To the Reader In planning for pregnancy, women are charting their course for the journey of a lifetime. In doing so, you may be attempting to fulfi ll a major life goal. It’s a time full of excitement and anxiety, gain and loss. If a women is not planning a pregnancy at this time, good health and active steps to prevent pregnancy are important. About one half of all pregnancies are unplanned. To reach the destination of motherhood, a woman faces a variety of transitions. The fi rst transition is before pregnancy - or preconception. This guidebook focuses on helping women get off to the best possible start by achieving maximum health before attempting to become pregnant. This will help the mother face the incredible physical and emotional demands of pregnancy and childbirth. Delaware has the fi fth worst infant mortality rate in the nation (about 9.3 deaths per 1000 live births). The percentage of low birth weight babies born in Delaware is above the national average (9 percent compared with 8 percent). This book is divided into sections that address improving Delaware’s birth outcomes and contributing factors. All of those involved in its creation hope that this information will give women a stronger sense of risks and benefi ts, enable them to make the best possible health choices and fi nd services and resources for help. As an additional reference, see the next page. for recommendations issued by the Centers for Disease Control and Prevention. Centers for Disease Control and Prevention (CDC) RECOMMENDATIONS FOR PRECONCEPTION CARE • Recommendation 1: Each woman and man should be encouraged to have a reproductive life plan. These tools can help women self-assess risks, make plans and take actions that will improve their health and that of their children. • Recommendation 2: Increase public awareness of the importance of preconception health behaviors and preconception care. • Recommendation 3: As a part of primary care visits, provide risk assessment and health counseling to all women of childbearing age to reduce reproductive risks and improve pregnancy outcomes. • Recommendation 4: Increase the proportion of women who receive interventions as follow-up to preconception risk screening to address long-term health conditions and other risks. • Recommendation 5: Provide additional intensive interventions to women who had a previous pregnancy that ended in an infant death, fetal loss, birth defects, low birth weight, or preterm birth. • Recommendation 6: As part of maternity care, offer one pre-pregnancy visit for women planning pregnancy. • Recommendation 7: Increase public and private health insurance coverage for women with low incomes to improve access to preventive women’s health and pre-pregnancy care. • Recommendation 8: Integrate components of preconception health into existing local public health and related programs, including emphasis on interventions for women with previous adverse outcomes. • Recommendation 9: Increase the collection and use of evidence to improve preconception health. • Recommendation 10: Maximize public health surveillance and related research mechanisms to monitor preconception health. Survey Please give us your thoughts on your binder materials. Please return the completed survey to the registration table. THANKS. YOUR AGE 14-17 18-25 26-29 30-34 35-40 over 40 YOUR EDUCATION High School Grad Some College Bachelor’s Degree Graduate Studies Health Professional Select your two favorite ways of getting information: Radio Newspaper Internet Television Books Magazines What sources do you use for written health information: Magazines Internet Newspapers Doctor’s handouts Books Health fair leafl ets, brochures Newsletters Does the binder content include information that you fi nd useful? Yes No What new topics should be included in the next binder? ______________________________________ _____________________________________________________________________________________________ What do you think about the binder’s appearance? Like a lot Like No opinion Dislike How would you change the appearance of the next binder? Add photos of people Add photos of babies Sketches of baby items, themes Lighter colors No changes How would you change the information in the next binder? Shorter information Info that is easier to understand No Changes If you are interested in receiving a health newsletter, please provide your name and mailing address with zip code. Name: ______________________________________________________ Street: ______________________________________________________ City:_______________________State: ________________________Zip Code: _________ Nutrition Good eating habits can prevent and treat a wide variety of health issues in women and babies, from diabetes and high blood pressure to birth defects. Poor eating habits can leave unborn babies without building blocks for growth and development. Between 1989 and 2004, 44 percent of Delaware women who experienced a poor pregnancy outcome (delivering too early, delivering an underweight baby, experiencing an infant death) did not gain enough weight during pregnancy, and 24 percent gained too much weight. Adjusting eating habits properly can be more diffi cult for pregnant women who experience nausea and vomiting. BALANCING THE DIET Use these guidelines to eat the right variety of foods each day. FFOODOOD GGROUPROUP AAMOUNTMOUNT A SSERVINGERVING IIS...S... 1 tortilla or bread slice, 1/2 bagel , Grains 6 servings or more ½ cup cooked rice, noodles ½ cup chopped or cooked Vegetables 5 servings or more vegetables 1 apple, orange, peach or ½ cup Fruits 4 servings or more chopped or cooked fruit 1 cup milk or yogurt, 1-2 slices of Milk 3 servings or more cheese 1 ounce meat/poultry/fi sh, Meat & Beans 6 ounces or more 1 egg, ½ cup cooked beans, 2 tablespoons peanut butter or nuts PRENATAL VITAMINS Check with your health care provider before taking vitamins. Large doses of vitamins A, C, D, E and K can be dangerous. However, mothers-to-be need much more iron, folic acid (vitamin B), calcium and phosphorus during pregnancy, especially if they are growing teens. Studies suggest that women who do not consume enough of the B vitamin folic acid before and during the early weeks of pregnancy are at increased risk of having a baby with a heart defect. Nutrition SPECIAL CONSIDERATIONS The medication used to treat some disorders may affect the way foods are absorbed by the body. Women with phenylketonuria (PKU) can pass on heart defects unless they follow a special diet before pregnancy. WIC provides free nutritious foods to eligible breast-feeding moms and their children. To fi nd out if you qualify, call WIC at 302-739-3671 or go to www.dhss.delaware.gov/ dhss/dph/chca/dphwichominf01.html Pursuing Motherhood 4 Best Weight Most pregnant women are concerned about weight gain: what is too much and what is too little. Between 1989 and 2004, 44 percent of Delaware women who experienced a poor pregnancy outcome (delivering too early, delivering an underweight baby, experiencing an infant death) did not gain enough weight during pregnancy, and 24 percent gained too much weight. Too much weight gain can increase a pregnant woman’s chances of gestational diabetes and preeclampsia. (See pg. 30) Not putting on enough weight can prevent the baby from growing at the right rate. THE NUMBERS Ideal weight gain recommended by most physicians is between 25 - 35 pounds after nine months. The best way for a woman to fi gure out her ideal weight gain is to see how close she was to ideal weight before conception. Body mass index (BMI) fi nds a person’s proper weight for their height. Your BMI is the number across the top of the chart below. BMI 19 20 21 22 23 24 25 26 27 28 29 30 35 40 (kg/m2) Height Weight (lb.) (in.) 58 91 96 100 105 110 115 119 124 129 134 138 143 167 191 59 94 99 104 109 114 119 124 128 133 138 143 148 173 198 60 97 102 107 112 118 123 128 133 138 143 148 153 179 204 61 100 106 111 116 122 127 132 137 143 148 153 158 185 211 62 104 109 115 120 126 131 136 142 147 153 158 164 191 218 63 107 113 118 124 130 135 141 146 152 158 163 169 197 225 64 110 116 122 128 134 140 145 151 157 163 169 174 204 232 65 114 120 126 132 138 144 150 156 162 168 174 180 210 240 66 118 124 130 136 142 148 155 161 167 173 179 186 216 247 67 121 127 134 140 146 153 159 166 172 178 185 191 223 255 68 125 131 138 144 151 158 164 171 177 184 190 197 230 262 69 128 135 142 149 155 162 169 176 182 189 196 203 236 270 70 132 139 146 153 160 167 174 181 188 195 202 207 243 278 71 136 143 150 157 165 172 179 186 193 200 208 215 250 286 72 140 147 154 162 169 177 184 191 199 206 213 221 258 294 73 144 151 159 166 174 182 189 197 204 212 219 227 265 302 74 148 155 163 171 179 186 194 202 210 218 225 233 272 311 75 152 160 168 176 184 192 200 208 216 224 232 240 279 319 76 156 164 172 180 189 197 205 213 221 230 238 246 287 328 WHAT BMI MEANS For a woman who is not pregnant, here’s how to interpret the BMI score. Weight Underweight = less than 18.5 Normal = 18.5-24 Overweight = 25-29 Obese = 30 and over If you are underweight or overweight, talk to a health care provider about how to reach the proper range. Pursuing Motherhood 5 RATE AND DISTRIBUTION A good pattern for weight gain throughout pregnancy is about three pounds in the fi rst trimester, 11 in the second, and 11 in the third.