you think of this in food terms, it is only about 200- 300  extra calories  or an extra large snack (e.g. one sandwich, or pot of yoghurt  and handful of nuts). So ‘eating for two’ is not an excuse to eat what you want, in fact eating too much can increase risks of gestational diabetes.

Calorie needs can be broken down per trimester : 
First trimester no increase in needs 
Second trimester: about 340 calories extra  (2 small snacks) 
Third trimester: about 450 calories extra (small meal).  
Calorie needs increase due to the increase in metabolic rate and the needs of the growing baby.  The further along in your pregnancy the more calories you need. However this is partially offset by fat stores laid down in early pregnancy and the lack of activity in later pregnancy.   The body is pretty adaptive and optimal weight gain has been achieved with less than optimal calorie intakes (e.g. morning sickness etc). 

There is an increase in calorie requirements during breastfeeding because of the need to produce breast milk. Calorie requirements tend to increase over the first six months of baby’s life  as breast milk increases. The average extra daily energy requirement for breastfeeding 475–500 calories per day. However even if your calorie intake does not increase, breast milk tends to remain adequate.  Because the nutrition status of the mother only has a small effect on the amount and make-up of breast milk the sufficiency of breast milk supply should be judged by baby’s growth and development, not on what the mother is eating.  

If there is any concern that the supply is not enough please talk to your midwife or doctor about what can be done. It is important that women understand the relationship between infant demand and milk production so that they do not introduce infant formula unnecessarily.  Well nourished women often have fat stores that are a good source of energy to support adequate breast milk. On average a woman will lose approximately 800g per month for the first 6 months of breast feeding.  Demand-fed infants effectively regulate their energy intake (and milk volume), so the volume a baby drinks depends on milk concentration.  

It is not wise for a breast feeding woman to go on a calorie restricted diet  (e.g. less than 1800 calories) to lose weight as some studies have shown this can reduce breast milk volume, especially in already lean women (however concentration was not looked at). Women need to allow adequate time to readjust after pregnancy, and weight loss after delivery to pre- pregnancy weight should not be expected to occur before 9–12 months. 

Weight Gain
There is no calorie level that women should eat, as it varies widely between individuals and very few people ‘count calories’.  Rather we want to eat enough to achieve optimal weight gain.  This is based loosely on body mass index (see the guidelines below). If you are gaining a lot of weight this can predispose some women to gestational diabetes and if not enough weight is gained it can impair the growth of the baby.  Weight gains outside the Institute of Medicine’s suggested ranges are associated with double the number of poor pregnancy outcomes as weight gains within the ranges.

Body Mass Index
Recommended weight gain
Less than 19.9
12 - 18kg
Between 20 and 26
11.5kg – 16kg
Between 26 - 29
7 -11 kg
Over 29
 Source: Institute of Medicine 1990.

The recommended rate of gain is approximately 0.4 kg/week in the second and third trimesters; for women with a lower BMI it is approximately 0.5 kg/week; and for women who are overweight  it is approximately 0.3 kg/week. This is only a guideline and it is common for women to gain weight slower or faster than this.
What to Eat
When pregnant it is important to follow a healthy diet that is relatively low in sugar, saturated fat, and salt, and to avoid too much processed foods.  When cooking, follow healthy cooking guidelines such as removing fat from meat, grilling, steaming or baking instead of frying; avoid adding too much extra salt and sugar, etc. Here are some healthy eating guidelines:  

1) Choose at least six servings of breads and cereals each day
e.g.  1 slice of wholegrain bread, 1 cup of pasta or rice, ½ of cereal or muesli, try other grains such as quinoa, lentils etc.  
These provide carbohydrates (sugar and starch), fibre, and nutrients such as B vitamins and minerals. Women who are pregnant should not be on a low carbohydrate diet.

• Eat plenty of breads and cereals, including rice, pasta, breakfast cereals and other
grain products.
• Choose wholegrain varieties because they provide extra nutrients and fibre. They
also help prevent constipation.

2) Have at least three servings each day of milk or milk products, preferably reduced- or low-fat products.
e.g. 1 glass of milk,  2 slices of hard cheese, pot of yoghurt (150g)
Calcium requirements are higher in pregnancy and breastfeeding. Pregnant women require milk and milk products as sources of protein, vitamins and minerals, especially calcium and iodine.
• Choose reduced- or low-fat milk, yoghurt and hard cheese.
• Milk and milk products provide most of people's calcium. If you do not eat these foods or eat very little of them, ask your doctor or dietitian about other calcium sources.
• Calcium is also found (in lower amounts) in foods such as wholegrain bread,
broccoli, canned salmon, sardines, spinach, baked beans, and tofu.
• If you are drinking soy milk, choose one that is calcium-fortified (check the label).

3 ) Eat at least 2 serves of lean meats, chicken, seafood, eggs, cooked dried beans, peas and lentils, and nuts and seeds
e.g. 2 slices cooked meat (about 100 g),  1 medium steak (120 g),  2 drumsticks or 1 chicken breast or leg (110 g), 1 medium piece of cooked fish (100g), 1 small can of canned fish (tuna, sardines, salmon or mackerel (90 g)), 1 egg (50 g), 1 cup canned or cooked dried beans, 1/3 cup nuts or seeds, 1 cup tofu

These foods give you protein, iron, zinc, and other nutrients which you need more of during pregnancy.  Iron is important for healthy blood and for the development of your baby. During pregnancy, it is important to have enough iron to prevent iron deficiency or anaemia.  Iron found in lean meats, chicken and seafood is absorbed well by the body (haem iron).  However eggs, beans, peas and lentils, and nuts and seeds have a form of iron that is not as easily absorbed (non-haem). 

Having foods high in vitamin C (broccoli, tomatoes, oranges, kiwifruit, mango, pineapple)  with your meals will help to absorb non haem iron. This is especially important for vegetarian and vegan women, who can find it hard to get enough iron.  Liver is a good source of iron, but eat no more than a small piece (100 g) once a week as it is high in Vitamin A.

Requirements of iodine are also higher in pregnancy; you can take a supplement that contains iodine especially for pregnant women. Seafood and eggs are also useful sources of iodine.

Fish is recommended 2 – 3 times a week because it is a source of omega -3s, which are important for baby’s brain development.

Food safety when choosing fish and seafood:  High intakes of mercury are unsafe for your baby. Some fish have higher levels of mercury, although there is little concern with canned tuna, canned salmon, mackerel or sardines, farmed salmon, tarakihi, blue cod, hoki, john dory, monkfish,  and flat fish like flounder. Fish that have higher levels of mercery (longer-lived and larger fish) include: uncanned wild-caught (not farmed) salmon, uncanned albacore tuna or mackerel, kahawai, red cod, orange roughy and ling can contain more mercury, so consumption of these should be limited to three 150 g servings per week.

 A small number of fish (eg, school shark, southern bluefin tuna, marlin, and trout) should be eaten only once a fortnight or not at all if consuming other types of fish or seafood.
If you don’t like fish you can take fish oil, but make sure it is a good quality one that has been tested for mercury and don’t exceed the guidelines on the bottle.

4) Drink Plenty of Fluids Every Day -  Aim for eight to nine cups of fluid each day.
Extra fluid may be needed during hot weather, after activity, or if you are vomiting or constipated.

Water or reduced- or low-fat milk are the best choices.
Be aware that caffeine consumption may affect your babys growth during pregnancy. Caffeine is naturally occurring in tea, coffee, and chocolate and is present in many cola-type or energy drinks. Watch the amount of caffeinated drinks you are consuming while pregnant. No more than six cups of tea or instant coffee, or three single shot espressos, or one double shot espresso coffee.  Also be careful with herbal teas; some can have an effect on hormone levels. Tea should be consumed away from meals as it reduces your ability to absorb iron from your food.  Limit soft drinks, flavoured waters, fruit drinks, cordials, and diet drinks because these are low in nutrients and may be high in sugar. 

Special Concerns:          

 If someone has any of the below conditions they should ask to talk to a dietitian:
• are 18 years old or younger
• have a medical condition affecting their eating, such as diabetes
• are having more than one baby (eg, twins or triplets)
• eat very little or have a history of eating problems
• are vegetarian or vegan.

Kristy Pemberton is a dietician living in New Zealand. With her husband Nigel, they have travelled all over the world and continue their globetrotting through work and pleasure.

If you found this post helpful & informative, please leave a comment below! We would love to have Kristy back with more great nutrition articles!

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