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PreNatal Nutrition Series: Week 4 Breastfeeding and Nutrition

By: Jamie Burger, dietetic intern 

 

Week 4 - Breastfeeding and Nutrition 

While breastfeeding, your body uses an abundance of energy and nutrients. Your diet is important to be able to supply the energy and nutrients required for optimal development of the baby as well as your own.


Calories

Breastfeeding mothers need more calories to meet their nutritional needs. An additional 450 to 500 calories are recommended for well-nourished breastfeeding mothers compared to the amount they were consuming prior to breastfeeding. This is about 2,300-2,500 kcal/day compared to 1,800 to 2,000 kcal per day. Additional calories are affected by the mothers age, BMI, activity level and how much she is breastfeeding.


Multivitamins While Breastfeeding

A multivitamin isn't required unless the mother's diet is lacking in certain nutrients. A vegetarian, vegan, or other special diet may not provide enough nutrients to support the baby and the mother. The recommended daily allowances for nearly all nutrients increase while breastfeeding. If the mother cannot get adequate nutrients from food alone, a multivitamin is recommended. 


Foods to Eat While Breastfeeding

Women do not need to limit or avoid specific foods other than certain types of seafood and caffeine. Although fish is a good source of protein and contains essential vitamins and minerals for breastfeeding, the type of seafood is important to consider. Most fish contain some amount of mercury, which accumulates in fish flesh and can pass to the infant through the mother. This can have effects on the brain and nervous system of the breastfed infant. Fish to avoid include: king mackerel, marlin, orange roughy, shark, swordfish, tilefish, and tuna. 


Caffeine should be limited as well since small amounts pass from the mother to the infant. This does not usually affect the infant if consumed in small amounts, about 2-3 cups of coffee per day. An infant is more likely to be fussy or irritable with high caffeine intake. Caffeine not only includes coffee but also soda, energy drinks, tea and chocolate. 


Special Recommendations for Mothers Who Are Vegan or Vegetarian

Breastfed infants of women who are vegetarian, vegan, or are eating very limited amounts of animal products may have a very limited amount of vitamin B12. This can lead to vitamin B12 deficiency in the infant, which can result in neurological damage. Vitamin B12 supplementation is recommended for this population.


 

 

Week 3 - Foods to eat to Optimize Your Baby's Development

To optimize the development of the baby during pregnancy, The Academy of Nutrition and Dietetics recommends the following: 

  • Gain the appropriate weight

  • Eat a balanced diet

  • Exercise regularly

  • Take appropriate vitamin and mineral supplements


Learn more about which foods you should and shouldn't have during pregnancy as well as proper calorie and fluid intake to optimize the baby's development below:


Dietary and Caloric Recommendations

To maintain a healthy pregnancy, it's important to eat approximately 300 extra calories each day for the baby. This should be coming from healthy sources like protein, fruits, vegetables, and whole grains. Although there are many cravings that come along with pregnancy, sweets and fats should be limited. Limiting these foods and eating a balanced diet can help reduce pregnancy symptoms like nausea and constipation. 


Fluid Intake

Fluid intake is very important during pregnancy. It is recommended to drink 8-10 glasses of water each day. Eating foods high in water content like soups, fruits, and vegetables are also beneficial. It's recommended you restrict your intake of caffeine and artificial sweeteners and to avoid all forms of alcohol. 


Ideal Foods to Eat During Pregnancy

It's important to "eat the rainbow" during pregnancy to make sure you're getting a variety of nutrients. The following foods are beneficial for not only fetal development, but your health as well:


Food Group

Specific Foods

Benefits

Vegetables

Carrots

Sweet Potatoes

Pumpkin

Spinach

Cooked greens

Tomatoes

Red sweet peppers

Vitamin A 

Potassium

Fruits

Cantaloupe

Honeydew

Mangoes

Prunes

Bananas

Apricots

Oranges

Red/Pink grapefruit

Potassium

Dairy

Fat-free or low-fat yogurt, skin or 1% milk, soymilk

Calcium

Potassium

Vitamin A

Vitamin D

Grains

Fortified cereals and cooked cereals

Whole grain products

Iron 

Folic acid

Proteins

Beans and peas

Nuts and seeds

Lean meats

Salmon, trout, gerring, sardines and pollock

Amino acids



Foods to Avoid

Avoid eating the following during pregnancy:

  • Unpasteurized milk and milk products like soft cheeses, including feta, queso blanco, and fresco, camembert, brie, or blue-veined cheeses, unless labeled "made with pasteurized milk".

  • Hot dogs and deli meats

  • Raw and undercooked seafood, eggs, and meat. Avoid sushi made with raw fish, but cooked sushi is safe. 

  • Refrigerated pate and meat spreads

  • Refrigerated smoked seafood


Prenatal Vitamin and Mineral Supplements 

Prenatal vitamins and mineral supplements are extremely important during pregnancy, but do not replace a healthy diet. They are to ensure all nutritional needs are met. Ask your doctor about the best prenatal vitamin for you. To learn more about essential micronutrients during pregnancy, check out Week 1 of the Prenatal Campaign.


 

Week 2 - Weight Gain

Although most may think when they're pregnant they have to "eat for two," this isn't the case. It is important to pay attention to how much weight is gained before and during pregnancy. Being overweight before pregnancy increases the risk of various pregnancy complications like gestational diabetes, high blood pressure disorders of pregnancy like preeclampsia, and the need for a C-section. Follow the guidelines below for appropriate weight management during pregnancy. 


Overweight

Being overweight before pregnancy increases the risk of various pregnancy complications like gestational diabetes, high blood pressure disorders of pregnancy like preeclampsia and the need for a C-section.


Underweight

If you are underweight before pregnancy, it is important to gain a good amount of weight during pregnancy to avoid the birth of a baby with a low birth weight. 


Gaining Weight

When you gain too much during pregnancy, it can increase the baby's risk of health problems like being born with a large birth weight. Gaining weight can also put you, the mother, at risk of postpartum weight retention and increases your risk of blood clots in the postpartum period. 

  • Where does the weight go? Since only 7 or 8 pounds is the weight of the baby, the other weight gain is in various parts of the body:

    • Breasts: 1-3 lbs
    • Uterus: 2 lbs
    • Placenta: 1.5 lbs
    • Amniotic fluid: 2 lbs
    • Increased blood volume: 3 to 4 lbs
    • Increased fluid volume: 2 to 3 lbs
    • Fat stores: 6 to 8 lbs
  • When should I gain weight? You need to gain around 1 to 4 pounds in the first few months of pregnancy if you start out at a healthy, normal weight. No extra calories are necessary to gain this weight. Steady weight gain is more important in the 2nd and 3rd trimesters. The guidelines tell us that you'll gain about 1 pound a week until delivery, which is an extra 300 calories a day to help meet this goal. For overweight women, it is recommended to gain about ½ pound per week in the 2nd and 3rd trimesters.

Consider these general guidelines for weight gain during pregnancy:

 


Pre-pregnancy Weight

Recommended Weight Gain

Recommended Weight Gain Carrying Twins/Multiples

Underweight (BMI under 18.5)

28 to 40 lbs

N/A

Normal weight (BMI 18.5 to 24.9)

28 to 40 lbs

37 to 54 lbs

Overweight (BMI 25 to 29.9)

25 to 35 lbs

31 to 50 lbs

Obesity (BMI 30 or more)

15 to 

25-42 lbs


Sources: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-weight-gain/art-20044360

 

 

 

Week 1 - Micronutrients 

Below are the 5 micronutrients that are of main concern for the pregnant mother:

 

Folateimg

Folate plays a critical role in the development of cells and fetal tissues. Supplementation with folic acid is widely recommended to all women of childbearing age to reduce the chance of a neural tube defect. Recommended intake for non-pregnant women is 400 ug/day and pregnant  women is 600 ug/day. Folate can be found in leafy green vegetables, fruits (such as oranges), and fortified cereals. Folic acid supplementation during pregnancy has also shown to reduce the risk of congenital heart disease and support proper development of the placenta. 


Iron

Iron requirements progressively increase until the third month because of the accumulation in fetal tissues. Because it's used for this process, inadequate intake during pregnancy associated with the increase of iron demand can cause iron deficiency. This can affect the growth and development of the fetus and increase the risk of a preterm birth, low birth weight, and postpartum hemorrhages. 


Calcium

Calcium is the most abundant mineral in the human body and is in our skeleton and teeth. Calcium sources are milk and derivatives as well as cereals and vegetables with lower amounts. Calcium is essential for fetal development and the requirement increases during pregnancy (from 50 mg/day at the halfway point, up to 330 mg/day at the end) and lactation. This is because the mobilization of the maternal skeleton, the greater efficiency of absorption in the intestine, and increased renal retention. Low-dose supplementation with calcium during pregnancy reduces the risk of developing both gestational hypertension and pre-eclampsia.

 

Vitamin D

Vitamin D is so important because calcium metabolism requires vitamin D. Also, in the first stage of pregnancy, vitamin D is involved in the regulation of cytokines (small proteins that control the growth of immune cells and red blood cells) and contributes to the embryo implantation and regulating hormone secretion. Maternal supplementation during pregnancy reduces the risk of pre-eclampsia as well as preterm delivery and low birth weight. High amounts of vitamin D are contained in fatty fish like salmon, eggs, cheeses, and high amounts are found in cod liver oil.

 

Iodine

Iodine is a major component of thyroid hormones and is essential for growth, formation and development of organs and tissues, and the metabolism of glucose, proteins, lipids, calcium and phosphorus. Fish and shellfish are the main food sources of iodine and it's also found in iodized salt. In pregnancy, iodine deficiency can increase the risk of spontaneous abortion, perinatal mortality,, birth deects, and neurological disorders. It also is considered by the World Health Organization as the most important preventable cause of brain damage. During pregnancy, iodine is necessary for the production of fetal thyroid hormones. Inadequate intake puts the baby at risk for developing hypothyroidism.



Micronutrient

Recommended Supplementation Per Day

Food Sources

Folate

600 mcg

400 mcg of childbearing age

Leafy greens, fruits (oranges), fortified cereals

Iron

27 mg 

Red meat, beans, nuts, fortified cereals, 

Calcium

1,000 mg

Milk,cheese, yogurt, dark leafy greens

Vitamin D

15 mcg

Cod liver oil, salmon, eggs, cheese

Iodine

220 mcg

Fish, shellfish, iodized salt

Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084016/ 

Tune in next week for part 2 of the Prenatal Nutrition series. Jamie will be discussing "Weight Gain During Pregnancy." 

To learn more about nutrition and what Cedardale has to offer, contact Samantha McCarthy, registered dietitian at smccarthy@cedardale-health.net 

 

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