||During pregnancy your body is going though many changes. To support these changes and the growth of your baby, you will need more nutrients and energy.
Following Canada's Food Guide and selecting more servings of foods to provide additional nutrients is the best way to ensure you are getting the energy you require to support a healthy baby. Women are encouraged to follow the Food Guide, including foods from all four food groups and allow their appetite to guide their energy intake.
- Eat 7-8 servings of Vegetables and Fruit each day - Eat lots of fruits and vegetables and remember if you drink juice, make sure it is 100% pure fruit juice. Choose colourful vegetables and fruits whenever you can. These are a great source of folate, vitamins and fibre.
- Eat 6-7 servings of Grain Products each day - Choose whole grain breads, cereals, crackers, pasta and rice. Grain products are a great source of carbohydrate (energy) and fibre.
- Eat 2 servings of Milk and Alternatives each day - Milk, chocolate milk, yogurt, cheese and foods made with milk are all great sources of calcium and protein. If you can't drink milk, fortified soy milk is a healthy alternative. Non-dairy foods also contain calcium, such as canned salmon with the bones, broccoli, and almonds. However, if you are not eating these foods everyday, then increase consumption of Milk and Alternatives to 3 servings a day to provide the calcium needed for pregnancy
- Eat 2 servings of Meats and Alternatives each day - For a great source of iron and protein choose leaner meat, fish and poultry or meat alternatives such as eggs, lentils, beans, tofu and peanut butter.
- Eat regular meals - Remember that if you don't eat, neither does your baby.
- Eat breakfast every day - Breakfast is an important meal to start off the day and if you skip breakfast you will probably not be able to make up those nutrients lost.
- Eat healthy snacks between meals - Pregnant women in their second and third trimesters need 2-3 extra Food Guide servings each day from a variety of food groups to support the extra energy and nutrients needed for pregnancy. Follow your appetite. When you are hungry between meals choose healthy foods such as yogurt, fruit, vegetables, homemade bran or oatmeal muffins, whole grain crackers with cheese, nuts, etc. Healthy snacks are a great way to meet your extra nutrient needs.
- Take a prenatal vitamin every day - Remember a prenatal vitamin does not reduce or replace healthy eating. It will help you get the extra vitamins and minerals you need while you are pregnant.
Folic acid/folate is an important vitamin to include in your eating habits before you are pregnant and during early pregnancy. Folate (found in food) or folic acid (in pill form) is a B vitamin that has been proven to help decrease the risk of neural tube defects (NTDs).
NTDs are birth defects that occur when the neural tube fails to close properly during the early weeks of pregnancy, resulting in abnormalities of a baby's spine, brain or skull such as spina bifida. This means that most women find out they are pregnant after the neural tube already forms, which is why supplementation is important before finding out about a pregnancy.
Health Canada and the Public Health Agency of Canada both recommend that all women who have any chance of getting pregnant take a multivitamin containing 0.4mg of folic acid every day. The multivitamins should be taken at least 2-3 months before pregnancy, throughout the pregnancy and for six weeks after the birth. The Society of Obstetricians and Gynaecologists of Canada further recommend that women with certain health or lifestyle risks might need to take a folic acid supplement up to 5 mg per day.
Taking a multivitamin does not replace the need to eat foods rich in folate and foods fortified with folic acid.
Good food sources of folate/folic acid:
- beets ½ cup,
- broccoli ½ cup,
- cauliflower ½ cup,
- corn ½ cup,
- bran cereal 30g,
- cantaloupe or melon 1/10 fruit,
- eggs 1 large,
- green peas ½ cup,
- romaine lettuce 1 cup,
- oranges and orange juice ½ cup,
- peanut butter 2tbsp.
Excellent food sources of folate/folic acid:
- asparagus 4 spears,
- sunflower seeds ¼ cup,
- baked beans with pork 2/3 cup,
- peanuts ¼ cup,
- kidney beans ½ cup,
- lentils, or chick peas,
- spinach 1 cup.
For more information on folic acid and neural tube defects visit the Public Health Agency of Canada.
Iron is an essential nutrient during pregnancy as it helps build healthy blood for you and your baby.
During pregnancy women may not get enough iron because they:
Not getting enough iron during pregnancy can cause: fatigue, reduced work capacity, cardiovascular stress, lower resistance to infection and iron deficiency. Iron deficiency can lead to:
- need more iron than they did before they were pregnant,
- do not eat enough foods containing iron, or
- do not absorb enough iron from the foods they eat due to low iron bioavailability of the diet.
Iron deficiency anemia is the most common nutritional deficiency during pregnancy. It happens most often during the third trimester of pregnancy.
- maternal anemia,
- premature delivery,
- low birth weight, and
- an increased risk of perinatal infant mortality
Dietary iron has two forms: heme iron and non-heme iron. Meat, poultry and fish contain both heme and non-heme iron. Heme is better absorbed than the non-heme form. It is also less affected by dietary factors that hinder iron absorption. This makes it an important dietary source of iron. Heme iron can provide up to one third of the total dietary iron that the body absorbs (Bjorn-Rasmussen et al, 1974).
Most of the iron we eat is in the non-heme form. About 60% of the iron found in meat, poultry and fish is in the non-heme form. Eggs and plant-based foods, such as legumes, vegetables, fruit, grains, nuts, and iron fortified grain products contain only the non-heme form.
Some tips for getting more iron into your body:
- Follow Canada’s Food Guide, including a mix of iron containing foods. Heme iron is found mostly in animal foods (beef, pork, chicken, fish, organ meats, game meat), and non-heme iron in meat alternatives (legumes, beans, lentils, peanuts, nuts) and iron-fortified foods (cereals, breads, pasta).
- Look at the Nutrition Facts Table on product packages to choose the foods that have the most iron in them.
- A daily supplement containing 16 to 20 mg of iron is recommended during pregnancy.
- Drink tea or coffee 1 or 2 hours between meals rather than with meals. These drinks can interfere with iron absorption.
- Do not take a calcium supplement or calcium-containing antacids during a meal. Wait 1-2 hours after a meal so it will not interfere with iron absorption.
- Include at least one food source of vitamin C with meals to increase the absorption of iron from foods. Vitamin C is found in most fruits and vegetables.
Calcium and Vitamin D:
You need calcium throughout your pregnancy to build strong bones and teeth for your baby. Pregnant women need 1000 mg of calcium per day. Vitamin D is also needed to absorb and use calcium, and pregnant women need 600 IU per day. Eat foods rich in calcium, such as:
- milk (all types)
- fortified soy beverages
Vitamin D Supplement for Pregnancy
Also eat foods that provide vitamin D such as milk, fortified soy beverages, fish and margarine.
Remember... your baby’s bones and teeth start forming in the womb! Getting enough calcium and vitamin D will help your teeth and bones stay healthy too!
Essential Fatty Acids:
Women need more fatty acids during pregnancy. Omega-3 fatty acids are transferred across the placenta and play an important role in the growth and development of the infant.
There are different types of omega-3 fatty acids in the diet. The omega-3 fat, alpha-linolenic acid (ALA) is found in some vegetable oils, nuts and seeds. These include canola oil, flax oil, walnut oil, walnuts and flax seeds. Our bodies can convert ALA into other omega-3 fats including docosahexaenoic acid (DHA).
DHA and another omega-3 fatty acid, eicosapentaonoic acid (EPA) are found only in animal tissue lipids. The best source of EPA and DHA is fatty fish. DHA is an important omega-3 fatty acid in the brain. During pregnancy, DHA is transferred from the mother across the placenta and accumulates in the growing fetal brain and other tissues. After birth, DHA is transferred through breast milk. Dietary DHA contributes to the mother's DHA status, and pregnant and breastfeeding women with higher intakes of DHA transfer more DHA to their fetus, and supply more DHA in their breast milk.
Women who wish to take a fish oil supplement need to look for a Natural Product Number (NPN) on the product label. This shows that the fish oil supplement is government-approved for safety, efficacy, and quality. Avoid taking cod liver oil, particularly if already taking a multivitamin supplement. Women may unintentionally have intakes of vitamin A above the safe level of 3,000 mcg retinol activity equivalent (RAE) or 10,000 IU, since both liver oil capsules and multivitamin supplements contain vitamin A.
Healthy Weight Gain for Pregnancy:
Women come in many shapes and sizes, all of which can be healthy. Most women will have a healthy weight gain while pregnant if they follow a few general tips:
- Eat a variety of foods according to Canada's Food Guide
- Be active while you are pregnant
- Eat when you are hungry, and do not cut back on food
If you do not gain enough weight while pregnant, you are at higher risk of having a low-birth weight baby. This may cause problems with the baby's development and growth. If you gain too much weight while pregnant, you are at higher risk of having a high-birth weight baby and of getting gestational diabetes (diabetes while you are pregnant). This may lead to a long labour and higher risk of illness for you.
During pregnancy you gain weight in many areas. Below is a list of the average weight gain in each area during a typical pregnancy. You may be surprised that only 5-8 pounds of this weight gain is fat. The fat is stored for extra energy that you will need while you are pregnant and breastfeeding.
Average weight gain in each area during pregnancy:
- Blood - 4 lbs
- Extra fluids/fluid retention - 2 to 3 lbs
- Energy stored as fat for pregnancy and breastfeeding - 5 to 8 lbs
- Placenta and amniotic fluid - 4 to 6 lbs
- Baby - 6 to 8 lbs
- Breasts - 2 to 3 lbs
- Uterus - 2 to 3 lbs
Note: If you have gained more than the recommended amount of weight in the pregnancy, do not diet to lose weight. Cutting out food and calories can put you and your baby at risk.
A healthy rate of weight gain in the first trimester is about 1 to 2 kg (2 to 4 lbs).
After their first trimester, women put on weight steadily, as they gain lean and fat tissues.
The recommended amount of weight to gain during a pregnancy depends largely on the woman’s weight before becoming pregnant. This should be assessed by a health professional and depends on many factors, including genetics, other health conditions, lifestyle, and other factors.
Too much caffeine isn’t good for your baby. Caffeine containing drinks can take the place of milk, fortified soya beverage or water. Caffeine stays in the body for a long time (especially during the second and third trimesters of pregnancy) and if you are pregnant, your baby can be exposed to it. Too much caffeine can affect the growth of your baby and how many nutrients are available to your baby during pregnancy.
Pregnant, lactating or women who may become pregnant: The recommendation by Health Canada is to limit your intake to no more than 300 mg each day. This is equal to about two-three 8 oz cups of coffee a day as long as you do not take any other sources. Be aware of the size of your coffee cup and any other caffeine sources in your diet.
Breastmilk: Caffeine is transferred to your baby through your breastmilk. As long as you stay within the recommended intake of 300 mg per day your baby should have minimal side effects.
Duration of effects: Caffeine can start to affect your body within one hour of consumption and takes over seven hours to leave your body. Tolerance of caffeine differs widely from person to person. Too much caffeine can make you feel edgy, unhappy, depressed, and have an upset stomach.
Side effects (on a healthy adult). Especially if you are not used to caffeine, one to four cups of coffee (100-450 mg) can:
- Make you more alert if you feel tired,
- Make your heart beat faster,
- Increase the number of calories your body burns,
- Cause you to have trouble sleeping, and
- Give you headaches, irritability, nervousness, heartburn, and diarrhea.
Withdrawal: If you are to stop taking caffeine suddenly you could experience withdrawal symptoms such as headache, fatigue, irritability and depression.
Cutting back: Cut back gradually to avoid headaches, drowsiness and concentration difficulties. Tips to cut back:
- Use a smaller cup
- Mix regular and decaffeinated coffee
- Brew tea for a shorter time
- Try a café-au-lait made of half coffee and half low fat milk
- If you drink soft drinks, choose caffeine-free cola or non-cola soft drinks.
- Substitute with non-caffeinated beverages
- Read food, beverage, ingredient lists and medication labels carefully to identify those with caffeine.
Fish is rich in high quality protein, essential nutrients and omega-3 fatty acids. It can be a very healthy choice for both men and women. Some types of fish contain environmental contaminants like methyl mercury. However, in general, the majority of fish sold in Canada have levels of mercury far below the maximum limit set by Health Canada. Canada’s Food Guide recommends eating at least 5 ounces of cooked fish each week as part of a healthy eating pattern.
Here is a detailed list of what the Health Unit recommends for amounts of fish that are safe to consume during pregnancy.
Some herbal teas, such as Chamomiles, aren’t good to drink when you’re pregnant.
Herbal teas generally considered safe if taken in moderation (2 to 3 cups per day):
- citrus peel
- lemon balm
- orange peel
- rose hip
Stay away from teas with Aloe, Coltsfoot, Juniper Berries, Pennyroyal, Buckthorn Bark, Comfrey, Labrador Tea, Sassafras, Duck Roots, Lobelia and Senna Leaves.
Nausea and Vomiting:
Nausea and vomiting in pregnancy (NVP) affects 50-90% of women. It usually subsides by 16 weeks, but about 20% of these women will experience symptoms throughout the pregnancy. Also known as morning sickness,it can occur at any time of the day.
Many women who experience NVP have feelings of anxiety and worry about the impact on their baby. There is no evidence that not being able to eat well short-term in the early weeks of pregnancy will have long-term effects on pregnancy outcome.
Dietary and Lifestyle Changes
Many people first try lifestyle and dietary changes to help with NVP.
- Eat what appeals to you.
- High protein meals and snacks may help improve symptoms of nausea and vomiting. Protein foods can include the following, only as tolerated:
- meat - beef, chicken, turkey, pork
- meat alternatives - chickpeas, lentils, kidney beans, black beans, romano and other beans, tofu, eggs, nuts, seeds
- dairy foods (milk, cheese, yogurt)
- Dietary & lifestyle advice may be tried with little risk – there is no evidence, however, that changes to dietary patterns are effective in relieving symptoms of NVP. The following suggestions are mainly anecdotal:
- get out of bed slowly
- get enough sleep
- drink small amounts of fluid throughout the day
- avoid drinking fluids during meals (mixing solids and liquids can increase NVP because it can make the stomach feel fuller and in some women can cause bloating, gas, and acid reflux)
- avoid sour or sweet drinks
- eat small, frequent meals of bland foods to avoid the “empty” feeling in the stomach
- eat a few crackers or dry toast
- avoid spicy, fried, or fatty foods
- avoid strong odours
- get some fresh air
- avoid getting too warm
- eat foods high in fibre to lower the risk of constipation, which may make feelings of NVP worse
- spit excess saliva and wash out mouth (excess saliva can increase symptoms of NVP)
A pregnant woman should try to consume at least 2 litres of fluid daily in small amounts taken frequently. Colder fluids, including ice chips and popsicles, appear to be easier to tolerate and can decrease the metallic taste in the mouth. There are also commercial products available that maintain the electrolyte balance (sports drinks, etc...). These products can be high in sugar and should be used cautiously.
The use of vitamin supplements is encouraged during pregnancy.
- Prenatal multivitamin
- if NVP was experienced in a previous pregnancy, there may be benefit in taking a multivitamin supplement several weeks before the next conception and during the first weeks of pregnancy
- a multivitamin without iron in the first trimester may be better tolerated until NVP subsides; a multivitamin containing iron should be resumed in the second trimester.
- Vitamin B6 (or pyridoxine)
- Vitamin B6 may be effective for the relief of nausea and vomiting in pregnancy. A pharmacist should be consulted on over-the-counter availability and safety of B6 supplementation.
An anti-nausea remedy containing dimenhydrinate (such as Gravol) may be used in some cases of NVP. Conditions such as heartburn, acid reflux, indigestion, gas, or bloating can make symptoms of NVP worse and should be relieved. Minor symptoms can be treated with antacids containing calcium carbonate. A primary care practitioner must be consulted before using these medications.
Alternative therapies, such as ginger supplementation, acupuncture, and acupressure may be beneficial in some cases of NVP. A pharmacist should be consulted on over-the-counter availability and safety of ginger supplements. A primary care practitioner should be consulted before trying any other alternative therapies.
For severe cases of NVP, there is prescription medication available. A primary care practitioner must prescribe this medication.
The following list includes signs & symptoms that the pregnant woman should be aware of and needing intervention.
Signs of dehydration include:
- Loss of appetite
- Dry mouth
- Reduced urine
- Dark coloured urine
- Flushed skin
- Dry skin
- Difficulty concentrating
- Loss of balance
Contact a physician if:
- dietary & lifestyle interventions do not work
- symptoms of heartburn, gas, bloating, and indigestion are making symptoms worse
- you are considering vitamin supplementation or alternative therapies
- dehydration and/or weight loss is experienced
- NVP extends beyond the early weeks of pregnancy
- causes of NVP may be due to non-pregnancy related factors (e.g., pre-existing illness)
- over-the-counter medications are being considered
- prescription medication for NVP may be needed
Heartburn is common during pregnancy. It’s caused by the pressure of the growing baby and hormone changes during pregnancy that allow stomach acid to move up to your throat. The following suggestions might help:
Some women take antacid medicine to help with heartburn. An antacid reduces the amount of acid in your stomach. Not all antacids are safe for pregnant women. Check with your doctor before you take one.
- Do not lie down after eating
- When you do lie down, raise your head and shoulders
- Avoid fried or greasy foods
- Drink fluids between meals, not with meals
- Avoid coffee, colas, alcohol and smoking
- Eat slowly. Take the time to chew well
- Eat small meals and snacks
Many women get constipated during pregnancy. It happens because food passes through your body more slowly when you are pregnant so you can absorb the extra nutrients you and your baby need.
Eat foods high in fibre such as:
- vegetables and fruit
- whole grains
- cooked or canned beans
- peas and lentils
Drink more fluids, especially warm or hot fluids.
Be physically active. There’s nothing like a good walk around the block to move things along!
Warning! If you are pregnant, do not use a laxative to treat constipation without checking with your doctor or nurse first. Laxatives can trigger the onset of labour contractions.
Food Allergy Risk Reduction During Pregnancy:
There is no need to avoid highly allergenic foods during pregnancy for the purpose of avoiding food allergies in the baby regardless of family history of food or environmental allergies.
A pregnant woman should avoid only the foods she is allergic to, and does not have to avoid the allergenic foods of the biological father.