Prenatal Nutrition Checklist Is to Help Guide Client Discussions

Home , Prenatal nutrition, Prenatal vitamins

November 2013

Welcome to the Prenatal Nutrition Manual for healthcare professionals working with pregnant women. This manual was designed by Public Health Dietitians from the Winnipeg Regional Health Authority and was created especially for use during Healthy Baby community drop-in programs.

The purpose of the Prenatal Nutrition Checklist is to help guide client discussions. It is not intended to be used in the following manners: - as a form for the client to fill out without follow up - as an assessment - as a form of charting to be kept on file The client’s name or other identifying information should not be written down on the checklist.

The goal of the Prenatal Nutrition Checklist is to provide evidence based prenatal nutrition information and corresponding handouts to equip healthcare professionals in their work with prenatal women.

How to use this manual: 1. Following this page is the Prenatal Nutrition Checklist. This is a conversation guide for you, the healthcare professional, to use when initiating a discussion with a prenatal client. The checklist encompasses all the major discussion points for a conversation on optimizing pregnancy outcomes through healthy eating and nutrition. 2. Each tab thereafter corresponds to each of the questions asked on the Prenatal Nutrition Checklist in the order in which they appear on the checklist. Within each tab, there are summaries of background evidence for the topic. 3. The colourful folder on the left contain handouts pertaining to each of the topics in the checklist. 4. A memory stick has been included with the electronic copies of resources that can easily be printed by each user of this manual as needed. A document at the back of the binder has been included with information on resource reordering, for resources that cannot be easily printed.

The resources, background information and summaries that have been included are the most up to date information available at the time of printing.

Prenatal Nutrition Checklist

 Are you taking prenatal vitamins?  Do you take any other vitamins/herbal products/herbal teas/medication? o If yes, please list: ______ Do you have anemia (low blood iron)?  Are you ever worried about food?

Do you have…  Diabetes?  Constipation?  Nausea/vomiting?  Diarrhea?  Heartburn?  Lactose intolerance?

Do you know which foods are important to eat during pregnancy? ______

Do you know which foods to avoid during pregnancy? ______

How is your appetite?  Always hungry  Rarely hungry  Often hungry

What beverages do you drink?  Coffee  Energy drinks  Tea  Pop

What do you know about breastfeeding? ______

Did you know? If you have at least one of the following, it is recommended that you take 5mg Folic Acid per day until you are 12 weeks pregnant. Prenatal vitamins usually contain 0.4-1.0 mg Folic Acid so you would need to take extra Folic Acid in a separate pill. Talk to your medical doctor or midwife.

 Insulin dependant diabetes  BMI >35  Epilepsy/epileptic seizures  Family history or previous baby with Neural Tube Defect  Or belong to a high risk ethnic group (Celtic, Sikh, Northern Chinese) Healthy Baby Prenatal Nutrition Checklist Resource Re-Ordering

Print from memory stick Order from other organizations Safe Foods/Food Safety Safe Foods/Food Safety

1. Artificial Sweeteners 1. Safe Food Handling For Pregnant 2. Eating Fish During Pregnancy Women (Health Canada: 3. Food safety during pregnancy http://www.hc- sc.gc.ca/contact/pubs-eng.php) Healthy Pregnancy Healthy Pregnancy

1. Healthy Eating Guidelines for 1. The Sensible Guide to a Healthy Pregnancy Pregnancy (Health Canada: 2. Thinking about having a baby http://www.hc- sc.gc.ca/contact/pubs-eng.php) 2. Eating Well with Canada’s Food Guide (Health Canada: http://www.hc- sc.gc.ca/contact/pubs-eng.php) 3. Dial-a-Dietitian pamphlet (1-877- 830-2892 or 204-788-8248 in Winnipeg) Constipation/Diarrhea

1. Constipation (EAL Nutrition Visual Aids, page 5) 2. Healthy Eating Guidelines for Increasing Your Fibre Intake Lactose Intolerance

1. Lactose Intolerance (EAL Nutrition Visual Aids, page 6) Caffeine

1. Caffeine During Pregnancy and Breastfeeding 2. Is caffeine safe in pregnancy 3. Are Herbs and Herbal Teas Safe to use during Pregnancy and Breastfeeding Nausea/Vomiting

1. Nausea and Vomiting In Pregnancy - WRHA 2. Nausea (EAL Nutrition Visual Aids, page 4) 3. Nausea and Vomiting of Pregnancy SOGC Heartburn

1. Heartburn (EAL Nutrition Visual Aids, page 7) 2. Safe medications for heartburn (EAL Nutrition Visual Aids, page 8) 3. Unsafe medication for heartburn (EAL Nutrition Visual Aids, page 9) 4. Managing Heartburn Anemia Anemia

1. High Iron Foods (EAL Nutrition 1. Iron, Are you getting enough? Visual Aids, page 2) (http://health.beefinfo.org/en/resour ces/nut_education/default.aspx) Diabetes

1. Healthy Eating Guidelines for Women with Gestational Diabetes 2. Sample Meal Plan Vitamins/Minerals Vitamins/Minerals

1. Prenatal vitamins (EAL Nutrition 1. Folic Acid it’s never too early Visual Aids, page 18) (Spina Bifida and Hydrocephalus 2. Multivitamins (EAL Nutrition Assoc of Canada – Email Visual Aids, page 3) [email protected] or call 1-800-565- 3. Food sources of folate 9488 or 204-925-3650 in 4. High Calcium foods (EAL Winnipeg) Nutrition Visual Aids, page 17)

REFERENCE SECTION:

The reference section has been included for health providers to have current and accurate information to share with participants or others. Each tab corresponds to one of the questions on the prenatal nutrition checklist in the order in which they appear on the checklist. The background information and summaries that have been included are the most up to date information available at the time of printing. Please check the original source for updates.

Artificial Sweeteners: Are they safe during pregnancy & breastfeeding?

Artificial sweeteners make food taste sweet without adding sugar or calories. Artificial sweeteners that have been added to packaged foods and drinks are safe during pregnancy and breastfeeding. SAFE Artificial Sweeteners during pregnancy and breastfeeding:

Aspartame (Nutrasweet, Equal) Sucralose (Splenda) Acesulfame Potassium (Ace‐k, Sunnett, Sweet One)

Sweetners under review by Health Canada Stevia (Sweet Leaf) • Health Canada has not approved stevia leaves and extracts as a sweetening agent. Further safety tests are needed.

UNSAFE Artificial Sweeteners during pregnancy and breastfeeding: Saccharin (Hermesetas) Cyclamate (Sweet `n Low, Sugar Twin)

Artificial Sweeteners are a beneficial sugar substitute for diabetics because they do not raise blood sugar levels.

Courtesy of Health Start for Mom and Me. Updated October 2012. References: PEN (2012). Sweeteners Evidence Summary. Canadian Diabetes Association (2011). Sugar and Sweeteners. Can be found at http://www.diabetes.ca/files/en_sweeteners_final.pdf. Health Canada (2010). Food and Nutrition: Sugar Substitutes. Can be found at www.hc‐sc.gc.ca.

Eating Fish During Pregnancy and Breastfeeding Eat 2 or more servings of fish every week. (1 serving = ½cup or 2.5 ounces) Choose a variety of SAFE fish during pregnancy and breastfeeding Light Tuna Shrimp Salmon Sole Sardines

Crab & Lobster Trout Mussels & Clams Scallops Oysters

Other safe fish include: pollock, anchovies, herring, carp, haddock, flounder, Atlantic mackerel, lake whitefish, perch, capelin, char, hake, mullet, and smelt. Limit these types of fish because they contain high amounts of mercury

Albacore & White tuna Shark Swordfish –No more than 10 ounces (2 cups) per week Eat NO more than 1 cup or 5 ounces (2 servings) Escolar & Marlin Fresh or frozen tuna Orange Roughy per month

Avoid UNSAFE fish during pregnancy and breastfeeding

Raw Fish Smoked fish, unless Imported fish from heated, Asia, especially dried or fish canned

• Fish oil Supplements are NOT recommended for women with intrauterine bleeding and bleeding disorders or women taking blood thinners. • Do NOT take cod liver oil • Choose fish instead of supplements.

Courtesy of Health Start for Mom and Me. Developed October 2012. References: Health Canada (2009).Prenatal Nutrition Guidelines for Health Professionals ‐ Fish and Omega‐3 Fatty Acids. Available at hc‐sc.gc.ca. PEN (2012). Pregnancy: Key practice points. “Are there safety concerns for the ingestion of fish in women who are pregnant, planning to become pregnant or breastfeeding related to mercury contamination? PEN (2012). Pregnancy Evidence Summary. Eat Safel y, Eat Well Food Safety During Pregnancy Eat Safely, Eat well Food Safety During Pregnancy

Your pregnancy is an important time. Eating safe and healthy foods is important to you and your baby. There are many things to consider when choosing and preparing food. This information is designed to help you make the best choices for you and your baby.

Why is food safety important during pregnancy?

• Foodborne illness can be caused by eating contaminated food. It can affect everyone, but it can be more serious for you and your baby when you are pregnant.

• During pregnancy your body changes. This Foodborne illness includes how your immune system works. can make your baby These changes may make you more likely to become sick, and certain diseases may cause sick before and after more serious illness for you and your baby. birth. • Foodborne illness can make your baby sick before and after birth. What should I eat during my pregnancy?

• A well-balanced diet with healthy foods and the nutrients that you need for a healthy pregnancy for you and your baby.

• Foods which are properly washed, stored and cooked to prevent foodborne illness.

• Foods which are safe for pregnant women.

How can I keep myself and my baby safe from foodborne illness?

• Bacteria that can cause foodborne illness include Listeria, Salmonella, Campylobacter and E. coli. • Bacteria can be found in a variety of raw and Choose foods that cooked foods including, meat, poultry, eggs, fruits, vegetables and dairy. are not considered

• Bacteria that can cause foodborne illness do high-risk. not change the smell, look or taste of your food. Follow safe food • Symptoms of foodborne illness are stomach handling practices. cramps, nausea, vomiting, fever and diarrhea.

• Most foodborne illness is unpleasant, but the symptoms usually go away after a few days. During pregnancy there is a risk of more serious complications for you and your baby.

• Proper food handling and taking steps to separate, chill, clean and cook will help to prevent foodborne illness. Listeriosis • Listeriosis is caused by Listeria , a bacteria that can contaminate food and lead to serious illness. Listeriosis can • Listeria is unique because it can be found be prevented by on foods which you do not usually cook and it can grow at refrigerator temperatures. avoiding certain • Foods that Listeria may be found on include: foods and handling unpasteurized cheese and milk, soft and food safely. mould-ripened cheese, deli meats, packaged hot dogs, raw seafood and smoked salmon. • Listeriosis in pregnant women can cause miscarriage or stillbirth, or your baby can be born very sick. • Symptoms of listeriosis include fever, headache, nausea and vomiting. • Listeriosis can be prevented by avoiding certain foods and handling food safely. FOODS TO AVOID SAFER ALTERNATIVES

All unpasteurized cheese and dairy Pasteurized hard cheese and dairy products products All soft cheeses, even if they are Pasteurized hard cheese pasteurized (e.g., Brie, Camembert, (e.g. Cheddar, Swiss, Parmesan feta, mould-ripened cheese such as and Colby), or cooked pasteurized Gorgonzola) soft cheese Deli meats (e.g., ham and turkey Deli meats that are cooked until slices, cured meats such as salami steaming hot (to internal tempera - and prosciutto ture of 74° C or 165° F or warmer) Uncooked hot dogs Hot dogs that are cooked until steaming hot (to internal tempera - ture of 74° C or 165° F or warmer)

Refrigerated pâtés and meat spreads Canned pâtés and meat spreads (they do not require refrigeration until after opening)

Refrigerated smoked fish and Canned smoked fish and seafood seafood products (e.g. smoked products (they do not require salmon) refrigeration until after opening) Raw and undercooked meat and fish Cooked meats and fish (e.g., (e.g., sushi, raw oysters, carpaccio, cooked whole chicken breast, steak tartar) roast pork, beef or salmon) Raw egg, egg dishes with runny Cooked eggs (until whites/yolk is whites/yolk or any food items solid) and dishes containing cooked containing raw or under-cooked egg or use pasteurized egg products eggs as an ingredient (e.g. eggnog, tiramisu)

Unpasteurized juice or cider Pasteurized juice or cider Raw sprouts (e.g. alfalfa, mung beans Cooked sprouts until steaming hot and clover) (to internal temperature of 74° C or 165° F or warmer) Safe food handling

Proper cooking, cleaning and storage of your food can remove or reduce the cause of foodborne illness.

There are four key steps in safe food handling:

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v a o u r e d s h h o o o e n c c l a S W T f u W T a K n W l f o R t 5 p s s C t U i p t K o o a l a a i o • • • B • • • m • W f B k • • • Nutrition during pregnancy

• Consult with the Canada’s Food Guide, your health care provider, a dietician or other resources such as Baby’s Best Chance to ensure you are getting a well balanced diet with the necessary vitamins and nutrients.

• Choose safer options while pregnant to avoid foodborne illness. Nutritional benefits and risks of fish Fish are an important source of protein and Omega 3 fatty acids which are important for your baby’s brain development. Salmon, trout, sole Some kinds of fish contain higher amounts and BC or Canadian of mercury, a metal that can be harmful to a developing brain. albacore tuna can be eaten in any quantities It is recommended that consumption of: • Ahi tuna (bigeye tuna), escolar, sea-bass, and anytime. shark, marlin, swordfish and barracuda be limited to 2 servings per month (150 grams). • Canned tuna (albacore), cod, bass, rockfish and trout be limited to 4 servings per week (300 grams). • Other fish (salmon, trout, sole and BC or Canadian albacore tuna) can be eaten in any quantities and anytime. Did you know? • Infant botulism is a rare disease that can occur when a child less than one year old swallows spores of Clostridium botulinum bacteria, which are found in dirt and dust and can contaminate honey. Honey should not be fed to newborns. • Avoid gardening and changing cat litter during pregnancy to reduce risk of toxoplasmosis. • Consume refrigerated leftovers within three days or freeze them for later use. • Do not refreeze defrosted food. • Follow all storage and cooking instructions and “best before” dates. Additional references

If you have further questions talk to your health care provider or consult with these additional resources.

BC Centre for Disease Control www.bccdc.ca http://www.bccdc.ca/dis-cond/a-z/_l/ Listeria/overview/Listeriosis.htm

Canada’s Food Guide http://www.hc-sc.gc.ca/fn-an/ food-guide-aliment/index-eng.php

Best Chance Website http://www.bestchance.gov.bc.ca

Baby’s Best Chance http://www.health.gov.bc.ca/library/ publications/year/2010/bbc.pdf

Canadian Partnership for Consumer Food Safety Education http://www.canfightbac.org

Healthlink BC http://www.healthlinkbc.ca

Do Bugs Need Drugs? http://www.dobugsneeddrugs.org Notes d e t i m i L n g i s e D c i h p a r G e o C a d n i L 655 West 12th Avenue Vancouver, British Columbia Canada V5Z 4R4 www.bccdc.ca/foodsafetyinpregnancy

Healthy Eating Guidelines for Pregnancy

Eating well during your pregnancy gives your baby healthy nutrients to grow and develop. Following Canada's Food Guide will provide the nutrition building blocks you need for a healthy pregnancy. Some nutrients, like folate (folic acid), iron, calcium and omega-3 fats, are particularly important during pregnancy.

To meet your energy (calorie) needs during pregnancy:

Follow . Canada's Food Guide for your age group.

During the second and third trimesters, add two to three additional Food Guide Servings each day. Enjoy them with meals,

or try . an extra snack such as:

» an apple and cheese

» yogurt and fresh fruit

» hummus with vegetable sticks

Get your energy from healthy foods rather than foods high in fat, salt or sugar like chips, salted pretzels, candy, sweetened beverages, cakes and cookies.

Visit . www.healthcanada.gc.ca/foodguide for serving size examples and meal and snack ideas.

To meet your folate (folic acid) needs, especially in the 1st trimester:

Take a daily multivitamin that has 0.4 mg (400 mcg) of folic acid.

» Do not take more than 1 mg (1000 mcg) per day.

Choose high folate foods every day such as:

» lentils and dried beans like chickpeas, black, navy and pinto beans

» edamame

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2013-07-23 | PAGE 1

» sunflower seeds and peanuts

» vegetables like broccoli, asparagus, okra, spinach, Brussels sprouts, collards and mustard greens

» some fruits like papayas and avocados

» enriched pasta

Folic acid is a B vitamin that helps your body make new cells. Folate is found naturally in some foods. Folic acid is a man-made form of folate. It can be hard to get enough from food alone, so you need to take a folic acid supplement before and during pregnancy, as well as afterward. Getting enough folate (folic acid) reduces the risk of a birth defect that affects the brain and spinal cord, called a neural tube defect.

To meet your iron needs throughout pregnancy:

Choose food sources of iron such as:

» cooked mussels, clams and oysters

» beef and lamb

» cooked organ meats

liver is very high in vitamin A. Do not eat more than one food guide serving (75g) of liver per week during the first three months of pregnancy.

» chicken and fish

» pumpkin seeds and cashew, pine and hazel nuts*

» dried beans, peas and lentils*

» fortified whole grain cereals*

» dark leafy greens like spinach and swiss chard* *Eat these iron rich foods with foods that are sources of vitamin C, like kiwi fruit, citrus or tropical fruit, or bell peppers to help iron absorption.

Take a daily multivitamin that has 16-20 mg of iron.

» Some women may need more. Talk to you healthcare provider about the amount of iron you need.

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2013-07-23 | PAGE 2

Iron helps build new red blood cells and helps them carry oxygen. During pregnancy, the amount of blood you have increases to meet the needs of both you and your baby. The iron you eat while pregnant will help your baby store enough for when she is born.

To meet your calcium needs, include 2 servings of milk and alternatives every day:

250 mL (1 cup) of 1% or skim milk or fortified soy beverage.

50 g of lower fat cheese (less than 20% M.F.)

175 g (3/4 cup) of yogurt or kefir

Calcium helps teeth, bones, the heart, nerves and muscles develop. Without enough calcium from your diet, calcium is taken from your bones to help your baby develop. Having enough calcium throughout your pregnancy meets the needs of both you and your baby.

To meet your omega-3 fat needs:

Eat at least 2 servings (150 g) per week of fatty fish like salmon, mackerel or herring.

» See the Additional Resources for information about choosing fish that is lower in mercury.

Choose walnuts, ground flax seeds, chia seeds, soy products and canola oil more often.

Some foods may be fortified with omega-3 fats. Read the label on foods like margarine, eggs, yogurt, juice and soy beverage.

Omega-3 fats are used for your baby's brain and eye development. Omega-3 fats include alpha linolenic acid (ALA), EPA and DHA. ALA is an essential fat found in plant sources like nuts, seeds and soy. ALA is used to make EPA and DHA. EPA and DHA are found in only a few animal-based foods such as fish. To meet your omega-3 needs, choose a variety of these omega-3 sources.

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2013-07-23 | PAGE 3

Other considerations for a healthy pregnancy:

Enjoy regular physical activity. Check with your doctor before beginning a new exercise program.

Some foods, like meat, fish, poultry and seafood may have bacteria that, if the meat is not properly cooked, can harm you or your growing baby. See the Additional Resources for specific food safety information.

Avoid alcohol during pregnancy.

You can have caffeine in moderation. Limit to 300 mg per day— about 500 mL (2 cups) of coffee or 1000 mL (4 cups) or tea per day.

Herbal supplements are not recommended during pregnancy. When limited to 3 cups per day, the following herbs taken as herbal tea are considered to be safe:

» bitter orange/orange peel

» echinacea

» peppermint

» red raspberry leaf

» rose hip

» rosemary

Sugar substitutes except cyclamate and saccharin are safe in moderation during pregnancy. Avoid consuming large amounts of foods that have sugar substitutes, as these foods could replace healthier foods.

If you are overweight or underweight, your nutrition needs may be different. Discuss this with your doctor who may refer you to a registered dietitian.

If you have nausea, vomiting, heartburn or constipation during pregnancy that is keeping you from eating, ask your family doctor or obstetrician for help.

If you are having twins or triplets, the healthy eating information in this handout also applies to you. You may however, have higher nutrient needs. Talk with your healthcare provider to find out the amount that is right for you.

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2013-07-23 | PAGE 4

Health Canada, The Sensible Guide to a Healthy Pregnancy . http://www.phac-aspc.gc.ca/hp-gs/pdf/hpguide-eng.pdf or 1-800- 622-6232.

Health Canada, Mercury in Fish . www.hc-sc.gc.ca/fn- an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.

Distributed by:

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2013-07-23 | PAGE 5 Best Food Forward Plan Shop Cook Enjoy

Thinking about having a baby? Important nutrients for you and your baby Healthy babies begin with healthy moms! The foods you eat before you become pregnant are important In addition to a healthy diet, pregnant women to help you and your baby be as healthy as possible. should take one multivitamin supplement daily that contains folic acid, iron and Vitamin B12. Make sure Eating Well with Canada’s Food Guide helps you that your supplement has no more than 10,000 IU of choose the foods that will give you the nutrition you Vitamin A because too much vitamin A can cause for pregnancy. Every day, eat a variety of foods from birth defects. each of the four food groups: • Vegetables and Fruit: 7-8 servings of a variety of Talk to your health care professional about taking a vegetables and fruit multivitamin supplement before you become • Grain Products: 6-7 servings emphasizing on pregnant. whole grains more often • Meat and Alternatives: 2 servings of poultry, fish, Folic Acid lean meat, dried peas, beans, lentils, eggs or Folic acid is a vitamin needed both before you tofu. conceive and during pregnancy. This vitamin helps • Milk and Alternatives: reduce the baby’s risk of developing a birth defect, called neural tube defect, which affects the brain and o Over 19 years of age: 2 servings of lower fat milk, cheese, yogurt or enriched soy beverages spinal cord. If neural tube defects occur, they o Under 19 years of age: 3-4 servings happen in the first month of pregnancy, likely before you even know you are pregnant! This is why it is so Pregnant women need just a little more food each important to make sure you’re getting enough folic day, but not until the second or third trimester. For acid every day before you get pregnant. most women, this means an extra one or two Food Guide Servings from any of the food groups each Since it is difficult to get enough folic acid from food day. One extra snack is usually enough, alone, women of childbearing age should take a for example, a small container of yogurt, half a daily multivitamin and mineral supplement that sandwich, or a piece of fruit with a small handful of contains 0.4 mg (or 400 μg) of folic acid three nuts. Use Canada’s Food Guide to help you months before becoming pregnant and throughout determine how much food is in “one serving”. pregnancy. Make sure the supplement contains no

more than 1 mg (or 1000 μg) of folic acid unless

your physician recommends otherwise.

Trusted advice from dietitians. www.dietitians.ca

It is important that your supplement also has vitamin Other things to think about when planning a B12 because high doses of folic acid can hide a healthy pregnancy vitamin B12 deficiency. Weight – Being at a healthy weight before you get In addition to a folic acid supplement, choose a pregnant is important for you and your baby. A healthy diet that includes foods higher in folic acid. healthy lifestyle with regular physical activity and Cooked asparagus, cooked spinach, romaine lettuce, healthy eating will help you achieve a healthy body kidney beans, chickpeas, lentils and sunflower seeds weight. Before you become pregnant, talk to your are some excellent sources of folic acid. health care provider about a healthy weight for you. How much weight you should gain during pregnancy Iron depends on your pre-pregnancy weight. During pregnancy, your requirements for iron increase. This extra iron is needed to make red blood For more on healthy weight gain during pregnancy cells that carry oxygen through your own body and see the Pregnancy Weight Gain Calculator at to your growing baby. Make sure your prenatal http://www.hc-sc.gc.ca/fn- multivitamin contains 16 to 20mg of iron. an/nutrition/prenatal/bmi/index-eng.php.

Also be sure to include foods that provide iron, such as whole grain and iron-enriched breakfast cereals, Caffeine – Caffeine crosses into the baby’s blood lean meats, dried peas and beans, dark green when you are pregnant. Take a look at your caffeine vegetables, dried fruits and nuts. To help your body intake and keep it to less than 300 mg a day. That’s better absorb the iron from plant-based foods, eat about the amount found in two. 240mL (8 ounce) them with foods that are high in vitamin C such as cups of coffee. Choose healthy beverages without berries, tomatoes, peppers, oranges, broccoli, caffeine such as water, sparkling water, milk or cauliflower, kale and potatoes. Avoid tea and coffee fortified soy beverage and decaffeinated tea or (during a meal and within one hour of eating a meal) coffee more often. as they decrease the amount of iron that your body absorbs from plant-based foods.

Trusted advice from dietitians. www.dietitians.ca

Approximate caffeine content of drinks (250 mL)*: Pregnant women and women who may become • Brewed coffee – 80-180mg pregnant are advised to limit eating frozen and fresh • Instant coffee – 76-106mg tuna, shark, swordfish, marlin, orange roughy and • Cappuccino or Latte – 45-75mg escolar to 150 grams per month, which is equals

• Black tea – 43-60mg two servings in Canada’s Food Guide. • Green tea – 25-45mg

• Decaffeinated coffee or tea – 0-5mg Up to 300 gm of canned albacore (“white”) tuna per • Cola soft drink (1 can/355 mL) – 36-50mg week can be safely consumed. All other fish and shellfish not listed above can be eaten. Choose a Herbal teas –Most herbal teas should be avoided variety. during pregnancy or when you are trying to conceive

a baby. . Alcohol – Alcohol can affect the unborn baby. Avoid Herbal teas that can be consumed in moderation alcohol if you are planning a pregnancy and when include ginger, bitter orange/orange peel, echinacea, you know you are pregnant. peppermint, red raspberry leaf, rosemary and rose hip. Have no more than 2-3 cups of these safe For more information: Visit the Healthy Pregnancy herbal teas per day. website or download a copy of A Sensible Guide to a Healthy Pregnancy. Other considerations for you and your baby

Mercury and fish – Pregnant women and women who may become pregnant can benefit from the nutrients in fish. However, because too much mercury can harm the fetus, it is important to know what amount and types amounts of fish are safe to eat.

UNTIL JULY 2016

Pork Beef Goat Lamb Chicken/Turkey

Tofu Fish Shrimp Canned Light Tuna Sardines Egg Yolk or Salmon

Lentils Beans Chickpeas Peanut Butter Infant Cereal

Healthy Start for Mom & Me Winnipeg, Canada. 2012 High Iron Foods (during pregnancy)

Pork Beef Goat Lamb Chicken/Turkey

Tofu Fish Shrimp Canned Light Tuna Sardines Whole Egg or Salmon

Lentils Beans Chickpeas Peanut Butter Nuts Iron Supplement Multivitamins (If breastfeeding or planning to become pregnant)

Superstore Extra Foods Wal-Mart

Centrum Exact Essentra Centrum Exact Essentra Centrum Equate Century Plus $ 13.97 $ 10.99 $ 13.99 $ 11.99 $13.97 $9.47

Shoppers Drug Mart Safeway

Centrum Life Centrum Regular Formula $ 18.99 $ 7.99 $15.89 $7.59

Note: Breastfeeding women need extra folic acid and vitamin D. Take a multivitamin each day if you are breastfeeding or planning to become pregnant. Nausea

Ginger Tea Lemon

Diclectin

Constipation

Beans Bran Cereal Whole Wheat Bread Brown Rice Chickpeas Lentils Popcorn

Apple with skin Orange Carrots Prunes Water

Fruits and Vegetables Dried Fruit Lactose Intolerance

¼ cup

Milk Soy Beverage Lactaid Milk

Lactaid Drops Lactaid Pills Heartburn

May want to avoid:

Acidic Food Spicy Foods Fried Foods Coffee

May want to try:

Milk Safe Medications for Heartburn (during pregnancy)

Note: Antacids interfere with iron absorption. Take occasionally in single recommended doses. Unsafe Medications for Heartburn (during pregnancy)

Baking Soda Alka-Seltzer ENO Pepto-Bismol Avoid as a drink Cleaning and baking are safe

Textures for Baby

Cooked Meat Blended Chicken Mashed Chicken Chopped Chicken (6 months) (7-8 months) (9-12 months)

Cooked Beans Blended Beans Mashed Beans Chopped Beans (6 months) (7-8 months) (9-12 months)

Cooked Mashed Carrots Chopped Carrots Vegetables (7-8 months) (9-12 months) Making Food for Your Baby

Meat Boil chicken until no Remove skin and longer pink inside bones from chicken

Beans Soak beans in water and place Boil beans until tender in the refrigerator overnight

Vegetables Peel carrots Boil until vegetables are tender Make Extra Food for Your Baby and Freeze for Later

Freeze extra food in an ice cube tray Frozen cubes of food Put frozen cubes in a plastic bag, label and date, and return to freezer. Take cubes out as needed

Storage: OR OR

In a refrigerator In a fridge freezer In a deep freezer for up to 3 days for 2 months for 6 months To Thaw: OR

Put frozen cubes in a Put frozen cubes in the pot and heat up refrigerator overnight (can add a bit of water) Powdered Infant Formulas

Enfamil A+ Good Start Similac

President’s Choice Parent’s Choice (Superstore) (Wal-Mart)

Note: Be sure formula is “iron fortified” or says “with iron”.

Infant Formula

Concentrate (add water) Ready-To-Feed (do not add water)

Presidents Choice Similac Check Label

Enfamil A+

Check Label

Good Start

Vitamin D Supplements

Superstore Extra Foods

D-drops D-Vi-Sol (Enfamil) D-drops D-Vi-Sol (Enfamil) D-Vi-Sol (Teddy’s) $16.49 $15.49 D-Vi-Sol (Teddy’s) $17.99 $15.49 $10.99 $ 10.99

Wal-Mart

D-drops D-Vi-Sol (Enfamil) D-Vi-Sol (Equate) $14.97 $12.97 $8.77 Vitamin D Supplements (Cont’d)

Shoppers Drug Mart Safeway

D-drops D-Vi-Sol (Enfamil) D-Vi-Sol (Life) D-Vi-Sol (Enfamil) $17.99 $17.99 $11.99 $15.99

High Calcium Foods (for strong bones)

1 cup fortified soy beverage (So Nice, So Good) Calcium ~30%30% Iron 6-8% Vitamin D ~45% Vitamin D 45%

Milk Soy Beverages Yogurt Cheese Smoothie

Canned salmon Broccoli Kale Tofu Bok Choy Sardines with bones

Note: Some Chinese brands of soy beverages are not fortified with calcium of vitamin D. Firm tofu contains more calcium than softer tofu (1 cup firm tofu = 25% DV; 1 cup soft tofu = 14% DV). Tofu is set in calcium sulphate. Prenatal Vitamins (before baby is born) Superstore Superstore Extra Foods Safeway

PregVit Exact PregVit PregVit Materna $38.30 (60 pack) $13.99 Materna $34.52 (60 pack) Materna $35.70 (60 pack) $17.77 Need to take 2 per day $19.99 Need to take 2 per day $19.79 Need to take 2 per day

Shoppers Drug Mart Wal-Mart Vita Health

Quest (180 capsules) PregVit PregVit Materna Materna Equate ~$35.00 (60 pack) $29.99 $24.99 $37.65 (60 pack) $10.97 $17.77 Need to take 2 per day Need to take 3 per day Need to take 2 per day

Note: PregVit prices listed include 1mg folic acid. Also comes with 5mg folic acid for ~ $5.00 more. Need a prescription from doctor for PregVit. Formula Preparation (Ready-To-Use)

Do not add water 1) Wash all utensils 2) Boil utensils in a 3) Clean top of can, 4) Pour into sterilized in hot soapy water. deep pot for shake well and open bottles. 2 minutes

5) Put nipple and ring 6) Test temperature. 7) Feed baby. 8) After feeding, discard on bottle, shake Let cool if too unused formula well. hot and feed or remaining in bottle Note: refrigerate. within 1 hour If you prepare more than one feeding, bottles must be refrigerated and used within 48 hours Formula Preparation (Concentrate)

1) Wash all utensils 2) Boil utensils in a 3) Boil more water for 4) Pour 120 mL of in hot soapy water. deep pot for 2 minutes, then remove concentrated liquid 2 minutes water from heat and formula. let cool until lukewarm

5) Add 120 mL of 6) Put nipple and 7) Test temperature. 8) Feed baby previously boiled ring on bottle, Let cool if too hot. water into sterilized shake well. bottle

Note: Liquid Concentrate Water Bottle Size If you prepare more 30 mL 30 mL 2oz than one feeding, 60 mL 60 mL 4oz bottles must be 90 mL 90 mL 6oz refrigerated and used 120 mL 120 mL 8oz within 48 hours 9) After feeding, discard unused formula remaining in bottle within 1 hour.

Formula Preparation (Powder)

1) Wash all utensils 2) Boil utensils in a 3) Boil more water for 4) For a single bottle: in hot soapy water. deep pot for 2 minutes, then remove Pour 180 mL of 2 minutes water from heat and water. let cool for 30 minutes

5) Add 3 level scoops 6) Pour mixture into 7) Put nipple and 8) Test temperature. of powder. Mix well. sterilized bottle. ring on bottle, Let cool if too hot. Standard Dilution: shake well. 1 level scoop per 60 mL of water. Note: Powder Water Bottle Size If you prepare more than one feeding, 1 scoops 60 mL 2oz 2 scoops 120 mL 4oz bottles must be 3 scoops 180 mL 6oz refrigerated and used 4 scoops 240 mL 8oz within 24 hours. 9) Feed baby. 10) After feeding, discard unused formula remaining in bottle within 1 hour.

Healthy Eating Guidelines for Increasing Your Fibre Intake

Why This Diet is Important

This fact sheet provides tips on how to add more fibre-rich foods in your diet. There are different kinds of fibre found in foods such as vegetables, fruit, legumes (peas, beans, lentils) and whole grains and cereals.

Some fibre can help to lower blood cholesterol and control blood glucose (sugar) levels. This is called soluble fibre and is found in some vegetables and fruit and legumes. Other types of fibre, called insoluble fibre from some vegetables and fruit, whole grains and wheat bran, help keep your bowels regular and may protect against colon cancer. Constipation may be improved with a diet that is high in fibre.

It is important to eat a variety of foods to get enough of both types of fibre. A healthy diet includes 25-38 grams of fibre a day. Talk to a dietitian if you want help on increasing the dietary fibre in your diet.

Use Canada's Food Guide to plan your meals and snacks. Refer to Additional Resources below to get a copy of the guide

Grains

» Eat at least six servings of whole grain products every day. Examples include rolled oats, barley, brown rice, quinoa and whole wheat breads, breakfast cereals and pasta.

» Use whole grain bread, rolls, pita or bagels when making toast or sandwiches.

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-09-21 | PAGE 1

» Replace at least half of the white flour with whole wheat flour in your recipes.

» Add 15-30 mL (1-2 Tbsp) of bran, ground flax seed or a very high-fibre cereal to your cereal in the morning.

Vegetables and Fruit

» Eat at least seven servings of vegetables and fruit every day. Aim for 1-2 servings of fruit and vegetables at every meal and snack.

» Eat the peels of your vegetables and fruits whenever possible.

» Try having fruit as a snack or as a dessert. Pears, raspberries and blackberries are top choices for fibre. Guava, persimmon and kumquat are exotic high fibre fruits worth trying.

» Eat vegetables and fruit instead of drinking juice.

Legumes

» Add barley, beans, peas or lentils to soups, stews and casseroles. For example, add black beans to spaghetti sauce or lentils to soup.

» Roast chickpeas or steam edemame (soybeans in a pod) for an easy snack.

» Use legume-based dips (ex: hummus, baba ghanoush) for veggies instead of sour cream based.

Nuts and Seeds

» Add toasted nuts, sesame seeds, sunflower or pumpkin seeds to salads and cereals.

» Sprinkle on pasta dishes and stir-fries.

» Grab a handful of nuts (60 mL (1/4 cup) as a quick snack.

Read Food Labels

» Compare products and pick the one with the most fibre. Be sure you are comparing the same serving sizes.

» Check for grams of fibre. High-fibre foods have four or more grams of fibre per serving.

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-09-21 | PAGE 2

» Look for ingredients such as bran, whole grain whole wheat, oatmeal or rye flour.

» Increase the fibre in your diet slowly to avoid gas, bloating and diarrhea.

Divide fibre-containing foods throughout the day at both meals and snacks.

Drink plenty of fluids. Here is an example of how to increase your fibre intake with only a few small changes:

Low Fibre Fibre Fibre High Fibre Diet Diet (g) (g)

Breakfast

175 mL (3/4 cup) flaked 0.8 5.0 125 mL (1/2 cup) flaked bran corn cereal cereal

250 mL (1 cup) low fat milk 0.0 0.0 250 mL (1 cup) low fat milk

1 slice (35 g) white toast 0.9 3.2 1 slice (35 g) whole wheat toast

15 mL (1 Tbsp) jam 0.2 0.9 15 mL (1 Tbsp) peanut butter

125 mL (1/2 cup) orange 0.3 3.1 1 small orange juice

Lunch

2 slices (70 g) white bread 1.8 6.2 2 slices (70g) whole wheat bread

75 g light tuna 0.0 0.0 75 g light tuna

15 ml (1 Tbsp) light 0.0 0.0 15 mL (1 Tbsp) light mayonnaise mayonnaise

1 medium leaf lettuce 0.1 0.1 1 medium leaf lettuce

1/2 tomato, sliced 0.8 0.8 ½ tomato, sliced

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-09-21 | PAGE 3

125 mL (1/2 cup) vanilla 0.0 0.0 125 mL (1/2 cup) vanilla yogurt

yogurt

2.0 60 mL (1/4 cup) raspberries

Snack

1 medium apple 2.6 5.0 1 medium pear

Water Water

Supper

75 g baked chicken breast 1.0 1.0 75 g baked chicken breast

125 mL (1/2 cup) mashed 1.6 4.0 1 medium baked potato with skin potato

125 mL (1/2 cup) carrots 2.2 2.2 125 mL (1/2 cup) carrots

250 mL (1 cup) low fat milk 0.0 1.2 250 mL (1 cup) romaine lettuce salad

125 mL (1/2 cup) vanilla 0.0 0.0 250 mL (1 cup) low fat milk pudding

1.3 125 mL (1/2 cup) fruit cocktail

Snack

4 melba toast 1.3 2.5 1/2 whole wheat pita crackers

30 g (1 oz) cheddar cheese 0.0 2.5 60 mL (1/4 cup) hummus

125 mL (1/2 cup) grapes 1.0 1.0 125 mL (1/2 cup) grapes

Water Water

Total Fibre 15.8g 41.9g

Information on fibre content is from the Canadian Nutrient File 2012.

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-09-21 | PAGE 4

Available from: . http://webprod3.hc-sc.gc.ca/cnf-fce/newNutrientSearch- nouvelleRechercheAliment.do?lang=eng

Canada's Food Guide - http://www.hc-sc.gc.ca/fn-an/food-guide- aliment/index-eng.php These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.

Distributed by:

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-09-21 | PAGE 5 Is caffeine safe in pregnancy?

Health Canada recommends that pregnant and breastfeeding women have less than 300 mg of caffeine per day.

New research says... What is 300 mg of caffeine? having more than 200 mg of

2 cups of coffee, brewed, drip method caffeine per may double the risk of miscarriage compared to not having caffeine.

OR 0 Buyer Beware! Some energy drinks contain the same amount of caffeine 3 cups of black tea as 14 cans of Coke!

Note: 1 cup = 8 oz =

Limit other foods that have caffeine and sugar:

Green Cola Cola Chocolate Hot Energy Iced Tea Drinks Slurpees Lattes Bars Chocolate Drinks Cappuccinos

Ideas to Boost Your Energy without Caffeine:

; Drink water ; Get a good night’s sleep ; Take a 10-minute walk ; Try not to skip meals ; Eat healthy

Reference: Health Canada. 2006. Caffeine. Available from www.hc-sc.gc.ca. Kaiser Permanente Division of Research (2008, January 22). Caffeine Is Linked To Miscarriage Risk, New Study Shows. ScienceDaily. Johns Hopkins Medical Institutions (2008, September 25). Caffeine Experts Call For Warning Labels For Energy Drinks. Revised by Healthy Start for Mom & Me Winnipeg, MB. Production made possible through contribution from the Public Health Agency of Canada (CPNP) and Healthy Child Manitoba (Healthy Baby). Revised June, 2009. Originally developed by Nina Kudriakowsky, RD, Mount Carmel Clinic. Caffeine During Pregnancy and Breastfeeding Limit caffeine intake to 300 mg per day Eating and drinking more than 200 mg per of caffeine per day during pregnancymay double the risk of miscarriage compared to not having caffeine

What is 300 mg of caffeine? 2 cups of coffee 3 cups of black tea

1 cup = 250 ml

Do NOT drink energy drinks during pregnancy or while breastfeeding

Limit other foods with caffeine:

Green Tea Chocolate Soft Drinks Cola Slurpee Latte Hot Chocolate Chocolate milk Iced Cappuccinos & Coffees Courtesy of Health Start for Mom and Me. References: Health Canada (2010). Caffeine: It’s your health. Available at www.hc‐sc.gc.ca. PEN (2012). Key Practice Points. What is the impact of caffeine intake in pregnancy and lactation? PEN (2012). Pregnancy Evidence Summary. PEN.(2010). Caffeine Practice Guidance Summary. Revised October 2012. Kaiser Permanente Division of Research (2008, January 22). Caffeine linked to miscarriage risk new study shows. Science Daily.

Are Herbs or Herbal Teas Safe to use during Pregnancy & Breastfeeding?

Some herbs are safe to use in cooking or tea. Limit these herbal teas to 2-3 cups a day:

9Echinacea 9Orange peel/bitter orange 9Peppermint 9Red raspberry leaf 9Rose hip 9Rosemary

* Supplements (pills or extracts) of the above herbs are not safe.

Is Ginger safe? 9Fresh ginger root is safe in cooking and tea.

9Ginger supplements (pills) are safe in pregnancy (maximum amount: 1.5 grams per day split into 3 to 4 equal doses for the relief of nausea and vomiting). * Ginger extract (liquid) is not safe * Ginger supplements (pills) are not recommended for breastfeeding women

Other safe warm drinks: 9Hot lemon water 9Hot apple juice 9Hot milk Herbs and Herbal Teas not safe during Pregnancy and Breastfeeding:

• Pregnant women should avoid these herbs and herbal teas due to known harmful effects.

• Breastfeeding women should avoid these herbs and herbal teas due to known harmful effects or because we do not have enough information.

³ Aloe ³Juniper ³ Black cohosh ³ Kava ³ Blue cohosh ³ Labrador tea ³ Buckthorn ³ Lobelia ³ Calendula (Marigold) ³ Chamomile ³ Licorice (candy is unsafe if contains ³ Chaste tree (Chasteberry) glycyrrhizin acid/licorice extract) ³ Coltsfoot ³ Passionflower ³ Pennyroyal ³ Comfrey ³ Sage ³ Dong quai ³ Sassafras ³ Ephedra ³ Evening primrose (safe during lactation) ³ Senna (small amount safe in short term) ³ Fennel (not enough information in pregnancy) ³ St. John’s wort ³ Feverfew ³ Tea tree oil ³ Ginkgo ³ Thuja ³ Ginseng (avoid in first trimester, caution in ³ Uva-ursi later stages of pregnancy and breastfeeding)

Pregnant and breastfeeding women should avoid these herbs and herbal teas because we do not have enough information:

³ Burdock ³ Linden ³ Hops ³ Red bush tea (Rooibos tea) ³ Japanese mint ³ Valerian ³ Lemon balm ³ Wild Yam

References: PEN - Practiced-Based Evidence in Nutrition. What herbal beverages/supplements are safe to take during pregnancy and lactation? Retrieved from: http://www.pennutrition.com/KnowledgePathway.aspx?kpid=3043&pqcatid=144&pqid=3092 . Last updated September 14, 2012. PEN – Practice-Based Evidence in Nutrition. (February, 2010). Herbs to Use with Caution During Pregnancy and Lactation. Retrieved from:http://www.pennutrition.com/KnowledgePathway.aspx?kpid=755&trid=1174&trcatid=34. March 19, 2010. Developed by Healthy Start for Mom & Me, Winnipeg, MB. Production has been made possible through financial contribution from the Public Health Agency of Canada (Canada Prenatal Nutrition Program) and Healthy Child Manitoba (Healthy Baby Program). Updated January 28, 2013.

Nausea and Vomiting in Pregnancy

Always feeling sick? You’re not alone! Many women experience nausea and vomiting due to hormone changes. The good news is that it usually disappears after the first three months.

Here are some tips to help you cope:

 Keep crackers, bread or dry cereal near your bed to eat before getting up.

 Get out of bed slowly and avoid sudden movements.

 Avoid having an empty stomach.

 Eat whatever appeals to you in five or six small meals throughout the day.

 Wait 30 minutes after eating before lying down or brushing your teeth.

 Drink fluids between meals, not with meals.

 Choose cold foods because they often do not have a strong smell.

 Eat lightly spiced foods.

 Avoid foods high in fat such as bacon, gravy, fried meat, French fries.

 Try smelling fresh cut lemons.

 If you have a bad taste in your mouth, suck on hard candy or ice cubes.

 Try ginger tea or ginger ale to settle your stomach.

 When cooking, open windows or use the fan.

 Avoid smoke, strong smells, alcohol and caffeine.

 Get plenty of fresh air.

 Being tired can make you feel worse. Try to get lots of rest.

To be used in conjunction with advice from a Registered Dietitian.

October 2012 PPublicublic EEducationducation NNauseaausea aandnd PPamphletamphlet VVomitingomiting ofof PregnancyPregnancy

For most women, the feelings of nausea and the IIntroductionntroduction episodes of vomiting decrease at some point during the More than half of all pregnant women suffer from nausea day so that they feel hungry again and can keep food and vomiting during their pregnancy. Since each woman down. However, if you are so sick that you are missing is different and each pregnancy is different, the severity meals day after day, your baby may not be getting all the of nausea and vomiting of pregnancy (NVP) will vary from daily nutrients to grow as healthy as he or she can. woman to woman. WWhathat ifif I justjust WWhathat causescauses NVP?NVP? ccan’tan’t keepkeep anythinganything down?down? No one knows exactly what causes the nausea of About 1% of pregnant women in Canada (some 4,000 pregnancy. Most researchers believe it’s a combination women per year) will suffer from excessive vomiting of the many physical changes taking place in your body in pregnancy called “hyperemesis gravidarum”. In such as the higher levels of hormones during early such cases, the lack of food, ﬂ uids and nutrients may pregnancy. be harmful to their health and the well-being of their baby. If left untreated, severe cases of NVP can lead to dehydration.

HHowow llongong willwill Dehydration happens when the body does not have mmorningorning sicknesssickness last?last? as many fl uids as it should. This may be caused by losing too many fl uids or not drinking enough. Severe Nausea and vomiting usually begin around the 6th week cases of dehydration may require intravenous fl uids and of pregnancy. Although common in the morning, “morning vitamin supplementation from the hospital. Seek medical sickness” can actually happen at any time of the day. For attention if you suffer from signs of dehydration such as 80% of sufferers, this condition stops around the 12th infrequent urination or dark yellow urine. NVP can be week of pregnancy although queasiness can come and diffi cult to control; the sooner you are diagnosed and go throughout pregnancy. The other 20% will suffer from begin treatment, the more likely you will be able to avoid nausea and vomiting for a longer period of time. Some severe symptoms. women may even have the condition until the end of their pregnancy.

Most women who suffer from NVP will see their condition HHelpfulelpful tipstips toto interfere with usual daily activities. Many will have to change their daily schedule in some way in order to cope ccontrolontrol nauseanausea andand vomiting:vomiting: with their condition. DIET – Food

• When you fi rst wake up, eat a few crackers and then TThehe hhealthealth effectseffects ofof nauseanausea andand rest for 15 minutes before getting out of bed. • Get up slowly and do not lie down right after eating. vvomitingomiting ofof pregnancypregnancy • Eat small meals or snacks often so your stomach Most cases of nausea and vomiting does not become empty (for example, every 2 in early pregnancy aren’t harmful hours). Try not to skip meals. to the mother and her unborn • Do not hesitate to eat whatever you feel like eating child. While short-term dietary and eat whenever you want to. However, it is best to defi ciencies do not appear avoid cooking or eating spicy, fatty and fried foods. to have any harmful effects • If cooking odours bother you, open the windows and on pregnancy outcome, turn on the stove fan. If possible, ask someone else severe and persistent NVP to cook the meals. symptoms can affect your health. PPublicublic • Try eating cold food instead of hot (cold food may Note: So called “natural products” are often used under not smell as strong as hot food). the assumption that they are safe. However, the safety EEducationducation • Sniffi ng lemons or ginger can sometimes relieve an and effectiveness of these treatments have not yet been upset stomach. proven and it is important to note that very few of these PPamphletamphlet • Eating salty potato chips can help settle the stomach products have been properly studied in pregnancy. Ask enough to eat a meal. your healthcare provider before taking herbal remedies.

DIET – Drinks MMedicationsedications • Drink small amounts of ﬂ uids frequently during the Although it is generally wise to stay away from over- day. the-counter medications during pregnancy, there is a • Avoid drinking ﬂ uids during meals and immediately safe and effective prescription medication that can help before or after a meal. women when nausea and vomiting affect their well-being and daily activities.

Food Ideas to Help Relieve Nausea Doxylamine succinate/pyridoxine HCI (Diclectin®), a combination of vitamin B6 and an antihistamine called Salty: Chips, pretzels doxylamine, is the only medication approved in Canada Tart/Sweet: Pickles, lemonade for the treatment of nausea and vomiting in pregnancy. Earthy: Brown rice, mushroom soup, peanut butter Its safety and effectiveness for the treatment of NVP Crunchy: Celery sticks, apple slices, nuts is recognized by Health Canada. Its safety throughout Bland: Mashed potatoes, gelatin, broth pregnancy has been long established and studies have Soft: Bread, noodles shown no evidence that harmful effects are experienced Sweet: Cake, sugary cereals by babies. Fruity: Fruity popsicles, watermelon Liquid: Juice, seltzer, sparkling water, ginger ale If Diclectin® does not cure your symptoms, other Dry: Crackers medications may be prescribed by your health care provider.

LIFESTYLE – Rest WWhoho cancan helphelp youyou withwith youryour NVP?NVP? • Get plenty of rest since nausea tends to worsen when a woman is tired. Try napping during the day. If you have NVP and are looking for support and Typically, a pregnant woman needs more sleep in counselling, you should talk to your healthcare provider. the fi rst three months of pregnancy. • You may need to take some time off work or make You may also contact the Motherisk NVP Helpline toll other arrangements for household chores and free at 1-800-436-8477 for ways to deal with morning childcare. sickness. For information on the safety and risks of • Enlist the support of friends and family. medications during pregnancy and breastfeeding, call the Motherisk Program at (416) 813-6780 or visit www.motherisk.org. LIFESTYLE – Other • Get plenty of fresh air and avoid warm places as FFinalinal thoughtsthoughts feeling hot can add to nausea. • Acupressure wrist bands or acupuncture can be There are many ways of lessening or eliminating nausea benefi cial for some women. If you are considering and there is no reason for women to feel guilty about acupuncture, consult your healthcare professional treating these symptoms. Your healthcare provider can and look for an experienced and licensed help you control the nausea and vomiting so that you can acupuncturist. have a pleasant and healthy pregnancy. • Try ginger, an alternative remedy thought to settle © Copyright SOGC 2000-2004 - The Society of Obstetricians and the stomach. Dosages of up to 250 mg four times a Gynaecologists of Canada web site provides information on a wide range of health and medical topics. The information contained herein is not intended NNauseaausea aandnd day appear to be safe. to substitute for the advice of a physician, and you are advised always to • Try taking your prenatal vitamins (one with a lower consult your doctor for specifi c information on personal health matters. Unless otherwise specifi cally indicated, the naming of any organization, product or VVomitingomiting ofof amount of iron if that mineral makes your nausea therapy on this site does not imply SOGC endorsement. worse) with food or just before bed. If multivitamins PPregnancyregnancy make your nausea worse, take folic acid alone on a daily basis.

Managing Heartburn

Why This Diet Is Important

Heartburn is caused by a back-up of stomach acid into the esophagus. When stomach acid comes into contact with the walls of the esophagus it often causes a "burning" feeling. Certain foods and lifestyle choices can increase the back-up of stomach acid, making symptoms worse. If you have symptoms of heartburn, avoiding certain foods can help decrease the burning you feel. Making lifestyle changes can also help. Consult your Doctor immediately if diet and lifestyle changes do not help, or if you experience vomiting, anemia, unplanned weight loss, chest pain or shortness of breath.

● Achieve and maintain a healthy weight.

● Stop smoking.

● Limit or avoid beverages that contain alcohol.

● Limit or avoid drinks with caffeine such as coffee, tea or cola drinks.

● Remain sitting upright during meals and for 45 to 60 minutes after eating.

● Avoid eating two to three hours before bedtime.

● Avoid eating large amounts of food at one time.

● Raise the head of your bed six to eight inches when sleeping. Try "bed blocks", special foam wedges or a hospital bed. Pillows may not be adequate as they raise only your head. Your esophagus should be higher than your stomach.

● Avoid clothing that is tight across your stomach.

● Limit or avoid foods that may trigger symptoms such as spices, peppermint, chocolate, citrus juices, onions, garlic and tomato

© 2013 DietitiansEnglish of Literature Canada. All Title rights reserved. May be reproduced in its entirety provided source is acknowledged. © 2010 Dietitians of Canada. All rights reserved. This informationMay be is reproducednot meant to inreplace its entirety advice providedfrom your medicalsource doctoris or individualacknowledged. counseling with a registered dietitian. It is intended for educationalThis and information informational is purposes not meant only. to replace advice from your medical doctor or individual counseling with a registered dietitian. It is intended for educational and informational purposes only. Updated: May 10, 2010 PAGE 5 Updated: 2008-10-28 | PAGEI 1

products.

Foods That May Cause Discomfort:

The types of foods that bother people with heartburn can vary a lot. Eat a variety of foods and take note of which foods cause you discomfort. When your symptoms have settled, you may try re- introducing these foods into your diet in small amounts and as part of a meal.

You may find that eating high fat foods cause you discomfort. Some people with heartburn report an increase in symptoms following a high fat meal. Choosing lower fat food choices is also part of healthy eating and can help with weight reduction.

● Do not try to cut out all fat from your diet. Limit the fat you use at the table and in cooking to 30 to 45 mL (2 to 3 Tbsp) each day. For more information on different kinds of fats and how to include healthier fats in your diet.

● Choose lower fat dairy products like 1% and skim milk and yogurt, lower fat cheese (less than 20% milk fat) and low fat sour cream.

● Eat lean meats and poultry (remove skin). Choose lower fat alternatives like lentils, chickpeas and tofu often.

● Limit amounts of high fat desserts and snacks like cookies, commercial baked goods and chocolate.

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Sample Meal Plan For Women with Gestational Diabetes

While you have gestational diabetes, it is important to eat three meals plusthree snacks a day. One snack should be at bedtime. It's also important to spread carbohydrate containing foods evenly throughout the day. (Refer to the fact sheet "Healthy Eating Guidelines for Gestational Diabetes" for more information.)

Use the sample meals and snacks below as a guide. Vary your meals and snacks based on your own food preferences.

Sample Breakfasts

Breakfast Number 1 Breakfast Number 2 Breakfast Number 3

175 mL (¾ cups) 1 slice (35 g) whole 2 slices (70 g) whole cooked oatmeal with wheat toast with 1/3 wheat toast with 10 2 Tbsp nuts avocado, mashed mL (2 tsp) non- 250 ml (1 cup) skim 30 g (1 oz) cheese or hydrogenated or 1% milk 1 hard boiled egg or margarine 1 medium orange 30 mL (2 Tbsp) 100% 1 scrambled egg with natural peanut butter diced mushrooms, Glass of water ½ medium mango bell peppers and onion 175 mL (¾ cup) plain 250 mL (1 cup) skim low fat or 250 mL (1 or 1% milk cup) diet fruit yogurt

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-11-20 | PAGE 1

Sample Lunches

Lunch Number 1 Lunch Number 2 Lunch Number 3

375 mL (1 ½ cups) Bean burrito - 125 Half roast beef mushroom & barley mL (½ cup) refried sandwich - 45 g (1 ½ soup beans, small whole oz) roast beef, 1 slice Half tuna salad wheat tortilla, 30 g (35 g) of whole grain sandwich on 1 slice (1 oz) grated bread, 10 mL (2 tsp) (35 g) of whole cheese, salsa, mayo, avocado slices, wheat bread lettuce and tomato tomato slices and lettuce Green salad - Vegetable sticks lettuce, tomato, with low fat dip 175 mL (¾ cup) plain, cucumber, broccoli, 250 mL (1 cup) skim low fat yogurt bell pepper, 1/3 of a or 1% milk 250 mL (1 cup) chopped avocado, 15 blueberries mL (1 Tbsp) oil and Glass of water vinegar dressing 250 mL (1 cup) skim or 1% milk

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-11-20 | PAGE 2

Sample Dinners

Dinner Number 1 Dinner Number 2 Dinner Number 3

75 g (2 ½ oz) 250 mL (1 cup) chilli Salmon burger - 75 g chicken breast con carne with (2 ½ oz) salmon with 15 mL (1 Tbsp) beans patty, 1 whole wheat barbeque sauce hamburger bun, 15 mL (1 Tbsp) reduced fat ½ medium potato, 75 mL (2/3 cup) with skin mayo, 125 mL (½ cup) brown rice red onion fried in 5 mL 60 mL (¼ cup) low Green salad - (1 tsp) canola oil, fat sour cream and lettuce, tomato, tomato slice and chives, for potato cucumber, broccoli, lettuce Asparagus spears, bell pepper, 15 mL 250 mL (1 cup) pan fried in 5 mL (1 (1 Tbsp) Italian coleslaw tsp) canola oil dressing 175 mL (¾ cup) of 250 mL (1 cup) skim 175 mL (¾ cup) plain low fat yogurt or 1% milk pineapple Glass of water 2 medium kiwi Glass of water

Snack Ideas

4 melba toast crackers and 50 g (1 ½ oz) cheese

60 mL (¼ cup) walnuts and 1 apple

15 mL (1 Tbsp) peanut butter (or other nut or seed butter) on 1 slice (35 g) of whole grain toast

750 mL (3 cups) of popcorn (low fat) and 250 mL (1 cup) milk

175 mL (¾ cup) plain, low fat yogurt and 1 small banana

175 mL (¾ cup) hummous and ½ pita

250 mL (1 cup) cottage cheese adn 125 mL (½ cup) pineapple tidbits

This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-11-20 | PAGE 3

Canadian Diabetes Association . www.diabetes.ca

Healthy Eating for Gestational Diabetes . http://www.pennutrition.com/viewhandout.aspx? Portal=RbCR&id=JMfrUAA=&PreviewHandout=bA==

These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.

Notes

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This information is not meant to replace advice from your medical doctor  or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: 2012-11-20 | PAGE 4

Food Sources of Folate

Information about Folate

● Folate is a water-soluble B vitamin. It is found naturally in foods. This vitamin cannot be stored in your body. You should eat folate- rich foods every day.

● Folate is important for everyone. It helps make red blood cells. If you do not have enough folate, you can get a type of anemia. If you have anemia you may feel tired, weak and unable to concentrate.

● Folate is very important for infants, children and women who are pregnant. It helps to prevent some birth defects.

● Folic acid is a form of folate. This is the type of folate found in vitamin supplements.

● Folacin is the generic name for folic acid and folic acid-related substances. It may be used instead of the words folic acid and folate.

How Much Folate Should I Aim For?

● Women who could become pregnant, are pregnant or breastfeeding need more folate. They should take a daily folic acid supplement of 400 micrograms (mcg) or 0.4 milligrams (mg).

Age in years Aim for an intake of* Stay below* mcg/day mcg/day

Men and Women 400 1000 19 and older

Pregnant Women 600 1000 19 and older

Breastfeeding Women 500 1000 19 and older *This includes sources of folate from food and supplements

Food Sources of Folate

Dark green vegetables like broccoli and spinach and dried legumes such as chickpeas, beans and lentils are naturally good sources of folate. In Canada, folic acid is added to all white flour, enriched pasta and cornmeal products. The following table will show you which foods are sources of folate.

Food Serving size Folate (mcg)

Vegetables and Fruit

Vegetables

Edamame/baby soybeans, cooked 125 mL (½ cup) 106-255

Okra, frozen, cooked 125 mL (½ cup) 142

Spinach, cooked 125 mL (½ cup) 121-139

Artichoke, cooked 125 mL (½ cup) 79-106

Turnips greens or collards, cooked 125 mL (½ cup) 68-93

Broccoli, cooked 125 mL (½ cup) 89

Asparagus, cooked 4 sprouts 80-88

Brussels sprouts, frozen, cooked 6 sprouts 83

Lettuce, romaine or mesclun 250 mL (1 cup) 65-80

Escarole or endive, raw 250 mL (1 cup) 75

Beets, cooked 125 mL (½ cup) 72

Potato, with skin, cooked 1 medium 48-66

Spinach, raw 250 mL (1 cup) 61

Fruit

Avocado ½ fruit 81

Papaya ½ fruit 58

Grain Products

Pasta, egg noodles, enriched, 125 mL (½ cup) 138 cooked

Pasta, white, enriched, cooked 125 mL (½ cup) 83-113

Bagel, plain ½ bagel (44.5 g) 101

Bread, white 1 slice (35 g) 60

Bread, whole wheat 1 slice (35 g) 18

Milk and Alternatives This food group contains very little of this nutrient

Meat and Alternatives

Meat Alternatives

Beans, cranberry/roman, cooked 175 mL (¾ cup) 271

Lentils, cooked 175 mL (¾ cup) 265

Peas (chickpeas, black- 175 mL (¾ cup) 180-263 eyed/cowpeas, adzuki), cooked

Beans (mung, adzuki), cooked 175 mL (¾ cup) 234-238

Beans (pink, pinto, navy, white, 175 mL (¾ cup) 157-218 kidney, great northern), cooked

Sunflower seeds, without shell 60 mL (¼ cup) 77-81

Meatless (fish sticks, meatball, 75 g (2 ½ oz) 59-77 chicken), cooked

Soy burgers/vegetarian, meatloaf or 75 g (2 ½ oz) 59 patty, cooked

Soy nuts 60 mL (¼ cup) 59

Organ Meat

Liver (turkey, chicken) cooked 75 g (2 ½ oz) 420-518

Liver (lamb, veal), cooked 75 g (2 ½ oz) 262-300

Liver (beef, pork) cooked 75 g (2 ½ oz) 122-195

Miscellaneous

Yeast extract spread 30 mL (2 Tbsp) 371 (vegemite or marmite)

Source: "Canadian Nutrient File 2010" . www.hc-sc.gc.ca/fn- an/nutrition/fiche-nutri-data/index-eng.php [accessed March 13, 2012]

Notes

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