You and Your Baby

Pregnancy is an amazing time of changes to your body…and your life. The foods you eat before and during pregnancy prepare your body to support the growth of your baby.  Eating nutritious foods gives your baby the best chance of a healthy beginning.

First Trimester - 0 to 12 weeks

By six weeks, your baby is the size of a pea. By seven to eight weeks all the baby’s major organs are partly formed.  Your body creates two special organs to support and nourish your child. The amniotic sac surrounds the baby with fluid and acts like a shock absorber.  The placenta is your baby’s life support system. It feeds your baby, brings oxygen and gets rid of wastes through the blood. Everything you eat, drink or smoke, including drugs, will be delivered to your baby through the placenta. Good nutrition is required so your body has the right building blocks for a healthy pregnancy.

Second Trimester - 13 to 28 weeks

Third Trimester - 29 to 40 weeks

Your baby does most of his or her maturing now.  By six months, your baby weighs less than 1 kilogram (less than 2 lb.). At birth, the average baby will weigh between 2.5 to 4 kilograms (6 to 9 lb.). Brain cells are growing very fast. Calcium is especially needed now for proper bone and tooth growth. Your baby is getting ready to be born.

Choose Healthy Foods

During your pregnancy, you will need extra food and nutrients.  WHAT you eat, as well as HOW MUCH is important.  The following nutrients are especially important.

• IRON is needed for healthy blood, placenta development and growth of your baby.
  • Good food sources of iron are red meat, liver, dried beans and peas, dried fruit and fortified cereals.
  • Iron from plant foods is best absorbed if eaten with foods rich in vitamin C.
  • Good VITAMIN C sources are broccoli, cabbage, potatoes,green pepper, tomatoes and tomato products, orange andgrapefruit and their juices, strawberries and melons.
  • Tea and coffee, when consumed with meals, may interfere with the absorption of iron.
  • Because many women have low iron stores, your doctor may prescribe iron as part of a multi vitamin and mineral supplement.
    

• ESSENTIAL FATTY ACIDS.  Generally, everyone should consume fat in moderation, but it is important to consume enough essential fat for proper growth and development of your baby.  Good sources of essential fats include:
  • Vegetable oil from canola, safflower, sunflower, peanut and flax.
  • Salad dressings made from canola, safflower, sunflower, peanut and flax oil.
  • Non-hydrogenated (soft-tub) margarines.
  • Fatty fish such as mackerel, salmon, and sardines.
  • Flax seed products.
    
    
• FOLIC ACID or FOLATE is necessary for healthy blood.
  • A folic acid supplement is recommended for all pregnant women and women planning to become pregnant (see page 9 for details) to help prevent neural tube defects.
  • Good food sources of folate are dark green lettuce, green peas, green beans, broccoli, dried peas and beans, oranges, melons, and enriched flour (baked and pasta products).
    
    
• CALCIUM and VITAMIN D are necessary for strong bones and teeth. In the summer, some vitamin D is made by your body when your bare skin is exposed to sun. In the winter, you need to get vitamin D from foods. Milk is fortified with vitamin D and rich in calcium. Cheese and yogurt are good sources of protein and calcium but not vitamin D.
  
  If you do not like to drink milk, try the following ideas:
  • Use milk in soups, puddings, sauces and casseroles.
  • Add skim milk powder to casseroles, puddings and soups.
  • Add cheese to casseroles, soups, salads and sandwiches.
  • Use plain yogurt as a vegetable dip and fruit yogurt as a fruit dip.
  • Blend milk, yogurt and fresh fruit together for a Fruit Smoothie.
  • Blend milk, yogurt, fresh herbs and soft raw or cooked vegetables for a Veggie Smoothie.

If you have an allergy or sensitivity to cow’s milk, calcium and vitamin D fortified soy beverages or yogurt and calcium fortified orange juice are possible alternatives.

If you cannot digest lactose (milk sugar), lactose reduced milk is available in most grocery stores. Liquid drops that you add to milk, or tablets that you eat prior to drinking milk are also available to help you break down lactose.

Other food sources of calcium are canned salmon (with bones), sardines, tofu (made with calcium), broccoli and toasted almonds.  Ask your doctor, community health nutritionist or registered dietitian for other suggestions.

Canada’s Food Guide to Healthy Eating

Choosing foods from each of the four food groups of Canada’s Food Guide to Healthy Eating will help you meet your special nutritional needs. The food guide gives a range of servings for each group. You need to eat enough servings to meet your nutrient and energy requirements. It is important to eat regularly and have nutritious between meal snacks.

1. Enjoy a variety of foods from the four food groups every day. Choose “Other Foods” in moderation.
2. Mark the foods you have eaten by checking the squares and circles in the chart.
3. Try to eat three meals and three snacks daily.  Your meals should contain foods from 3 to 4 food groups.  Your snacks should have one to three food groups.

For twin and triplet pregnancy: Choose the highest number of servings from each food group and double the milk products to 6-8 servings/day. 

 
EXAMPLES OF ONE SERVING

MILK PRODUCTS
Whole, 2%, 1%, skim milk: 250 mL (1 cup)
Buttermilk, chocolate milk: 250 mL (1 cup)
Cheese (hard or sliced): 50 g (2 slices)
Cottage cheese: 500 mL (2 cups)
Yogurt: 175 g (3/4  cup)
Ice milk: 250 mL (1 cup)
Soup (1:1 milk dilution): 375 mL (1-1/2 cups)
Milk desserts: 250 mL (1 cup) ie: puddings
Ice cream: 375 mL (1-1/2 cups)
Milk shake: 250 mL (1 cup)
Evaporated milk (diluted): 250 mL (1 cup)

GRAIN PRODUCTS
Sliced bread: 1 slice
Cooked pasta, rice or grains: 125mL (1/2 cup)
Ready-to-eat cereal: 30 g Cooked cereal: 175 mL (3/4 cup)
Bagel, pita, naan: 1/2
Roti, chapati, tortilla, taco shell: 1 medium
Pancakes, waffles: 1 medium
Roll or muffin: 1 small
Hamburger/wiener bun: 1/2 bun
Crackers (plain): 7-11
Popcorn (plain): 500 mL (2 cups)

VEGETABLE AND FRUIT PRODUCTS
Fresh, frozen or canned: 125 mL (1/2 cup)
Any whole fresh fruit or vegetable: 1 medium
Juice: fresh, canned or from frozen concentrate:
125 mL (1/2 cup)
Tomato sauce: 125 mL (1/2 cup)
Dried fruit: 60 mL (1/4 cup)
Tossed salad: 250 mL (1 cup)
French fries: 125 mL (1/2 cup)

MEAT AND ALTERNATIVES
Cooked lean meat, poultry, fish or organ meats: 50-100g (2-3 oz)
Cooked dried peas, beans or lentils: 125 mL-250 mL (1/2-1 cup)
Nuts or seeds: 60 mL (1/4 cup)
Peanut butter: 30 mL (2 tbsp.)
Eggs: 1-2
Tofu: 100 g (1/3 cup)
Wieners: 2 
 

Other Foods

Taste and enjoyment can also come from other foods and beverages that are not part of the four food groups. Some of these foods are high in fat or calories or low in nutrients, so eat them in moderation. Examples include cakes, cookies and pastries, potato chips, chocolate bars and soda pop.

Caffeine

Caffeine may be harmful to your baby’s development.

• Caffeine is found in coffee, tea, chocolate, cola beverages, energy drinks and certain drugs.
• Limit consumption of all caffeine-containing beverages to two – 8 oz. (250 mL) cups per day.
• Drink nutritious beverages such as water, milk, or unsweetened 100% fruit or vegetable juice instead of caffeine containing beverages.

Herbal Teas and Herbs

Many herbal teas and herbs can act like harmful drugs and can affect your baby.  The following herbal teas are considered safe in moderation (2 to 3 cups per day):

• Citrus peel, ginger, lemon balm, linden flower and rosehip. *
• Drink hot water with lemon or lime juice, hot milk or hot apple juice as an alternative to herbal teas, regular tea or coffee.

* Check with your doctor, community health nutritionist or a registered dietitian before using any other herbal teas.

Artificial Sweeteners

The use of saccharin and cyclamate are not recommended in pregnancy. Moderate amounts of the artificial sweeteners aspartame, sucralose (Splenda), or acesulfame K potassium (Sunette) are considered safe during pregnancy.  They may be present in beverages, table top sweeteners, baked products, desserts, spreads, salad dressings or gum.

Vegetarian Concerns

Well planned lacto-ovo vegetarian diets that include a wide variety of plant foods along with milk and eggs can meet the nutritional needs of pregnant women.

• Vegetarian diets need to be well balanced to meet the needs for iron, zinc and vitamin B12.
• Strict vegan diets consist only of plant foods. They can be low in calories, iron, zinc and vitamin B12, vitamin B6, calcium and vitamin D.
• Talk with you doctor, registered dietitian or community nutritionist if you are eating poorly or not eating one entire food group as recommended in Canada’s Food Guide to Healthy Eating.

Vitamin and Mineral Supplements

Generally, foods are the ideal sources for vitamins and minerals because they are in the correct balance and are in a form absorbed best by the body. For the woman who is planning a pregnancy or is pregnant, supplements play an important supportive role in the health of a woman and her baby.

• Take a daily supplement of 0.4 mg of folic acid (folate) as part of a multi-vitamin/multi-mineral supplement for several months before becoming pregnant and during the entire pregnancy.
• Taking a larger amount of folic acid (folate) may be necessary if you have a family history of neural tube defects, diabetes or if you take anticonvulsants medication.
• Read vitamin labels carefully.  Taking quantities of vitamins and minerals in amounts greater than what your doctor has recommended may be harmful. Do not take a daily amount more than 10,000 I. U.  (3.330 RE) of Vitamin A as it may cause birth defects in your baby.
• If calcium supplements are recommended, avoid bone meal and dolomite. They may contain traces of lead. Look for calcium supplements containing calcium carbonate as they have the most calcium per weight. Take calcium pills between meals or at bedtime. Consider calcium with vitamin D if you don’t drink milk. 
• Calcium supplements with vitamin D are also available in the form of caramels or soft chews. Each chew contains 500 mg calcium and 100-200 IU of vitamin D. They provide an alternative to calcium pills and can be taken with meals.
• Your doctor may recommend an iron supplement of at least 30 mg elemental iron.
• Talk with you doctor, registered dietitian or community nutritionist if you are eating poorly or not eating one entire food group as recommended in Canada’s Food Guide to Healthy Eating.

Water and Salt

You need plenty of fluids during your pregnancy to help carry nutrients and wastes in the blood and to help keep you cool.

• Drink 8-12 glasses of fluid per day, including water, milk, juice, soup and excluding coffee, tea and cola beverages.
• There is no need to cut back on salt even if your blood pressure is high.
• If your water system has lead or copper pipes then run the tap water freely for two minutes in the morning to flush the minerals out.
• To decrease the chance of bacterial contamination do not drink water from lakes, streams, and rivers unless you boil it for two minutes before drinking, brushing teeth or washing dishes.

Weight Gain

How Much Weight Should You Gain?

Weight gain is a normal part of pregnancy and is needed for your baby’s health. A woman who does not gain enough weight is more likely to have a low birth weight baby. A baby who weighs less than 2.5 kg (5.5 lb.) often has to stay in hospital longer and is at more risk of major health problems. Gaining too much weight can make delivery more difficult. The excess weight can also be difficult to lose after pregnancy.  The type and amount of food you eat affects the health and weight gain of you and your baby.

• The recommended weight gain for a healthy baby depends on your weight before pregnancy.  Check the body mass index (BMI) chart to see if your pre-pregnancy weight was within the healthy weight range.
• Most women can eat according to their appetite. If you are gaining too much or too little weight you may need to change what you are eating. You may need a referral to a registered dietitian.
• Your weight gain should be gradual and steady.
• Any sudden change in weight should be discussed with your doctor.
• Dieting is not safe in pregnancy.
• Short women should aim for the lower end of the weight gain recommendation for their BMI category.
  
  If you were a healthy weight (BMI of 20 to 27) before pregnancy:
• Recommended total weight gain is 11.5 to 16 kg (25-35 lb.).
• In the first trimester, women typically gain between 1.0 and 3.5 Kg (2-8 lb.).
• A good rate of gain after the 1st trimester is approximately 0.4 Kg (0.75 lb.) each week.
  
  If you were underweight (BMI of less than 20) before pregnancy:
• Recommended total weight gain is 12.5 to 18 kg (28-40 lb.).
• A good rate of gain after the first trimester on average is 0.5 kg (1.0 lb.) each week.
  
  If you were overweight (BMI of more than 27) before pregnancy: 
• Recommended total weight gain is 7 to 11.5 kg (15-25 lb.).
• A good rate of gain after the first trimester on average is 0.3 kg (0.5 lb.) each week.
  
  Multiple Pregnancy:
• Recommended total weight gain is 16 to 20.5 kg (35-45 lb.).
• A good rate of gain after the first trimester on average is 0.7 kg (1.5 lb.) each week.
• Women carrying triplets should gain 20.5-30 kg (45-65 lb.) by delivery or about 1 kg (2.2 lb.) each week.
  
  Teen Pregnancy
• Although the BMI is not recommended as a tool to assess the weight status of adolescents, it may be used with pregnant adolescents who have been having their periods for at least two years to determine appropriate weight-gain recommendations. If you are pregnant and have been having your periods for less than two years, consult your doctor. 
  

Check Your Weight Gain During Pregnancy

Where Does the Weight Go?

Lifestyle

Exercise

Exercise and physical activity help you feel and look great. Being physically active helps prepare your body for labour, delivery and a faster recovery.  Check with your doctor before beginning or continuing an exercise program. Here are a few guidelines for exercise in pregnancy:

• Walking is a great place to begin, if you have not been active. Start any new exercise slowly and gradually increase the intensity and time.
• Swimming, bicycling or exercise classes are other good activities for pregnant women.
• Take rests often.  Do not push yourself.
• Drink plenty of water before, during and after exercise.
• Eat a healthy snack and drink a healthy beverage such as water, 15 to 30 minutes before exercising.
• Avoid exercises that involve laying on your back after the fourth month.
• Do not exercise when it is hot or very humid, to prevent overheating.

Smoking and Tobacco

Chemicals from tobacco are passed along to your baby and baby gets less oxygen and nutrients when you smoke. Babies born to women who smoke are:

•  more likely to be born premature and weigh less.
• at increased risk of sudden infant death syndrome (SIDS).
• more likely to get sick and have developmental problems.

Quit smoking and avoid second hand smoke, especially during pregnancy and breast feeding. For more information refer to AADAC’s Small Steps Matter: A guide to help you quit smoking, or contact the Smokers’ Help Line 1-866-332-2322.

Alcohol

During pregnancy no amount of alcohol is safe to drink at any time. Alcohol can cause permanent birth defects and affect the growth and development of your baby. Drink water, milk, fruit or vegetable juice instead of alcohol.

Fetal Alcohol Spectrum Disorder (FASD) describes brain damage and a range of birth defects caused by drinking alcohol during pregnancy. FASD is the leading cause of preventable mental disability and birth defects in Canada. A baby with FASD may have one or more of the following problems:

• small head;
• heart, skeleton and/or kidney defects;
• problems eating or sleeping;
• learning difficulties;
• short attention span;
• memory problems; and
• difficulty learning from experiences.

These problems do not go away – FASD is permanent. There is no cure for alcohol-related birth defects and brain damage. The harm lasts a lifetime.

Drugs and Medications

There are many prescription, over-the-counter and street drugs that will seriously affect the health of your baby if taken during pregnancy. Ask your doctor or pharmacist before taking any home remedies, medications or drugs.

• If you are struggling with an addiction to cigarettes, alcohol or drugs, ask your doctor to refer you to an addictions program or consult your community health center.
   

Common Discomforts

Morning Sickness or Nausea

“Morning sickness” means feeling sick, and/or actually vomiting or throwing up. It can happen any time during the day.  It often happens in early pregnancy (first trimester). The smell or taste of some foods may make you feel sick. Some non-food odours such as perfume or smoke can make you feel sick as well. This is different for every woman. Here are some ideas that may help:

• Eat foods that appeal to you.
• Eat crackers or dry toast before you get out of bed. Get lots of rest.
• Change position slowly, especially when standing or sitting up.
• Eat a healthy snack before you go to bed.
• Drink fluids between meals, not with meals.
• Greasy, fried foods or spicy foods may not agree with you.
• Eat cold meals like sandwiches if cooking smells bother you.
• Open windows to freshen the air.
• Get help from others to prepare meals if possible.

Heartburn

Heartburn is a burning feeling in the chest and throat. It is caused by food mixed with stomach acids backing up from the stomach.

• Eat small amounts of food more often. Eat slowly and chew foods well.
• Spicy foods, fatty or fried foods, coffee and tea can make heartburn worse. Avoid any food or drink that bothers you.
• Do not lie down for two hours after eating.
• Check with your doctor before taking antacids or other mixtures to relieve heartburn.
• Use extra pillows to raise your head and shoulders in bed.

Constipation

Constipation is caused by the slowing down of your digestive system. The growing baby may also put pressure on your bowel. To ease constipation:

• Drink at least 8-12 glasses of fluid per day.  Eat regularly.
• Eat more high fibre foods such as vegetables, fruit, dried fruit, whole grain breads and cereals, nuts, seeds, dried peas and beans.
• Exercise every day.  Walking for at least 20 minutes will help.
• Talk to your doctor if the problem continues.

Food Cravings or Distastes

You may have cravings for certain foods.  Indulge a little but don’t let cravings upset your healthy eating. Some women may crave dirt, clay, starch, ashes, mothballs or other non-food items. If you have these cravings or are not eating any servings from one entire food group as recommended in Canada’s Food Guide to Healthy Eating, talk with your doctor, registered dietitian, or community nutritionist.

Leg Cramps

If you get a cramp in your calf, straighten your leg and bend your ankle and toes slowly towards your knee. Wearing support hose during the day or resting with your feet up may help prevent the cramps. Diet or lack of calcium is rarely the cause of leg cramps. Talk to your doctor if the problem continues.

Food Safety

Food Borne Illness

Food poisoning or food contamination by bacteria or parasites can happen anytime but pregnant women and their unborn children are at high risk of illness. Symptoms include nausea, vomiting, diarrhea and fever.  To protect your food and prevent illness, follow these steps for proper storage, handling and cooking food.

• Avoid eating raw meat, fish, poultry, eggs and unpasteurized food.
• Avoid soft cheeses and patés made from unpasteurized milk or cream.
• Don’t eat pre-cooked and ready-to-eat foods that are past their expiry dates.
• Store leftovers for only 24-72 hours (one to three days) in the refrigerator.
• Keep cold foods cold at 4°C (40°F).
• Keep hot foods hot at 60°C (140°F). Reheat to 70°C (165°F).
• Wash hands, work surfaces and utensils with hot soapy water, especially when working with raw foods.

Chemical Contamination

• Fish low in mercury include canned “light” tuna and fresh and canned Pacific salmon.
• Use canned “light” tuna. Canned “white” (albacore) tuna is generally higher in mercury than canned “light” tuna.
• Avoid eating fresh or frozen predatory fish (tuna, shark, swordfish and some local Alberta fish). These fish have higher levels of mercury. Contact your local public health centre for more information.
• Listen for public health warnings about the possibility of wild game contamination in your area.

Feeding Your Baby

Breastfeeding is best for your baby during at least the first six months because:

• Breast milk is easy to digest and provides nutrients in the amounts your baby needs. Your milk changes to meet the needs of your growing baby.
• Breast milk helps protect your baby from illness and infections.
• Breastfeeding may help prevent food allergies.
• Breastfeeding is less costly and more convenient than formula.
• Breast milk is always ready and at the right temperature.
• Breastfeeding can continue beyond two years and still provide benefits to you and your baby.

Almost all women can breastfeed. Support from family and friends will help make breastfeeding successful. For those few women who are unable to breastfeed, commercial iron-fortified infant formula is recommended until 9 to 12 months of age. 

Taking Care of Yourself After Baby Comes

Continuing to eat according to Canada’s Food Guide to Healthy Eating provides you with the nutrients and energy you need to recover from pregnancy and delivery and to support you in taking care of your growing baby.

• Eating healthy foods and regular physical activity is part of a healthy lifestyle and will help you gradually return to a healthy weight after delivery.
• Your healthy eating and physical activity habits set a good example for your baby for an entire lifetime.

Things to Keep in Mind for Future Pregnancies

• If you are planning another baby, it is recommended you take a folate supplement of 0.4 mg (400 ug) per day at least several months before trying to get pregnant and during your next pregnancy.

For more information on eating well, breastfeeding and feeding your baby contact:

• A public health nurse or community health nutritionist at the health unit office in your regional health authority.
• A registered dietitian at a hospital in your regional health authority or in private practice.
• Your doctor.

Other Resources and Sources of Help

All women need support and information when they are pregnant. Women have the right to be safe and free from violence. Some women have difficulty obtaining enough food to meet the needs of pregnancy.  Some communities have special pregnancy programs that offer food and milk coupons, prenatal vitamins and counselling. Also consider local food banks, food co-ops or collective kitchens. Contact the office in your local health region or your doctor about sources of information in your community.

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