Healthy Eating & Exercise

Healthy Eating, Exercise in Pregnancy
Food Pyramid

It’s natural and healthy to put on weight during pregnancy. Your body needs to change to accommodate your growing baby, and to give your baby the best start in life. A well balanced diet is important for good health, not only during pregnancy but even before conception and into the postnatal period. This ensures you have a good store of nutrients to meet the demands of your developing baby.

Contrary to popular belief, you don’t need to eat for two in pregnancy – it’s the quality of what you eat, not always the quantity, that’s important.

What is an Appropriate Weight Gain?
Everyone has different energy and weight gain requirements in pregnancy depending on pre-pregnancy weight. Your weight will be recorded at your first visit to your GP and to the Hospital and your Body Mass Index will be calculated on this measurement. Excessive weight gain is not beneficial to your health nor the health of the pregnancy.

The total amount of weight gained in normal-term pregnancies varies considerably among women. This table contains a guide for singleton pregnancies.

(Specific requirements for multiple births to be discussed with your Consultant Obstetrician)

Aim for a minimum of weight gain up to 20 weeks and an average weight gain of ½ kg or 1 lbs per week from 20 weeks to term. The average daily calorie increase is 150 to 200 calories in the first trimester and 300 calories a day in the second and third (the equivalent of an apple or yogurt).

How can I safely monitor my weight gain?
You will be more likely to achieve and maintain a healthy weight before, during and after pregnancy if you:

1. Cut down on sugar, fat, salt for more fresh fruit, vegetables and high fibre cereals.

2. Base your meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible.

3. Eat fibre-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta.

4. Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories.

5. Eat a low-fat diet and avoid increasing the fat and/or calorie intake in your food.

6. Eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods).

7. Eat breakfast.

8. Watch the portion size of meals and snacks, and how often you are eating.

9. Make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life – for example, by taking the stairs instead of the lift or taking a walk at lunchtime.

10. Adopt a food ratio of :15-20% Protein, 30% Fat, and 50 -55% Carbohydrate.

11. Weigh yourself regulary.

Dieting in pregnancy is not advisable due to the potential risk to the developing fetus.

Why your weight matters during pregnancy and after birth
Most women who are overweight will have a straightforward pregnancy and birth and deliver healthy babies. However being overweight does increase the risk of complications to both you and your baby. This information is about the extra care you will be offered during your pregnancy and how you can minimise the risks to you and your baby in this pregnancy and in a future pregnancy.

What is BMI?
BMI is your body mass index which is a measure of your weight in relation to your height and how that fits into a weight classification. Almost one in five (20%) pregnant women have a BMI of 30 or above at the beginning of their pregnancy.

When should my BMI be calculated?
You should have your BMI calculated at your first antenatal booking appointment. You may be weighed again later in your pregnancy.

What are the risks of a raised BMI during pregnancy?
Being overweight (with a BMI above 25) increases the risk of complications for pregnant women and their babies. With increasing BMI, the additional risks become gradually more likely, the risks being much higher for women with a BMI of 40 or above.

THE HIGHER YOUR BMI, THE HIGHER THE RISK!

Risks for your baby associated with a raised BMI include:
If you have a BMI of 30 or above before pregnancy or in early pregnancy, this can affect the way the baby develops in the uterus (womb). Neural tube defects (problems with the development of the baby’s brain and spine) are uncommon.
The overall rate of neural tube defect is around 1 in 1000 babies are but if your BMI is over 40, your risk is three times that of a woman with a BMI below 30.

Miscarriage – the overall risk of a miscarriage under 12 weeks is 1 in 5 (20%), but if you have a BMI over 30, your risk increases to 1 in 4 (25%).
You are more likely to have a baby weighing more than 4 kg (8 lb & 14 ounces). If your BMI is over 30, your risk is doubled from 7 in 100 (7%) to 14 in 100 (14%) compared to women with a BMI of between 20 and 30

1. Stillbirth – the overall risk of stillbirth is approximately 1 in 200 (0.5%), but if you have a BMI over 30, your risk is doubled to 1 in 100 (1%).
2. If you are overweight, your baby will have an increased risk of obesity and diabetes in later life.

What are the risks of a raised BMI during labour and birth?
There is an increased risk of complications during labour and birth, particularly if you have a BMI of more than 40. These include:
1. Developing thrombosis.
2. Developing gestational diabetes.
3. Developing pre eclampsia/ hypertension/ high blood pressure.
4. Your baby being born early (before 37 weeks).
5. A long labour.
6. The baby’s shoulder becoming ‘stuck’ during birth.
7. An emergency caesarean birth.
8. A more difficult operation if you need a caesarean section and a higher risk of complications afterward, for example your wound becoming infected.
9. Anaesthetic complications, especially with general anaesthesia.
10. Heavy bleeding after birth (postpartum haemorrhage) or at the time of caesarean section.

HEALTHY EATING

The amount of weight women may gain during pregnancy can vary greatly.
A healthy diet will benefit both you and your baby during pregnancy. It will also help you to maintain a healthy weight after you have had your baby. In general you do not need extra calories for the first two-thirds of pregnancy and it is only in the last 12 weeks that women need an extra 200 kilocalories a day.

Trying to lose weight by dieting during pregnancy is not recommended even if you are obese, as it may harm the health of your unborn baby. However, by making healthy changes to your diet you may not gain any weight during pregnancy and you may even lose a small amount. This is not harmful.

Additional information is available from: HSE Healthy Eating During Pregnancy
(which is included in this pack)

EXERCISE

Your Doctor and Midwife should ask you about how physically active you are.
You may be given information and advice about being physically active as this will be a benefit to your unborn child.

1. Make activities such as walking, cycling, swimming, low impact aerobics and gardening part of everyday life and build activity into daily life by taking the stairs instead of the lift or going for a walk at lunchtime.

2. Minimise sedentary activities, such as sitting for long periods watching television or at a computer.

3. Physical activity will not harm you or your unborn baby.

However, if you have not exercised routinely you should begin with no more than 15 minutes of continuous exercise, three times per week, increasing gradually to 30 minute sessions every day. A good guide that you are not overdoing it is that you should still be able to have a conversation while exercising. Additional information is available from www.getirelandfit.ie

AN INCREASED DOSE OF FOLIC ACID

Folic acid helps to reduce the risks of your baby having a neural tube defect.
If your BMI is 30 or above you should take a daily dose of 5 mg of folic acid. This is a higher dose than the usual pregnancy dose, and it needs to be prescribed by a doctor. Ideally you should start taking this a month before you conceive and continue to take it until you reach your 13th week of pregnancy. However, if you have not started taking it early, there is still a benefit from taking it when you realise you are pregnant.

VITAMIN D SUPPLEMENTS

All pregnant women are advised to take a daily dose of 10 micrograms of vitamin D supplements. However, this is particularly important if you are obese as you are at increased risk of vitamin D deficiency.

PLANNING FOR LABOUR AND BIRTH

For women with a BMI over 40 Because of these possible complications, you should have a discussion with your obstetrician and/or midwife about the safest way for you to give birth.

ANAESTHETIC REVIEW

If you have a BMI of 40 or more, arrangements should be made for you to see an anaesthetist to discuss a specific plan for pain relief during labour and birth.

INTRAVENOUS CANNULA

If your BMI is over 40, it may be more difficult to insert a cannula (a fine plastic tube which is inserted into the vein to allow drugs and/or fluid to be given directly into your blood stream) into your arm. Your Midwife will usually insert this early in labour in case it is needed in an emergency situation.

PAIN RELIEF

All types of pain relief are available to you in labour if required. However, having an epidural (a regional anaesthetic injection given into the space around the nerves in your back to numb the lower body) can be more difficult if you have a high BMI. You can discuss your pain relief options with your Midwife and or Doctor.

DELIVERING THE PLACENTA (AFTERBIRTH)

An injection is normally recommended to help with the delivery of the placenta (afterbirth) to reduce the risk of postpartum haemorrhage (heavy bleeding).

What happens after birth?
After birth some of your risks continue. By working together with your Midwives and Doctors you can minimise the risks, here are a few points to remember:

1. Breastfeeding is best for your baby. It is possible to breastfeed successfully if you have a BMI of 30 or above. Extra help should be available if you need it.

2. You should continue to take vitamin D supplements whilst you are breastfeeding.

3. Continue to follow the advice on healthy eating and exercise. If you want to lose weight once you have had your baby, you can discuss this with your GP.
You may also consider a weight management service such as Weight Watchers or Slimming world.

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