PREGNANCY

The lifestyle that's good for your growing baby is good for you, too.

"What do you want, a boy or a girl?"

"I don't care. I just want a healthy baby."

A familiar conversation for most pregnant women, and it reflects the importance most parents place on giving their babies the best possible start in life. While some things that affect the development of your baby are beyond your control, a healthy lifestyle provides the best conditions for your baby's growth and helps you to feel your best, too.

Nutrition and Weight Gain

How much weight should you gain during pregnancy? Physicians and nutritionists now recognize that the optimum weight gain depends on many factors, including the woman's pre-pregnancy weight and her previous nutritional status. While many will recommend eating to appetite, if you have been dieting most of your life or have a weight problem, you may find this instruction difficult to follow and should ask for more specific guidelines. A woman of average size beginning her pregnancy at her ideal weight will probably gain between 25 and 35 pounds, more (40 - 50) if she's carrying twins.

To gain that weight, your physician or midwife will probably recommend a "balanced diet." What does that mean? It means eating a variety of foods, with an emphasis on fruits, vegetables and grains; plus some extra attention to getting enough protein, calcium, iron and folic acid. Making good nutritional choices is more important than aiming for a specific weight gain, so if you have any concerns or questions consulting a nutritionist is an excellent idea.

For pregnant women, Canada's Food Guide to Healthy Eating (available from your local public health department) recommends:

• 5 to 12 servings of grain,
• 5 to 10 servings of fruit and vegetables,
• 3 to 4 servings of milk or dairy products, and
• 2 to 3 servings of meat and alternatives.

Extra protein is needed to help the baby's brain and body develop normally, and is usually obtained from meat, dairy products, eggs, legumes, and grains. During pregnancy, a woman should plan for one extra serving a day of one of these foods.

Calcium is an essential component of the growing baby's bones and teeth, and if there is not enough in the mother's diet, some may be taken from her own bones. The most common source of calcium is dairy products milk, yogurt and cheese and about two extra servings a day will provide enough. Calcium can also be found in spinach, broccoli, dried beans, almonds and canned salmon. If you cannot tolerate dairy products, you should discuss this with your doctor or a nutritionist, as a supplement may be necessary.

Iron is part of the red blood cells (in both mother and baby), which transport oxygen throughout the body. It can be found in liver, eggs, red meat and dried beans. Vitamin C aids iron absorption, so drinking orange juice with the meal, for example, will maximize the benefits of iron-rich foods.

Folic acid is a B vitamin which has been found to be very important in preventing spinal cord defects (like spina bifida). These problems originate early in pregnancy, so many experts recommend increasing the intake of folic acid even before conception. Foods high in this nutrient include organ meats, dark green vegetables, legumes, oranges, cantaloupes and honeydew melons.

The Society of Obstetricians and Gynaecologists of Canada recommends a .4 mg daily folic acid supplement or the dietary equivalent for all women planning a pregnancy, from the time birth control is discontinued until 12 weeks after the last menstrual period. For women at higher risk (e.g. women who have had a previous baby with a spinal cord defect), an increased dosage of 1.0 to 4.0 mg daily is advised.

Your doctor may recommend other vitamin supplements, especially if your diet is restricted in some areas. You may also want to consult a nutritionist about your special diet needs.

What About Exercise?

Anne Davidson teaches aerobic classes, and exercise has always been an important part of her life. When she became pregnant, she didn't want to stop.

"I learned that listening to my body was the most important thing," she says. "If I was tired, or feeling uncomfortable, I stopped or slowed down." Anne felt very positive about being able to maintain her fitness level during her pregnancy.

The benefits of fitness like increased energy and decreased stress are especially welcome in the childbearing year. And research suggests that moderate exercise may also be beneficial for the fetus. A 1993 study by Dr. James Clapp found that women who exercised at least three days a week for at least 30 minutes each time had larger and better-functioning placentas than those who were fit before pregnancy but did not exercise.

The Canadian Physiotherapy Association advises pregnant women to follow these exercise guidelines:

• Take time to warm up and cool down.
• Drink plenty of fluids take breaks for a drink as needed. Take care not to get overheated or dehydrated.
• Don't exercise on an empty stomach; have a light and nutritious snack about an hour before exercising.
• Wear comfortable, non-restrictive clothing, appropriate footwear and a good supportive bra.
• Avoid exercises that involve twisting or jarring motions.
• If an exercise hurts, stop doing it.
• Discuss your exercise plans with your physician or midwife.

What are good activities for pregnant women? Swimming is an excellent choice because the water supports the extra weight and reduces the chance of muscle strain. Walking and low-impact aerobics are also good choices. Some physicians recommend avoiding activities such as horseback riding and skiing because the pregnant woman's shifting centre of gravity can make falls and injuries more likely. Scuba diving is also not recommended because the effects of underwater pressures on the fetus have not been determined.

Working While Pregnant

We're a long way from the days when employed pregnant women were forced to quit work as soon as they started to "show," and today most expectant mothers plan to work until their due date.

However, if your work involves exposure to potentially hazardous chemicals, you should ask for a temporary transfer to another work area or take extra precautions. (If you have questions about the safety of your work environment, the Motherisk Clinic in Toronto will advise callers from across Canada: (416) 813-6780.) As well, you need to consider the physical demands of your work. Long periods of standing or heavy lifting may cause problems for you during your pregnancy. This might require some negotiation with your employer or recommendations from your physician.

Just as with exercise, it's important for you to listen to your body. Many women are able to work to the end of their pregnancy, but your situation either because of the demands of your job, or the changes in your body may make leaving work earlier a wise decision.

Rest Is Important

Many pregnant women find they crave extra rest. Again, it's best to accept that your body knows what it needs but how can you fit rest into a busy schedule? You may be able to get to bed earlier at night, take a nap after work or after supper, or "power nap" during your lunch break. Remember, this isn't laziness on your part even if there's not much visible evidence yet, your body is working hard to create this new baby!

Exercise Cautions

Exercise is not recommended if you have any of the following conditions:

• hypertension
• ruptured membranes
• incompetent cervix
• persistent 2nd or 3rd trimester bleeding
• a history of premature labour or slow fetal growth
• pre-existing medical conditions such as heart or lung disease.

In addition, if you experience shortness of breath, bleeding or fluid from the vagina, abdominal pain, or dizziness and nausea, stop exercising and contact a physician.

Please Avoid:

Smoking: If you're a smoker, you'll never have a better reason to quit. Woman who smoke during pregnancy have a higher incidence of placental insufficiency (where the placenta doesn't function well), miscarriage, premature birth, and underweight babies. Ask your public health department about programs to help you quit or cut back as much as possible.

Your newborn should also have a smoke-free environment. Frequent exposure to second-hand smoke increases your baby's risk of respiratory illness, ear infections, and SIDS (sudden infant death syndrome).

Alcohol: We know that frequent or binge drinking can cause serious harm to the fetus (fetal alcohol syndrome). Babies born with this syndrome may have developmental delays, physical abnormalities and behaviour problems as they grow older. But so far, we don't know how much or how little alcohol might cause more subtle problems. That's why many experts think it's best to avoid alcohol entirely, especially in the first trimester.

Drugs:Always check with your doctor or pharmacist before using any drug even a common over-the-counter remedy to make sure it is safe during pregnancy. There are many legal and illegal drugs that can harm your baby's development. Cocaine use during pregnancy, for example, can cause prematurity, birth defects, bleeding in the brain, and neonatal death. You can contact Motherisk if you have any concerns: (416) 813-6780.

* Since 1998, most of Canada's cereal grain products have been fortified with folic acid. It is estimated that fortification provides an additional 0.2 mg of folic acid to most of the population. Talk to your caregiver about whether you should be taking additional folic acid supplements.

Spring 1999