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