The Newborn’s Stomach
I see many new families in the hospital, as a staff Lactation Consultant, and in their homes, with my private practice, and I hear many similar questions. One of the recurring themes comes across in statements like “my baby can’t be getting very much” or “my baby is feeding so frequently, I must not have milk. This cannot be normal!” There are many charts on the Internet that show an illustration of the size of a newborn’s stomach, I felt putting these illustrations into real world sizes we can see would be helpful.
Below is an illustration I have created showing the approximate size and volume of a newborn’s stomach on day one, day three, at one week, and at one month. Newborns’ tummies are tiny, and cannot/should not take in large volumes, so they need to feed frequently. In the first day or two, their little tummy fills with 2-15 ml during a breastfeed, and then, snuggled in close to your warm chest and familiar heartbeat, they fall asleep. Just as you may be drifting off to sleep or decide that you too should eat something, they start to wake up and show signs of hunger; their sweet little fists fly frantically to their mouth and their lips start smacking together. Their little tummies have started to digest that perfect amount of colostrum, and they are starting to get hungry again. A newborn baby feeds 8-12 times in 24 hours, which means they will be feeding about every 1-3 hours. After the first 24 hours and for the first week or two the baby should feed the minimum of 8 times in 24 hours to ensure they stay hydrated (shown by pees and poops), assist with things like jaundice and weight loss/gain, establish Mom’s milk supply properly and get lots of practise at the art of breastfeeding.
They often cluster feeds together; this means your precious little one may breastfeed for 45 minutes then fall asleep, then wake 30 minutes later and feed for another 30 minutes, and fall asleep. The next feed may happen 2 hours later, then 3 hours after that, then an hour later… I’m sure you get the idea; there is no set schedule. This is the best way to establish a healthy milk supply and to allow baby to control when they eat and how much. You can not breastfeed your baby too much, but you can breastfeed them too little.
Many families feel the need to supplement their baby; maybe they are concerned with the frequent feedings, or feeling pressured from their doctor or family. I often hear my clients comment that they hear their well-meaning family members say “The baby is crying again, she must be hungry” or “The baby is fussing, are you sure you have milk?” or “the baby just ate an hour ago, you must not have enough if he is hungry already.” This can create, or further feed the insecurity a new mother may already be feeling, and often leads to unnecessary supplementation. Some families feel they need to supplement due to pressure from the Doctor, and other families are supplementing for legitimate medical reasons (these reasons should be clearly communicated to you). When you are supplementing it is crucial that you keep in mind how small those little tummies are. If you supplement too much this will cause baby to sleep longer and feed less frequently and any time they are supplemented away from the breast you losing the stimulation and removal of milk needed to signal your body to make more milk; this will directly impact your milk supply. If you are supplementing always seek guidance from an expert in feeding- a board certified lactation consultant (IBCLC) will help guide you through how to supplement, how to protect your supply while supplementing and how to wean the supplements when the time is right.
Understanding the size of your Baby’s stomach, the average volume taken in during a breastfeed and typical newborn feeding frequency can help alleviate some anxiety a mother feels when she is trusting her body to nourish her child. Newborns are only this tiny for a short time, those stomachs grow quickly and they get more efficient at breastfeeding which means breastfeeding sessions become less frequent and shorter. For now enjoy those snuggles, and feel encouraged that your baby is feeding frequently and doing a fantastic job of “demanding” a healthy supply of breast milk. The great effort you and your baby put in during the first few days establishes a solid start for a happy and healthy breastfeeding relationship.
Katie Wickham RN BScN IBCLC
Healthy Mums
Your guide to eating well during pregnancy and breastfeeding
A healthy lifestyle before pregnancy.
Following a healthy lifestyle can help your chances of conceiving and having a successful pregnancy. Eating well is important because having a balanced diet and being a healthy weight helps your chances of getting pregnant and also helps the future health of your baby.
Below are some general suggestions for a healthy lifestyle. See your health professional for more specific advice to prepare for pregnancy.
Maintain a healthy body weight
Being overweight or underweight can reduce fertility, so it’s important to keep your body weight within the normal healthy range. Body Mass Index (BMI) is a measure of whether you’re in a healthy weight range and can be calculated by dividing weight (in kgs) by height (in m2). You should aim for a BMI of between 20 and 25, as this will optimise your chances of getting pregnant.
Be active
Regular exercise helps you stay healthy. Aim for around 30 minutes of moderate physical activity most days, or every day of the week.
What about Supplements?
In NZ a daily tablet of 0.8 mg of folic acid is recommended starting four weeks before you get pregnant and continuing right up until the 12th week of pregnancy. Folic acid has been shown to reduce the risk of neural tube defects such as spina bifida in babies.
A daily 150 mcg iodine tablet is also recommended from when you first become pregnant, & during pregnancy and breastfeeding. Some health professionals may suggest you start iodine tablets when you are trying to get pregnant as well. Talk to your doctor or your lead maternity carer (LMC) about which tablets are recommended.
Eat well
It’s recommended you follow a healthy balanced diet because eating well helps prepare your body for a healthy pregnancy:
• Eat 3 regular meals every day, with a healthy snack between meals if you need to.
• Eat a variety of nutritious foods from the 4 food groups every day:
Smoking, alcohol & caffeine can reduce your chances of conceiving and having a healthy pregnancy (see your health professional for specific advice):
or at least reduce the amount you drink.
• Caffeine can reduce your fertility and delay your ability to become pregnant. Be aware of how much caffeine you consume from coffee, tea, cola and chocolate. You may wish to limit, or avoid caffeine for now.
What should I be eating when I’m pregnant or breastfeeding?
Whether you are planning pregnancy, already pregnant or breastfeeding, healthy eating is important for you and your baby. Although there will certainly be some nutrients you need more of, generally the key to eating well is including a variety of nutritious foods from the four major food groups each day.
At least 6 serves
At least 6 serves
(if breastfeeding, aim for at least 7 serves)
At least 3 serves
At least 2 serves
Fruit & Vegetables
Breads & Cereals (preferably wholegrain)
Milk & Milk Products (preferably low or reduced fat)
Meats & Alternatives
• fresh
• canned • frozen • dried
(choose lower salt and sugar options if using canned products)
Are there any special nutritional requirements during pregnancy?
Energy
When you’re pregnant your body forms a growing baby and lays down extra fat stores for breastfeeding later on. As well as needing extra fuel for your own body and your growing baby, more nutrients are required for the increased tissue
of the uterus, placenta and blood cells. You may notice your appetite increases to ensure you eat enough for you and your baby. This doesn’t mean you need to eat for two! In fact, gaining too much weight when you’re pregnant may cause pregnancy complications and it could negatively impact your baby’s health later in life.
During the first trimester, you generally don’t need to eat any extra food. During the 2nd and 3rd trimesters, you need to eat a little more food than usual, but not as much as you may think! Although you don’t need to start strictly counting calories, the extra energy you need every day is around
1400 kJ (340 kcal) in the 2nd trimester and around 1900 kJ (450 kcal) in the 3rd trimester.
Remember this varies significantly between different women. On the following page you can view some examples of the extra food you need to eat each day, just choose one per day (in addition to your normal diet).
Extra food during pregnancy
(each bullet point gives an example of the extra food you may need each day)
2nd Trimester:
3rd Trimester:
Smoothie Recipe
Combine the following in a blender:
125g 220g can 1⁄2 cup
1⁄2 cup Wattie’s Peach Slices in Clear Fruit Juice Wattie’s 99% Fat Free Vanilla Creamed Rice Yoghurt
Milk
Iron
When you’re pregnant you’ll need a lot more iron than normal (particularly in the last 2 trimesters)
to support your growing baby and to increase the capacity of your blood to carry iron and oxygen. The best way to get more iron in your diet is to make sure you are eating enough iron-rich foods. Your iron levels will be checked by a blood test early in your pregnancy and again in the third trimester.
Foods containing iron include:
Lean red meat (lamb, beef, venison, pork), chicken, fish, beans and lentils, nuts and green leafy vegetables like spinach. Although all these foods contain iron, your body absorbs the most iron from animal foods such as meat, chicken and fish.
Fat
You don’t need to eat extra fat when you’re pregnant. Instead, make sure you are eating fats which are beneficial for good health for both you and your baby. The essential fats we need from food (because our body can’t make them) are polyunsaturated fats called linoleic acid (omega-6) and alpha linolenic acid (omega-3). From these essential fats, our body produces other essential longer chain fats which are very important for your unborn baby’s growth and development, particularly for the brain and eyes.
We generally consume enough omega-6 in our diet, but we don’t eat as much omega-3, so it’s a good idea to boost your omega-3 intake by regularly consuming:
Tips to boost iron intake:
Folate
Folate (or folic acid) is a B-vitamin essential for several functions in your body including the formation of red blood cells and the growth of new tissues. You need significantly more folic acid in your diet when you are pregnant. This is especially important because folic acid is shown to reduce the risk of neural tube defects such as spina bifida in babies.
In NZ a daily tablet containing 0.8 mg of folic acid is recommended starting four weeks before you get pregnant and continuing right up until the twelfth week of pregnancy. Talk to your LMC or doctor about which tablet is recommended.
Do I need to take supplements?
It’s also a good idea to eat plenty of high folate foods including:
If you eat a wide variety of foods from the four food groups every day, vitamin and mineral supplements are generally not necessary with the exception of folic acid and iodine (see paragraphs above).
Although not routinely recommended during pregnancy, some women may need a vitamin D or an iron supplement, but only on recommendation from your health professional.
Vitamin D is mostly made when the skin is exposed to sunlight and is important for bone health & many other health benefits. Some women in NZ are at risk of having a low Vitamin D level & this will affect the Vitamin D status of
their babies. You may be at higher risk of low Vitamin D levels if you have naturally dark skin, if you keep your skin covered by clothing all year around, if you spend very little time outdoors or if you live in southern parts of NZ. Talk to your doctor or LMC about whether a Vitamin D supplement is recommended for you.
If your iron stores are low, particularly in the last trimester, your doctor may prescribe iron supplements.
If you’re not eating as well as you should be because you’re feeling sick, lacking energy or are very busy, you could try a nutritional supplement drink like Complan which provides extra vitamins and minerals, protein, carbohydrate and energy (and may help you maintain a better nutritional intake). Chat with your health professional for more information or call the Forbaby Careline on 0800 55 66 66.
What can I do to help relieve pregnancy discomforts?
Morning Sickness
“Morning sickness” affects most women to some degree during pregnancy. Fortunately, for most women the nausea and vomiting occur in the first trimester only and disappear by weeks 14-16.
If you’re having a hard time eating a balanced diet in your first trimester, you are not alone! Because of queasiness, some women eat all the time and gain a lot of weight. Others are hardly able to keep anything down and lose weight.
For many women, there’s only a few foods they seem to tolerate. Getting enough folic acid and iodine
and preventing malnutrition and dehydration are the most important considerations in the first trimester.
Although there’s no “cure” for morning sickness some women recommend the following tips to help:
Constipation
Some women complain of constipation during pregnancy. Drinking plenty of fluid (aim for 9 glasses each day), eating foods high in fibre, such as wholegrain breads and cereals and fruit and vegetables and gentle regular exercise can help to prevent or ease symptoms.
Water and reduced fat milk are the best choices for your fluid intake.
Tips to increase fibre intake:
• If you feel sick in the morning, get out of bed slowly so your body doesn’t change position too quickly.
• Have a cup of tea and a biscuit or a piece of toast before you get up because morning sickness can be made worse by low blood sugar levels.
• Try dry salty foods like crackers or toast.
• Try ginger biscuits or ginger ale.
• Eat small meals and snacks rather than big meals.
• Try a milky drink before you go to bed.
• Rest when you can, being tired makes the problem worse.
• Trysniffingalemon-sometimescitrussmellscanhelp. • Avoid tight waistbands - pressure on your tummy
can make you feel more nauseous.
Heartburn and Indigestion
Heartburn and indigestion are very common in pregnancy, more so during the later stages.
For many women it feels like an uncomfortable burning sensation due to acid passing up from the stomach into the oesophagus (food tube).
To help prevent heartburn try eating small amounts of food more often rather than large meals so the stomach has less to empty. Avoid spicy and fatty foods and try a milky drink before bedtime.
Cravings and Aversions
It’s common to experience strong likes and dislikes (cravings and aversions) for certain foods during pregnancy, especially in the first 3 months. As long as you eat a variety of foods from the four food groups, cravings and aversions for certain foods shouldn’t cause a problem with your pregnancy. Some women crave non-food items, such as clay. Craving and eating non-food items is known as ‘pica’ and this can be dangerous to both you and your baby. Always seek medical advice if you are affected by this problem.
Are there any special nutritional requirements while I’m breastfeeding?
Energy
Whilst breastfeeding, your body needs extra energy and nutrients for producing breast milk and feeding your baby. This means eating around an extra 2000 kJ (approx 480-500 kcal) per day. Each bullet point below gives an example of the extra food you may need to eat each day in addition to your normal diet:
• a large bowl of natural muesli with chopped fruit and nuts, topped with low fat milk
• acupofthicksoup(e.g.pumpkin) with 2 slices of toast topped with cottage cheese and a banana.
• aberry,banana,milkandyoghurt smoothie and 2 slices of fruit toast with a little margarine
Hunger is your best guide of how much energy
you need – you shouldn’t be breastfeeding and feeling hungry.
Keep in mind these are fairly general guidelines, some women won’t need to eat as much extra food as others. Make sure you are eating enough food while also aiming for a gradual loss of the extra weight you gained during pregnancy.
Attempting to severely restrict your food intake to lose weight quickly is not recommended because very low energy intakes may reduce your breast milk volume and good nutrition is important for your health and breast milk quality. Hunger is your best guide of how much energy you need - you shouldn’t be breastfeeding and feeling hungry.
Fluids
Breastfeeding can make you feel thirsty because your body uses extra fluid to produce milk so listen to your body and drink plenty of liquids. Aim to drink around 10 glasses of liquid each day, sometimes extra may be needed during hot weather or after exercise. Water and low fat milk are the best choices. Try drinking a glass of water or milk whenever you sit down to breastfeed your baby- you’ll often find you are thirstier when you’re breastfeeding.
Snack and meal ideas when pregnant and breastfeeding
Snacks
Being organised with healthy snacks is often the key to eating well. Here are a few food suggestions and tips
to make it easier for you:
Lunches
Lunch-time, especially if you’re working away from home throughout your pregnancy, can be a tricky time for making healthy, safe food choices. Here are some lunch ideas that are nutritious and safe:
Evening meals
Preparing the family meal early in the day so it only needs cooking or reheating at night can be a life saver when dealing with the hectic 4.00pm – 7.00pm time. Casseroles and oven-baked dishes (e.g. lasagne) are ideal. Remember to always
keep pre-prepared foods in the fridge, then re-heat until piping hot!
Frozen vegetables are often as nutritious as fresh and they’re a super quick way to ensure you are eating a nutritious, balanced meal. Keep plenty stocked in the freezer.
Food safety & foods to avoid
In extreme cases, bacteria found in food can be harmful to your unborn baby (including miscarriage, serious illness or death to newborn babies). Following basic food safety guidelines and avoiding very high risk foods will help you stay protected.
• Leftovers should be stored in clean covered containers, stored in a cold fridge and thrown out after 2 days.
• Re-heat leftover food until it is piping hot (70oC) and do not reheat more than once.
• Cook food thoroughly, especially meat, chicken & fish which should be cooked right through. Eat cooked food while it is hot.
• Store raw meat on the bottom level of the fridge so juices don’t drip on other foods and keep raw and cooked foods separate.
You need to be extra careful to avoid certain foods which may contain a bacteria called ‘Listeria’ which can grow on foods stored in the fridge. Listeria can harm your unborn baby. Avoid:
• Processed meats e.g. ham, pate, salami, luncheon. • Raw or smoked seafood including sushi, smoked
salmon, marinated mussels, oysters.
• Raw or partially cooked eggs e.g. in mayonnaise, smoothies or some desserts.
• Soft serve ice-cream.
• Cream or custard e.g. in pre-made cakes &
pastries.
• Hummus and other dips containing tahini.
• Cold cooked or smoked chicken.
During pregnancy it’s best to avoid alcohol altogether because safe limits are unknown and alcohol can cause
both mental and physical abnormalities for your baby.
When you are pregnant & during breastfeeding, limit or avoid caffeine containing drinks and foods e.g. tea, coffee, cola and chocolate. Too much caffeine isn’t good for your baby & has been linked to negative complications such as miscarriage.
Limit your caffeine intake to a maximum of 300mg per day. This is approximately equivalent to:
1 large long black coffee, or 3 cappuccinos, or 4 cups of plunger coffee, or 6 cups of instant coffee, or 6 cups of tea or 400g plain chocolate.
Visit the food smart website www.foodsmart.govt.nz for more information on food safety during pregnancy.
Mercury in Fish
Fish is an excellent food to eat while you are pregnant and breastfeeding as it’s low in saturated fat, high in protein, essential fatty acids such as omega-3, and minerals such as iodine and zinc.
In NZ, guidelines have been developed around which types of fish are safest to eat when you’re pregnant, because of mercury levels found in some fish species. Luckily most fish varieties commonly eaten in NZ have very low levels of mercury and are therefore safe for pregnant women to eat freely. For more information on the safest varieties of fish to consume, & fish to avoid because of higher mercury levels visit www.foodsmart.govt.nz
Rest & Activity...
when pregnant and breastfeeding
Sport NZ recommends pregnant women do moderate physical activity at least three
times a week. Walking, jogging, swimming, low impact aerobics and yoga are best. Don’t get too hot and watch your heart rate doesn’t go too high as this can reduce blood flow & oxygen to your baby.
Moderate exercise is also good for breastfeeding mums. Plan to exercise after feeding so your breasts won’t be full and uncomfortable and wear a supportive sports bra. Drink plenty of water especially in hot weather.
Take walks with your baby - if you carry your baby in a backpack, their extra weight will use up even more energy. Remember whether you are a new mum or a mum-to-be, it’s healthy to take time out for yourself to recharge your batteries.
• Try resting while your baby sleeps during the day.
• Rest when your body tells you it is tired.
• Friends and family can help by bringing meals, helping with cleaning and washing and by watching your baby and other children so you can have a break.
For more copies of
Healthy Mums
For more copies of Healthy Mums please register on the website to order resources: Forbaby.co.nz/healthprofessionals
Or call the Forbaby Careline on:
0800 55 66 66
More quick recipe ideas available at
foodinaminute.co.nz
For more advice on pregnancy nutrition, baby and toddler feeding visit: forbaby.co.nz
or call our forbaby health professionals on the Careline 0800 55 66 66.
IF82 - July 2013
Your guide to eating well during pregnancy and breastfeeding
A healthy lifestyle before pregnancy.
Following a healthy lifestyle can help your chances of conceiving and having a successful pregnancy. Eating well is important because having a balanced diet and being a healthy weight helps your chances of getting pregnant and also helps the future health of your baby.
Below are some general suggestions for a healthy lifestyle. See your health professional for more specific advice to prepare for pregnancy.
Maintain a healthy body weight
Being overweight or underweight can reduce fertility, so it’s important to keep your body weight within the normal healthy range. Body Mass Index (BMI) is a measure of whether you’re in a healthy weight range and can be calculated by dividing weight (in kgs) by height (in m2). You should aim for a BMI of between 20 and 25, as this will optimise your chances of getting pregnant.
Be active
Regular exercise helps you stay healthy. Aim for around 30 minutes of moderate physical activity most days, or every day of the week.
What about Supplements?
In NZ a daily tablet of 0.8 mg of folic acid is recommended starting four weeks before you get pregnant and continuing right up until the 12th week of pregnancy. Folic acid has been shown to reduce the risk of neural tube defects such as spina bifida in babies.
A daily 150 mcg iodine tablet is also recommended from when you first become pregnant, & during pregnancy and breastfeeding. Some health professionals may suggest you start iodine tablets when you are trying to get pregnant as well. Talk to your doctor or your lead maternity carer (LMC) about which tablets are recommended.
Eat well
It’s recommended you follow a healthy balanced diet because eating well helps prepare your body for a healthy pregnancy:
• Eat 3 regular meals every day, with a healthy snack between meals if you need to.
• Eat a variety of nutritious foods from the 4 food groups every day:
- – Eat plenty of fruit and vegetables. At least 2 handfuls of fruit and at least 3 handfuls of veggies each day. Fresh and frozen are excellent choices. If using canned products, make sure you choose lower sugar and salt options.
- – Include some protein foods each day e.g. lean meat, chicken, fish, eggs, tofu & tempeh, legumes, nuts and seeds.
- – Include some milk and milk products each day, preferably reduced or low-fat options e.g. green or lite blue top milk, yoghurt, cheese & custards.
- – Have plenty of breads and cereals, preferably wholegrain options e.g. bread, crackers, breakfast cereals, rice & pasta.
• Drink plenty of liquids, water is best.
• Avoid foods & drinks which are high in saturated fat and sugar, as these provide lots of ‘empty’ calories but are often low in other important nutrients e.g. bakery items like pies, sausage rolls, donuts, cakes; snack foods like chocolate, sweets, crisps; and takeaways like burgers, fish and chips and deep fried chicken; drinks like fizzy drinks, energy drinks & thick shakes.
Smoking, alcohol & caffeine can reduce your chances of conceiving and having a healthy pregnancy (see your health professional for specific advice):
- Smoking cigarettes significantly reduces your fertility. If you smoke, you may wish to seek support to help you give up.
- Even drinking moderate amounts of alcohol can reduce your fertility. Also remember there is no safe limit of alcohol during pregnancy so you may wish to avoid alcohol altogether for now,
or at least reduce the amount you drink.
• Caffeine can reduce your fertility and delay your ability to become pregnant. Be aware of how much caffeine you consume from coffee, tea, cola and chocolate. You may wish to limit, or avoid caffeine for now.
What should I be eating when I’m pregnant or breastfeeding?
Whether you are planning pregnancy, already pregnant or breastfeeding, healthy eating is important for you and your baby. Although there will certainly be some nutrients you need more of, generally the key to eating well is including a variety of nutritious foods from the four major food groups each day.
At least 6 serves
At least 6 serves
(if breastfeeding, aim for at least 7 serves)
At least 3 serves
At least 2 serves
Fruit & Vegetables
Breads & Cereals (preferably wholegrain)
Milk & Milk Products (preferably low or reduced fat)
Meats & Alternatives
• fresh
• canned • frozen • dried
(choose lower salt and sugar options if using canned products)
- breakfast cereals
- breads and crispbreads
- pasta & cous cous
- rice & other grains e.g. oats
- milk
- cheese
- yoghurt & ice cream
- calcium fortified soy milk (an alternative to cows’ milk)
- lean meat, chicken, fish
- eggs
- nuts & seeds
- legumes
Are there any special nutritional requirements during pregnancy?
Energy
When you’re pregnant your body forms a growing baby and lays down extra fat stores for breastfeeding later on. As well as needing extra fuel for your own body and your growing baby, more nutrients are required for the increased tissue
of the uterus, placenta and blood cells. You may notice your appetite increases to ensure you eat enough for you and your baby. This doesn’t mean you need to eat for two! In fact, gaining too much weight when you’re pregnant may cause pregnancy complications and it could negatively impact your baby’s health later in life.
During the first trimester, you generally don’t need to eat any extra food. During the 2nd and 3rd trimesters, you need to eat a little more food than usual, but not as much as you may think! Although you don’t need to start strictly counting calories, the extra energy you need every day is around
1400 kJ (340 kcal) in the 2nd trimester and around 1900 kJ (450 kcal) in the 3rd trimester.
Remember this varies significantly between different women. On the following page you can view some examples of the extra food you need to eat each day, just choose one per day (in addition to your normal diet).
Extra food during pregnancy
(each bullet point gives an example of the extra food you may need each day)
2nd Trimester:
- a handful of raw nuts & a slice of toast topped with edam cheese & a piece of fruit.
- a large banana & a pottle of fruit yoghurt.
- a homemade egg and salad sandwich and a small
packet of raisins.
- a cup of soup and 2 slices of wholegrain toast.
- a small date scone and a low-fat hot chocolate drink.
- 3 wheat biscuits, 200mL low fat milk and a small sliced banana.
As you can see, you don’t need to ‘eat for two’ but a little extra healthy food each day will make sure you keep up the energy and nutrients needed for your growing baby!
Remember, gaining a healthy amount of weight is a normal part of pregnancy and helps to achieve a healthy outcome for you and your baby. A healthy weight gain during pregnancy (if you were in the
Calcium
Calcium is an important mineral for the normal development of your baby’s bones and teeth and to maintain your own skeleton. Make sure you eat at least three servings of calcium-rich foods every day.
Milk and milk products are a great source of calcium including: Reduced or low fat milk, low fat yoghurt, pasteurised cheese and cottage cheese.
Other foods which contain calcium include:
Canned salmon, green vegetables, dried fruit and nuts (e.g. almonds and dried apricots), tofu and tempeh, calcium-fortified soy milk.
Tips for increasing calcium intake:
• Add extra milk or yoghurt to your cereal.
• Make a milk / yoghurt / fruit smoothie.
• Eat yoghurt or low fat ice-cream with fruit for dessert. • Keep cans of salmon handy for salads or sandwiches. • If using a soy milk, choose a calcium-fortified product.
3rd Trimester:
- a large handful of nuts & a medium banana & 2 or 3 crispbreads topped with cheese slices.
- a homemade egg and salad sandwich & a pottle of fruit yoghurt.
- a cheese and tomato toasted sandwich & an apple & a pottle of fruit yoghurt.
- a large bowl of natural muesli with chopped fruit and nuts, topped with low fat milk or yoghurt.
- slices of toast topped with grilled cheese and a banana.
- a mixed berries, milk and yoghurt smoothie, and 2 slices of fruit toast with a little margarine.
healthy weight range before becoming pregnant) is about 11.5-16kg, but can vary significantly from one woman to another. If you were underweight before pregnancy, you may need to gain more weight. If you were overweight then you may need to gain less. The best way to make sure you are on track with weight gain is to ask your LMC or doctor to monitor your weight during your pregnancy.
Smoothie Recipe
Combine the following in a blender:
125g 220g can 1⁄2 cup
1⁄2 cup Wattie’s Peach Slices in Clear Fruit Juice Wattie’s 99% Fat Free Vanilla Creamed Rice Yoghurt
Milk
Iron
When you’re pregnant you’ll need a lot more iron than normal (particularly in the last 2 trimesters)
to support your growing baby and to increase the capacity of your blood to carry iron and oxygen. The best way to get more iron in your diet is to make sure you are eating enough iron-rich foods. Your iron levels will be checked by a blood test early in your pregnancy and again in the third trimester.
Foods containing iron include:
Lean red meat (lamb, beef, venison, pork), chicken, fish, beans and lentils, nuts and green leafy vegetables like spinach. Although all these foods contain iron, your body absorbs the most iron from animal foods such as meat, chicken and fish.
Fat
You don’t need to eat extra fat when you’re pregnant. Instead, make sure you are eating fats which are beneficial for good health for both you and your baby. The essential fats we need from food (because our body can’t make them) are polyunsaturated fats called linoleic acid (omega-6) and alpha linolenic acid (omega-3). From these essential fats, our body produces other essential longer chain fats which are very important for your unborn baby’s growth and development, particularly for the brain and eyes.
We generally consume enough omega-6 in our diet, but we don’t eat as much omega-3, so it’s a good idea to boost your omega-3 intake by regularly consuming:
- Oily fish e.g.canned tuna, sardines, salmon and mackerel
- Canola, flaxseed, soybean and walnut oils for cooking or dressings
- Some nuts and seeds e.g. walnuts and flaxseeds
- If you use an oil-based spread choose an omega-3 rich option such as a canola oil spread
Tips to boost iron intake:
- Eat 2 serves of lean meat, chicken, fish/seafood, eggs, nuts, seeds or legumes each day (the iron in meat, chicken and fish/seafood is better absorbed by your body than other foods).
- If you are a vegetarian, regularly eat vegetables and legumes, dried fruit, nuts and seeds, wholegrain breads & cereals and fortified breakfast cereals.
- Add plenty of leafy green vegetables, dried peas, beans and lentils to your meals.
- Add vitamin C rich foods to your meal to help absorption of iron e.g. oranges, kiwifruit, tomatoes, broccoli.
- Choose an iron-fortified breakfast cereal.
- Snack on dried fruit, nuts and seeds e.g. apricots,
pumpkin seeds, cashew nuts.
- Avoid drinking tea with your meals as the tannins will reduce iron absorption.
- Discuss the need for iron supplements with your doctor if your blood iron levels are low.
Iodine
Iodine is an essential nutrient for the healthy growth and development of your unborn baby and a deficiency can result in impaired mental and physical development. In NZ it can be difficult to get enough iodine through your normal food intake. This is due to several reasons including less use of iodised salt and milk & dairy products now contain less iodine than they used to.
Your baby’s iodine status depends on how much iodine you consume during pregnancy and breastfeeding. In NZ, it’s recommended you take a daily tablet containing 150 mcg iodine throughout your pregnancy and when you are breastfeeding. Talk to your LMC or doctor about which tablet is recommended.
It’s also a good idea to regularly consume foods which contain iodine including:
• low fat milk products
• eggs, fish and seafood
• if you add salt to food or during cooking, choose iodised salt
Folate
Folate (or folic acid) is a B-vitamin essential for several functions in your body including the formation of red blood cells and the growth of new tissues. You need significantly more folic acid in your diet when you are pregnant. This is especially important because folic acid is shown to reduce the risk of neural tube defects such as spina bifida in babies.
In NZ a daily tablet containing 0.8 mg of folic acid is recommended starting four weeks before you get pregnant and continuing right up until the twelfth week of pregnancy. Talk to your LMC or doctor about which tablet is recommended.
Do I need to take supplements?
It’s also a good idea to eat plenty of high folate foods including:
- Green leafy vegetables
- Wholegrain breads and cereals
- Legumes such as baked beans, cooked chickpeas
- Fortified breakfast cereal
If you eat a wide variety of foods from the four food groups every day, vitamin and mineral supplements are generally not necessary with the exception of folic acid and iodine (see paragraphs above).
Although not routinely recommended during pregnancy, some women may need a vitamin D or an iron supplement, but only on recommendation from your health professional.
Vitamin D is mostly made when the skin is exposed to sunlight and is important for bone health & many other health benefits. Some women in NZ are at risk of having a low Vitamin D level & this will affect the Vitamin D status of
their babies. You may be at higher risk of low Vitamin D levels if you have naturally dark skin, if you keep your skin covered by clothing all year around, if you spend very little time outdoors or if you live in southern parts of NZ. Talk to your doctor or LMC about whether a Vitamin D supplement is recommended for you.
If your iron stores are low, particularly in the last trimester, your doctor may prescribe iron supplements.
If you’re not eating as well as you should be because you’re feeling sick, lacking energy or are very busy, you could try a nutritional supplement drink like Complan which provides extra vitamins and minerals, protein, carbohydrate and energy (and may help you maintain a better nutritional intake). Chat with your health professional for more information or call the Forbaby Careline on 0800 55 66 66.
What can I do to help relieve pregnancy discomforts?
Morning Sickness
“Morning sickness” affects most women to some degree during pregnancy. Fortunately, for most women the nausea and vomiting occur in the first trimester only and disappear by weeks 14-16.
If you’re having a hard time eating a balanced diet in your first trimester, you are not alone! Because of queasiness, some women eat all the time and gain a lot of weight. Others are hardly able to keep anything down and lose weight.
For many women, there’s only a few foods they seem to tolerate. Getting enough folic acid and iodine
and preventing malnutrition and dehydration are the most important considerations in the first trimester.
Although there’s no “cure” for morning sickness some women recommend the following tips to help:
Constipation
Some women complain of constipation during pregnancy. Drinking plenty of fluid (aim for 9 glasses each day), eating foods high in fibre, such as wholegrain breads and cereals and fruit and vegetables and gentle regular exercise can help to prevent or ease symptoms.
Water and reduced fat milk are the best choices for your fluid intake.
Tips to increase fibre intake:
- Add fruit to cereal for breakfast or try banana on wholegrain toast.
- Bulk up your dinner with plenty of vegetables or salad.
- Keep a bag of corn in the freezer to add to stir frys or quick meals.
- Add baked beans to mince dishes or as a topping on baked potatoes.
- Snack on kiwifruit and raw nuts.
- Use wholegrain bread instead of white.
• If you feel sick in the morning, get out of bed slowly so your body doesn’t change position too quickly.
• Have a cup of tea and a biscuit or a piece of toast before you get up because morning sickness can be made worse by low blood sugar levels.
• Try dry salty foods like crackers or toast.
• Try ginger biscuits or ginger ale.
• Eat small meals and snacks rather than big meals.
• Try a milky drink before you go to bed.
• Rest when you can, being tired makes the problem worse.
• Trysniffingalemon-sometimescitrussmellscanhelp. • Avoid tight waistbands - pressure on your tummy
can make you feel more nauseous.
Heartburn and Indigestion
Heartburn and indigestion are very common in pregnancy, more so during the later stages.
For many women it feels like an uncomfortable burning sensation due to acid passing up from the stomach into the oesophagus (food tube).
To help prevent heartburn try eating small amounts of food more often rather than large meals so the stomach has less to empty. Avoid spicy and fatty foods and try a milky drink before bedtime.
Cravings and Aversions
It’s common to experience strong likes and dislikes (cravings and aversions) for certain foods during pregnancy, especially in the first 3 months. As long as you eat a variety of foods from the four food groups, cravings and aversions for certain foods shouldn’t cause a problem with your pregnancy. Some women crave non-food items, such as clay. Craving and eating non-food items is known as ‘pica’ and this can be dangerous to both you and your baby. Always seek medical advice if you are affected by this problem.
Are there any special nutritional requirements while I’m breastfeeding?
Energy
Whilst breastfeeding, your body needs extra energy and nutrients for producing breast milk and feeding your baby. This means eating around an extra 2000 kJ (approx 480-500 kcal) per day. Each bullet point below gives an example of the extra food you may need to eat each day in addition to your normal diet:
- a large handful of nuts & a large banana & 2 or 3 crispbreads topped with cheese slices
- ahomemadeeggandsalad sandwich and a pottle of fruit yoghurt and an apple
- acheeseandtomatotoasted sandwich, an apple and a pottle of fruit yoghurt
• a large bowl of natural muesli with chopped fruit and nuts, topped with low fat milk
• acupofthicksoup(e.g.pumpkin) with 2 slices of toast topped with cottage cheese and a banana.
• aberry,banana,milkandyoghurt smoothie and 2 slices of fruit toast with a little margarine
Hunger is your best guide of how much energy
you need – you shouldn’t be breastfeeding and feeling hungry.
Keep in mind these are fairly general guidelines, some women won’t need to eat as much extra food as others. Make sure you are eating enough food while also aiming for a gradual loss of the extra weight you gained during pregnancy.
Attempting to severely restrict your food intake to lose weight quickly is not recommended because very low energy intakes may reduce your breast milk volume and good nutrition is important for your health and breast milk quality. Hunger is your best guide of how much energy you need - you shouldn’t be breastfeeding and feeling hungry.
Fluids
Breastfeeding can make you feel thirsty because your body uses extra fluid to produce milk so listen to your body and drink plenty of liquids. Aim to drink around 10 glasses of liquid each day, sometimes extra may be needed during hot weather or after exercise. Water and low fat milk are the best choices. Try drinking a glass of water or milk whenever you sit down to breastfeed your baby- you’ll often find you are thirstier when you’re breastfeeding.
Snack and meal ideas when pregnant and breastfeeding
Snacks
Being organised with healthy snacks is often the key to eating well. Here are a few food suggestions and tips
to make it easier for you:
- Dried fruit – sultanas, apricots, dates
- Sandwiches
- Vegetable sticks
- Fresh fruit or pottles of fruit
- Creamed rice
- Canned soup
- Popcorn
- Yoghurt
- Low fat crackers and cheese, tomatoes or avocado
- Nuts e.g. raw almonds
Lunches
Lunch-time, especially if you’re working away from home throughout your pregnancy, can be a tricky time for making healthy, safe food choices. Here are some lunch ideas that are nutritious and safe:
- Sandwiches or toast using whole grain bread with the following toppings or fillings:
• Peanut butter
• Canned salmon or tuna
• Lettuce, grated carrot, avocado • Baked beans
• Cheese and tomato or celery
• Mashed banana
- Canned or pottle soups, with toast
- Baked potato - microwaved and topped with
cheese, beans or tuna
- Canned, pouch or frozen prepared meals to be heated at work
Wash fresh fruit and vegetables well before you eat them
Evening meals
Preparing the family meal early in the day so it only needs cooking or reheating at night can be a life saver when dealing with the hectic 4.00pm – 7.00pm time. Casseroles and oven-baked dishes (e.g. lasagne) are ideal. Remember to always
keep pre-prepared foods in the fridge, then re-heat until piping hot!
Frozen vegetables are often as nutritious as fresh and they’re a super quick way to ensure you are eating a nutritious, balanced meal. Keep plenty stocked in the freezer.
Food safety & foods to avoid
In extreme cases, bacteria found in food can be harmful to your unborn baby (including miscarriage, serious illness or death to newborn babies). Following basic food safety guidelines and avoiding very high risk foods will help you stay protected.
- Wash and dry hands well before and after handling food.
- If eating out, make sure food is piping hot & well- cooked immediately before you eat.
- Avoid eating at buffets or sandwich/salad bars where food has been sitting uncovered.
- Wash fruit and vegetables well before eating.
- Eat food before use-by and best-before dates and
within 2 days of opening the package.
- Use chilled food (e.g. yoghurt or cheese) within 2 days of opening the package. Store safely in a cold fridge.
High risk foods to avoid
• Leftovers should be stored in clean covered containers, stored in a cold fridge and thrown out after 2 days.
• Re-heat leftover food until it is piping hot (70oC) and do not reheat more than once.
• Cook food thoroughly, especially meat, chicken & fish which should be cooked right through. Eat cooked food while it is hot.
• Store raw meat on the bottom level of the fridge so juices don’t drip on other foods and keep raw and cooked foods separate.
You need to be extra careful to avoid certain foods which may contain a bacteria called ‘Listeria’ which can grow on foods stored in the fridge. Listeria can harm your unborn baby. Avoid:
- Chilled, ready to eat food e.g. from a supermarket deli or buffet
- Prepared ready-to-eat foods such as sushi, sandwiches & salads e.g. coleslaw, rice salads etc.
- Soft and semi-soft pasteurised cheese e.g. brie, blue, feta, ricotta, mozzarella, camembert.
- Unpasteurised raw milk, raw milk cheeses or yoghurts.
(NB: Most milk and dairy products for sale in NZ are pasteurised and therefore safe)
• Processed meats e.g. ham, pate, salami, luncheon. • Raw or smoked seafood including sushi, smoked
salmon, marinated mussels, oysters.
• Raw or partially cooked eggs e.g. in mayonnaise, smoothies or some desserts.
• Soft serve ice-cream.
• Cream or custard e.g. in pre-made cakes &
pastries.
• Hummus and other dips containing tahini.
• Cold cooked or smoked chicken.
During pregnancy it’s best to avoid alcohol altogether because safe limits are unknown and alcohol can cause
both mental and physical abnormalities for your baby.
When you are pregnant & during breastfeeding, limit or avoid caffeine containing drinks and foods e.g. tea, coffee, cola and chocolate. Too much caffeine isn’t good for your baby & has been linked to negative complications such as miscarriage.
Limit your caffeine intake to a maximum of 300mg per day. This is approximately equivalent to:
1 large long black coffee, or 3 cappuccinos, or 4 cups of plunger coffee, or 6 cups of instant coffee, or 6 cups of tea or 400g plain chocolate.
Visit the food smart website www.foodsmart.govt.nz for more information on food safety during pregnancy.
Mercury in Fish
Fish is an excellent food to eat while you are pregnant and breastfeeding as it’s low in saturated fat, high in protein, essential fatty acids such as omega-3, and minerals such as iodine and zinc.
In NZ, guidelines have been developed around which types of fish are safest to eat when you’re pregnant, because of mercury levels found in some fish species. Luckily most fish varieties commonly eaten in NZ have very low levels of mercury and are therefore safe for pregnant women to eat freely. For more information on the safest varieties of fish to consume, & fish to avoid because of higher mercury levels visit www.foodsmart.govt.nz
Rest & Activity...
when pregnant and breastfeeding
Sport NZ recommends pregnant women do moderate physical activity at least three
times a week. Walking, jogging, swimming, low impact aerobics and yoga are best. Don’t get too hot and watch your heart rate doesn’t go too high as this can reduce blood flow & oxygen to your baby.
Moderate exercise is also good for breastfeeding mums. Plan to exercise after feeding so your breasts won’t be full and uncomfortable and wear a supportive sports bra. Drink plenty of water especially in hot weather.
Take walks with your baby - if you carry your baby in a backpack, their extra weight will use up even more energy. Remember whether you are a new mum or a mum-to-be, it’s healthy to take time out for yourself to recharge your batteries.
• Try resting while your baby sleeps during the day.
• Rest when your body tells you it is tired.
• Friends and family can help by bringing meals, helping with cleaning and washing and by watching your baby and other children so you can have a break.
For more copies of
Healthy Mums
For more copies of Healthy Mums please register on the website to order resources: Forbaby.co.nz/healthprofessionals
Or call the Forbaby Careline on:
0800 55 66 66
More quick recipe ideas available at
foodinaminute.co.nz
For more advice on pregnancy nutrition, baby and toddler feeding visit: forbaby.co.nz
or call our forbaby health professionals on the Careline 0800 55 66 66.
IF82 - July 2013