P R E N A T A L  H E A L T H

NUTRITION & PREGNANCY

The approach to healthy nutrition during pregnancy we advocate is simple.  Understanding the physiologic changes that underlie the nutritional demands of pregnancy can help present basic guidelines for eating, without suggesting that we become rigid and bogged down by rules. Guidelines are based on the changes your body goes through while pregnant and the needs these changes present.

Remember, you need to ingest protein, because protein is one of the essential building blocks of the human cell that cannot come from body stores you have. If you don’t eat enough protein, your body will break down your very own cells, and the by product of this process: ketones (can be measured in your urine), are considered harmful to the baby.

Your body is building a new circulatory system, complete with blood (plasma and red blood cells) for the baby. Your body has to convert a lot of its stored iron into hemoglobin (oxygen carrying part of the red blood cell and one of the components measured when assessing anemia).  Your own circulatory system has to expand so that it can take care of sending oxygen and nutrients to the new life. It is easy to use up iron stores that you have had for your life in this process and to still need more iron (half of the building block of hemoglobin). Therefore it is good to know which foods contain substantial amounts of absorbable iron and to eat them. Consider it good practice to engage in habits that also enhance the absorbability of the iron you are eating such as:

1. Eating vitamin C containing foods at the same time as those that contain iron.

2. Better not to eat Calcium rich foods or take a Calcium supplement with iron containing foods, as it can impede the absorption of iron.

3.  Cook high acid foods (vit. C, tomato sauce for example), in a cast iron skillet, as the acid will leach the iron into the sauce and will then be consumed.

Click here to download a list of iron containing foods that you can refer to. In addition to that, it is easy just to remember basic food groups that are high in iron.

1. lean red meats (beef and lamb).

2. legumes (black beans, red beans, chick peas, lentils),

3. dried fruits (prunes, raisins, currants, apricots etc.).

4. fermented soy products i.e. miso, tempeh.

The issue of iron absorption vs, iron consumption deserves a bit of elaboration. Click here for the article "Rebuild Your Iron" which provides an encyclopedic but easy read on this subject. Ample amounts of heme (iron) and protein (globin) are needed to form the hemoglobin molecule. Women who are less anemic when pregnant will experience less fatigue. This fatigue can become quite debilitating if you are in your third trimester. So if you start soon you can ward it off.

Sugar consumption in pregnancy is another favorite topic of mine. There is so much information out there regarding which sugars are better for glycemic control, for obtaining the best nutrition for the sugar you are getting and on and on. All of these factors are important, but the most important thing to stress about sugar consumption is that eating too much of it, either as simple sugars or complex carbohydrates (starches, carbs), will produce a bigger baby than necessary. My former and current patients can attest to one of my favorite sayings. Three things make babies larger than they need to be: Gestational Diabetes, Genetics, and Haagen Dazs. We can control for the Haagen Dazs factor. Let’s try not to turn this into an adversarial relationship, where I recommend that you not eat too many desserts and you feel more driven to do the forbidden because of this. I have helped out many large babies: equal to and greater than 10 pounds without infant injury, however, it is much harder work for you; so understand where I am coming from when we broach the subject of eating. No one, especially me, wants to make you feel like a bad mama. I just want to spell out some realities that it would be good for you not to lose track of.  And yes, in my mother’s generation, they put women on diets, even diet pills, restricted weight gain, and made women feel criminal for putting on a normal poundage, but let’s not overcompensate for the unwise practices of yore, by showing them that it’s okay to gain 60 pounds. I’ll tell you one thing: it is definitely not necessary. A little discipline now, will pay off after the birth when it’s a little more difficult (at least for the first few months) to get back to your normal exercise routine. Sorry for the sermon. There won’t be many; and thanks for listening.

Of course there is much more to say regarding proper nutrition for pregnancy. Please consult the links for such topics as other necessary nutrients, alimentary no no’s, healthy seafood eating, vegan diet, etc.

CALCIUM NEEDS DURING PREGNANCY AND LACTATION

(excerpted from AAP statement on Breastfeeding)

Although the demand for calcium during pregnancy and lactation may increase by 200-300 mg per day, a recent study reported that fetal needs for calcium can be met by increased maternal absorption of calcium, with no loss of calcium from the mother’s bones. While breastfeeding, the mother is able to meet the needs of her infant by mobilizing calcium from her spinal bone and excreting less calcium in her urine. Five months after she resumes menstruation, replacement of minerals in the spinal bone has occurred, although total bone mineral density is still somewhat lower than levels measured after delivery.

This study is the first to provide a long-term, longitudinal look at calcium metabolism in a group of women followed before, during, and after their pregnancy through five months postmenstruation. The availability of dual-energy X-ray absorptiometry and quantitative computerized tomography have made it possible to detect small changes in the calcium content of bone that occur along with other dramatic metabolic changes of pregnancy and lactation.

However, as is often the case, more research is needed to examine calcium metabolism in other subgroups of the population. The fourteen subjects followed in this study were healthy, well-nourished, white middle-class women whose usual diet was rich in dairy products ( average intake was 1171 mg of calcium throughout the study). Dietary intake of calcium increased significantly by 296 mg at the third trimester. All of the women were between the ages of 23 to 41 years. None delivered twins. Lower calcium intakes, maternal age, and multiple births could all change the metabolic picture. In the meantime, these findings are consistent with the most recently revised dietary recommendations that additional increases in calcium during pregnancy and lactation are not needed in women whose usual diet is rich in dairy products and other good sources of calcium.

Sources:

Ritchie LD, Fund EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE, and King JC. 1998. A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. AJCN 67(4): 693-701.

Allen LH. 1998. Women’s dietary calcium requirements are not increased by pregnancy or lactation. AJCN 67(4): 591-592.