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King Edward Memorial Hospital

Nutritional Fitnessin Pregnancy

WOMEN AND NEWBORN HE ALTH SERVICE

Delivering a Healthy WA

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Why Fitness?

You need nutritional tness because of the demand placed on your body toprovide nourishment for a healthy baby, while increasing just about all of yourown normal vital functions, including cardiac output and respiration increase.

The ability to respond to these demands will depend partly upon yournutritional tness.

Conception begins an amazing array of changes in your body. Looking atthese changes as they occur in the mother, placenta and baby throughoutpregnancy will show the special needs for nutrients and how important thechoice of foods becomes.

The First Trimester

The changes Special points about nutrition

In early pregnancy you mayfeel tired and experiencesome nausea and vomiting.Morning sickness however,may occur at any time ofthe day.

Choose smaller, lighter meals morefrequently and use plenty of easilydigested carbohydrate foods to counteractmorning sickness and revitalize.

Where do you fnd carbohydrates?In breads, breakfast cereals, pasta, rice,crackers, fruits and starchy vegetables.

Be aware that caffeine canirritate the lining of yourstomach.

Limit caffeine intake to less than 200mg(milligrams) per day.

How much caffeine in a cuppa?Coffee instant 80-100mg/cup percolated 100-150 brewed 100-500

drip 100-120 decaffeinated 2-4Tea - amount depends on strength of thebrew 8-90mg/cupCola drinks 45mg/375ml canHot chocolate or 50-70mg/cupCocoaChocolate bars 20mg/100g bar

Your body now uses slightlymore energy to maintain itsnormal functions.

You do not need to eat more food, buttry not to skip meals. Use foods rich in Bvitamins so that release of energy in thecells is more ef cient.

B vitamins are found in wholegraincereals, legumes, lean pork, lean beefand lamb, chicken and sh, leafy greenvegetables, milk, cheese and vegemite.

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The First Trimester (continued)


Your blood volume beginsto increase in readiness forcarrying more nutrients andenergy to your growing baby.

In the rst trimester theplacenta grows, in size andweight, more than yourbaby.

The fertilised egg undergoesrapid cell division and theorgans are forming in the

rst two to eight weeks.

A womans need for folate (folic acid) hasdoubled. This vitamin is needed for bloodformation and building of body cells. Take0.5mg of folate in a single dose or in amulti-vitamin. A higher dose of 5mg is recommendedfor women who have diabetes or are

overweight (high BMI).

How can you get more folate?Highest levels are in fresh green leafyvegetables (raw or lightly steamed) and inforti ed breads.Moderate levels in vegemite, marmite,promite, nuts, oranges, avocados andwholegrain bread.

Protein is the building material for all cellgrowth. Are you eating two serves of highprotein foods each day?

Protein foods are: lean meat, sh, chicken,milk, egg, cheese, beans (legumes), lentilsand nuts.

Vegetarians should use plenty of legumes,lentils, nuts and tofu.

Maternal alcohol consumption can harmthe developing fetus. For women who arepregnant, not drinking is the safest option.



The babys brain, spinalcord and nerves areforming.

The development of the nervous systemrequires both polyunsaturated and saturatedfats. So while a high fat diet is notrecommended, do choose a variety of fats inmoderation.

Eat small to moderate amounts of fat.

Use butter or margarine sparingly.

Choose fat reduced milk.Cut out fried foods: grill, steam, bake or boil.Trim fat from meat and remove chicken skinbefore cooking.Cut down your intake of cakes, biscuits,pastries, crisps, greasy takeaways, battered/crumbed food and rich desserts.

Eat two or three sh meals per week. Avoideating sword sh, shark/ ake, orange roughyand cat sh often as these types may have toomuch mercury. The baby is vulnerable to theharmful effects of mercury.

Iodine is an essential nutrient for thedeveloping brain. Fish and shell sh, dairy foodand bread are good sources. Use iodized salts.

Increased progesteronelevels cause the smoothmuscle in you uterus andgastrointestinal tract torelax: the movement offood through your gutbecomes slower allowingmore time for nutrientabsorption.

Increasing your bre intake now will helpprevent constipation.

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Eat 2 fruit and 5 vegetables each day.Choose wholemeal and wholegrain breads,cereals, wholemeal pasta and brown rice.

Drink six to eight glasses of water everyday to improve the effect of bre.

Your saliva becomes more

acidic and greater careshould be taken to avoidtooth decay.

Sugary drinks and sweet foods provide

little nutrient value and greatly increaseyour risk of tooth decay.

Eat less sugar!Cut down on the amount of sugar you addto drinks and food. Avoid sweets, softdrinks, cordial, avoured milk, sweetcakes, biscuits, chocolates, lollies, honeyand jam.Low joule soft drinks and cordialssweetened with nutra sweet and Equalsweetener are all safe to use in pregnancy.

You can expect a weight gainof zero to two kilogramsin this trimester. An earlymore rapid weight gainis often characteristic ofmultiple pregnancy orcatch-up growth if you areunderweight.

There is no increase in energy (calories/kilojoules) required in the rst trimester,but food choices should be changing inpreparation for the high nutrient demandsof later pregnancy

The Second Trimester

This stage of the pregnancy, from 13 to 26 weeks, is a time of great change.The mother, placenta and baby are th ree parts of a unique relationship,working together with each part strengthening and making possible theactions of the others.


Healthy weight womencan expect a weight gainof a little less than halfa kilogram each weekto allow for the growthof your baby and thestorage of a fat reservefor later in pregnancy andbreastfeeding.

Normal weight gain can bebetween 0-450g per weekdepending on your pre-pregnancy BMI.

The amount of energy needed from foodnow increases by 10-15%. This representsapproximately 100-150 calories.

Nutrient needs in pregnancy are greaterthan energy needs, so improve the qualityand variety of your food choices whileeating only a little more. For example,you need twice as much iron and extracalcium. Continue to avoid high fat andhigh sugar foods so you will be able toincrease nutrients without adding lots ofcalories.

Your taste may change andyou may experience anincrease in appetite.

A pregnant woman should eat to appetitebut not take this as an opportunity toovereat or to indulge in junk food.

Your blood volume increasesin order to supply your babywith oxygen and nutrientsas well as give you a healthyglow.

It is not necessary to include vitamin andmineral supplements if your food choicesre ect those suggested in the Food Wheelon page 10.

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The Second Trimester (continued)


The placenta is now anactive organ, able toconcentrate some nutrientsfrom your blood to ensurethat your baby is wellsupplied.

A high calcium diet will ensure that thecalcium stores in your bones are notdepleted.

How much calcium is enough?A pregnant women needs 1000mg/day.For example2 cups HiLo milk 700mg1 cube cheese 260mg1 orange 50mg TOTAL 1010mg

At 20 weeks gestation, yourbaby is growing in length, ata maximum rate.

Your skin needs ten minutes in the sun aday (avoid 10.00am - 2.00pm or 11.00am -3.00pm during daylight saving hours). Thishelps you make vitamin D which is neededfor bone development.

Your body provides glucosefor your baby as its growthand movement increases.Your baby will often movenoticeably more after youhave eaten carbohydrates.

Glucose is best supplied by complexcarbohydrate foods (breads, breakfastcereals, pasta, rice, starchy vegetables)and by the natural sugars in fruit, milk andyoghurt.Remember, you should not skipmeals.

The Third Trimester

On average, the developing baby enters this trimester 35cm long and 0.9kg,but will grow into a 51cm long, 3.4kg baby. Therefore, the third trimesteris characterised by rapid growth. Babys muscles gain in bulk and strength,nerve fibres function more efficiently, and bones develop and add strength.Optimal nutrition will be rewarded with a healthier and fitter final threemonths for mother and baby.


Around the 30th weekof pregnancy, you reachmaximum blood volume.Onaverage you have 50% moreblood.

Increasing both the content and yourbodys absorption of iron from food willprevent anaemia.

The baby accumulates mostof its iron stores in the lasttrimester, and can do so atthe mothers expense.

Where can you get iron?Highest levels are in red meats, chickenand sh. Other foods like wholegraincereals and breads, dried fruits, broccoli,spinach, Milo, eggs and baked beans willprovide more iron if eaten at the sametime as either meat or foods high invitamin C (eg orange, capsicum, tomato orfresh juices).

Most of the minerals must besupplied to the baby now tostrengthen bones and formteeth.

Your baby may draw the calcium it needsfrom bones. It is important that you have ahigh intake of calcium at this time to keepyour bones strong.

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The Third Trimester (continued)


Your weight gain will continue toaverage half a kilogram each week. Atotal weight gain between 10 and 16kilograms is considered optimal. Therewill be quite healthy variations aroundthis average: a women commencingpregnancy underweight, should gain

the upper value, perhaps more;whereas very overweight womenwould do better to gain less than 5kgs.

Overweight women can use thefood and exercise guides on theKEMH website under Nutritionand Dietetics.www.kemh.wa.health.gov.au

Excessive weight gained in pregnancymay be dif cult to lose after deliveryand does carry some risks.

The best time to lose weight iseither before or after pregnancy.

Heartburn may occur more oftenas your baby grows because thepregnancy hormones cause relaxationof the muscle at the top of yourstomach.

Small meals taken morefrequently will help. Avoidcaffeine containing drinks asthey irritate your stomach lining.Cut out fried and fatty foods,as well as strongly avoured orspiced foods. Taking iron tablets

can make heartburn worse.Check with your doctor.

Your baby accumulates a remarkableamount of fat in the last weeks of your

pregnancy.At 34 weeks gestation, your babysweight increases at its greatest rate. Eat regular balanced meals so

that all the nutrients are atoptimum levels in your blood andglucose is in constant supply forbabys energy needs.

The Third Trimester (continued)


Constipation occurs morefrequently.

Fefol and other iron supplements can causeheartburn, constipation and/or diarrhoea.Dietary changes can provide both relief ofthese symptoms and a reduced need fororal iron supplements.

Near delivery higher levelsof the maternal hormoneestrogen results in a higherwater content of your bodytissues. This is noticeable as

uid retention (puf ness)in your face, ngers andfeet.

Women should not severely restrict wateror salt. There is enough sodium and othermineral salts present in the large variety offoods recommended for pregnancy withoutthe addition of cooking or table salt.Moderate use of iodised salt is acceptable.

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Breastfeeding

Your body is well prepared for feeding your newborn baby. It has storedenergy during the middle stages of your pregnancy ready to begin productionof breast milk as soon as your baby is born. In fact, you may have alreadynoticed, in the latter part of your pregnancy, a thickish milk leaking fromyour breasts. Colostrum provides sustenance for your baby for the firstthree to five days of its life until your breast milk is in full production. Theantibodies in breast milk will provide your baby with protection against anyinfections over the duration of breast feeding.

Breast milk alone is the best food for your baby for the first six months.Your breast milk is specifically suited to your babys growth needs. At thebeginning of a feed your milk is lower in fat, but after you let-down thefat content increases. Suckle on demand to ensure the maintenance of anadequate supply to meet growth needs of your baby.


Your body needs even moreenergy to produce milk thanto provide nourishmentto your unborn child. Youmay feel tired, hungry andthirsty!

Eat to your appetite, choosing foods ofhigh nutritional quality. (refer to theFood Wheel on page 10). These foods will provide ALL thevitamins and minerals you need.

Drink well over the day. Eight to ten

glasses of water would be adequate. Rest whenever possible.

BREADS AND CEREALS1 serve is:

1 slice bread 2 large/4 small crackers 1/2 cup cooked rice 1/2 cup cooked pasta 2/3 cup breakfast cereal 1/2 muf n 1/2 bagel

LEAN MEAT, POULTRY,FISH, EGGSTotal of 150 to 200grams dailyFATS,

SWEETSKeep to aminimum

MILK, CHEESEAND YOGHURT1 serve is:

I cup milk 3cm cube of

cheese 200 gram carton

of yoghurt

Food wheelA pattern for daily food choices in pregnancy

ALCOHOLNone

FRUITS1 serve is an average piece of whole fruit a melon wedge 180mls fruit juice 1/2 cup berries, sliced or cooked fruit 1/4 cup dried fruit

CITRUS, MELON,BERRIES

OTHER

D A R K

G R E E

N

D E E P

Y E L L O

W

O T H E R

STA RC HY

D R I E D B E AN S , P E AS

NUTS,SEEDS F

A T S , S W

E E T S

WHOLEGRAINS 3 to 5serves

2 to 3serves

2 to 3serves

6 to 11serves

2 to 4serves

VEGETABLES1 serve is 1/2 cupcooked or raw, or1 cup of raw leafyvegetables

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Breastfeeding (continued)


Your milk is providing theminerals needed for thedevelopment of your babysbones and teeth.

You require 1000mg calcium to meet thisneed and maintain your own bone status.

For example:1 200g tub of low fat yoghurt 350mg2 cups of HiLo milk 600mg20 almonds 60mg TOTAL 1010mg

Remember that your milkcan carry drugs such asalcohol and caffeine acrossto your baby. It is moredif cult for your baby tobreak these down and expelthem.

Always check with your doctor beforetaking medications.

For women who are breastfeeding, notdrinking is the safest option.

Weight loss appears to beindividual. Some peopleare less ef cient at usingenergy than others. Watchand adjust your meal intakeaccordingly.

For those of you losing weight quickly,eat more foods of high nutritionalquality.

If you fail to lose or actually beginto gain weight choose foods high innutritional quality, and limit your fatand sugar intake. (See pages 3 and 4).

Maintain the tness of yourbody

Exercise regularly walking, cycling,swimming are the most appropriate.

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Compiled by: Department of Nutrition and Dietetics

Website: http://wnhs.health.wa.gov.au

September 2008 WNHS 0510 Rev 1

Revised September 2012

Disclaimer: The advice and information contained herein is provided in good faithas a public service. However the accuracy of any statements made is not guaranteedand it is the responsibility of readers to make their own enquiries as to the accuracy,currency and appropriateness of any information or advice provided. Liability for any

act or omission occurring in reliance on this document or for any loss, damage or injuryoccurring as a consequence of such act or omission is expressly disclaimed.

WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memoria l Hospi ta l

374 Bagot Road Subiaco WA 6008

Telephone: (08) 9340 2222

This information is available in alternative formats upon request

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