Tag: Pregnancy

Are you really eating for two? While you are definitely providing nutrition for two, you do not need that many more calories during pregnancy than your normal intake. The first trimester does not require additional kilocalories – 340 kilocalories are required in the second trimester and 450 kilocalories are required in third trimester for those at a healthy pre-pregnancy weight/BMI (Academy of Nutrition and Dietetics, 2023).

When assessing nutritional needs during pregnancy, it is important to maintain a balanced plate in terms of macronutrients (protein, fat, and carbohydrates) but vary the macronutrients regularly to help ensure intake of various vitamins and minerals.

Macronutrients for pregnancy

You could get into percentage breakdowns, but the easiest way to plan your meals is by using the plate method. This assumes:

• ½ your plate is non-starchy vegetables
• ¼ of your plate is protein
• ¼ of your plate is carbohydrates

Where is the fat? Many foods play double (or triple) duty and fall under more than one category of macronutrients. Such is the case with fat. Your fat intake will generally be included with your protein source, cooking fat like butter or olive oil that is used in vegetable preparation, and dairy that may make up a portion of your carbohydrates.

While the plate method is the preferred and easiest way to track macronutrients in pregnancy, it is important to note that many women drastically underestimate their protein needs. If you’re counting or weighing, 71g of protein per day is a good guide for the first half of pregnancy while increased need does not occur until second and third trimesters. Protein needs depend on weight — 1.1 g/kg of body weight, so some women may need more than 71 grams. If you’re struggling with protein due to meat aversions, see the below list of good sources of protein for alternatives (Academy of Nutrition and Dietetics, 2023).

Food Serving Size Protein Content

Lean beef: 3 ounces, 22 grams.

Chicken breast: 3 ounces, 26 grams

Salmon: 3 ounces, 22 grams.

Eggs: 2 eggs, 12 grams.

Milk: 1 cup, 8 grams.

Greek yogurt: 6 ounces, container 16 grams.

Northern beans: ½ cup, 6 grams

Peanut butter: 2 tablespoons, 7 grams

Meeting protein needs in pregnancy is relatively easy. Good sources include lean beef, chicken, seafood, dairy foods, beans and nuts. Keep in mind that a 3 ounce portion of meat is only about the size of a deck of cards, or the palm of a woman’s hand (FoodData Central, 2023)

Good sources of macronutrients

Protein

– Eggs

– Lean meat

– Greek yogurt

– Beans, peas, and lentils

– Chickpeas

– Nuts and nut butters

– Fish

– Protein powders

Fat

– Avocado

– Nuts and nut butters

– Pasteurized cheese

– Full fat yogurt

Carbohydrates

– Fruits and vegetables

– Sweet potatoes

– Rice

– Quinoa

– Dairy

– Whole grains

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

Reviewed and edited by Heather Emerson-Payne, RD, PhD, 2023

References

Academy of Nutrition and Dietetics. Nutrition Care Manual. Comparative Standards, Gestational Diabetes Mellitus. https://www-nutritioncaremanual-org.wku.idm.oclc.org/topic.cfm?ncm_category_id=1&lv1=5517&lv2=18188&lv3=273833&ncm_toc_id=273833&ncm_heading=Nutrition%20Care. Accessed July 12, 2023.

Academy of Nutrition and Dietetics. Nutrition Care Manual. Comparative Standards, Normal Pregnancy. https://www-nutritioncaremanual-org.wku.idm.oclc.org/topic.cfm?ncm_category_id=1&lv1=272980&lv2=26918&lv3=268758&ncm_toc_id=268758&ncm_heading=Nutrition%20Care. Accessed July 12, 2023.

FoodData Central. U.S. Department of Agriculture, Agricultural Research Service. https://fdc.nal.usda.gov. Accessed August 14, 2023.

Institute of Medicine. 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. https://doi.org/10.17226/10490.

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It is important to adjust your nutrition as needed in order to support a healthy pregnancy. Below is a list of foods that are generally considered unsafe for pregnancy and are best to limit or avoid.

Avoid

• Alcohol – Alcohol can cross the placenta and can impact your growing baby’s development.
• Raw shellfish
• High mercury fish – The bigger the fish, the more mercury it will contain. Shark, swordfish, tilefish, king mackerel, big eye tuna, marlin, orange roughy should be avoided.
• Pre-cut fruits and vegetables – While there is no reason to limit or avoid fruits and vegetables as a whole, pre-cut fruits and vegetables have a higher risk of contamination with food borne illness. This does not apply to canned or frozen items. When purchasing fresh produce, it is important to follow food safety guidelines and wash and store them properly before consuming.
• Pre-made salads such as ham salad and chicken salad should not be consumed by pregnant women unless they are prepared at home.
• Toxoplamsa gondii is a parasite that is present in cat feces. Pregnant women should not change litter boxes for this reason.

Limit

• Caffeine – It is recommended to limit to 200mg of caffeine per day
• Sugar – Sugar does not directly cause gestational diabetes, but there are several things that increase risk, one of which is overweight/obesity prior to pregnancy. Eating too much added sugar can lead to eating too many kcal, which could lead to overweigh/obesity, which can in turn predispose someone to gestational diabetes (“Centers for Disease Control,” 2022).
• Artificial sweeteners – Research is suggesting that artificial sweeteners can interfere with our gut microbiome as well as increasing the likelihood of your child preferring sweet foods as they grow up (Ruiz-Ojeda et al., 2019).
• Deli meat – Deli meat and hot dogs should be heated until steaming hot. If you’re worried, heating deli meats to 165F greatly reduces the risk of listeria contamination.(“U.S. Food and Drug Administration,” 2022).
• Good choices rich in omega3 fatty acids, but lower in mercury include salmon, shrimp, tilapia, flounder, canned light tuna (includes skipjack tuna) but albacore tuna and yellowfin tuna should be limited to 4 ounces per week (“United States Environmental Protection Agency,” 2022).

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

 Reviewed and edited by Heather Emerson-Payne, RD, PhD, 2023

References

Centers for Disease Control. (2022). Diabetes Risk Factors. Updated, April 5, 2022. Accessed August 14, 2023. https://www.cdc.gov/diabetes/basics/risk-factors.html

Ruiz-Ojeda, F. J., Plaza-Díaz, J., Sáez-Lara, M. J., & Gil, A. (2019). Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Adv Nutr, 10(suppl_1), S31-S48. doi: 10.1093/advances/nmy037. Erratum in: Adv Nutr. 2020 Mar 1;11(2):468. PMID: 30721958; PMCID: PMC6363527.

U.S. Food and Drug Administration. (2022). Food Safety for Pregnant Women, Their Unborn Babies and Children Under Five. Pages 1-3. Accessed August 14, 2023. https://www.fda.gov/media/83740/download?attachment

United States Environmental Protection Agency. (2022). EPA-FDA Advice about Eating Fish and Shellfish. Updated November 3, 2022. Accessed July 12, 2023. EPA-FDA Advice about Eating Fish and Shellfish | US EPA

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During pregnancy, your usual energy level may take a dip at times, especially as your body adapts to hormonal shifts and increased body weight. Sometimes you may feel like lying on the couch all day, but inactivity can increase your fatigue. Try the following tips to help boost your energy level on those days that you’re feeling tired.

• Watch your diet. When you’re feeling tired, you naturally reach for sugary foods to help boost blood sugar levels. Eating sugar-rich foods will give you a spike of energy, but at the expense of a big dip afterward.  Instead, reach for protein-rich snacks that have some fat to help keep your blood sugar level steady. Try swapping a cookie for peanut butter on a cracker, or low sugar yogurt. 

• Get up and move a bit. You may not be up for a workout, but a short walk can wake up your body and boost your energy. Just think about doing 10-15 minutes of any activity, such as walking, doing several sets of going up and downstairs, or a portion of an exercise DVD. The key is to keep the intensity down and just move your body.

• If you don’t feel like aerobic exercise, spend 5-10 minutes strength training with a resistance band or hand weights.  Choose a weight or resistance that allows you to do at least 12 repetitions and 2-3 sets. Avoid overloading your weight lifting when your feeling tired–the goal is to get your blood pumping with some gentle reps.

• Take a power nap. You may think this is counterproductive, but if you feel exhausted, sometimes the best remedy is a short nap. The rules for an effective power nap are to keep it between 15-20 minutes, and avoid napping after 3 PM.  The sweet spot is sometime just after lunch and before 3:00 PM—any later than that can disrupt your nightly sleep. Remember to set the alarm, so you don’t oversleep, and even if you don’t fall asleep, taking the time to rest can be helpful. 

• Take a shower. One of the best ways to increase your energy level is by taking a shower. Avoid having the water temperature too hot, and end with a cold rinse if you can tolerate it. 

• Increase your fluid intake. Mild dehydration can make you feel tired, so monitor your fluid intake to make sure you’re drinking enough. Water is the best choice, but juices and even tea and coffee count. Aim for eight glasses of fluid or more a day. A good way to determine whether you’re dehydrated is by checking the color of your urine. If it’s deep yellow, it’s your cue to up your fluid intake. Aim for urine that is pale to almost clear.

• Use your breathing to decrease stress and improve your energy level. Pregnancy can be stressful, and when you’re feeling tense, your breath can become shallow. You can improve your breathing and reduce stress by “belly breathing.”  Hold your hands over your tummy, and as you breathe, allow your abdomen to expand outward (you should feel your tummy expand into your hands).  Avoid breathing with your upper body (where your shoulders lift and tense) and relax your shoulders as you slowly breathe in and out with your belly expanding and relaxing. Practice belly breathing several times a day to help train yourself to breathe correctly. 

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Exercise isn’t an all or nothing situation.  Although you may not always be able to fit in a gym visit or run into your day, you can easily up your physical activity levels by incorporating these simple tips into your daily routine.

• Break the habit of parking as close as possible to your destination. Consistently adding a short walk whenever you drive somewhere can add lots of healthy steps to your day.
• Take the stairs. Never take the elevator or escalator whenever possible. Stairs are a great way to get a burst of cardio, and stepping strengthens gluts and legs.
• Sit on an exercise ball.  Swap an exercise ball for your desk chair. Sitting on an exercise ball helps to improve posture, balance, and core strength. Roll your hips on the ball every 30 minutes or so to improve circulation and ease back strain. 
• Stand up often and consider a standing desk or treadmill desk. Standing burns more calories than sitting, and you’ll supercharge your energy output by using a treadmill desk.

• Skip a seated lunch and add a walk. The benefits of fitting in a bout of exercise mid-day are many and include burning calories, improving mood, and boosting energy. 
• Stretch at your desk. Set the alarm for every 30 minutes as a reminder to do some stretches. You can do many stretches in your chair, twisting to each side, or dropping down in front to stretch your back.
• Work out around the house.  Make everyday tasks double as an exercise by upping your pace as you move around the house and doing several stairs sets (up and down) whenever using your stairs. Think about how you can create a habit of exercising throughout your day, such as having a hand weight in your bathroom so you can do one-handed lifts while you brush your teeth, or squats while you’re waiting for your coffee to brew.
• Use technology. Set up an alarm on your phone to let you know it’s time to get up and move for a few minutes. It helps to keep the phone far enough away that you have to get up to turn off the alarm.  Also, if you’re a tech person, consider getting a fit bit or other fitness tracker to help motivate you to exercise more consistently. 
• Use TV time to move.  Instead of settling on the couch to watch your favorite program, set up a mini workout area in front of your TV, with a resistance band, hand weights and a jump rope or step for some cardio. 

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As your pregnancy progresses and you move into your second trimester, you may start to experience a lower tummy tugging sensation with movement or burning sensation in your labia (the outer lips of the vulva). Typically, this discomfort is caused by your round ligaments being stretched and can vary between mildly uncomfortable to a sharp pain that spans from your lower belly to groin.

Your round ligaments are a key support for your uterus, spanning from each side of your uterus down to your pelvis. As your baby grows, tension is increased on the ligaments as they stretch. Activities that cause an up and down motion on your belly (such as running or walking) or fast movement to the side or raising upright can result in the ligament pain, especially during your baby’s growth spurts.

Round ligament pain is common during pregnancy, especially in later pregnancy, but there are ways to ease the discomfort and reduce the amount and frequency of pain. Keep in mind that if you experience abdominal pain that doesn’t ease with rest, is sustained, or becomes increasingly severe, contact your healthcare provider.

Tips for easing round ligament pain:

• A warm bath can help ease soreness and tension on the ligaments. 
• Use your hands under your belly to manually lift your belly up and support it. This will take pressure off the round ligament.

• Ask your doctor about whether you can take acetaminophen if the pain makes normal, day to day activity difficult.

• Slow down and avoid sudden movements. Over time you’ll become aware of the type of movements that increase round ligament pain and try avoiding them.

• Try and flex your hips by sitting in a chair or bending forward whenever you cough, sneeze, or laugh. Bending at the hip helps to ease the tension on the ligaments.

• Wear a belly support band while exercising or other weight-bearing activities.  The band helps take tension off your round ligaments and reduce pain. Look for a band that’s made of a breathable, stretchy fabric, with secure front Velcro closure. It should be wide enough to support your lower tummy but allow for comfortable movement.  
  • For the best fit:
    • Wrap it around your low back and bring the ends to the front so they meet just below your belly button.
    • Before you fasten the band, take a breath in and draw your tummy up as you fasten the band, so it’s gently supporting your belly. 
    • The band should feel supportive but not impede movement or make it hard for you to take a deep breath. 
    • Frequently check the band during exercise and reposition if it feels loose.

• Although exercise may bring on round ligament pain, it’s important to keep moving. Try modifying your fitness routine by taking breaks when you start feeling ligament pain, wearing a belly support band, or reducing your running or walking pace and distance until the pain resolves.  If you continue to have pain with weight-bearing exercise, consider switching to non-weight-bearing exercise such as stationary biking or swimming.

References

Chaudhry, S. R., & Chaudhry, K. (2018, December 15). Anatomy, abdomen and pelvis, uterus round ligament
https://www.ncbi.nlm.nih.gov/books/NBK499970/Tobah, Y. B. (2018, April 18). What causes round ligament pain during pregnancy? 
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/round-ligament-pain/faq-20380879h

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One of the most common pieces of advice is to listen to your body. While this is not bad advice, it is lacking in that your body is doing something you have never experienced before! While there are no hard and fast rules, we hope this article will give you some good ideas about what changes you can expect to experience when working out during pregnancy, as well as what things are not normal and may warrant a call to your doctor. 

You may notice a decrease in your ability to do activities you were able to do previously. Things may feel harder than they used to, especially strenuous activities. Feeling a little bit more short of breath is okay. This is normal. Your body is also growing a human and is working very hard! Give yourself some slack when picking your intensity. 

You may notice yourself feeling hotter during a workout. Pregnancy brings elevated body temperatures, so this is normal. Make sure you wear loose-fitted clothing, avoid exercising in excessive heat or humidity, and stay-hydrated! 

You may notice your balance may be off. This is normal. With weight gain and a shift in your body’s “center”, you may notice yourself having a harder time with balance or activities that rely heavily on balance. For this reason, allow yourself to hold onto something during these types of activities, or consider stopping them until after the baby arrives. 

You may notice your heart beating faster. This may or may not be physically noticeable, but if you wear a device that measures heart rate, you may notice this. This is a completely normal occurrence during pregnancy and it will return to normal after the baby is born. That said, if you ever notice any chest pain or discomfort, this is not normal and should be evaluated by your doctor. 

Some things that are NOT normal during exercise and should be evaluated immediately.

1. If you notice any vaginal bleeding or leaking of fluid during or after exercise. 
2. If you have any pain in your abdomen, chest, or calves. 
3. If you feel dizzy, short of breath, or have a headache. 
4. If you notice any regular painful contractions. 

Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-e188.

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