Appropriate weight gain for mom and baby

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1 Jeanne Morris RD CDE Kaweah Delta Outpatient Specialty Clinics Sweet Success Program Nutritional needs go up during pregnancy Appropriate weight gain for mom and baby Prevent nutrition related complications to mom and baby 1

2 Pre pregnancy Weight Weight Gain Goal Normal weight Underweight Overweight Obese 25 to 35 pounds 28 to 40 pounds 15 to 25 pounds 11 to 20 pounds Low weight gain can lead to preterm births and low birth weight babies High weight gains can lead to Hypertension Gestational Diabetes ** Large babies (delivery issues or C section) Future health risks to mom/baby like obesity and associated co morbidities (HTN, DM, etc) 2

3 Usual recommendation for increasing calories during pregnancy is 300 calories a day This could be 1 slice whole wheat bread 1 cup low fat milk 1 Tbsp peanut butter Iron Folic Acid Calcium Omega 3 fatty acids and DHA 3

4 Iron helps keep blood healthy a woman produces more blood during pregnancy Iron poor blood is called anemia women with anemia may feel tired and weak and have fainting spells Iron rich foods Red meats Dried beans Fortified breads and cereals Dark green leafy vegetables Vitamin C helps the intestines absorb iron Pregnant women should try to have a vitamin C source when they are eating iron rich foods Sources of vitamin C Oranges and citrus Tomatoes Mango and papaya Bell peppers especially red and yellow 4

5 All women should consume at least 400 mcg of folic acid during childbearing years Folic acid helps to prevent neural tube defects of the brain and spinal cord If all women consumed enough folic acid before and during pregnancy rate of neural tube defects would drop by 70% Women should consume at least 600 mcg folic acid once they become pregnant Dark leafy green vegetables Fortified cereals Beans and peas Oranges and other citrus Asparagus Women often need to take a supplement to meet their needs 5

6 Calcium is important for the growth and development of bones, heart, muscles, and nerves of the baby Good sources of Calcium Milk Cheese Yogurt Sardines with bones Fortified orange juice DHA (docosahexaenoic acid) is one type of Omega 3 fatty acid that can help with the development of baby s brain and eyes Best source is fish like salmon, sardines, trout If a woman does not like fish she should talk with her doctor about taking a supplement Other sources of Omega 3 fats Walnuts, Wheat germ, Flaxseed 6

7 Need to be careful of eating certain fish due to the mercury content Avoid Swordfish King mackerel Tile Fish Shark Limit albacore tuna Caffeine limit to one 12 ounce cup of coffee Choose decaf coffee, tea, and colas Raw meat or fish Sushi Uncooked hot dogs Uncooked deli meats Raw eggs Unpasteurized milk, cheese, or juice Alcohol 7

8 We are seeing more Gestational Diabetes Mellitus (GDM) as the rate of Pre Diabetes and Type 2 Diabetes goes up A kind of diabetes that happens only during pregnancy Hormones from the placenta cause changes in the body when a woman is pregnant insulin needs go up in the second and third trimester 8

9 Women are usually screened at weeks or at first prenatal visit if they had GDM with previous pregnancy A 50 gram glucose challenge is given Blood sugar less that 140 one hour later is a negative Blood sugar equal to or greater than 140 one hour later is a positive and leads to the next step Next step is to do a 100 gram glucose challenge over 3 hours 9

10 GDM is diagnosed if 2 or more values are equal to or greater than the following Fasting 95 1 hour hour hour 140 Women with only one value out can be diagnosed as Impaired Glucose Tolerance and should still watch their diet Women with GDM have all the same nutritional needs as other pregnant women The key is controlling their blood sugars on a daily basis meal by meal Sometimes diet is not enough and certain pills or insulin are used to promote blood sugar control Exercise like walking and swimming can also help 10

11 Important part of the diet The part of the diet that raises blood sugar Starches Fruits Milk Milk 11

12 It is important to eat adequate carbohydrate for good nutrition and weight gain Goal is to use portion control to promote good blood sugars Carbohydrates can be counted in Grams Exchanges Choices Servings One exchange/serving/choice = 15 grams 1 slice of bread ½ cup potato 1/3 cup rice/pasta ½ cup oatmeal 1 6 inch tortilla ½ cup corn/peas 1 fruit size of tennis ball 1 cup fresh fruit ½ banana ½ cup canned fruit 1 cup milk 6 oz no sugar added yogurt 12

13 It is often recommended that pregnant women have 2 3 carbohydrate choices per meal or grams One choice or 15 grams per snack Veggies do not count in allowance unless they are starchy (corn, peas, potatoes) Using the plate method always balance the meals/carbs with protein and free veggies Serving size Total carbohydrates 13

14 Sugar substitutes can be used Sugar alcohols are not recommended Still provide carbs/affect blood sugar/cause diarrhea Sorbitol Maltitol Xylitol Mannitol Sugar free foods are often still full of carbs Pies contain fruit and starch Ice cream contains milk Sometimes it is better to eat the real thing and count it in the carbohydrate allowance Anything less than 5 grams per serving Examples Sugar free jello Crystal Light Diet Soda Sugar free popsicles Iced tea plain or artificially sweetened Most veggies Protein foods Spices/fresh salsa/vinegars 14

15 Helps fill us up at the meal Can help stabilize blood sugar When protein foods are eaten at the meal can usually stick to the carbohydrate restriction Add calories to the diet Can help to prevent weight loss when carbohydrate restriction is followed 15

16 Low in carbohydrates Low in protein Low in fat Fill half the plate to help fill up free food 16

17 Meeting those special nutritional needs of pregnancy and keeping mom and baby s blood sugars in control Pros best sources of iron are red meats also dark leafy greens both have little affect on blood sugar Cons Iron fortified cereals are not a good choice bread and beans need to be counted as carbs Careful with use of Vitamin C source to increase absorption Orange juice NOT ok (or any fortified fruit juice) Could use Vitamin C fortified Orange flavored sugar free drink mixes like Crystal Light or other brands 17

18 Pros Dark leafy greens and asparagus are still good choices most women should probably taking a supplement Cons Fortified cereals not recommended and bread/beans need to be counted in carbs Oranges will be counted in meal carbs Fruit not recommended as a snack Only get so many carbs in a meal Pros Cheese and Cottage cheese and dark green veggies are all low in carbs (milk loses Lactose when it becomes a cheese product Cons Cows Milk/Yogurt has to count in carb allowance and not recommended at bfast Could use soy or almond milk if it is fortified Greek yogurt lower carbs but lower calcium 18

19 Pros Fish and seafood as long as it is not breaded breading is carbs Pros Walnuts are mostly protein and fat Pros flax seed and wheat germ not high in carbs when eaten in small amounts Cons none The usual things we say are: drink more milk eat iron fortified cereal for breakfast drink a glass of orange juice eat more beans in your meals snack on fruit We have to be careful how we deliver those recommendations because of the importance of good blood sugar control 19