Your body goes through a great deal of hormonal, physiological, and physical changes during pregnancy.

The way you nourish your body during this process will affect your own health, as well as the health of your baby. By following some fairly easy nutrition guidelines, you can be on your way to a healthy pregnancy. Healthy Weight Gain Many women are concerned about weight gain during pregnancy. Some women fear gaining too much weight, wondering if they will ever get back to their pre-pregnancy size; others feel they may not be gaining enough weight. A woman gains more weight than just the weight of the baby. In order to produce a healthy baby, your body requires extra fluids-extra water, blood, and amniotic fluid. During pregnancy you gain about 15 to 20 pounds in water alone. You can discuss with your provider the appropriate amount of weight for you to gain during your pregnancy. The chart below provides some general recommendations. Recommended Weight Gain During Pregnancy And your body mass index* is: < 19.8 19.8 to 26.0 26.0 to 29.0 >29.0

If your normal range is: Underweight Normal weight Overweight Obese

You should gain: 28 to 40 pounds 25 to 35 pounds 15 to 25 pounds 0 to 15 pounds

* Body mass index can be calculated with use of the following equation: weight (in kilograms) / [height (in meters)]2. Your Body's Nutritional Needs During pregnancy your body has increased nutritional needs. Although the old adage "eating for two" isn't entirely correct, you do require more macronutrients (for example, calories, protein, and fluids) and micronutrients (for example, calcium, folate, and iron). Nutrient Calories Protein Calcium Folate (folic acid) Iron Additional daily requirements for pregnant women 300 (in the second and third trimesters) 60 mg 1200 mg 15 mg 30 mg

In general, most women can meet these increased nutritional needs by choosing a diet that includes a variety of nutritious foods, including 8 to 10 glasses of water a day, and by taking a prenatal vitamin prescribed by their health care provider. A simple way to ensure that you are getting all the nutrients that you and your baby need is by eating a variety of foods from each of the food groups every day. Each food group has something to offer your body. Grains like cereal and pasta, for example, are good sources of energy. Fruits and vegetables are packed with water-soluble and fat-soluble vitamins, as well as antioxidants and fiber. The food group that includes meats, poultry, fish, eggs, tofu, and beans offers your body protein, B vitamins, folate, and iron. Dairy products are the best source of calcium and vitamin D. Your body is unable to function properly if it is missing the nutrients from any one of these food groups-so remember that your goal is variety. Whenever possible, choose healthy, low-fat foods like whole grains and fresh fruits and vegetables instead of snack foods like chips, donuts, and soda pop. You don't need to avoid all of your favorite foods, just balance them with nutritious foods so that you don't miss any important vitamins or minerals. Including the

following foods in your daily diet will help ensure that you fulfill your body's vitamin and mineral needs during your pregnancy: Protein Sources (3 servings per day) Calcium Sources* (4 servings per day for pregnant women, 5 servings for pregnant teens)

y y y y y y y y

Lean meats Fish Beans Nuts Poultry Eggs Soy products Peanut butter Sources of Folate

y y y y y y

Milk Yogurt Ice cream Cheese Cottage cheese Pudding

*Fat-free and low-fat versions are best when available Sources of Iron

y y y y y y y

Liver Dark green leafy vegetables Nuts Citrus fruits Dried beans and lentils Enriched breads or cereals Eggs

y y y y y y y

Lean red meats and poultry Dried beans and lentils Enriched breads or cereals Nuts and peanut butter Eggs Dark green leafy vegetables Dried fruits

Should I Restrict the Salt in my Diet? It is not necessary for all women to restrict their salt or sodium intake during pregnancy. In general, if a woman minimizes the amount of salty foods in her diet (for example, snack foods, dried fish or meat, pickled foods, or frozen dinners), she will be regulating her salt intake sufficiently. You and your health care provider should discuss any special diet needs that you might have. What If I Have Cravings to Eat Non-Food Items? During pregnancy some women crave non-food items like ice, antacids, clay, dirt, cigarette ashes, or starch. This is called pica. When a woman has pica during pregnancy, it may indicate lack of a specific vitamin or mineral. It is important to inform your health care provider if you have cravings for non-food items or have eaten non-food items. Non-food items can be dangerous to you and your baby.

Diet for a healthy pregnancy

Approved by the BabyCenter Philippines Medical Advisory Board

y y y y y y y y

Fine-tune your diet, even if you already eat well Eat the right kinds of fish Some foods are no-nos Take a suitable prenatal vitamin-mineral supplement Don't go on a diet Gain weight gradually Eat small meals every few hours Occasional treats are okay

Fine-tune your diet, even if you already eat well

Now that you're a mom-to-be, it's important to try and increase your intake of certainvitamins and minerals (such as folic acid and iron). You may also need to slightly increase your calorie intake as your pregnancy progresses.

If your diet is poor to begin with, it is even more important to make the transition to eating nutritious, well-balanced meals. Limit junk food, as it offers little more than empty calories, which means calories with few or no nutrients. (Visit our eating wellsection for some easy, healthy recipe ideas).

Your body becomes more efficient when you're expecting a baby and makes even better use of the energy you obtain from the food you eat. The average woman does not need any extra calories for the first six months of pregnancy and only about 200 extra calories per day for the last three months.

Two hundred calories is equivalent to: two slices of wholemeal toast and margarine/butter a jacket potato with an ounce of cheese one slice of cheese on toast. 2 ounces of canned tuna or chicken on three whole grain crackers

Your own appetite is the best indication of how much food you need to eat. You may find your appetite fluctuates during the course of your pregnancy: In the first few weeks, your appetite may fall away dramatically and you may not feel like eating proper meals, especially if you suffer from nausea or sickness.

 During the middle part of your pregnancy your appetite may be the same as before you were pregnant or slightly increased.

Towards the end of your pregnancy your appetite will probably increase, but if you suffer from heartburn or a full feeling after eating you may find it helpful to have small frequent meals. The best rule to remember is to eat when you are hungry. Don't worry about your changing appetite as long as you are following the advice given about the type of food you need to eat and you are gaining weight at the appropriate rate, which your midwife or doctor will monitor.

Eat the right kinds of fish

Experts have recommended that pregnant women and children under 16 should not eat big fish such as shark, swordfish, or marlin, as they may contain potentially unsafe levels of naturally occurring mercury. Although the mercury in these fish won't harm you, mercury can harm your baby's developing nervous system.

Pregnant and breastfeeding women, and those who are trying to conceive should eat no more than four medium-size cans of tuna, or two fresh tuna steaks per week. This advice is based on two medium-size cans with a drained weight of 140g per can and fresh tuna steaks weighing about 140g when cooked or 170g raw.

You can eat as much white fish as you like. This includes cod, haddock, coley, plaice and sea bass.

Oily fish have high levels of omega-3 fatty acids which are important for your baby -- but don't eat too much at a time. Oily fish, such as fresh tuna, can contain environmental pollutants, such as dioxins and PCBs (polychlorinated biphenyls). These build up in your body over a long period of time. Some evidence show that they can interfere with the development of your unborn baby.

Stay safe by striking a balance a range of oily fish, such as fresh tuna, sardines, pilchards and trout, with fish that have lower levels of pollutants, such as haddock, red snapper, coley, or hake. Fish contains proteins, minerals, vitamin D, and omega-3 fatty acids, which your baby will miss out on if you give it up altogether.

Some foods are no-nos

During pregnancy you should try to avoid:

Raw seafood, such as oysters or sushi that has not been frozen before making.

Cheeses with a white, "moldy" rind, such as brie and camembert, and blue-veined cheeses like Stilton. All these cheeses could contain listeria, a bacteria that could harm your baby.

Pat, raw or undercooked meat, poultry, and eggs (cook all meat until there are no pink bits left and eggs till they are hard). All are possible sources of bacteria that can harm your unborn child.

Liver and liver products (pat, liver sausage, liver spread) should be avoided, too, because they may contain large amounts of the retinol form of vitamin A, too much of which could be bad for your developing baby.

Some pregnant women need to avoid nuts. If you, your partner, or any of your other children (if you have any) have a history of allergies such as hayfever, asthma, oreczema, don't eat nuts during pregnancy and breastfeeding to reduce your baby's chances of developing a potentially serious nut allergy.

Avoid alcoholic drinks during pregnancy, too. Drinking alcohol can cause physical defects, learning disabilities, and emotional problems in children, so give up alcoholcompletely while you are pregnant.

You might want to cut down on caffeine, too. This may be easy for women who are suddenly revolted by the stuff during their first trimester, but that doesn't happen for everyone. Why is caffeine a potential problem? Research has linked consuming more than 300mg of caffeine a day with an increased risk of miscarriage and low birth weight, and one study has linked even low levels of caffeine to miscarriage. To be on the safe side stick to no more that three mugs of instant coffee, three cups of brewed coffee, six cups of tea, or eight cans of cola per day. Or, you may want to be more cautious and cut down further on caffeine, or switch to non-decaffeinated hot drinks and colas, instead.

Take a suitable prenatal vitamin-mineral supplement

In an ideal world -- free of morning sickness or food aversions -- a well-balanced diet would be all an expectant mom ever needed. But in the real world, a prenatal vitamin-mineral supplement may be good insurance to help you meet

your nutritional needs. Ask your doctor whether you should take a vitamin supplement.

Folic acid is one supplement that is particularly important to take before you conceive -- and for the first three months or so of pregnancy. A lack of this B vitamin has been linked with neural tube birth defects such as spina bifida. Experts advise women to take 400 micrograms (mcg) of folic acid in a supplement from the time they start trying for a baby until the 12th week of pregnancy.

Some experts recommend that you take a supplement containing 10 mcg of Vitamin D every day. Because of the tropical climate in the Philippines, most women do not need extra Vitamin D. But if you keep well-covered and don't get much sunlight on the skin, you may be at risk of Vitamin D deficiency. See your doctor for advice.

Later on in your pregnancy, you may need to take an iron supplement. Your iron levels will be checked periodically during your pregnancy, and your doctor will advise you about your individual needs.

If you are a strict vegetarian, have a medical condition such as diabetes, gestational diabetes, pre-eclampsia, or anemia, or if you have a history of low-birthweight babies, do talk with your doctor about any special supplements you might need.

Remember, though, that more is not always better: Vitamin A supplements which contain retinol, the animal form of vitamin A, can be toxic to unborn babies in large quantities. The plant-based carotene type of vitamin A is safe in pregnancy. Great doses of most vitamins and minerals could be harmful to your developing baby.

Don't go on a diet
Dieting during pregnancy is potentially hazardous to you and your developing baby. Some diets can leave you low on iron, folic acid, and other important vitamins and minerals. Remember, weight gain is one of the most positive signs of a healthy pregnancy.

Women who eat well and gain an appropriate amount of weight are more likely to have healthy babies. So if you're eating fresh, wholesome foods and gaining weight, relax: you're supposed to be getting bigger!

If you are overweight, you can improve your eating habits, cut out junk food, and get some exercise (make sure you

talk to your doctor first). Your doctor may prefer that you still gain a little weight, but at the lower end of the spectrum. Ask your doctor to advise you on how to manage your weight as your pregnancy progresses.

Gain weight gradually

During your checkups, you will be weighed routinely. Weight gain varies amongst individuals and depends on many factors. Average weight gain during pregnancy seems to be between 8 kilos (18 pounds) and 15 kilos (32 pounds). Concentrate on eating a healthy diet: plenty of carbohydrates, lots of fruits and vegetables, reasonable amounts of protein, and just a little in the way of fats and sugars.

When you put on weight may be as important as the total amount. Most women gain the least weight during the first trimester and steadily increase, with the greatest amount being put on over the course of the third trimester when the baby is growing the most.

Eat small meals every few hours

Even if you're not hungry, chances are your baby is, so try to eat every four hours. And if morning (or all-day) sickness, food aversions, heartburn, or indigestion make eating a chore, you may find that eating five or six small meals, rather than the usual three larger ones, is easier on your body.

Remember, your developing baby needs regular sustenance, so try not to miss meals.

Occasional treats are okay

You don't have to give up all your favorite foods just because you're pregnant. But processed foods and snacks and sugar-packed desserts shouldn't be the mainstay of your diet, either. So as far as snacks are concerned, try a banana rather than luxury ice cream, or a frozen fruit sorbet instead of canned peaches in sugary syrup. But don't feel guilty if you crave for the occasional cookie. Enjoy every bite!

If you eat too little while breastfeeding, you may not produce as much milk. When breastfeeding a single baby 300-500 calories per day should be added to the diet. When feeding twins an extra 6001000 calories per day should be added to your diet. Total caloric intake when lactating is 2300-2500 calories for singleton and 26003000 calories for twins Obviously calcium for milk production comes from the mother. When calcium levels in mom's blood are not adequate for her needs and those of her child, calcium deposited in her bones is withdrawn for milk production. In fact, if something is lacking in mom's current diet, mom's body will dip into her reserves of nutrients to keep breast milk nutrientdense. However, you are going to need your body to be healthy for a long time to take care of your growing child, so don't short change yourself! Be assured that the composition of nutrients in human milk is consistent. A nutrition shortage for mom is more like to reduce the quantity of milk than the quality of the milk for baby. Vitamins:
y y y y

Vitamin D-If mother/infant not exposed to sunlight or diet low in Vitamin D, breastfed infants need to be supplemented 5-7.5 ug/day. Vitamin B12-If mother is a vegan, infant will be B12 deficient,even if mother shows no sign of deficiency. Vitamin K-Very low risk for developing hemorrhagic disease, but all infants are given 0.5-1mg injection of 1-2mg oral Vitamin K.

Iron:
y y

Usually adequate for 6 months, unless infant is supplemented with food too quickly. Solid food may decrease iron absorption and the diet may need to be supplemented.

Vitamins Vitamin levels in breast milk can be affected by maternal intake as

well as length of lactation . Vitamin A decreases as lactation progresses from 2,000mg/L to as low as 300mg/L. Low doses of exogenous Vitamin A (<15mg/day) seem to have little effect, but larger doses (>15mg/L) will increase vitamin A concentration in breast milk. Unless maternal intake is marginal to poor, the amount supplied is adequate and supplementation is not necessary. Breast milk contains about 0.1-1.0mg/L of vitamin D and metabolites, which roughly represents approximately 1.5 to 6 percent of maternal plasma concentrations. Maternal intake does not seem to predict the milk content, but low maternal vitamin D plasma levels may limit transfer into breast milk. Mothers who have restricted intake of foods rich in vitamin D, such as strict vegetarians, and those who are exposed to limited sunlight may have critically low plasma levels. In this case, the infant may need vitamin D supplements of 10mg/day. Vitamin E is present in high concentrations in colostrum (8mg/L) and decreased to 3 to 4mg/L in mature milk. Vitamin E concentration in breast milk is responsive to maternal intake; supplementing the infant is usually not necessary, provided the mother has adequate intake. Vitamin C is usually found in adequate concentrations of about 100mg/L of breast milk in well-nourished mothers. Intake less than 100mg/day may decrease milk content, but doses over 100mg/day will not increase it. Vitamin C content in breast milk is eight to ten times higher than maternal plasma concentration. The quantity of vitamin K in breast milk is approximately 0.8 to 1.0mg/L, and this can be increased to 60mg/L with maternal supplementation of 5mg/day. Vitamin K supplementation for newborns may be recommended for infants at risk for hemorrhagic disease. A single intramuscular (IM) dose of 1 to 5mg IM can be given to the mother 12 to 24 hours before delivery, 0.5 to 1mg can be given within one hour of birth, or 2mg orally can be given to the infant. Higher doses may be needed if the mother has been taking anticoagulants. Thiamine is present in low concentrations in early milk at a concentration of 20mg/L, but the concentration increases significantly in mature milk to 175-250mg/L, which is adequate for the infant. Riboflavin concentrations are high in early milk and decrease to 400-600mg/L in mature milk. The amount of niacin present is dependent upon maternal intake, rising from 0.5mg/L in early milk, to 1.8 to 2.0mg/L in mature milk, and possibly reaching

as high as 6mg/L with higher intake. Vitamin B6 starts low in colostrum and increases as much as ten-fold from 0.09 to 0.31 mg/L in mature milk. Vitamin B6 levels in breast milk increase with increased maternal intake, but may be reduced in women who have been using oral contraceptives for an extended period of time. Vitamin B12 and folate are usually found in excess because they are secreted bound to whey proteins. In well-nourished mothers, vitamin B12 concentrations are adequate (0.5 to 1.0mg/L) and supplementation has little effect. However, levels as low as 0.05 to 0.75mg/L have been reported in cases of women who were strict vegetarians, malnourished, or had hypothyroid-induced pernicious anemia. Infant supplementation would be recommended in such cases. Folate concentrations usually remain adequate in breast milk in spite of maternal plasma concentration or intake. The average folate concentration in breast milk ranges from 80 to 140mg/L. Minerals Unlike vitamins, minerals do not seem to correlate with maternal intake or maternal plasma levels. Phosphorous seems to be highest in early milk, at 147mg/L, decreasing to 107mg/L in mature milk. Calcium increases from 259mg/L to 290mg/L and magnesium increases from 248mg/L to 330mg/L. It has been speculated that these three minerals in these concentrations are important in bone remodeling occurring in infancy. Copper, iron, and zinc concentrations seem to be strongly related to liver stores of the mother accumulated during the third trimester. Maternal intake has very little effect on them. Copper and iron concentrations start high in early milk, leveling off to 0.3mg/L of each. Zinc also starts higher (4mg/L), declining to 1.1mg/L at 6 months postpartum, and decreasing still to 0.5mg/L after 1 year. Both iron and zinc have a high bioavailability in breast milk, but the bioavailability of copper is unknown. Manganese declines from 6mg/L after 1 month of lactation to 3mg/L after 3 and 6 months, but is much better absorbed than the manganese found in infant formulas. Selenium is strongly influenced by maternal selenium status. It tends to be high early in lactation (40mg/L), decreasing in mature milk. Iodine in breast milk varies according to maternal intake and geographic region. In iodine-sufficient areas, the breast milk content is approximately 150mg/L, and in iodine-deficient areas it can be as low as 15mg/L.

!!!T. J. Clark's Prenatal/Postnatal Multivitamin/Mineral Formula!!!

Lactation (0 6 months) Net Calories Protein Fat Carbohydrate + 550 C + 25 g/d 45 g/d Lactation ( 6 12 months) 400 C + 18 g/d 45 g/d

Calcium Iron Vitamin A (Retinol) Vitamin A (Betacarotene)

1000 mg/d 30 mg/d 950 IU 3800 IU + 0.3 mg/d + 03 mg/d

1000 mg/d 30 mg/d 950 IU 3800 IU + 0.2 mg/d + 0.2 mg/d

Vitamin B1 Vitamin B2 Vitamin B5 Vitamin B6 Vitamin C Folic acid Vitamin B12 Vitamin D Vitamin E Magnesium Manganese Copper Phosphorus Zinc Choline

10.0mg
2.5 mg/d 80 mg/d 150 mg/d 1.5 mg/d 10 mg

10.0mg
2.5 mg/d 80 mg/d 150 mg/d 1.5 mg/d 100 mg

15 I.U. 350 mg 1.0mg 1.0mg 125.0mg 7.5mg 550 mg

15 I.U. 350 mg 1.0mg 1.0mg 125.0mg 7.5mg 550 mg

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