A GUIDE TO Prenatal Nutrition Table of contents Key nutrients 4 Fatigue during pregnancy 6 Constipation during pregnancy 8 Healthy calorie intake during pregnancy 10 Weight gain during pregnancy 12 Exercise during pregnancy 13 Eating fish during pregnancy 14 Eat right to sleep tight 15 Pregnancy superfoods for a super-pregnancy 18 Water: your pregnancy BFF 27 Foods and habits to avoid during pregnancy 28 Benefits of DHA and lutein during pregnancy 30 Planning to feed your baby: the benefits of breastfeeding 32 Breastfeeding tips before bringing your baby home 34 2 Welcome to this exciting time in your life Wherever you are on the path of motherhood, we know you are committed to supporting your little one with excellent nutrition. That is why we are excited to share this prenatal education guide with you. It covers everything from nutrition for you while you are pregnant and breastfeeding, to the latest science behind important nutrients for infant nutrition and development — such as lutein, DHA, and vitamin E. 3 Key Nutrients Why you and your baby need them, and where to get them During pregnancy, your blood volume is increasing and so is your baby’s. As blood quantity increases, so does your need for iron. Iron is necessary to carry oxygen to active and IRON growing cells. The daily recommended dose of iron during pregnancy is 27 mg. Iron can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes. You can get iron from eating red meats, beans, lentils, and fortified grains, and from taking an iron-fortified prenatal multivitamin. This same mineral that is good for your bones and teeth is good for your baby’s developing bones and teeth as well. You should get CALCIUM around 1,000 mg of calcium per day. Milk and dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli, canned salmon, dark leafy greens, sardines, or a calcium supplement. Your baby’s muscles, tissues, and organs are all constructed of this primary building block. During the third trimester, your baby PROTEIN is growing faster than ever, so protein is especially important. Fortunately, most women get plenty of protein in their diets from foods such as meats, chicken, and fish, as well as milk, beans, peas, lentils, nuts, and tofu. 4 Many pregnant women in Canada don’t get enough vitamin D. Vitamin D works with calcium to help your baby’s bones and teeth develop. During pregnancy, the mother VITAMIN D transfers vitamin D to the baby, so if she is deficient in vitamin D, the baby is too. The vitamin D recommendation for pregnant women is 600 IU/day. Good sources are milk and other beverages fortified with vitamin D and fatty fish, such as salmon. Exposure to sunlight also converts a chemical in the skin to vitamin D. Check with your health care professional to see if the prenatal multivitamin he or she might recommend contains an adequate amount of vitamin D. In addition, most types of milk (except for evaporated) are fortified with vitamin D. Vitamin C is especially important during the third trimester. Vitamin C promotes healthy gums and also helps your body absorb iron. VITAMIN C In addition to being abundant in citrus foods, vitamin C is also found in broccoli, tomatoes, peppers, kiwis, and berries. Other vitamins and minerals Many other vitamins and minerals (such as folic acid) can be just as important towards the end of your pregnancy as they were earlier. As labour approaches, your body needs a strong immune system, antioxidants, and nutrition for optimal functioning and healing. Keep eating your fruits and vegetables. If you are having trouble eating all your servings during meals, try eating several small snacks a day that include these food groups. And if your doctor recommended a prenatal multivitamin, keep taking it. Beyond these essential vitamins and minerals, there are two other dietary components to consider adding to your diet, which we will cover in the next section: DHA (the acronym for docosahexaenoic acid) and lutein. 5 Fatigue during pregnancy You can’t make an omelet without breaking eggs and you can’t be pregnant without feeling tired at some point. Follow our nutrition and lifestyle advice and put pregnancy fatigue to bed. While pregnancy is a wonderful, amazing experience, it is also sometimes tiring. Fatigue is one of the most common symptoms, particularly in the 1st and 3rd trimesters, and while nothing can 100% zap fatigue, fueling your body with the right nutrients can help give you the energy boost that you need. Why are you so tired? If you have concerns about ongoing pregnancy fatigue, talk to your doctor to rule out anemia or other possible causes. Once these have been eliminated, think about the fact that your body is working hard to support a new life and adapt to the physical changes that come with the development of a baby. See? Feeling tired is a good thing. It means that your body is taking care of your baby. So if increased progesterone, lower blood sugar levels, and lower blood pressure sap your energy, give yourself a pat on the back. Your baby is getting bigger. 6 Keys to fighting pregnancy fatigue When fatigue strikes, try these tips to help reduce symptoms. Choose nutrient- and protein-rich foods like low-fat milk, yogurt, beans, chicken breast, or peanut butter. Always skip the quick fix, like donuts, candy, or sugary drinks (we know, they are really tempting, aren’t they?). They might do the trick in the short term, but eventually they will leave you feeling more tired than before. Energy drinks should be thought of as dietary supplements and might not be safe for your baby. Check with your doctor before using these types of products. Eat every four hours if you can, beginning with a balanced breakfast. Try to include at least one serving of whole grain and one fruit or vegetable with each mini-meal or snack. Vitamins and minerals (especially iron) are important too. Get as much as you can from iron-rich and nutrient-dense foods, and make sure to take your prenatal supplements as directed by your doctor. Limit caffeine. The Public Health Agency of Canada recommends no more than 300 mg of caffeine (or about two cups of coffee) a day while pregnant. Oh, and tea and sodas count, too. Exercising regularly (with your doctor’s guidance) can also be what you need to help you get that boost of energy to make it through the day. Water, water, water. Drink at least ten cups of water or other fluids daily. Now here’s a big one: listen to your body, and get the rest you need. It sounds simple, but it can be easy to forget. Follow this advice and you can hope to look forward to a pregnancy where fatigue won’t become a major drag. 7 Constipation during pregnancy Half of all pregnant women get constipated at some point, and this could be due to hormones, diet, or the pressure of a growing uterus. What can you do about it? Here are some tips for easing constipation during pregnancy Eat high-fibre foods such as whole grain cereals and breads, brown rice, beans, and fresh fruits and vegetables every day. Adding a couple of tablespoons of unprocessed wheat bran (available at health food stores) to your cereal in the morning and following it with a glass of water can help. Be patient as it may take a few days before you notice a difference. Don’t forget to drink plenty of water. Try to drink 2.5 L (10 cups) of water or other beverages every day. Your urine should be clear or pale yellow – a sign of proper hydration. You can always try some prune juice. Some people find that drinking a warm beverage right after waking up helps too. Iron can cause constipation. You may want to check with your health care provider about switching to a supplement with less iron. Another pregnancy tip: your bowels are most likely to be active after meals, so make time for the bathroom after you eat. Listen to your body. Never put off going to the bathroom when you feel the urge. 8 Moving might also help to… get things moving. Exercise regularly. Walk, swim, ride a stationary bike, and do yoga. All of these can help ease constipation and leave you feeling more fit and healthy. And if none of the above helps, talk to your doctor about taking an over-the-counter fibre supplement or stool softener. Do not use a laxative without checking with your doctor or nurse first. Laxatives can trigger the onset of labour contractions. Experiencing pregnancy constipation? Relax, follow the tips above, and you will soon be a regular “expert” at managing it. TIP: Breaking up your daily food intake into five or six smaller meals can help with constipation relief. Can constipation be serious? Not usually, but occasionally, it can point to another problem. If you have severe constipation that is accompanied by abdominal pain or that alternates with diarrhea, or if you pass mucus or blood, call your doctor or midwife immediately. Also, straining during a bowel movement or passing a hard stool can lead to or worsen hemorrhoids. Hemorrhoids can be extremely uncomfortable, though they rarely cause serious problems. In most cases, they go away fairly soon after the baby is born.