This interview was originally published in The Sherman Hub News in Lyndsay's column "Mom Talk: prenatal and parenting wellness."
Eating well during pregnancy can make a lifetime of difference for both mother and baby. Food eaten by the pregnant person is broken down and absorbed into the bloodstream, and then passed to the fetus through the placenta and umbilical cord. The very start of a healthy body is the gestational period inside the womb.
There are basics that are quite commonly known: no shellfish, sushi or soft cheese, try not to eat too many sugary foods or drinks, do drink plenty water and eat lots of greens. There are plenty of misconceptions about nutrition during pregnancy and lots of misinformation. Unlike a pregnant woman’s primary prenatal health providers like an Obstetrician or Midwife, a Registered Dietitian (RD) is often overlooked. Yet for the health and well-being of the mother and baby, RDs are essential. According to Jacquie Reeds, MSc, RD, they are “the go-to source for nutrition information as the College of Dietitians of Ontario ensures that RDs provide only accurate information.”
“RDs can help in complex health situations where someone has multiple food allergies or health concerns, or can help with eating on a strict budget or even meal planning and basic
nutrition education. Everyone has different needs with regard to nutrition and it is the role of the RD to help address these needs.”
Jacquie Reeds is a local resident and mother of three - a five year old, three year old, and a four-week old. She has a Masters of Science and is a Registered Dietician. We did a ‘Question & Answer’ with Reeds to get some very important details about nutrition during pregnancy and its effect during pregnancy and afterward for mother’s and baby’s bodies (i.e. continued growth and sustenance for breastfeeding).
Q & A with a Registered Dietician
Q: How is pregnancy affected by nutrition?
A: More and more research is published each year which points to prenatal (pregnancy) nutrition as being one of the most critical factors influencing childhood and adult health. Certainly, we have understood for quite some time that certain nutrients are required to promote healthy fetal growth (ie. Adequate folic acid intake pre- conception and in the first 12 weeks of pregnancy has been shown to reduce the risk of neural tube defects). It seems that the mother's body makes fetal growth and development a priority in that the required nutrients are offered up to the developing fetus first; however if nutrition is not sufficient, the fetus will also suffer. One of the most well known examples of this is a low overall nutritional intake, which can result in low birth weight. All in all, the better the nutrition of the mother, the better the outcome for both infant and mother.
Q: In what ways does the pregnancy benefit from proper nutrition?
A: Proper nutrition in pregnancy has been linked with a number of benefits, including better overall health for the infant and mother. More specifically, proper prenatal nutrition promotes optimal brain and bone development, better birth weights (which predict better overall health outcomes for baby), and a better prenatal experience for the mother.
Q: In what ways could it suffer? What foods/nutrients are most important and from what sources?
A: There are a number of very important nutrients in pregnancy:
Calcium - sources include milk, cheese, yogurt, fortified soy/rice/cashew/ almond (and other alternative) milks/ beverages, tofu, almonds, broccoli... Calcium is important for bone development in the fetus, and as many have heard, the mother's calcium status can suffer at the expense of ensuring adequate calcium delivery to the fetus (we have all heard about women with many children suffering from poor dental health, which could be a result of both low calcium and dental care).
Vitamin D - fortified milks (cow/rice/ almond/soy/cashew/etc), salmon ... While Health Canada recommends the same amount of vitamin D for adults whether they are pregnant or not, it is important for calcium
absorption and balance and thus bone development. Most prenatal vitamins provide 400 IU of vitamin D; however, I recommend pregnant women also take an additional 1000 IU vitamin D3 supplement each day.
Folic Acid - fresh fruits and vegetables, especially oranges and leafy greens. Folic acid has even been added to Canadian grain products such as breads, cereals and pasta. Women of childbearing age are encouraged to take a folic acid supplement (1 mg) every day to help promote proper neural tube development in the event that they become pregnant. In some cases, a physician will recommend a higher dose, such as 5 mg daily.
Vitamin B12 - milk and alternatives and related products (eg. Cheeses, yogurts, etc.), meat, fish, poultry, fortified soy products, eggs. While vitamin B12 does not usually receive a lot of attention in prenatal nutrition articles, I mention it because high intakes of folic acid can hide B12 deficiency. It is also worth mentioning because it is important for nerve health and development and because B12 is found in protein-rich foods and protein is important for growth and development. Routine prenatal blood work does not include a check on vitamin B12 status, but I always recommend checking serum vitamin B12 status, and if levels are less than 300 pmol/L, I recommend a supplement.
Iron - meat, fish, poultry, fortified breakfast cereals and soy products, legumes, pumpkin seeds, ... Iron is important in pregnancy because it is a key ingredient in red blood cells which are being mass produced to provide an adequate blood supply for both mother and baby. Brain development is also aided by adequate maternal iron intake. This is why most prenatal supplements contain approximately 27 mg of iron. Serum ferritin is supposed to be checked in all pregnant women to ensure adequacy and determine if there is a need for additional iron supplementation.
Omega-3 Fatty Acids (specifically EPA & DHA) - Salmon, mackerel, rainbow trout, walnuts, ... EPA and DHA are required for brain development; however, these important nutrients are not always discussed with pregnant women. In general, eating fish two to three times a week will provide enough EPA & DHA. Someprenatal supplements provide EPA and DHA. If someone is looking for a separate supplement, choose one with 1000 mg of combined EPA and DHA. For those looking for information on the safety of a variety of fish in pregnancy, search online for: A Guide To Eating Fish For Women, Children and Families.
Q: In what way is nutrition important for the breastfeeding mom after the baby is born?
A: Nutrition in the breastfeeding mother is nearly as important as prenatal nutrition. All of the nutrients important in pregnancy are also important for lactation, though some of the rationale differs. For example, while iron continues to be important, it is not directly for the infant's sake. There is not much iron in breast milk; however, it is important for the postpartum mother to replenish her iron stores for overall health, but also for energy.
Vitamin D can pass into breast milk, but to meet the infant's needs, the mother would need to take more than the recommended supplemental dose, which cannot be widely recommended. Rather, it is better to supplement the infant directly with a dropper-style liquid vitamin D supplement. Without focusing on the details of each nutrient, nursing mothers will want to drink plenty of fluids, include calcium-rich foods throughout the day, and include protein-rich foods (meat/ fish/poultry/nuts/seeds/legumes/ tofu/eggs/etc.).
Q: What are some common misconceptions you've noticed when it comes to prenatal nutrition and eating?
A: One of the most common misconceptions with regard to prenatal nutrition is the notion that a pregnant woman is "eating for two." Obviously there is a grain of truth in this; however, that second person is really quite small, and thus overall calorie needs do not increase by more than approximately 300 calories per day in a singleton pregnancy. Realistically for those who have adequate access to food, they will do fine if they eat regularly throughout the day and eat health-promoting real foods (ie. avoid processed, boxed foods) according to hunger and contentment (satiety).
Interestingly, the general consensus is that a breastfeeding mother has greater calorie needs than a pregnant woman. Again, eating based on individual hunger and satiety is advised.
Q: What are the best resources online and in the community to find out more about prenatal nutrition?
A: Registered Dietitians (RDs) are the go-to source for nutrition information as the College of Dietitians of Ontario ensures that RDs provide only accurate information. Hamilton residents whose family physicians are members of the Hamilton Family Health Team (or the Stone Church or McMaster Family Health Teams) have OHIP- covered access to RD consultation through their family doctors' offices. There are also RDs available to North End residents at North Hamilton Community Health Centre. At any time, people can visit eatrightontario.ca to access nutrition information provided by Ontario
RDs. Eat Right Ontario also provides free email or phone consultation with Ontario RDs.
Hamilton Public Health Services is another trustworthy source of nutrition information, as they too employ RDs.
For reliable information about the safety of food, beverages and medication in pregnancy and while breastfeeding, access Mother Risk - a website and hotline developed by Sick Kids in Toronto.
There are other people and professionals in the community who may be knowledgeable about nutrition; however, be critical and careful if they are not trained and current RDs.
Q: How can someone determine if a resource is accurate?
A: Registered Dietitians are required to share only evidence-based information. Outside of seeking out RD counsel, people should use their own critical thinking skills to determine whether or not they should trust nutrition information. If someone is unsure, one can contact EatRight Ontario online or by phone (1-877-510-5102) to double- check.