Prenatal nutrition


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  • The role nutrition plays in your baby’s development is critical. More and more evidence is connecting a woman’s nutritional status during pregnancy to the health of her child-not just at birth but throughout his or her life. Some recent studies show that Mom’s nutrition while pregnant my actually alter the function of her child’s DNA and predispose the child to conditions and diseases such as obesity, heart disease and diabetes.Today we will covering an overview of pregnancy nutrition starting with the top nutrients to include in your daily diet, food and substances you should avoid, healthy weight gain and how to avoid the pregnancy 50+ weight gain, common nutrition related problems in pregnancy and diet after baby’s born.
  • Protein is made up of amino acids which are building blocks of every cell in your body and your baby’s developing body. The RDA is increased to a minimum of 71g/day. Aim for 71-100 grams per day or 20% of your calorie intake.1 ounce of protein is 7 grams of protein. Palm of hand is ~3 ounces or 21g of protein. Egg white is 6g protein. 1 cup of milk has 8g protein. Protein foods stay with you longer, helping to reduce hunger.Choose lean sources of protein if weight gain is an issue.
  • Carbohydrates provide energy for the body and is the preferred source of energy.Carbohydrates should not be restricted during pregnancy to avoid ketosis, which is harmful to baby.Consume 45-64% of calories from carbohydrate. Gestational diabetes ~45% or 175g/day.Encourage whole grains (48g/day or 3 servings). Examples of whole grains include brown rice, whole wheat pasta, 100% whole wheat bread, corn tortillas, popcorn and oatmeal.
  • Fat has a key role in developing your baby’ s brain and nervous system. It also provides energy and keeps you feeling full longer. Aim for 20-35% of calories from fat.Omega 3 fatty acids have been shown to reduce the risk of preterm births, preeclampsia and HTN in pregnancy.One recent study found that women who took daily supplements of DHA had longer gestations, bigger babies and fewer preterm births. DHA is found in the brain and is important for brain development. Recommend 300mg/day. EPA is found in every structure of the body and its recommended to consume 220mg/day. The American diet is typically low in omega 3 fatty acids. Some prenatal vitamins contain DHA. Otherwise, you should try and get it from your diet or supplements.Vegetarian sources: Algae (fish eat it to produce their high omega 3 content).DHA enhanced eggs (Egglands: hens fed sea kelp 57mg DHA/egg yolk vs regular eggs 29mg)Recommend supplements of omega 3 fatty acids. Ideally, look for 1000mg of DHA/EPA combined. Flax mostly ALA form with only 10% conversion to DHA/EFat has a key role in developing your baby’ s brain and nervous system. It also provides energy and keeps you feeling full longer. Aim for 20-35% of calories from fat.
  • Some nutrients are of special concern during pregnancy. Folate (food form) also called folic acid (supplement form) plays a key role in developing your baby’s spinal cord early in pregnancy, but its also important later on in the pregnancy, too as your blood volume increases. NTD thought to result from a deficiency of folate or genetic defect affecting folate metabolism. Neural tubes are formed from the 18-26th day of gestation when many women don’t even know they are pregnant. Good plan to take a prenatal or regular MVI prior to pregnancy.Aim for 600 micrograms per day. Your prenatal should have this amount, but food sources are often absorbed better (and these foods have other benefits), so make sure and include foods high in folate everyday. Many foods have folate in them: oranges and orange juice, strawberries, avocados, nuts, dark green leafy vegetables, asparagus, broccoli, starchy beans and many foods now fortified with folate.
  • Your daily iron needs practically double during pregnancy, from 18mg to 27mg/day. This increase is due to the increase in blood volume (20-30%) during pregnancy. Iron helps your body form hemoglobin, the protein that carries oxygen in the blood. You need this oxygen to get to your placenta to help your baby develop. Iron deficiency can increase preterm delivery, low birth weight babies and increase risk of maternal/child mortality.Aside from your prenatal vitamin, you find iron in animal foods like beef, poultry (higher in dark meat), pork, fish, and egg yolks, although you can get iron in seeds, beans, lentils and dark-green leafy vegetables, dried fruit and whole grains. Liver is high in iron, but its also high in vitamin A (retinol form). Too much in the first trimester can be harmful to baby.Instead of chips or crackers for snacks, snack on cold cereal since its fortified with iron.Iron that is found in plant sources is not absorbed as well. To improve absorption, eat foods that are high in vitamin C along with your iron-rich foods. Take your prenatal vitamin with orange juice to increase iron absorption.Cooking iron rich foods in an iron skillet may also help boost your iron intake because some of the iron from the pan will leach into your food.Compounds in coffee and tea inhibit the absorption of iron. Do not take your iron supplement with coffee or tea.
  • Calcium is not only important for bone health of Mom and baby, but it has been shown to reduce risk of high blood pressure (both during pregnancy and not pregnant).If you don’t get enough calcium (1000mg/day), your body will take it from your bones, leaving you at higher risk for osteoporosis. The good news is that your body actually absorbs calcium better when you’re pregnant.Most prenatal vitamins contain only 250mg of calcium, so plan to take in more from your diet. For packaged foods, calcium has to appear on food labels, so you can easily know how much calcium the food you are eating contains.If you are taking extra calcium, you only absorb ~500mg at one time, so split up the calcium supplement during the day. If you don’t like dairy foods or can’t tolerate them, there are a lot of foods now fortified with calcium, such as orange juice. Spinach has too much oxalate that binds with calcium to be a good source.
  • Consuming adequate fluid is critical for your body. You can survive for a long time on stored nutrients, but you couldn’t last a week without fluid.Fluid transports nutrients to your cells and waste materials away from them, keeps your body the proper temperature and moves fiber through your digestive system.Blood is 83% water and blood volume increases during pregnancy. Also, what do you think your baby is floating around in? Amniotic fluid! Areas in the brain associated with taste and smell are developing while in the womb. Amniotic fluid has different flavors and smells depending on what you eat and this fluid is inhaled and swallowed by baby. Could you increase the possibility that baby will like more vegetables if they are introduced to them in the womb????!!!Thirst is not a good indicator of adequate hydration. Often by the time you are thirsty, you are already mildly dehydrated. Watch your urine-it should be clear color. If dark, you need to drink more water.
  • So, how to we meet all of our nutrient requirements each day?The USDA developed this guideline called MY Plate which shows the proportion of calories that should come from each of the 5 food groups: Grains, Protein, Vegetables, Fruits and Dairy. This guide works great for both pregnant and non-pregnant people.
  • One of the most difficult things to control during your pregnancy is your weight. This picture shows were weight is being distributed in the body during pregnancy for a recommended total of 25-35 ppounds. Too much weight gain:Harder to hear baby’s HR and measure the uterus to plot baby’s growth.Increased backaches, leg pain and varicose veins.Increased risk of gestational diabetes, HTN and preeclampsia.Increase risk of C-section-baby too big for the birth canal.Increased risk of chronic disease if weight doesn’t come off after the birth.Also risks if Mom doesn’t gain enough weight.
  • Recommended weight gains are based on pre pregnancy weights. If you started out underweight, you should gain more weight than if you started your pregnancy overweight. The rate of weight gain is also important. Putting on pregnancy pounds gradually is the best approach to weight gain during pregnancy. During the first trimester, 1 to 4 pounds is recommended.2nd and 3rd trimester weight gains, depending on your weight status ranges from a half to one pound per week. Try not to step on the scale everyday during your pregnancy. Because of variations in weight due to fluid balance, you might find you gain 3 pounds in one day and lose 1 pound the next. Gradual weight gain is not linear!As long as the overall trend is slow steady weight gain and baby is growing and gaining weight-don’t stress out about the exact number.If you suddenly gain 5 pounds or more in one week, you should check with your doctor. It could be a sign of fluid gain associated with preeclampsia.Not gaining enough weight can also be a concern. Risk includes low birth weight baby, premature delivery and risk of developmental delays.Twins: weight gain of 37-54 pounds.
  • First Trimester: Even though the 1st trimester is a time of incredible growth for your baby, she’s so small that her growth doesn’t require any significant energy. Listen to your body. Some days you might be more hungry than others.2nd Trimester:Baby goes from weighing 1 ounce to more than 2 pounds. To support your baby’s growth, you need to consume 300-350 calories more per day.You don’t need to eat it all at once- you can spread them out over the course of the day.3rd Trimester:Baby gains ~4 pounds. Take in an extra 450-500 calories per day. As long as you are gaining the proper weight, don’t stress about eating exactly 450-500 calories per day.Increased calorie requirements from increased RMR with pregnancy (burn more calories growing a baby) and increased storage of fat and protein in Mom.Trust your gut! If you feel hunger (below the shoulders) you need to eat! If you feel it above the shoulders, try and distract yourself because you would be eating for emotional reasons.
  • Show examples of healthy foods that meet this calorie level and also empty calorie foods for comparison.
  • Rule number one of pregnancy nutrition: Don’t let anyone tell you (and don’t tell yourself) that you are eating for two. To think that you need to eat as many calories to support your baby as you need to support yourself is misguided.Hunger Scale-1-10Thirst center and the hunger center don’t interact, so if you consume calories from liquids, it doesn’t tell the hunger center you have eaten. Except for low fat milk, beverages should be calorie free. Drink water before meals.Healthy snacks should act as a bridge between meals, ~100-150 calories per day and keep you satisfied for 1-2 hours. Keep healthy snacks available and visible at home and work. Unhealthy snacks out of sight/reach. Examples of healthy snacks.Exercise guidelines:Its recommended that pregnant women get the same level of exercise as non-pregnant women which is 150 minutes per week.Check with your doctor before starting, usually if you did it before pregnancy, you can do it now.Keep heart rate under 140 beats per minute.Do the talk test: You should be able to keep a conversation going while exercising.Avoid jumping or bouncing.Keep core temperature down-don’t get overheated which can hurt baby.
  • Usually, I like to focus on what you should eat, but with pregnancy, we also have to talk about what not to eat.Throughout your pregnancy, you and your baby are at high risk for getting sick. Your immune system is weaker because your body is so busy growing another person, and your baby’s immune system is developing and not even close to operating at full strengthHerbal Supplements:Normal herbs like basil are fine in normal amounts. We do need to be careful about concentrated herbal supplements. There is no safe level.Always check first with your doctor. Avoid aloe, agave nectar, black cohosh, ephedra, ginseng, ginkgo biloba, goldenseal, saw palmetto, willow bark, yohimbe.It is a myth that certain foods can cause a miscarriage.No specific foods that induce labor. No research to back up evening primrose oil, castor oil or spicy foods. Best to let nature happen.12 ounces of seafood or low mercury fish allowed per week. Albacore tuna 6 ounces/week.
  • Caffeine may also reduce fertility. May decrease blood flow to the placenta. Over 200mg/day,2x increase miscarriage.Study on caffeine and labor times. For every 100mg of caffeine, labor increased by 5 hours!Feeling tired without the caffeine? Try and get some exercise, eat a healthy snack, drink water for hydration, and take a nap if needed.Try going half caffeine in coffee. 1 scoop of decaff for every 1 scoop regular. 24 ounces= 12 ounces of caffeine.Listeria is a type of bacteria that can grow at refrigerator temperatures where most bacteria can’t. It can grow in unpasteurized milk and cheese and ready to eat meats (cold cuts, deli meats). Fruits and vegetables that haven’t been washed properly can also be contaminated.Symptoms include fever, chills, muscle aches diarrhea, headache, stiff neck and confusion. Pregnant women are 20 times more likely to get listeriosis than other healthy adults. 1/3 of cases in the United States are in pregnant women. Especially dangerous in the first trimester because it can cause miscarriage. It can also cause MR, seizures and developmental problems in the brain, heart and kidney of the baby.Always heat meats out of the refrigerator. Make sure soft cheeses say on the label they have been pasteurized (Brie, Camembert, feta, blue, Gorgonzola and quesoblanco or fresco. Ricotta cheese wont be pasteurized, but the heat treatment used during curd formation exceeds the requirements for pasteurization. Always wash fruit and vegetables before eating.
  • Caffeine:Generic brewed coffee, 8oz =133mg (range 102-200)Starbucks brewed, 16oz grande = 320Mcdonalds brewed 16oz = 100Starbucks latte, 16oz = 150Espresso 1oz = 40-75mgIced Tea 8 oz = 5-26mgTea 8oz = 53 (40-120)Snapple, lemon 16oz= 42mgGreen Tea 8oz= 24-40mgMountain Dew, regular and diet 12oz= 54mgPepsi, regular and diet 12oz=38/36mgCoke 12oz= 35mgSprite, 7-up, Sierra Mist, Fresca = zeroMonster Energy Drink 16oz = 160Red Bull 8o =80Dark Chocolate 1.4oz bar=31Milk Chocolate 1.5oz bar=9Hershey Kisses, 9 = 9Excedrin, 2 tablets 130mg, NoDoz 1 tablet=200mg
  • Cravings are normal. Up to 85% of moms-to-be experience at least one craving. Most often, cravings or food adversions are due to the changing hormones in your body while you are expecting. The most common cravings are for sweet, salty and sour foods. The extent of the cravings is what you may need to worry about. If the junk food you are craving is filling you up and you aren’t hungry for healthy foods, you have a problem. And too much can lead to excess weight gain and pregnancy complications.Emotions, especially the feeling of entitlement or reward (you need or deserve the extra food) is common.Power of suggestion-just seeing, smelling etc can lead to a craving.Don’t let yourself get too hungry. Distinguish between physical and emotional hunger.Don’t substitute if there is no good substitute. You may just need to eat it and get over it.Eat variety-only eat protein, you will crave carbohydrates.Being tired may increase cravings for energy. If you are feeling low on energy, your brains natural reaction is to crave something sweet because sugar provides instant energy. Fat provides lasting energy, so if your body senses that energy levels have been running low for awhile, it signals you to eat something with fat.Pica can lead to non food cravings.Substitutions:Chocolate: Chocolate yogurt, fudgsicle, chocolate granola barPotato chips: popcorn
  • 70-80% of pregnant women experience some stomach upset due to pregnancy hormones. Its usually gone by 14-16 weeks, but can happen any time of the day.Go bland early- PL toast or crackers w/in 15 minutes of waking. Keep at bedside is helpful.Avoid complete empty stomach. When the stomach is empty, the acids in your stomach signal nauseous feelings to your brain. Keep snacks available.Eat small portions.Eat foods low in fat and sugar. Fat takes longer to digest. Sugar can cause a spike and then drop in energy and blood sugar levels.Stay hydrated. Nausea can be a side effect of dehydration. Suck on ice chips, sip cold water. 102 ounces fluid/day. Stay cool. Over heating makes nausea worse.Take prenatal vitamins at night. Iron can increase nausea. Don’t take on an empty stomach.Lemon and sour candy can reduce nausea. Try lemon scents. Low fat gingersnaps, ginger tea or ginger gum.Strong smells and food smells can trigger nausea. Eat more cold foods or use the microwave.
  • Heartburn often gets worse during the 2nd and 3rd trimester due to progesterone relaxing the sphincter muscle and increasing size of the uterus pressing on the stomach.Slouching puts pressure on the esophagus.Too much liquids at meals fills up the stomach pouch. Try to drink more between meals.Try not to overeat at a meal.Chew gum after eating to increase swallowed saliva which neutralizes acid in the stomach.
  • Constipation is causes by pregnancy hormones progesterone and estrogen. Progesterone slows down digestion to increase nutrient absorption. Estrogen helps expand the uterus, which puts pressure on the GI tract, increasing constipation. Also iron supplements, decreased activity and a low fiber contribute to constipation. Estimated that 50% of pregnant women have constipation.When you move, it stimulates food wastes to move faster through the body.Probiotics in yogurt, kefir (fermented milk) or supplements may help.No use of laxatives which may cause uterine contractions. No mineral oil which can decrease absorption of minerals.Can try an OTC fiber supplement.Talk with your MD if constipation becomes chronic.
  • Fibers main function is to keep food/waste moving through the GI tract. Fiber can also keep you feeling full longer along with helping your body maintain a healthy cholesterol level.During pregnancy, you need to get 28g of fiber per day (that’s 3g more than pre-pregnancy amount).Pregnant women need more fiber in their diets to combat their increased risk of constipation.Fiber is only found in plant foods-not animal foods.Look for opportunities throughout the day to add more fiber to your diet. Start with a high fiber cereal in the morning. Some additional ways to add fiber to your diet are: read slide
  • Congratulations! Baby is here. Whether you had a fast labor and delivery or a c-section, childbirth takes a lot out of you.But good nutrition can help restore your body to what is once was. Recovery usually takes 2-4 weeks for a vaginal birth and 8-10 weeks for a c-section.Certain nutrients are especially important during the recovery period:Calories: During the recovery period its important to take in enough calories, otherwise other nutrients, such as protein will be used for fuel instead of healing and repair. 1500 calories/day minimum if bottle feeding and 1800 minimum if nursing.Protein helps build and repair cells and muscles that were damaged during childbirth, especially if you had a c-section. Get a minimum of 71g/day. Focus on lean protein from meat, seafood, fish, poultry, eggs, nuts, seeds, beans and soy at every meal.Iron requirements stay high at 27mg/day during recovery due to blood loss during delivery. After recovery, you can drop back down to 18mg/day as long as you aren’t anemic.Vitamin C is good for wound healing. Aim for 85mg/day from fruits and vegetables.Fiber is important since many women complain of constipation in the weeks following delivery. To avoid this, drink lots of fluid and eat 28g fiber/day.Extra insurance, continue your prenatal vitamin.
  • You have to eat additional calories per day to help your body produce milk, ~400-500 calories than before pregnancy.Don’t consume less than 1800 calories/day-your milk production may suffer with less calories.Treat your lactation diet pretty much the same as your pregnancy diet.Carbohydrates provide fuel to the body. Do not go on a low carbohydrate diet while nursing. 300g/day, mostly whole grain.Protein should be 20% of calories or 73-110g/day depending on body size.Most of the nutrients you need to pay attention to when nursing are the same ones you focused on during pregnancy, but amounts may be greater.Consume omega 3’s, especially DHA from fish or supplements for baby’s brain development.Most women don’t have adequate vitamin D levels in their breast milk, baby should take supplemental drops. Mom should be supplementing, too.Liquids: To create a liquid in your body, you need to add extra liquid to your diet. It doesn’t all have to be water.Keep an insulated mug of ice water on the table next to the chair you will be nursing. That way you can drink when baby drinks.Alcohol and caffeine pass into breast milk, which means that if you drink your baby does too. Alcohol can interrupt a baby’s sleep, and large amounts passed to a newborn on a regular basis can cause problems with brain development. Alcohol may also affect your ability to produce milk because it suppresses oxytocin, the hormone that signals milk production in your body. If you feel you need an occasional alcoholic drink, try to have it right after a feeding. Alcohol isn’t stored in your milk, so as long as you wait 2-3 hours after you have one drink to feed your baby, the amount of alcohol that passes to your baby will be very small. You can also pump and discard your milk to avoid passing alcohol to your baby.As for caffeine, even small amounts of this stimulant can leave a baby jittery and irritable, cause interrupted sleep, increase her heart rate and affect her breathing. In general, limit yourself to 200mg/day. If you notice your baby seems to be feeling the effects of the caffeine, cut it out of your diet. Your baby will be most sensitive for the first 6 months, but its best to limit caffeine the whole time you are nursing.
  • The first step to successfully losing weight after pregnancy is to have realistic expectations based on the amount of weight you gained throughout the past 40 weeks.During an average pregnancy, 25-35 pounds are gained.Approximately 10 of those pounds comes off right after you deliver your baby and the placenta.Within 2-4 weeks after delivery, you’ll likely lose another 5 or more pounds as the fluid balance in your body starts to return to normal.It also takes 4 weeks for the uterus to contract back to normal. Nursing can speed up the process!A good rate of weight loss is about 1 pound per week after the recovery phase. If you gained a lot of weight, then 2# per week might be realistic.Goal is to get back to your pre-pregnancy weight by the baby’s first birthday.Focus on nutrient dense foods. These foods provide you with the nutrients it needs to function, as a bonus, they’re often low in calories, too. Right after delivery, start focusing on foods that contain the following filling components: Protein: takes longer to digest, keeping you satisfied for a longer period of time. Aim for 75g-100g/day. Lean protein (give examples)2. Fiber- fiber is indigestible plant matter. Your body tries to digest it, but it can’t so it keeps you feeling full longer. Minimum 25g/day. Reviewed earlier high fiber foods. Try for ideas. 3. Focus on whole grain carbohydrates, limit refined carbohydrates. Remember the plate picture in the beginning of the presentation. ¼ carbohydrate, ¼ lean protein, ½ fruits and vegetables.4. Water- Drinking water before and during meals aids in digestion, and helps fill you up a bit, even if only temporarily. Drink 91 ounces of total fluid (a little more than 11- 8oz cups per day, majority from water.5. Of course, you should try to reduce items like alcohol, sweets and desserts, fried foods and regular soft drinks. You have to create a calorie deficit. Be smart about beverages-majority should be calorie free. No connection between the hunger and thirst center in the brain. Drinking calories from liquids does not tell the hunger center to cut back on calories from solid food.Eat smaller portions more frequently-don’t skip meals, use smaller plates, cups and utensils. Lets take a look at how portion sizes have increased in just the last 20 years.
  • 5. Listen to your body-Your belly always tells you when you’ve had enough. So instead of cleaning your plate every time you sit down to a meal, listen to what your belly is saying. There is a distinct difference between feeling satisfied and feeling stuffed! When you push the plate away at satisfied, you leave room for your body to use stored fat as energy so you can get the weight loss you desire. Always wait 15-20 minutes before going back for seconds because it takes that long for your stomachs fullness signal to reach the brain. Hunger felt below the shoulders!6. Breast feed to burn more calories-Depending on how much milk you produce, you can actually burn more calories while breast feeding than you did growing your baby! Of course, because you still need to balance the calories you’re eating with the calories you are burning, there’s no guarantee you will lose weight simply by breastfeeding. Breast milk is naturally high in fat for baby’s brain development. How does your milk get so high in fat? By breaking down excess fat from your body. Pregnancy hormones signal your body to store fat, but your body mobilizes that fat into breast milk after you deliver.7. Get Moving- Calories in versus calories out. Talk to your doctor about when its safe for you to start adding exercise back into your routine. A good time to exercise is when your baby is sleeping, or maybe someone can watch the baby so you can exercise. Work on both cardio and strength exercises. You probably gained some muscle during pregnancy just by carrying around an extra 25-30 pounds. Adding resistance exercise will help keep that extra muscle gained during pregnancy.8.Practice mindfulness at meals- Maybe difficult with baby, but the more you can eat without distraction, the more likely you will listen to your body and start paying attention to hunger cues. Turn off the TV, computer etc while eating. Eat meals and snacks at the table. This is a great habit to get into for the whole family. There are many benefits to families eating together at the table.9. Keep a food journal- considered the #1 way to lose weight by increasing your accountability for what you are putting in your mouth. There are many free food journal apps that you can use on your smart phone, ipad etc or computer.10. Get enough sleep- Studies show that sleep deprived people are heavier than those who get 7-8 hours of sleep a night. Two specific hormones are to blame for the excess weight. Leptin is produced in your fat cells and its responsible for telling your brain when you’re full when eating a meal. Ghrelin is produced in your GI tract and its job is to tell your brain when you’re hungry. When you are sleep deprived, your body decreases production of leptin and increases production of ghrelin. The result is one tired mom who’s hungry and can’t get satisfied and keeps on eating. I know its hard to get sleep with a new born-try and catch a nap during the day if possible and use good sleep hygiene.
  • No Fad Diets!
  • Prenatal nutrition

    1. 1. Lori Treb MS, RD, CDE
    2. 2.  Protein is made up of amino acids that arethe building blocks of every cell in the body. Aim for 71-100 grams per day. 1 ounce of protein is 7 grams. Choose lean sources of protein.
    3. 3.  Provide energy for the body. Should not be restricted during pregnancy. Consume 45-65% of calories or 225-325g/day. Make most of your grains whole grains.
    4. 4.  Low intake may increase risk of pretermbirth, preeclampsia and hypertension. DHA found in the brain. Recommend300mg/day. EPA is found in every structure of the body.Recommend 220mg/day. Food sources: Salmon, anchovies, sardines, crab, light tuna,shrimp (all low in mercury). Vegetarian Sources: Algae, DHA enhanced eggs.
    5. 5.  Folic acid helps develop baby’s spinal cordwhich develops between day 18-26 ofgestation. 600 mcg/day Take prenatal vitamin Food sources: Oranges, orange juice, strawberries, avocados,nuts, dark leafy green vegetables, asparagus,broccoli, starchy beans and fortified foods.
    6. 6.  Requirements increase from 18mg to27mg/day due to increased blood volume. Best absorbed from animal foods: Beef, poultry, pork, egg yolks (avoid liver). Plant sources of iron not absorbed as well.Consume with vitamin C foods: Oranges, tomatoes, cantaloupe, kiwi, peppers,broccoli, strawberries, potatoes. Cook with iron skillet. Avoid iron inhibitors
    7. 7.  Important for bone health and blood pressurecontrol. Recommend 1000mg/day. Should be dividedthroughout the day. Increased absorption during pregnancy. Food sources: Dairy foods, fortified soy and almond milk, darkleafy greens (except spinach), broccoli, fortifiedfoods (such as orange juice).
    8. 8.  Take in 90ounces (11 cups/day). Thirst is not a good indicator of hydrationstatus. The color of your urine should be clear. Drink a tall glass of water with meals. Carry a water bottle with you. Add cucumber, citrus, pineapple or berries toyour water.
    9. 9. PrePregnancyweightPrePregnancyBMITotal WeightGain DuringPregnancyRate ofWeight Gain(averageper week,2nd and 3rdtrimester)Underweight <18.5 28-40pounds1.0-1.3HealthyWeight18.5-24.9 25-35 0.8-1.0Over Weight 25.0-29.9 15-25 0.5-0.7Obese 30+ 11-20 0.4-0.6How Much Weight Should You GainFirst trimester gain 1-4 pounds.
    10. 10.  1st Trimester (weeks 1-13)No additional calories needed. 2nd Trimester (weeks 14-27)Take in an extra 300-350 calories. 3rd Trimester (weeks 28-40)Take in an extra 450-500 calories.
    11. 11.  You aren’t eating for 2, so don’t double yourcalorie intake. Eat smaller, more frequent meals. Eat until comfortable, not stuffed. Eat lean protein, vegetables and fruit first. Choose whole grains. Increase calorie free beverages like water. Pick healthy snacks. Watch out for emotional eating. Exercise.
    12. 12. Don’t Eat orDrink ThisWhy to Avoid AlternativeStrategyAlcohol Passes to the fetus.Can cause braindamage anddevelopmentaldelays. Increasedrisk of miscarriageand stillbirth.Consume non-alcoholic drinks.Unpasteurized milk,cheese, juice orhoney. Raw Sprouts.May containdangerous bacteria.Always look for theword pasteurizedon the label. Don’teat sprouts.High mercury fish(shark, swordfish,king mackerel,tilefish, albacoretuna).Mercury can causeproblems withbaby’s developingbrain and nervoussystem.Choose low mercuryfish, such assalmon, shrimp,crab, clams,scallops, catfish,tilapia, pollock,cod, and light tuna.Foods and Beverages to Avoid During Pregnancy
    13. 13. Use Caution WithThese FoodsWhy to UseCautionAlternativeStrategyDeli Meats Can contain Listeriabacteria that cansurvive atrefrigeratortemperatures.Heat deli meatsuntil steaming hot(165 degrees) if youchoose to eat them.Sweeteners Agave Nectar cancause uterinecontractions.Saccharin crossesthe placenta.Animal studies showincreased cancerrisk in offspring.Choose safersweeteners inmoderation (Stevia,Splenda, sugar,pasteurized honey.Caffeine Crosses theplacenta; canincrease baby’sheart rate and slowgrowth.Limit your caffeineintake to no morethan 200 mg/day.Foods to Be Cautious of During Pregnancy
    14. 14. Food Caffeine ContentCoffee, 8 ouncesStarbucks Latte, 16 ouncesStarbucks, brewed, 16 oz133mg (100-200)150mg320mgTea, 8 ouncesGreen Tea, 8 ouncesSnapple Ice Tea, 8 ounces53mg (40-120)24-40mg42mgMountain Dew, 12 ounces 54mgPepsi, 12 ounces 38Sprite, 7 up 0Monster Energy Drink, 16 oz 160mgDark Chocolate, 1.45ouncesMilk Chocolate, 1.5 ounces31mg9mgCaffeine Content
    15. 15.  Go bland early. Avoid an empty stomach. Eat small portions Eat foods low in fat and sugar. Stay hydrated and cool. Try lemon or ginger. Avoid tight fitting clothing. Take prenatal vitamins at night. Avoid food smells.
    16. 16.  Stop eating 2-3 hours before lying down. Sleep with head elevated and lay on leftside. Sit up straight with good posture. Avoid large meals. Drink smaller amounts of liquid with meals. Avoid greasy, fatty foods. Avoid caffeine, carbonated beverages andchocolate. Chew gum after eating.
    17. 17.  Drink, drink, and drink more water. Add probiotics. Move your body. Try splitting prenatal vitamin: ½ AM and ½PM to spread out the iron. Increase fiber to 28g/day.
    18. 18.  Fiber is only found in plant foods. Sneak fiber into your diet: Use whole wheat flour for ½ of white. Leave skins on fruits and vegetables. Shred and puree vegetables and add to soups, saucesand casseroles. Make fruit and vegetable smoothies. Add canned beans to salads, soups, pasta dishes. Snack on popcorn, fruit, vegetables, and high fibercereal.
    19. 19.  Vaginal Delivery: 2-4 weeksC-Section: 8-10 weeks. Consume adequate calories. Minimum of1500/day if bottle feeding and 1800/day ifbreastfeeding. Focus on lean protein, iron, vitamin C andfiber. Continue prenatal vitamins.
    20. 20.  Calories: 1800-2200/day. Additional 400-500calories per day. Protein: 73-110g/day or 20% of calories. Carbohydrates: 300 grams/day Omega 3 fatty acids Vitamin D: 1000 IU/day Fluids: 128 ounces/day (16 cups) Caffeine Alcohol
    21. 21.  Have realistic expectations. 10# lost from delivery of baby and placenta. 5# lost in 1-2 weeks as fluids return to normal. 4 weeks for uterus to contract back to normal. Focus on nutrient dense foods. Lean protein Fiber ( Whole grain carbohydrates Be smart about beverages. Eat smaller portions more frequently.
    22. 22. CHICKEN CAESAR SALAD20 Years Ago Today390 calories1 ½ cups790 calories3.5 cupsCalorie difference: 400 calories
    23. 23. If you walk the dog for 1 hour and 20minutes, you will burn approximately 400calories.**Based on 160-poundpersonCalories In = Calories Out
    24. 24. 20 Years AgoCoffee(with whole milk and sugar)TodayMocha Coffee(with steamed whole milk andmocha syrup)45 calories8 ounces350 calories16 ouncesCalorie difference: 305 calories
    25. 25. If you walk 1 hour and 20 minutes,you will burn approximately 305calories.**Based on 130-poundpersonCalories In = Calories Out
    26. 26. 20 Years Ago TodayCalorie difference: 290 calories500 calories4 ouncesMUFFIN210 calories1.5 ounces
    27. 27. If you vacuum for 1 hour and 30 minutesyou will burn approximately 290 calories.**Based on 130-poundpersonCalories In = Calories Out
    28. 28. 140 calories3-inch diameterCalorie difference: 210 calories350 calories6 inch diameter20 Years Ago Today
    29. 29. If you rake the leaves for 50 minutes youwill burn the extra 210 calories.**Based on 130-pound personCalories In = Calories Out
    30. 30. Calorie difference: 500 calories820 calories320 caloriesTURKEY SANDWICH20 Years Ago Today
    31. 31. *Based on 160-poundpersonIf you ride a bike for 1 hour and 25minutes,you will burn approximately 500 calories.*Calories In = Calories Out
    32. 32. Calorie Difference: 525 calories1025 calories2 cups of pasta withsauce and 3 largeMeatballs.20 Years Ago Today500 calories1 cup spaghetti withsauce and 3 smallmeatballsSPAGHETTI AND MEATBALLS
    33. 33. *Based on 130-poundpersonIf you houseclean for 2 hours and 35 minutes,you will burn approximately 525 calories.*Calories In = Calories Out
    34. 34. Calorie Difference: 257 calories590 caloriesCHEESEBURGER20 Years Ago Today333 calories
    35. 35. If you lift weights for 1 hour and 30minutes, you will burn approximately 257calories.**Based on 130-poundpersonCalories In = Calories Out
    36. 36. 20 Years Ago Today435 calories2 cups865 calories4.5 cupsCalorie Difference: 430 calories
    37. 37.  Listen to your body Hunger is physical Appetite is emotional Breastfeeding to burn more calories. Get moving. Practice mindfulness at meals. Keep a food journal. Get enough sleep.