Nutrition in Pregnancy

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Nutrition in Pregnancy

• Presented by
• Dee Anne Domnick, CPM, LM, MH

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Throughout Pregnancy While Breastfeeding

• Make most of your food choices healthy ones.
• Eating too many foods that are high in fat during
  pregnancy leads to too much weight gain for you
  without meeting your increased need for
  nutrients.

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Some nutrient requirements more than double
during pregnancy, while caloric needs increase
only about 15 percent
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Why is a healthy diet important during
pregnancy?

• For the health of both the pregnant woman and the
  developing baby
• Healthy foods are the building blocks of the
  growing baby since pregnancy is a complex time of
  developing new tissues and organs.

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Approximately half of all pregnancies in the
United States result in prenatal or postnatal
death or an otherwise less than healthy baby.

• Major developmental defects, such as neural tube
  and heart deformities, occur in approximately
  120,000 of the 4 million infants born here each
  year.
• Exposure to toxic chemicals, both manufactured
  and natural, cause about 3 percent of all
  developmental defects
• At least 25 percent might be the result of a
  combination of genetic and environmental factors.

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Monitoring of Weight Gain is ImportantEspecially
of Underweight Women

• In addition to the growth of the fetus associated
  with maternal weight gain, pregnant woman store
  fat to prepare the mother for lactation.

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Weight Gain During Pregnancy

• An additional 25-35 pounds is considered
  desirable for the benefit of both the mother and
  developing infant
• Recommended by the National Academy of Sciences
  /Institute of Medicine

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Women who are underweight when they conceive

• should gain about 28-40 pounds

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Those who are overweight

• should gain no more than 15-25 pounds

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Short women (under 62 inches)

• should set lower goals for weight gain, 18-30
  pounds

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Extremely Obese Women

• should gain no more than 15 pounds

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Young Adolescents

• should gain between 28 and 40 pounds, regardless
  of their pre-pregnancy weight and height

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Women Carrying Twins

• should gain 35-45 pounds, regardless of
  pre-pregnancy weight and height

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According to the American College of
Obstetricians and Gynecologists (ACOG), pregnant
women should increase their usual servings of a
variety of foods from the four basic food groups
to include the following

• Four or more servings of fruits and vegetables
  for vitamins and minerals
• Four or more servings of whole-grain or enriched
  bread and cereal for energy
• Four or more servings of milk and milk products
  for calcium
• Four or more servings of fruits and vegetables
  for vitamins and minerals
• Three or more servings of meat, poultry, fish,
  eggs, nuts, dried beans and peas for protein

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Is it necessary to take a vitamin/mineral
supplement during pregnancy?

• Though its possible to meet the requirements for
  most nutrients through a balanced diet, most
  experts recommend pregnant women take daily
  vitamin supplements, including iron folic acid,
  as a safe guard.

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According to the National Academy of Sciences/
Institute of Medicine, supplementation should
begin at the start of the second trimester at the
following levels

• Iron.....................30 milligrams (mg)
• Folic Acid......400 micrograms (mcg)
• Calcium...........250 mg
• Vitamin C...50 mg
• Vitamin B12........2 mcg
• Vitamin D...5 mcg
• Copper.2 mg
• Zinc....15 mg
• Vitamin B6....2 mg

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Vegans

• Add an additional
• 10 mcg of Vitamin D
• 2 mcg of Vitamin B12

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About Folic Acid

• Folic acid in a vitamin supplement, when taken
  one month before conception and throughout the
  first trimester, has been proven to reduce the
  risk for an NTD-affected pregnancy by 50 to 70.
  
• Folic acid, a B-vitamin, is necessary for proper
  cell growth and development of the embryo.

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Newborn with Spina Bifida
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Anencephaly
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Cleft Lip Palette
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Folic Acid--important in cell development(a
water soluble vitamin)

• Recent research suggests that taking folic acid
  before and during early pregnancy can reduce the
  risk of spina bifida and other neural tube
  defects (NTDs) in infants.
• The U.S. Public Health Service recommends that
  all women of childbearing age that are capable of
  becoming pregnant should consume 400 micrograms
  (mcg) of folic acid daily to reduce their risk of
  having an NTD-affected pregnancy.

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How Can Women Get Enough Folic Acid?
There are three ways women can get enough folic
acid to help prevent spina bifida and
anencephaly. They can choose to

• Take a vitamin supplement containing 400
  micrograms of folic acid daily.
• Eat a fortified breakfast cereal daily which
  contains 100 of the recommended daily amount of
  folic acid (400 micrograms).
• Increase consumption of foods fortified with
  folic acid (e.g., enriched cereal, bread, rice,
  pasta, and other grain products) in addition to
  consuming food folate from a varied diet (e.g.,
  orange juice and green vegetables).

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Foods rich in folate include

• orange juice from concentrate,
• dark-green leafy vegetables
• (spinach, broccoli, asparagus, romaine lettuce)
• other vegetables
• (carrots, tomatoes, potatoes)
• beans and pulses like black-eyed beans lentils
• whole grains (i.e. brown rice some cereals)
• citrus, bananas, kiwis and strawberries,
• liver
• fish
• eggs
• milk

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Vitamin A supplementation is not recommended
during pregnancy

• Excessive levels of Vitamin A can be toxic to the
  fetus
• Adequate levels of Vitamin A are available
  through a balanced diet

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Calories--To support the rapid growth of the
fetus, pregnancy demands an additional 300
calories a day over pre-pregnancy needs

• This is approximately the same number of calories
  as supplied by
• 2 ½ cups of low-fat milk OR
• 1 cup of ice cream OR
• A bagel with cream cheese OR
• A tuna fish sandwich

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Protein Both the expectant mother and developing
fetus need increased amounts of protein.

• It is recommended that pregnant women consume 60
  grams of protein a day.
• This is only 10 grams more than non-pregnant
  women.
• Since most Americans regularly consume more than
  they require, most women will not need to
  consciously increase their protein consumption
  during pregnancy.

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Protein Sources

• Seeds
• Nuts
• Beans, legumes
• Grains
• Sprouts

• Eggs
• Dairy Products
• Fish
• Lean Meats
• Fowl

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Suggestions for Complementing Proteins (they do
not need to be consumed at the same meal as
believed) These are menu ideas for vegetarian
dishes

• Bread made with milk or cheese
• Pasta with milk or cheese
• Rice and milk pudding
• Cereal and milk
• Rice-cheese dishes or casseroles
• Cheese sandwiches
• Yogurt and barley soup
• Sesame and milk
• Sesame seeds in bean soup
• Lentils and rice
• Wheat bread with baked beans

• Stir fried tofu and rice
• Tomato, rice and beans
• Rice-bean casserole
• Wheat-soy bread
• Lentil curry on rice
• Corn-soy bread
• Bean or pea curry on rice
• Corn tortillas and beans
• Pea soup and toast
• Legume soup with bread

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Iron

• The iron requirement doubles during pregnancy
• 30 mg/day during the second and third trimesters.

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Additional iron is needed as a result of
increased maternal blood volume.

• Also, the fetus stores enough iron to last
  through the first few months of life.

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What is anemia?

• Anemia is a blood disorder that is defined as
• a level of red blood cells (RBCs) that is below
  normal, or
• a level of hemoglobin that is below normal
  (hemoglobin is the oxygen-carrying protein in red
  blood cells).

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There are several forms of anemia, such as

• iron deficiency anemia
• hemolytic anemia (destruction of RBCs)
• vitamin B-12 deficiency anemia
• folic acid deficiency anemia
• Vit. E deficiency anemia
• Vit. C deficiency anemia
• anemias caused by inherited abnormalities of RBCs
  (for example, sickle cell anemia and thalassemia)
  
• anemia caused by chronic (ongoing) disease, such
  as rheumatoid arthritis.
• and more

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To Get the Most of Iron from One's Diet

• Eat high-iron meals with vitamin C or foods high
  in vitamin C.
• (Taking 200-500 mg. of Vit. C nearly doubles
  iron absorption).
• Tannic acid, caffeine, and phosphates inhibit
  iron absorption avoid them.
• Avoid antacids they neutralize stomach acids,
  which enhance iron absorption.
• Minimize use of laxatives, which decrease the
  amount of time the body has to absorb iron.
• Minimize consumption of refined carbohydrates
  they cause the secretion of more-alkaline
  digestive juices, which decrease the acidity of
  the stomach.
• Do not take iron supplements or high-iron meals
  with dairy products, which neutralizes stomach
  acidity.
• Niacin, B1, B2, pantothenic acid, choline, B12,
  folic acid, cobalt, and copper are involved in
  the absorption, assimilation, and utilization of
  iron.
• Use leavened whole grains yeast in the
  fermentation process makes iron available.
• Do not rely on iron-fortified foods iron used by
  manufacturers is often a phosphate compound not
  soluble in the human digestive tract.
• Large doses of supplemental zinc or calcium
  interfere with iron absorption.
• Cast-iron cookware adds iron to food, especially
  if the food cooked in it is acidic.
• Minimize exposure to cigarette smoke and other
  air pollutants.
• Regular aerobic exercise improves iron absorption
  because of the body's greater need for
  oxygen-carrying capacity.
• Choose iron supplements carefully.

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You can help reduce your risk of iron deficiency
anemia by eating foods that contain iron all
throughout pregnancy. These include

• Red meats
• Shellfish
• Poultry (dark meat)
• Eggs
• Fortified breakfast cereals whole grain breads
• (check the container to see if the cereal or
  bread contains iron)
• Oatmeal
• Blackstrap molasses
• Green leafy vegetables
• Baked potato, with skin
• Cooked beans
• Raisins, dates, prunes, figs, apricots

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The iron in fruits, vegetables, cereals eggs is
not absorbed as efficiently as iron from meat,
fish poultry.

• Iron absorption from these non-flesh foods is
  enhanced when consumed with foods high in Vitamin
  C (such as orange juice) or served with meat,
  fish or poultry.

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Selected Food Sources of Heme Iron

• Food
  Milligrams
  per serving DV
• Chicken liver, pan-fried, 3 ounces
  
  11.0 61
• Oysters, canned, 3 ounces
  
  5.7 32
• Beef liver, pan-fried, 3 ounces
  
  5.2 29
• Beef, chuck, blade roast, lean only, braised, 3
  ounces 3.1
  17
• Turkey, dark meat, roasted, 3 ounces
  2.0
  11
• Beef, ground, 85 lean, patty, broiled, 3 ounces
  2.2
  12
• Beef, top sirloin, steak, lean only, broiled, 3
  ounces 1.6
  9
• Tuna, light, canned in water, 3 ounces
  1.3
  7
• Turkey, light meat, roasted, 3 ounces
  1.1
  6
• Chicken, dark meat, meat only, roasted, 3 ounces
  1.1
  6
• Chicken, light meat, meat only, roasted, 3 ounces
  0.9
  5
• Tuna, fresh, yellowfin, cooked, dry heat, 3
  ounces 0.8
  4
• Crab, Alaskan king, cooked, moist heat, 3 ounces
  0.7
  4
• Pork, loin chop, broiled, 3 ounces
  
  0.7 4
• Shrimp, mixed species, cooked, moist heat, 4
  large 0.3
  2
• Halibut, cooked, dry heat, 3 ounces
  0.2
  1

DV Daily Value. DVs are reference numbers
developed by the Food and Drug Administration
(FDA) to help consumers determine if a food
contains a lot or a little of a specific
nutrient. The FDA requires all food labels to
include the percent DV (DV) for iron. The
percent DV tells you what percent of the DV is
provided in one serving. The DV for iron is 18
milligrams (mg). A food providing 5 of the DV or
less is a low source while a food that provides
1019 of the DV is a good source. A food that
provides 20 or more of the DV is high in that
nutrient. It is important to remember that foods
that provide lower percentages of the DV also
contribute to a healthful diet. For foods not
listed in this table, please refer to the U.S.
Department of Agriculture's Nutrient Database Web
site.
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Selected Food Sources of Non-Heme Iron

• Food
  Milligrams
  per serving DV
• Ready-to-eat cereal, 100 iron fortified, ¾ cup
  18.0
  100
• Oatmeal, instant, fortified, prepared with water,
  1 packet 11.0
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• Soybeans, mature, boiled, 1 cup
  
  8.8 48
• Lentils, boiled, 1 cup
  
  6.6 37
• Beans, kidney, mature, boiled, 1 cup
  5.2
  29
• Beans, lima, large, mature, boiled, 1 cup
  4.5
  25
• Ready-to-eat cereal, 25 iron fortified, ¾ cup
  4.5
  25
• Blackeye peas, (cowpeas), mature, boiled, 1 cup
  4.3
  24
• Beans, navy, mature, boiled, 1 cup
  4.3
  24
• Beans, black, mature, boiled, 1 cup
  3.6
  20
• Beans, pinto, mature, boiled, 1 cup
  3.6
  21
• Tofu, raw, firm, ½ cup
  
  3.4 19
• Spinach, fresh, boiled, drained, ½ cup
  3.2 18
• Spinach, canned, drained solids ½ cup
  2.5 14
• Spinach, frozen, chopped or leaf, boiled ½ cup
  1.9 11
• Raisins, seedless, packed, ½ cup
  1.6 9
• Grits, white, enriched, quick, prepared with
  water, 1 cup 1.5
  8
• Molasses, 1 tablespoon 0.9
  5

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Iron teaDrink daily for iron maintenance. Take
with Vit. C folic acid supplements for
persistent anemia.

• Mix equal parts
• Yellow Dock root
• Nettles
• Red Raspberry leaf tea
• Dulse
• Drink 1 cup daily

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Parsley

• Nutritionally
• the culinary multi-vitamin
• a nutrient powerhouse.
• Contains high levels of
• beta carotene
• vitamin B12
• Chlorophyll
• Calcium
• more vitamin C than citrus fruits
• and just about all other known nutrients.

• is just like an immune-enhancing multi-vitamin
  and mineral complex in green plant form. It is
  one of the most important herbs for providing
  vitamins to the body. Parsley is made up of
  proteins (20 per cent), flavonoids (maintain
  blood cell membranes, antioxidant helper),
  essential oils, iron, calcium, phosphorus,
  manganese, inositol, sulphur, vitamin K, beta
  carotene, and especially vitamin C.

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Iron Tincture

• (This is an alternative to iron supplements)
• Dandelion root
• Yellow Dock root
• Nettle leaf
• Take 1-2 droppers/day
• (depending on degree of anemia).

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Calcium Rich Foods

• Leafy Greens
• Tofu
• Almonds
• Beans
• Sesame seeds
• Black strap molasses
• Figs
• Cheese and milk
• Sardines and salmon
• Hard water

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Factors Increasing Calcium Absorption

• Body needsgrowth, pregnancy, lactation
• Vitamin D
• Milk lactose
• Acid environmenthydrochloric acid, citric acid,
  ascorbic acid (vitamin C)
• Protein intake and amino acids such as lysine and
  glycine
• Fat intake
• Exercise
• Phosphorus balance

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Factors Decreasing Calcium Absorption

• Vitamin D deficiency
• Gastrointestinal problems
• Hypochlorhydria (low stomach acid)
• Stress
• Lack of exercise
• High fat intake
• High protein intake
• Oxalic acid foods
• (beet greens, chard, spinach, rhubarb, cocoa)
• Phytic acid foods (whole grains)
• High phosphorus intake

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Calcium Stew

• (This is an alternative to calcium supplements)
• Slippery Elm bark
• Borage
• Comfrey leaf and/or root
• Oatstraw

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What Is Preeclampsia?

• Preeclampsia is a condition that typically starts
  after the 20th week of pregnancy and is related
  to increased blood pressure and protein in the
  mother's urine (as a result of kidney problems).

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Metabolic Toxemia of Late Pregnancy

• Preeclampsia, toxemia, and eclampsia are all
  symptomatic degrees of the same disease that Dr.
  Tom Brewer calls "metabolic toxemia of late
  pregnancy" (MTLP)
• Brewer, Tom 1982.

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Metabolic Toxemia of Late Pregnancy is evidenced
by symptoms of

• High blood pressure
• Edema
• Sudden weight gain
• Proteinuria
• Spots before the eyes
• Headaches
• Elevated liver enzymes
• in the most severe cases
• eclamptic seizures.

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Preeclampsia

• affects the placenta, and it can affect the
  mother's kidney, liver, and brain.
• Preeclampsia is also a leading cause of fetal
  complications, which include low birth weight,
  premature birth, and stillbirth.

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Eclampsia

• When preeclampsia causes seizures, the condition
  is known as eclampsia--the second leading cause
  of maternal death in the U.S.

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The Brewer Diet for Pregnancyadapted fromWhat
Every Pregnant Woman Should Know by Tom and Gail
Brewer

• 4 exchanges of milk (1 cup each) whole milk,
  low fat, skim, buttermilk. If using soy milk, 1.5
  cups per serving. One serving of cheese is
  approximately 1.25 ounces.
• 2 calcium replacements for each serving of
  unfortified soy almonds, walnuts, sunflower
  seeds, brazil nuts, broccoli, molasses, wheat
  germ
• 2 eggs
• 6 exchanges of fish, liver, chicken, lean beef,
  lamb or pork, any kind of cheese. Beans, grains,
  nuts and seeds and vegetables may also be
  included in this area, but do not count an item
  twice. (Average exchange is 1 ounce meat or hard
  cheese, 1/4 cup of tuna or soft cheese, 1 cup of
  milk, 1 egg, 1/2 cup beans or grains, 2 to 3
  ounces of nuts, and about 5 ounces of most
  vegetables.)
• 2 exchanges of fresh, dark green, leafy
  vegetables broccoli, brussels sprouts, spinach,
  romaine lettuce... (Average exchange is 1/2 to 1
  cup)
• 5 exchanges of whole grain bread, starchy
  vegetables and fruits. (An average exchange is 1
  slice bread, 1/2 cup cereal, pasta or rice, and
  1/2 piece of fruit.)
• 2 exchanges Vitamin C foods. (Average exchange
  is 1 fruit or 1/2 cup.)
• 5 exchanges fats and oils. (1 tablespoon butter,
  oil or mayonnaise)
• 1 exchange Vitamin A food
• Drink to thirst
• Salt foods to taste
• Liver (4 ounces) once a week (Though some people
  object to eating any organ meat during pregnancy
  because of the risk of toxic chemicals supposed
  in organ meats.)

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Who Is More Likely to Develop Preeclampsia?

• Women with chronic hypertension (high blood
  pressure before becoming pregnant)
• Women who developed high blood pressure or
  preeclampsia during a previous pregnancy,
  especially if these conditions occurred early in
  the pregnancy
• Women who are obese prior to pregnancy
• Pregnant women under the age of 20 or over the
  age of 40
• Women who are pregnant with more than one baby
• Women with diabetes, kidney disease, rheumatoid
  arthritis, lupus, or scleroderma.

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Vegetarian Guidelines for PregnancyThe list
below should be used only as a guide. A serving
refers to a normal sized portion that you would
have for a meal or a substantial snack. For
example, a cereal serving can be two small slices
of bread, a portion of pasta or a large potato. A
fruit serving is equivalent to one whole piece
and a vegetable serving is about 3.5 oz (100g).
If you are gaining weight normally, the size of a
serving can be based on appetite.

• Food Group Cereals (wheat, oats, rice, barley,
  rye etc.) Servings / day Four
• Food Group Pulses (beans, chick peas, lentils
  etc.) Servings / day One - two
• Food Group Nuts seeds (almonds, peanuts,
  nutbutters, sesame seeds etc.) Servings / day
  One - two (small servings)
• Food Group Leafy greens, Red yellow
  vegetables, Fresh fruit, Dried fruit Servings
  / day Four - five
• Food Group Dairy products Soya products (soy
  milk, tofu, etc.) Servings / day Three -
  four
• Food Group Vegetable oils fats Servings /
  day Two (small servings)
• Food Group Yeast extract other B12 fortified
  foods Servings / day One

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Vegetarian Pregnancy by Sharon Yntema

• Provides excellent information on pregnancy
  nutrition, and not just for vegetarians!

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Incredible Vegan Recipes

• Gentle World, Inc.P.O. Box 238Kapa'au, HI,
  96755U.S.A.
• fax [phone]

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Treatment of High Blood Pressure

• It is important to take steps to keep your blood
  pressure under control.
• The treatment goal is blood pressure below 140/90
  and lower for people with other conditions, such
  as diabetes and kidney disease.
• Adopting healthy lifestyle habits is an effective
  first step in both preventing and controlling
  high blood pressure.

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Magnesium and Hypertension

• Magnesium is a potent vasodilator
• Displaces calcium from smooth muscle cell
  surfaces
• Interferes with acetylcholine at the myoneuronal
  junction
• Low blood levels commonly found in hypertensives,
  especially diabetics
• 50 of magnesium-depleted individuals are
  hypertensive
• Magnesium deficiency causes influx of calcium
  into vascular muscle cells increasing
  contractility
• Magnesium deficiency pontentiates constrictor
  effect of humoral pressor agents
• Supplementation most useful in patients on
  diuretics (6-12mm Hg additional lowering)

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Magnesium Rich Foods

• Leafy Green Vegetables
• Nuts and Seeds, esp. almond, pumpkin, cashew
• Beans and Legumes
• Wheat Germ
• Avocado
• Potatoes
• Chocolate
• Hard Water

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Calcium and Hypertension

• Hypertensives tend to consume less calcium than
  normotensives.
• Hypocalcemia is correlated with blood pressure.
• The relationship between dietary low potassium
  and high sodium and hypertension correlates more
  with low dietary calcium.
• Calciums hypotensive effect may be associated
  with increased sodium excretion.
• Calcium supplementation studies have produced
  conflicting results (modest lowering at best).

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The Food and Drug Administration (FDA) and the
Environmental Protection Agency (EPA)Consumer
Advisory on Methylmercury in Fish

Revised March 19, 2004

• Fish and shellfish contain high-quality protein
  and other essential nutrients, are low in
  saturated fat, and contain omega-3 fatty acids.
• Some fish and shellfish contain high levels of
  mercury that may harm an unborn baby or young
  child's developing nervous system.
• Women might wish to modify the amount and type of
  fish they consume if they are planning to become
  pregnant, are pregnant, nursing, or feeding a
  young child.
• By following the following recommendations for
  selecting and eating fish or shellfish, women
  will receive the benefits of eating fish and
  shellfish and be confident that they have reduced
  their exposure to the harmful effects of mercury.

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FDA EPA recommendations for reducing the
exposure to high levels of mercury in women who
may become pregnant, pregnant women, nursing
mothers, and young children

• Do not eat Shark, Swordfish, King Mackerel, or
  Tilefish because they contain high levels of
  mercury.
• Eat up to 12 ounces (two average meals) a week of
  a variety of fish and shellfish that are lower in
  mercury.
• Five of the most commonly eaten fish that are low
  in mercury are shrimp, canned light tuna, salmon,
  pollock, and catfish.
• Another commonly eaten fish, albacore ("white")
  tuna has more mercury than canned light tuna. So,
  when choosing your two meals of fish and
  shellfish, you may eat up to six ounces (one
  average meal) of albacore tuna per week.

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Fish from Local Waters

• Check local advisories about the safety of fish
  caught by family and friends in your local lakes,
  rivers and coastal areas.
• If no advice is available, it should be safe to
  eat up to six ounces (one average meal) per week
  of fish you catch from local waters, but don't
  consume any other fish during that week.

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"I don't see the fish I eat in the advisory.
What should I do?"

• If you want more information about the levels in
  the various types of fish you eat, see the FDA
  food safety website
• www.cfsan.fda.gov/frf/sea-mehg.html
• or the EPA website
• www.epa.gov/ost/fish

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Listeria In the rare case that a woman become
sick from Listeria, the baby that shes carrying
could get sick or die.

• Although Listeria bacteria are killed with
  thorough cooking, these "tough bugs" can grow in
  the refrigerator and survive in the freezer.

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Symptoms of Listeria Infection can develop from 2
to 30 days after having eaten contaminated food.
If the infection spreads to the unborn baby, it
could trigger early labor.

• Tell your doctor or midwife right away if any of
  these symptoms develop
• fever and chills, or other flu-like symptoms
• headache
• nausea
• vomiting

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To prevent Listeria infection, take these
precautions

• If eating meat eat only thoroughly cooked meat,
  poultry or seafood.
• Thoroughly reheat all meats purchased at deli
  counters, including cured meats like salami,
  before eating them.
• Wash all fruits and vegetables with water.
• Follow label instructions on products that must
  be refrigerated or that have a "use by" date.
• Keep the inside of the refrigerator, counter
  tops, and utensils clean.
• After handling raw foods, wash your hands with
  warm soapy water, and wash the utensil you used
  with hot soapy water before using them again.
• Use hard cheeses, like cheddar, instead of soft
  cheeses during pregnancy.
• If you do use soft cheeses during pregnancy, cook
  them until they are boiling (bubbling).
• Use only pasteurized dairy products. It will
  state "pasteurized" on the label.
• If you do use hard cheeses made from
  unpasteurized milk, use only those marked "aged
  60 days" (or longer).

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Do you have any questions about Listeria?

• Call 1-(800) FDA-4010
• Department of Health and Human Services
• Food and Drug Administration (HFI-40)
• 5600 Fishers Lane, Rockville, MD 20857
• DHHS Publication No. (FDA) 96-2304S

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Pregnant women should use caution with vitamins
A, C, and D in higher doses than the recommended
daily allowances.

• Synthetic vitamin A in some drugs used for acne
  and psoriasis can cause birth defects in the
  developing fetus.
• The concern with toxicity of vitamin D in
  pregnancy is calcification of the placenta and
  other soft tissues. The mother is also more prone
  to developing kidney stones.
• Vitamin C taken in extra large doses is thought
  to cause miscarriage in the early weeks of
  pregnancy and can cause harm to the baby after
  birth.

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Picaa rare craving to eat substances other than
food, such as dirt, clay, ice, laundry starch or
coal. Speculated to be psychological, cultural,
or even physiological.

• The craving may indicate a nutritional deficiency
  such as anemia, or may result in anemia.
• In some cases interferes with adequate nutrient
  intake or absorption
• Should be discouraged.

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Caffeine in Pregnancy

• Some studies suggest that drinking more than 2 to
  3 cups of coffee daily increases the chances of
  low birth weight.
• Watch for hidden caffeine in teas, soft drinks,
  chocolate products.
• As with other diuretics, caffeine consumption
  should be discussed with ones healthcare
  practitioner

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Should sodium intake be restricted during
pregnancy?

• Answer No. In fact, sodium requirements
  increase during pregnancy.
• The sodium provided by the average diet is likely
  to be adequate for expectant mothers.
• Use of additional salt is rarely warranted.
• Excessive sodium intake does contribute to high
  pressure in some people.

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Is it safe to have an occasional cocktail, beer
or glass of wine?

• Because the effects of occasional alcohol
  consumption during pregnancy are unknown, most
  health authorities recommend not drinking alcohol
  during pregnancy.
• Habitual alcohol consumption does affect the
  developing infant.
• Studies show that pregnant women who drink 1-2
  drinks per day tend to have smaller babies.

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Alcohol Use in Pregnancy

• Women who use alcohol during pregnancy have a
  greater risk of giving birth to babies with fetal
  alcohol effects (FAE) or the more serious fetal
  alcohol syndrome (FAS).

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Fetal Alcohol Syndrome (FAS)

• Characterized by
• Growth retardation
• Facial malformations
• Heart malformations
• Small head size
• Mental deficiency
• FAS affects about 40 percent of babies born to
  women who drink heavily throughout pregnancy.

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Tips for Reading Food LabelsCheck out those
little stickers on the fresh fruits and
vegetables in your market.

• A five digit code beginning with a 9 means that
  produce was grown organically.
• A five digit code beginning with an 8 identifies
  genetically engineered produce.
• A label with four digits indicates conventionally
  grown food.
• For further details, read "Talking Fruit" at
  http//www.plantea.com/genetically-modified-foods
  .htm
• Packaged food with the USDA ORGANIC symbol must
  follow these labeling guidelines 100 Percent
  Organic 100 Organic at least 95 Made
  with Organic at least 70
• To learn more, read "How to Read the New Organic
  Labels" at http//www.theorganicreport.com/pages/
  12_how_to_read_the_new_organic_labels.cfm

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Increase omega-3 and omega-6 fatty acids

• vegetable, nut, seed oils
• salmon, herring, mackerel, sardines,
• walnuts
• flaxseed oil, evening primrose oil, black currant
  oil

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Many superfoods are high in anti-oxidants that
fight free radicals in the body.

• Free radicals may sound a little like an
  extremist terrorist sect evading capture and
  wreaking havoc across the globe and in fact
  within the context of your body this would be
  right.
• They are, in part, a natural occurrence through
  metabolism however extra and unnecessary free
  radical load can be put on our bodies by external
  factors including pollution, cigarette smoke,
  radiation, burnt foods, deep fried fats and
  cooked foods.
• When enough of these free radicals invade our
  immune system problems occurs.
• This is when you need antioxidants to build up
  the immune system and fight off the free radicals
  in the form of superfoods or supplements.
• (See more on SuperFoods within your supplemental
  reading list).

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Pregnancy presents a good opportunity for
nutrition education.

• The basic principles of good nutritionbalance,
  variety and moderationshould be encouraged
  during pregnancy and as lifetime habits.
• Clients should be counseled to enjoy a variety of
  nutrient-rich foods for their own good health and
  the health of their unborn children.

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