Confused about what nutritional supplements you need in pregnancy? You’re not alone.

Recently, our Director and Principal Dietitian, Dr Shelley Wilkinson and her colleagues published a scientific paper. This paper looked at what supplements women were taking in pregnancy.

In the lead up to this  analysis of the women’s diets in the Queensland Family Cohort Study they knew that multiple micronutrient (MMN) use in low and middle-income countries improved gestational weight gain, birth weight and was thought to reduce preterm births, BUT the potential benefits and/or harms high-income countries was not clear.

Dr Shelley and her colleague, Dr Linda Gallo did a podcast with the MJA talking about what was found. Have a listen to hear what was discussed.

 

Why is there confusion about what supplements to take?

Many women want assurance that their nutritional needs are being met. Supplements are often seen as a more efficient way of obtaining required nutrients compared with food.

In a study by Malek and colleagues, supplement users had low confidence that their nutritional needs were being met. Over 80% took a multiple micronutrient supplement aka ‘pregnancy multivitamin’ during pregnancy. Women suspected what they ate wasn’t very nutritious. They worried they weren’t getting enough things like green leafy vegetables or red meat. Women also felt they lacked the knowledge to decide whether what they ate was enough and was balanced.

 

The influence of the strong advertising dollar.

Companies spend thousands upon thousands of dollars are spent trying to convince people to buy their products.  Advertising is a powerful tool that can influence our thoughts, feelings, and behaviours. It works by manipulating various psychological techniques to create a compelling story that resonates with consumers. Some of the ways that advertisers do this are:

  • Emotional Appeal: Ads often evoke strong emotions like happiness, fear, or nostalgia. By tapping into our emotions, advertisers can create a personal connection with their target audience. With pregnancy supplements this is often pitched as “just in case” or “peace of mind”.
  • Social Proof: People are more likely to follow the crowd. Ads often feature satisfied customers or celebrities to demonstrate that others are enjoying the product or service.
  • Scarcity and Urgency: Creating a sense of limited availability or time can increase perceived value and encourage immediate action. Pregnancy is for a relatively short period of time … you don’t have to do this “forever”, just for the nine months or so….
  • Repetition: Repeated exposure to an ad can make it more familiar and memorable, increasing its effectiveness. This is where flyers in pharmacies, ‘Bounty Bags’, antenatal clinics etc etc come in.
  • Targeting: Advances in technology allow advertisers to target specific demographics, interests, and behaviors, making their messages more relevant and impactful. Hello Meta algorithm!?!

 

What does the science say about supplements versus a food first approach?

We are all familiar with the phrase, “you can’t out train a bad diet” meaning exercise can’t make up for poor dietary habits in the long run; similarly, you can’t “out supplement a bad diet”.

The increases in five food group serves in pregnancy address the increases in most nutrient requirement changes in pregnancy; an extra 2.5 serves from the grains group and 1 extra serve from meat and alternatives group.

In pregnancy it’s important to remember, in the majority of cases, that we need to take a food first approach. Supplements should not substitute a wholefood diet.

There are benefits to eating a variety of foods, which contain many complementary nutrients and other compounds we cannot obtain from supplements.

We don’t have one of our dietary guideline as “eat a wide variety of nutritious foods” for nothing.

However, there IS strong evidence on taking SPECIFIC NUTRIENTS in the lead up to and during pregnancy that has DEMONSTRATED EFFECTS on pregnancy outcomes.

 

What nutrients do I need to supplement in pregnancy?

There is high certainty evidence that folic acid supplementation ≥400 µg per day preconception (at least the month before) and in the first 3 months of pregnancy is associated with a reduction in risk of neural tube defects.

The NHMRC (2010) Public Statement: Iodine Supplementation for Pregnant and Breastfeeding Women suggests pregnant women take an iodine supplement of 150 µg each day to avoid poor infant neurodevelopment.  Iodine’s most important known function is as a component of thyroid hormones. Thyroid hormones play a vital role in the regulation of metabolic processes such as growth and energy expenditure. It is also involved in development, especially of a baby’s brain.

Food sources of folic acid and folate, as well as iodine are important.

Food Standards Australia New Zealand (FSANZ) developed a mandatory folic acid fortification standard to help reduce the incidence of neural tube defects and a mandatory iodine fortification standard to address the re-emergence of iodine deficiency in the population. These standards, effective from later  2009 required the addition of folic acid to bread-making flour in Australia and iodine (via iodised salt) to bread in Australia and New Zealand.

 

What nutrients might I need to supplement in pregnancy?

Australian Pregnancy Care Guidelines living document contain the most up-to-date evidence around supplementation in pregnancy. Nutrients of consideration are vitamin D, iron, calcium, and omega 3.

Vitamin D – helps to maintain muscle and bone strength and helps our body to absorb calcium from food. In pregnancy, vitamin D also helps to develop baby’s bones. Most of our vitamin D is made in our skin by the sun’s ultraviolet rays. There is limited evidence to support testing of all women for vitamin D status in pregnancy and the benefits and harms of vitamin D supplementation in pregnancy remain unclear.Vitamin D supplementation may be a consideration for women with vitamin D levels lower than 50 nmol/L.

 

Iron deficiency anaemia is a common condition both in Australia and around the world, affecting over 1.5 billion people. It is particularly prevalent in certain population groups – in Australia around 12 per cent of women are anaemic. Iron is an important component of haemoglobin, which has an oxygen carrying role.

The easiest absorped dietary iron is haem iron. It comes from animal-based foods. Examples of foods include: red meat, chicken, fish. Non-haem iron is less easily absorbed but can be boosted through eating these foods with vitamin C containing foods. Non haem examples are: green leafy vegies, legumes and nuts, eggs, as well as wholegrain breads and cereals. Good vitamin C sources are citrus fruits, kiwi fruit, tomatoes, and capsicum.

If someone is taking an iron supplement absorption is highest if iron is given on alternate days. The amount of iron in pregnancy multivitamins is not enough – iron should come from a specific iron supplement (with our without vitamin C in it).

 

Calcium – is found predominantly in milk and milk-based foods, with smaller amounts in bony fish, legumes and most nuts, fortified soy beverages and breakfast cereals. Calcium is important for the development of bones and teeth. It is also important for muscle contractions and nerve conduction. There is consistent evidence from systematic reviews that calcium supplementation reduces the risk of gestational hypertension and pre-eclampsia with a clearer effect among women with low dietary calcium than among women with adequate dietary calcium.

 

Omega 3 long chain fatty acids – are important for brain and eye development as baby grows in the womb, as well as for reducing overall inflammation at a cellular level. In pregnancy, they have been linked to a reduction in the risk of preterm birth and may lengthen pregnancy too. However, the studies that showed the effect on pregnancy length showed this was only ‘in the subgroup of women with a singleton pregnancy and low n-3 status early in pregnancy, but not overall’. The researchers also noted it was hard for women to take the omega-3 supplements in the way they were meant to in the study rules.

As these essential fats cannot be made by the body, they must be obtained from food or supplements.

However, this is NOT a green light for omega-3 supplementation.

Omega-3 supplements used to be all the rage for heart health, but recent position papers from the Heart Foundation have shown that it is eating FOOD SOURCES of omega-3 rather than popping the SUPPLEMENTS have the most positive impact on heart health. Perhaps it’s the same for pregnancy?

The good news is that fish and seafood should be an important part of the diet in pregnancy.

It is an excellent source of protein, is low in saturated fat, has high amounts of omega 3 and can be a good source of iodine. Great sources of omega-3 include: canned sardines, salmon (fresh or canned), some canned tuna, as well as mackerel and herrings

 

What nutrients and substances are people talking about but aren’t covered in the guidelines?

Choline – Is on people’s radars as Australian Eggs are running a great promotion at the moment. And rightly so – eggs are an excellent source of choline. But so is meat, fish, poultry, and dairy. It’s also found in potatoes, legumes, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage) and sunflower seeds. Choline is important for brain and spinal cord development during pregnancy, and it has been linked to childhood cognition.

 

Inositol – aka myo‐inositol, an ‘isomer‘ of inositol, is a naturally occurring sugar commonly found in cereals, corn, legumes and meat. Myo‐inositol is one of the intracellular mediators of the insulin signal and is related to insulin sensitivity in type 2 diabetes. The potential beneficial effect of improving insulin sensitivity suggests that myo‐inositol may be useful for women in preventing gestational diabetes.

These conclusions come from very few studies (seven! … with six done in Italy and one in Ireland). The people who looked at these seven studies said understanding the results were hard as many different doses were given at different times during pregnancy. They call for more  studies to see if taking myo-inositol  helps prevent gestational diabetes  …. and also to  find out when and how much myo-inositol needs to be taken …and, importantly, to see if taking myo-inositol has any effects on their developing babies.

 

How can working with a dietitian support a woman meeting her pregnancy nutrition goals?  

So, in pregnancy, bub needs good nutrition for essential nutrients for healthy growth and development.

And for Mum, you need balance or juggle:

  • Adequate energy (kilojoule) intake (you’re growing a baby),
  • Managing  weight gain (keeping in the best range for your pre-pregnancy BMI),
  • Managing pregnancy side-effects/symptoms,
  • Reducing your risk of chronic disease (as pregnancy can be a natural ‘stress test’ that can accelerate the trajectory of some lifestyle diseases), and
  • Maintaining a healthy immune system (through safe food selection, storage and preparation).

Accredited Practising Dietitians can help you  overcome the barriers of eating a nutritious diet in pregnancy. This may be helping provide information, support, or meal planning ideas.

 

In our short online modules you will learn how to TRANSFORM your habits from wanting to change to making them stick. More information here. Including access to Nutrition Essentials for Pregnancy.

An individual consult involves a more thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. If you would like further information book an appointment  now.

 

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PODCAST – Eating for Two? Peak Nutrition for Pregnancy

 Recently, our Director and Principal Dietitian, Dr Shelley Wilkinson spoke with Laureate Professor Clare Collins about pregnancy nutrition.

In this podcast Clare and Shelley cover nutritional needs of pregnancy. Topics they discuss include the importance of a nourishing, high quality diet in pregnancy, food safety, weight gain, and recommended supplements. They back up these facts with the nutrition science that sits behind the recommendations and practical solutions to achieve these goals.

Listen here or through your favourite streaming service.

 

Dr Shelley’s featured recipe on No Money, No Time.

 

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Busted! (PART 2). Three more myths about pregnancy nutrition: Supplements, morning sickness, and food freedom

Congratulations! You’re embarking on an incredible journey of pregnancy. Amidst the excitement, there’s also a whirlwind of information (and sometimes misinformation) about what to do (and not do) to ensure a healthy pregnancy.

Nutrition plays a crucial role, and navigating myths surrounding supplements, morning sickness, and food choices can feel overwhelming.

Last month we looked at the myths of ‘eating for two’, pregnancy food cravings and weight gain in pregnancy. This month let’s debunk three more myths so you can feel empowered to make informed choices about nourishing yourself and your growing baby.

Myth #1: Pregnancy Vitamins Guarantee All Your Nutritional Needs

Despite a strong marketing push, pregnancy multivitamins (or the “pink” multivitamins) are not required by most women.

There are only two essential nutrients recommended for pregnancy:

  • folic acid, crucial for reducing the chance of neural tube defects in your baby, and
  • iodine, for growth and development, especially of baby’s brain.

Other nutrient supplements that may be required if a deficiency is diagnosed (iron, vitamin D, vitamin B12), someone is at risk of pre-eclampsia (calcium) or women avoid certain food groups, such as vegetarians or vegans (iron, vitamin B12).

Remember: A well planned and balanced diet is the foundation of a healthy pregnancy. A food first approach is best for most nutrients needed.

Dietary supplements play a specific and supporting role, rather than acting as an insurance policy “just in case”.

Myth #2: Morning Sickness Means You Can’t Eat (or You Have to Eat Bland Foods Only)

Morning sickness, though often referred to as such, can strike any time of day. Feeling nauseated can make the thought of food unappealing, but avoiding food can actually worsen the symptoms.

Taming the Tummy Troubles:

  • Small and Frequent Meals: Opt for smaller, more frequent meals throughout the day to avoid an empty stomach.
  • Find Your Triggers: Identify foods that worsen your nausea and avoid them temporarily.
  • Hydration is Key: Stay hydrated by sipping water or clear fluids throughout the day. Ginger tea may also help soothe nausea.
  • Bland Doesn’t Have to Be Boring: Bland foods like crackers or toast can be your lifesaver, initially. But explore other easily digestible options like crunchy dried breakfast cereals, yoghurt, fruit smoothies, or mashed potatoes.

Don’t Fear Flavour:

While some bland foods might be comforting initially, don’t feel limited. Experiment with different flavours and textures that appeal to you. Ginger, peppermint, and citrus can sometimes help settle your stomach.

Myth #3: There’s a Long List of “Forbidden Foods” During Pregnancy

Sometimes it can feel like the list of foods to avoid in pregnancy is longer that what you are allowed to eat. Due to changes in a woman’s immune system during pregnancy, you are more susceptible to food poisoning.

This is from the usual culprits – Salmonella, E.coli and Campylobacter – but also one you hear a lot about in pregnancy, Listeria. 

However, if you avoid all foods that carry a risk for harbouring listeria, it is likely that you will consume fewer nutrients. This is not ideal as you ARE growing a baby. 

You don’t have to go without! For every item on the “no” list, there are a number of alternative and this table will help to make those choices (source). 

Foods to avoid Safe alternatives to enjoy
·       Deli meats

·       Pre-sliced and pre-packaged meats

·       Cold ready to eat chicken

 ·       Meats cooked at home

·       Tinned fish (two to three times per week)

·       BBQ chickens, if eaten immediately when hot
·       Chilled or raw seafood

·       Sashimi or sushi

·       Smoked salmon (or other smoked fish varieties)

·       Oysters

·       Pre-cooked shellfish including prawns and crabs

 ·       Tinned fish including salmon and tuna (two to three times per week)

·       Freshly cooked seafood, including shellfish, eaten hot
·       Pre-packaged or pre-cut fruit, vegetables and salads

·       Salad and sandwich bars

·       Buffets

 ·       Homemade salads with freshly washed ingredients

·       Freshly cut and washed fruit

·       Canned or frozen fruit and vegetables
·       Soft cheese including brie, camembert, ricotta, feta and blue cheese

·       Pate or meat spreads

 ·       Hard cheeses such as cheddar

·       Processed cheese

·       Cream cheese spreads

·       Plain cottage cheese

·       Soft cheeses that are cooked and eaten when hot

Freedom with Responsibility:

Beyond these exceptions, you can enjoy a variety of foods during pregnancy.

Here’s what to prioritise for a healthy pregnancy diet:

  • Fruits and Vegetables: Aim for a rainbow! They provide essential vitamins, minerals, and fibre.
  • Whole Grains: Choose wholegrain bread, low GI brown rice, quinoa, and oats for sustained energy and healthy digestion.
  • Lean Proteins: Include protein sources like chicken, fish (excluding mercury-rich varieties), beans, lentils, and tofu for building and repairing tissues and supporting your baby’s growth.
  • Healthy Fats: Don’t fear healthy fats found in avocados, nuts, seeds, and olive oil. These are essential for fetal brain and eye development.

 

NEED MORE HELP?

We offer individual consultations and self-paced online courses as we know you all have different learning styles and budgets. Attending an individual session OR online course with a Lifestyle Maternity dietitian will allow you to assess your diet against recommended guidelines and identify changes that can be tailored to your lifestyle and dietary preferences.

In our self-paced online course you will be encouraged and guided to assess your own health habits against pregnancy recommendations, participate in activities around setting health goals for optimal nutrition and learn how to adapt your routines with confidence to achieve these goals to make them stick. More information here.

An individual consult involves a more thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. If you would like further information book an appointment  now.

 

 

 

IMAGE CREDIT: Olena Sergienko, Unsplash

IMAGE DESCRIPTION: Pink mug with a yellow tag on a tea bag.

 

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Busted! Three Myths About Pregnancy Nutrition (PART 1)

Congratulations! You’re pregnant. It’s a whirlwind of emotions, doctor’s appointments, and a million questions about what to do (and not do) to ensure a healthy pregnancy.

Nutrition is a big one, and with all the information (and sometimes misinformation) floating around, it’s easy to get caught in a web of myths. Let’s debunk three of the most common myths about pregnancy nutrition so you can focus on feeling your best and nourishing your growing baby.

Myth #1: You Have to “Eat for Two”

This age-old adage might sound logical, but it’s a misconception. While your body does need additional nutrients to support your baby’s development, the increase isn’t as dramatic as “eating for two” implies.

In the first trimester your energy (kilojoule) needs are about the same as when you weren’t pregnant.

It’s only when you get into your second and third trimesters that you need more protein and energy—an extra 1400kJ a day (second trimester ~ 300 calories)) and 1900kJ a day (third trimester ~ 450 calories)) is all you need.

Your protein needs are only 60grams per day.

What is this in ‘real food’? An extra serve from the meat and alternatives group and two to three serves from the breads/cereals/grains group.

Focus on Quality Over Quantity:

Instead of simply doubling your portions, prioritise nutrient-dense foods. Think fruits, vegetables, whole grains, lean proteins, and healthy fats. These provide essential vitamins, minerals, and fibre that are crucial for both you and your baby.

Listen to Your Body:

Hunger cues are your best guide during pregnancy. Some days you might feel hungrier than others. Pay attention to your body’s signals and eat until you’re comfortably satisfied, not stuffed.

Myth #2: Certain Cravings Mean Your Body Needs Something Specific

Pregnancy cravings can be intense, from ice cream to pickles (or even a bizarre combination of both!). While some believe cravings are your body’s way of signaling a nutritional need, it’s not always that simple.

Cravings Don’t Always Equal Deficiencies:

Cravings can be influenced by hormones, fatigue, or simply the appeal of a particular flavour or texture. Don’t feel guilty about indulging occasionally, but remember moderation is key. Practicing eating mindfully can help here.

Fuel Your Body With Balanced Choices:

If you’re craving sweets, opt for a piece of fruit with a dollop of yoghurt or a homemade smoothie with fresh berries. Maybe add a shake or two of drinking chocolate on top? If you are craving something salty make some home cooked popcorn and lightly salt or opt for some lightly salted and roasted nuts, like almonds or macadamias. This way, you satisfy your cravings while getting some valuable nutrients in the process.

Myth #3: We shouldn’t talk about weight gain during pregnancy

Weight gain is a natural part of pregnancy, and the amount varies depending on your pre-pregnancy weight and various other factors.

However, there’s a healthy range for weight gain during pregnancy. Using a personalised pregnancy weight tracker can support attainment of this goal. Studies show that when a woman knows how much weight to gain during her pregnancy AND is provided with continual feedback about how she is progressing, she is more likely to gain an appropriate amount of weight.

Rather than a one-size-fits-all approach, this approach tailors a weight gain goal to each and every woman during her pregnancy.

Focus on a Balanced Diet for Optimal Weight Gain:

Eating healthy, nutritious foods during pregnancy is important so you get all of the vitamins, minerals and nutrients that you need to ‘grow your baby’.

Weight gain in pregnancy is a matter of balance. You need to balance the foods you eat with the amount of activity you do, as well ensuring your baby is growing well.

It’s important to eat to appetite, make good food choices and track within the shading of your Personalised Pregnancy weight tracker – don’t focus too much on only one or two of these elements.

Healthy weight gain is about getting the balance right.

Bonus Tip: Stay Hydrated!

Staying hydrated is crucial throughout pregnancy for many reasons, including aiding digestion, regulating body temperature, and delivering nutrients to your baby.

Aim for eight glasses of water per day and adjust based on your activity level and climate.

Remember:

Every pregnancy is unique. What works for one woman might not be the best approach for another. Focus on making healthy choices that nourish your body and your growing baby.

NEED MORE HELP?

We offer individual consultations and self-paced online courses as we know you all have different learning styles and budgets. Attending an individual session OR online course with a Lifestyle Maternity dietitian will allow you to assess your diet against recommended guidelines and identify changes that can be tailored to your lifestyle and dietary preferences.

In our self-paced online course you will be encouraged and guided to assess your own health habits against pregnancy recommendations, participate in activities around setting health goals for optimal nutrition and learn how to adapt your routines with confidence to achieve these goals to make them stick. More information here.

An individual consult involves a more thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. If you would like further information book an appointment  now.

IMAGE CREDIT: Ella Olsen, Unsplash

IMAGE DESCRIPTION: Three identical meal prepped containers with brown rice, colourful vegetables and chickpeas arranged in sections.

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Ultra-Processed Foods and Pregnancy Health: Understanding the Risks and Making Informed Choices

During pregnancy, a woman’s nutritional needs increase to support the growth and development of her baby. However, the modern diet is increasingly dominated by ultra-processed foods, which can pose significant risks to both maternal and fetal health.

Understanding the potential consequences of ultra-processed food consumption during pregnancy is crucial for making informed dietary choices and supporting optimal health outcomes.

Defining Ultra-Processed Foods

Food processing generally refers to any action that alters food from its natural state, such as drying, freezing, milling, canning, or adding salt, sugar, fat, or other additives for flavour or preservation.

Ultra-processed foods are not simply foods that have been modified by processing, but rather edible products formulated from food-derived substances, along with additives that heighten their appeal and durability.

Ultra-processed foods are heavily industrially processed products that have undergone multiple alterations, often involving a combination of techniques such as hydrogenation, extrusion, and fortification.

These foods are typically low in fibre, nutrients, and water, while being high in unhealthy fats, added sugar, and salt. Examples of ultra-processed foods include packaged snacks, sugary drinks, processed meats, and ready-made meals. They are the foods that typically can’t be “created in your kitchen”.

Impact of Ultra-Processed Foods on Maternal Health

Excessive consumption of ultra-processed foods during pregnancy can lead to a range of health concerns for mothers, including:

  • Excessive gestational weight gain (GWG): Ultra-processed foods are often high in calories and low in satiety (being filling), contributing to excessive weight gain during pregnancy. GWG is associated with increased risks of gestational diabetes (GDM), preeclampsia, and postpartum complications.
  • Increased risk of GDM: GDM is a condition characterised by high blood glucose levels during pregnancy. Ultra-processed foods, particularly those high in added sugar, can make management of BGLs in GDM harder.
  • Elevated blood pressure: Ultra-processed foods often contain high amounts of sodium, which may contribute to elevated blood pressure during pregnancy. This can increase the risk of preeclampsia, a serious pregnancy complication.
  • Nutrient deficiencies: Ultra-processed foods are often low in essential nutrients, such as fibre, vitamins, and minerals, which are crucial for maternal health and fetal development.

Impact of Ultra-Processed Foods on Fetal Health

The harmful effects of ultra-processed foods can extend beyond maternal health and impact fetal development as well:

  • Increased risk of fetal growth restriction (FGR): FGR is a condition characterized by slowed fetal growth. Ultra-processed foods, particularly those low in protein and essential nutrients, may increase the risk of FGR.
  • Increased risk of obesity in offspring: Children born to mothers with high ultra-processed food intake during pregnancy may have an increased risk of developing obesity later in life. 

Recommendations for Limiting Ultra-Processed Food Consumption

From Australian national dietary surveys we know that over one-third of Australians energy intake (kilojoules) come from ultra-processed (i.e. junk food and drink).  That’s one bite in every three.

Given the potential risks associated with ultra-processed food consumption during pregnancy, healthcare providers recommend that pregnant women prioritise a diet rich in whole, minimally processed foods.

Here are some practical tips for limiting ultra-processed foods:

  • Focus on whole foods: Fill your plate with nutrient-rich whole foods like fruits, vegetables, legumes, whole grains, and lean proteins.
  • Cook at home: Prepare meals at home using fresh ingredients whenever possible. This gives you control over the ingredients and reduces the temptation to rely on packaged, heavily processed foods.
  • Read food labels carefully: Pay attention to food labels and identify ingredients that indicate ultra-processing. These include preservatives, emulsifiers, sweeteners, and artificial colours and flavours.
  • Limit sugary drinks: Avoid or significantly reduce consumption of sugary drinks, including soft drinks, fruit juices, and sweetened coffee beverages. Make water your drink of choice.
  • Choose whole-grain over refined grains: Opt for whole-grain products like whole-wheat bread, biscuits and cereals, and quinoa over refined grains like white bread and processed biscuits and cereals.
  • Snack on healthy alternatives: Replace unhealthy snacks like chips and biscuits with nutrient-rich options like fruits, vegetables, nuts, and yoghurt.
  • Seek professional guidance: Consult with an accredited practising dietitian for personalised advice on limiting ultra-processed foods and creating a balanced, nutrient-rich diet during pregnancy.

Ultra-processed foods, while convenient and appealing, pose significant risks to both maternal and fetal health during pregnancy.

By prioritising whole, unprocessed foods and limiting ultra-processed options, pregnant women can promote their own well-being and ensure optimal health outcomes for their developing babies.

Remember, making informed dietary choices during pregnancy is an investment in your health as well as the health and wellbeing of your baby.

Do you need help in making changes to your dietary routines?

Our specialist maternal health dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals.

 

 

EXTRA READINGS AND REFERENCES:

https://www.globalfoodresearchprogram.org/wp-content/uploads/2021/04/UPF_ultra-processed_food_fact_sheet.pdf

https://www.abc.net.au/news/2023-12-16/dependency-ultra-processed-foods-history-health-concerns-experts/103196858

https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-022-01298-w#:~:text=Ultra%2Dprocessed%20food%20intake%20during%20pregnancy%20and%20postpartum%20may%20increase,environment%20and%20breastfeeding%20%5B5%5D.

https://pubmed.ncbi.nlm.nih.gov/36235585/

 

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IMAGE DESCRIPTION: Stack of four donuts with pink icing and covered in coloured sprinkles

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Five important things to consider when becoming pregnant after weight loss surgery.

What is bariatric surgery?

Bariatric surgery, also known as weight-loss surgery, is a type of surgery that involves making changes to your digestive system to help you lose weight. It is designed to make the stomach much smaller, which causes you to feel full after eating only a small amount of food.

The most common types in Australia are gastric bypass (called Roux-en-Y gastric bypass) and gastric sleeve surgery (called sleeve gastrectomy). Lap band surgery (called gastric banding) is also a type of bariatric surgery.

 

How does bariatric surgery help fertility problems?

Bariatric surgery can help you lose significant amounts of weight and improve your overall health. Being above your most comfortable or healthy weight may trigger hormone imbalances that can affect your ovulation cycles and make it harder to get pregnant. Moving towards a healthier weight can help address these issues. Improved fertility results from promoting more predictable ovulation cycles and reducing insulin resistance.

Significant weight loss can lead to dramatic fertility improvements. As such, it is important to consider contraception following this type of surgery and not to try to become pregnant straight away. This is for a number of reasons. The first is that it  gives your body time to lose weight (and importantly, stabilise) before conceiving. Secondly, delaying conception also allows your body’s vitamin levels to stabilize, which reduces the risk for fetal malnutrition as well as complications like premature birth and low birth weight.

Here are five important tips for women who want to fall pregnant after bariatric surgery:

  1. Wait at least 12 to 18 months after surgery before trying to conceive. This will give your body time to heal and adjust to the changes caused by surgery.
  2. Reach and maintain your most comfortable or healthy weight before getting pregnant. This will help to reduce the risks of complications during pregnancy. You should not be actively trying to lose weight.
  3. Eat a nourishing diet and take an appropriate multivitamin. This will help to ensure that you are getting all the nutrients that you and your baby need. Bariatric surgery causes malabsorption, a significant reduction in nutritional intake, or both. Following this type of surgery you need lifelong multivitamin supplementation. A “pregnancy multivitamin” will not be enough.
  4. Be as physically active as possible. Prioritising movement, reducing sitting time and finding activities that you enjoy all support your health and wellbeing. Think bone, heart, and mental health as well as helping to manage your weight and metabolic and reproductive health.
  5. See your health care professional team regularly for antenatal care. This will help to ensure that your pregnancy is progressing normally.

How can a dietitian help?

At a minimum, a pregnant person who has had bariatric surgery should see a dietitian in early pregnancy and then approximately every trimester. Bariatric surgery can change the way your body absorbs nutrients, so you can be at increased risk of developing nutrient deficiencies.

Once you become pregnant you have the additional issues of juggling:

  • increased requirements for protein and most micronutrients,
  • the pregnancy symptoms that can further affect your intake (nausea, vomiting, reflux, constipation, food aversions), and
  • the need to monitor your weight gain closely, especially in the second and third trimesters.

It is important to talk to your bariatric surgery team and a maternal health accredited practising dietitian about your specific needs and to develop a plan to make sure that you are getting all the nutrients that you and your baby need and that this is monitored through blood tests.

The dietitians at Lifestyle Maternity are expert maternity dietitian who have also worked with bariatric surgeons, providing care to their patients. For further information book an appointment with a Lifestyle Maternity Dietitian.

References:

Queensland Clinical Guidelines. Obesity and pregnancy (including post bariatric surgery). Guideline No. MN21.14-V6-R26. Queensland Health. 2021.

 

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Is what and how you eat working for you…or against you?

We think ‘diet’ is a four-letter word.

Food restriction or “dieting” means intentionally depriving yourself. Ongoing deprivation is generally only ‘successful’ for a certain amount of time before we ‘fall off the wagon’ and start eating for comfort or to rebel against the ‘diet’.

Initially we might feel temporarily better before we inevitably become disappointed or frustrated with ourselves that we ‘failed’ and decide to “diet” again.

Why does the diet industry thrive? Repeat business!

Does this cycle sound familiar?

The majority of clients that we see for weight management are already aware of what an ‘everyday’ food and a ‘sometimes’ food is, yet struggle to reach or maintain their most comfortable weight. Why is that?

When working towards your weight loss goals it is imperative to not only look at what you eat but also why you eat, how you eat and where you eat.

We are all capable of eating when we are not physically hungry and it is quite normal to do this on occasion. This is called ‘non-hungry eating’. Do it too often however and this type of eating behaviour can result in unwanted weight gain or difficulty losing weight.

If we can reduce the amount we are eating when we don’t really want it, as well as reduce the amount we are eating when we don’t really enjoy it, it will make reaching a healthy, comfortable weight easier without relying on extreme diet restrictions.

Experience tells us that in many situations, a particular type of food might taste great initially, but if we pay attention to the taste, texture and flavour, surprisingly quickly the food becomes less pleasurable.

Being more aware of whether or not we are enjoying the food we are eating is an important step in reducing the overall amount of food we eat.

Do you start off enjoying something but then just keep eating to finish it off?

The If not dieting© ‘Law of Diminishing Pleasure’ is a concept that can assist us to eat less, while at the same time increase our enjoyment from food. It can show us that if we eat with awareness, the more we eat of a particular food the less pleasure we receive as we continue to eat that particular food. It applies to all types of food that we eat although the rate of decrease will vary for various types of foods.

By being more mindful of this decrease in pleasure we can continue to eat all types of foods (everyday and sometimes foods), however learn to eat less by stopping earlier – when our enjoyment has diminished.

Lifestyle Maternity Dietitians specialise in dietary counselling methods that focus on the behaviour of eating. We use a coaching approach to weight management and healthy eating that draws on evidence based strategies to promote a ‘life-skills’ focus to facilitate lifestyle change to assist our clients achieve a more comfortable and healthy weight.

For further information or advice on being a healthier you, make an appointment here.

 

IMAGE CREDIT:  Nicolas Hoizay/Unsplash

IMAGE DESCRIPTION: Looking down into a spiral staircase

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Controlling Non Hungry Eating: one piece of the puzzle for achieving your most comfortable weight

One of the most common techniques our Lifestyle Maternity Dietitians use with clients is a range of strategies to help them identify their patterns of Non Hungry Eating, also known as NHE.

WHAT IS NHE?

 Non hungry eating is eating when you aren’t physically hungry for food.

HOW CAN I TELL IF I DO ANY NHE?

 Ask yourself the following questions:

  • Do I usually eat a piece of cake that someone has baked for me even if I am not hungry, because I don’t want to offend them?
  • Do I finish what is on my plate when I am eating out, even if I feel full before all the food is finished, so that I don’t waste it?
  • Do I ever overeat a food because it is really delicious? (E.g. sometimes it is hard to eat just one Tim Tam!)
  • Do I ever eat something like a chocolate bar or have a few glasses of wine after a really long, stressful day to make myself feel better?

These are just some examples of NHE – and there are many more!! Some NHE is normal and many people do it. When we end up doing a lot of NHE it can be hard to maintain a comfortable weight and it may also contribute to weight gain.

WHAT ARE SOME TIPS I CAN USE TO REDUCE MY NHE?

  • Question your hunger levels before eating. Do your best to only eat when you are physically hungry.
  • Don’t restrict foods; tell yourself, “I can have it if I want it, but am I really hungry for it?
  • Avoid eating when you are distracted (E.g. in the car, in front of the TV, when you are working) as it is hard to really assess hunger levels when you are doing other things.
  • Eat off a plate. Don’t eat out of packets as you can’t see the volume you are eating when you do this. This will help increase your awareness of how much you are eating.
  • Keep a food diary and also record your hunger levels before and after meals and snacks.
  • If you are consuming high calorie foods and fluids to comfort yourself (E.g. after a bad day) consider other options other than eating to comfort yourself such a going for a walk, taking a hot shower or long bath, talking to a friend or streaming an episode of your favourite show.

If you would like to learn more about identifying your NHE triggers, strategies to reduce NHE episodes or how to eat mindfully make an appointment here.

To read more about NHE and other techniques to help you be the healthiest you can be, resulting in achieving and maintaining a comfortable and healthy weight without being deprived of food or losing quality of life AND to enjoy food without feeling guilty, visit Dr Rick Kausman’s website.

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IMAGE DESCRIPTION: 5 red apples in a row against a grey background

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Can what I eat and how I move help my Polycystic Ovary Syndrome?

What is PCOS?

Polycystic Ovary Syndrome (PCOS) affects around 10% of Australian women in their reproductive years. This is due to hormonal changes.

This ‘syndrome’ is linked to a range of health issues for affected women, trans or non-binary people. In the short term, those with PCOS may have reduced fertility and difficulty conceiving. In the longer-term obesity, diabetes and cardiovascular disease are more likely for people with PCOS.

Normally the ovaries produce large amounts of the female hormone oestrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels are often mildly increased.

The causes of PCOS are unknown. In some cases, it seems to run in the family whereas for other women the condition only occurs when they are above their most healthy weight.

Women who have PCOS may experience:

  • Irregular menstrual cycles – menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average.
  • Amenorrhoea – some women with PCOS do not menstruate, in some cases for many years.
  • Infertility – related to less frequent, incomplete or absent ovulation.
  • Increased body hair (hirsuitism)
  • Obesity
  • Acne

There may also be long-term health risks. Recent research suggests that PCOS is related to insulin resistance and the development of type 2 diabetes. Some women with PCOS develop type 2 diabetes, especially if they are overweight.

What is the latest research on PCOS and lifestyle changes?

Recently, new international evidence-based guidelines for the assessment and management of PCOS were released. This large body of work documented results from studies around the world and gives direction for the best treatment steps to take.

A take home message from these guidelines is the important role of ‘lifestyle management’ as the first line of therapy for PCOS and outline the clear benefits that result from a very achievable weight loss and increase in physical activity.

Do I have to get back to my ‘healthy’ BMI range for me to see improvements in my health?

No, the good news is that research shows that achieving a loss of just five to ten percent of your body weight, whatever weight you are at now, has significant effects for fertility and symptom management in women with PCOS. What might this look like? For most women, it is a loss of only 4 to 5 kg. Further health benefits come from greater losses, and are enhanced by increasing physical activity.

How active do I have to be to get health benefits?

A good goal is at least half an hour of moderate-intensity physical activity on most, preferably, all days. You do not have to do it all at once. Your exercise can be spread over the day, in ten minute blocks. Try three ten minute walks, or two fifteen-minute periods of activity.

What does moderate-intensity activity mean? Moderate-intensity means you are exercising at a comfortable pace. A good guideline is the “talk test” – you should be able to maintain a conversation easily without being short of breath.

What happens if I am already in my healthy BMI range?

Maintaining your weight in the healthy range can help prevent symptoms and longer term health risks for women with PCOS. Being a healthy weight is a balancing act: having a good knowledge of nutrition is important, but we also need to understand the reasons for why we eat, how we eat, what we eat, who we eat with and where we choose to eat. Believe it or not, there is a lot more to reaching and maintaining a comfortable weight than counting up kilojoules!

Dietitians are trained to take a key role in assisting women with PCOS to manage their symptoms. Here at Lifestyle Maternity, specialist women’s health dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. We look forward to supporting you on your journey to better health and quality of life. For further information book an appointment with a Lifestyle Maternity Dietitian or enrol in an online, self-paced course.

 

Interested in the new PCOS app that was produced to accompany these guidelines? Check it out here

 

 Figure 1. The Lifestyle and PCOS infographic produced to accompany the new PCOS guidelines.

 

 

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Image description: Sugar snap peas with one pod open, showing three peas.

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Alcohol could affect your fertility more than you think

Most people are aware that alcohol should be avoided in pregnancy. But did you know that drinking alcohol can affect fertility?

Drinking any amount of alcohol can make it more difficult to conceive. Despite no definite cut off with alcohol intake and fertility, it is recommended that people do not drink when trying to conceive.

How much is enough?

This advice is supported by recent research from the US that showed the associations between drinking alcohol and decreased chances of successful conception.

It is thought that alcohol consumption disturbs the delicate sequence of hormonal events around ovulation, fertilisation, and implantation. Even light drinking. (What?!)

Aussie, Aussie, Aussie…

Socialising and drinking in Australia tend to go hand in hand. Heavy drinking is seen as acceptable in almost all social situations, from weddings to sports matches, and even at baby showers.

Binge drinking is not uncommon – one in three Australians drink more than they should on a single occasion. (This resource from Your Fertility has a great run down on what a standard drink looks like).

Want more reasons?

Reducing or quitting alcohol can improve your life in many ways. It can:

  • improve your mood and sleep,
  • increase your energy,
  • improve your relationships with your loved ones,
  • help you perform better at work,
  • lower your risk of long-term health problems such as cancer and heart disease, and
  • save you money.

Here are ten top tips from UK’s drinkaware on how to socialise without alcohol.

  1. Plan ahead. If you know you don’t want to drink on a night out, a little bit of planning ahead can make things much easier. Deciding on an alternative drink to have before you go out can also help you avoid stumbling.
  2. Tell people. This can have a few benefits – announcing your intentions can give you the confidence and motivation to stick to them. Friends can also offer support if you need it, and it helps avoid any awkward moments.
  3. Be ready for peer pressure. People will usually move on or respect your decision if you stand firm.
  4. Explore alcohol-free alternatives. Alcohol-free beers, wines and spirits are an easy replacement for your usual tipple.
  5. Organise some alcohol-free activities. Some classic drink-free nights out that never get boring include trips to the cinema, late-night food markets, theatre, or bowling.
  6. Watch your savings grow. Then every month, enjoy putting that money towards a treat or something else you’ve been meaning to get.
  7. Try some new hobbies and grow your network. You might have an old interest you always wanted to pursue or try something completely new.
  8. Get active. Not only will you be getting the health benefits of drinking less, like more energy and better sleep but you’ll be getting fit too.
  9. Have some plans for the morning after. Make sure it’s something you really look forward to and you’ll be more determined to stay alcohol-free the night before.
  10. Celebrate your progress. Drink-free nights are something to be proud of, so celebrate them. You’ve stuck to your goals, saved some money, and made a great step towards improving your health and fertility.

 

If you need more help or support please speak with your GP or try one of the available helplines like Hello Sunday Morning or Counselling Online.

 

IMAGE CREDIT: Unsplash/ Wine Mattheieu Joannon

IMAGE DESCRIPTION: Three wine glasses being held up together to touch

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A dietitian’s diary of managing morning sickness

Elated is an understatement to the feeling of finding out that I was pregnant. And of course being a dietitian, I began planning my meals and snacks to optimize my nutritional intake and ensure I could be as healthy as possible for my growing baby.

Fast forward one week and this plan went completely down the drain…literally. Morning sickness had struck without warning and here I was facing the toilet bowl more frequently than my dinner plate. While it is referred to as morning sickness it was certainly not the case. I felt miserable all day and could not stand the sight and smell of numerous foods. I even found the simple task of brushing my teeth to be a battle in keeping my stomach contents down.  And not only was that gigantic pregnancy multivitamin difficult to swallow thanks to my extremely sensitive gag reflex, but it often made me feel even worse afterwards. So how would it be possible to follow a balanced diet and provide my baby with all the vitamins, minerals and nutrients to give them the healthiest start to life?

Unfortunately, there is not a magical cure for morning sickness, but here are a few strategies that I followed to help alleviate my symptoms.

 

  1. I had small frequent sips on water and other fluids.

 Why? To prevent dehydration which can be dangerous to both yours and baby’s health.

 

 

  1. I chose much smaller portion sizes and would eat a small meal or snack every two hours.

 Why? Because having an empty stomach or alternately a very full stomach can make nausea worse.

 

 

  1. I tried to include carbohydrate containing foods and protein rich foods at each meal or snack.

 Why? There is some evidence that this may improve symptoms of nausea and vomiting.

 

 

  1. I avoided high fat foods (like fried foods, full cream dairy and fatty meats).

Why? These foods take longer to digest and sit in your stomach for longer.

 

 

  1. I avoided strong cooking aromas or foods that made me feel worse.

Why? Strong smells can worsen nausea and put you off your meal and some women develop particular food aversions during pregnancy. Remember to re-introduce any excluded foods once you start to feel better.

 

 

  1. I swapped my big pregnancy multivitamin to a much smaller tablet containing just folic acid and iodine. Before changing your supplement it is recommended to discuss it with your doctor or dietitian.

Why? Because most pregnancy multivitamins contain a large dose of iron, that can be harsh on an already sensitive stomach. Also, it is much easier to swallow a smaller tablet. Folic acid and iodine are the two minimum essential nutrients to supplement during pregnancy. Folic acid reduces the chance of neural tube defects and iodine is particularly important for baby’s brain development. Once you are feeling better it is a good idea to trial your regular pregnancy multivitamin again, but it is still ok to stay with your folic acid/iodine supplement all the way through (and remember that your iodine needs go UP when you are breastfeeding!).

 

 

  1. I waited…and waited…

Why? Fortunately most women find that morning sickness symptoms tend to ease on their own by the second trimester. Hence, time may eventually provide the best relief.

 

 

This was my typical days intake:

On waking up and before hopping out of bed:

  • 1-2 Sao crackers

Breakfast:

  • 1-2 pieces of toast with a very light scraping of margarine and vegemite
  • ½ glass of reduced fat milk

Morning Tea:

  • Piece of fruit
  • Salt and vinegar rice crackers or snack size tiny teddy pack

Lunch:

  • Pureed soup with cheese and a bread roll

Afternoon tea:

  • Popcorn
  • Tub of low fat yoghurt

Dinner:

  • 2/3 cup basmati rice
  • Fresh sticks of celery, carrot, cucumber and capsicum
  • Small piece of tofu or plain meat (cooked by my hubby while I was hiding from the cooking odours in the opposite end of the house)

Supper:

  • Piece of fruit
  • ½ glass of reduced fat milk

 

Do not be too concerned if you lose a small amount of weight because of nausea and vomiting, as this weight will usually return. However, if you are experiencing a severe or prolonged case of morning sickness it is important to speak to your Obstetrician or Midwife. In some severe cases you may require some medication to help control the nausea and vomiting or a drip to help you rehydrate.

 

Finally, if you are finding it difficult to regain lost weight and struggling to eat a balanced diet it may be beneficial to consult a Dietitian who can provide you with individualised advice. Please reach out to Lifestyle Maternity if you’d like some nutrition help at this time.

 

 

IMAGE CREDIT: Sergey Kotenev/ Unsplash

IMAGE DESCRIPTION: Stack of 7 crackers with one leaning against the stack

AUTHOR CREDIT: Camille Davis, APD

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Help! I’ve got gestational diabetes and my blood glucose readings are high.

What is gestational diabetes?

Gestational Diabetes Mellitus (GDM) or gestational diabetes (GD) is a type of diabetes that occurs during pregnancy. It is diagnosed following a 2-hour Oral Glucose Tolerance Test (OGTT) at around 24 to 28 weeks of pregnancy.  

Some women whose health, pregnancy or family history put them at a higher risk will also have this test early in their pregnancy.  

The OGTT is a blood test ordered by your GP, obstetrician, or antenatal clinic. This is considered a ‘universal test’, which means all pregnant women should have this test. 

What happens if my blood glucose levels stay too high in pregnancy?

If high blood glucose levels (BGLs) are not treated you and your baby may experience a number of problems.  Women with sub-optimal BGLs are at much higher risk of developing type 2 diabetes mellitus after pregnancy. This risk increases when women are not supported to follow a healthy lifestyle during and after pregnancy. This risk is exacerbated by postpartum weight retention in the longer term.

A woman with GDM can have a baby that has an unhealthy growth pattern before it is born.  Glucose crosses the placenta into your baby’s bloodstream. If your BGLs are high, your baby will receive high amounts of glucose.  A baby’s insulin still works well meaning, even in utero, it is able to store this extra glucose and will grow faster and fatter.

This means the growing baby can be at risk of:

  • being a very large baby
  • being born early
  • being distressed during birth, and/or
  • having low blood glucose levels at birth.

Babies born to mums who have had sub-optimal BGLs are also more likely to be overweight or obese into their adult lives, and have diabetes themselves.

What do I do if I have a high BGL reading?

If you have a high BGL it is important to work out why so you can minimise the chance of it happening again. Ask yourself the following questions to help work out why your level might be high.

Did you eat a larger meal than usual (e.g. eating out)?

Check your serve sizes against the portions list and sample meal plan provided by your dietitian.

Did you eat too much carbohydrate?

Take care with large serves of bread, pasta, noodles and rice – these can increase your BGLs.

Try to choose slow release (low GI) carbohydrate e.g. grain bread in place of white, high fibre cereal rather than low fibre and fresh fruit rather than juice. Make sure you choose ‘slow’ rather than ‘no’ carbs.

Did you wait long enough after eating before your BGL test?

Always wait for a full hour after starting to eat a meal before testing and delay snacks until after you test.

Were your hands clean?

Always wash your hands prior to testing, dirty hands can affect your BGL reading.

Have you been taking your diabetes medication as prescribed?

If you have been prescribed insulin or other medication to manage your gestational diabetes missing this medication will cause a high BGL reading.

Were you active after your meal?

Sitting down immediately after your meal can cause a higher BGL reading than if you do some activity such as a short walk or some housework.  Exercise can help to lower your BGL after a meal.

Do you need more help?

Our specialist maternal health-GDM dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals. 

 

 

 

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Pregnancy nutrition – how do you measure up?

Growing a healthy baby relies on getting the extra nutrients that your baby needs for growth and development.  The food and drink you eat is the main source of nutrients for your growing baby. In pregnancy, there are amounts and types of food that are recommended to eat each day to get all the nutrients you and bub need. However, in many surveys across pregnancy, the large majority are not meeting these recommendations.

What do women eat during pregnancy?

Only 10%–40% of pregnant women meet current recommendations for fruit and vegetable intake.

Less than 1% achieve recommenced breads and cereal intakes and extremely low numbers meet pregnancy Nutrient Reference Values for folate, iodine, calcium, zinc, and fibre from food alone.

Less than half consume the recommended nutrient supplements (iodine, folic acid) pre-pregnancy with minimal change once pregnancy is confirmed.

In a study of over 800 women Australia-wide, it was found that no woman had dietary patterns that aligned with recommendations from the Australian dietary guidelines. However, over 60% believed that they did.

A poor-quality diet in pregnancy has been linked with a higher risk of unhealthy weight gain, high blood pressure and anaemia. It can also contribute to a lower birth weight and increased risk of chronic disease in babies into their adult lives.

How do you measure up?

The Australian dietary guidelines recommend expectant mothers eat two serves of fruit and five serves of vegetables every day. Are you getting your ‘2 & 5’ each day? A good way to check how you’re going is by writing out a fruit and vegetable tracker like the one below.

Meal Fruit Vegetables
Breakfast Type:

 

Serves:

 Type:

 

Serves:
Morning snack Type:

 

Serves:

 Type:

 

Serves:
Lunch Type:

 

Serves:

 Type:

 

Serves:
Afternoon snack Type:

 

Serves:

 Type:

 

Serves:
Dinner Type:

 

Serves:

 Type:

 

Serves:
Supper or dessert Type:

 

Serves:

 Type:

 

Serves:
Total serves  

 

 

How might you use the tracker to add more fruit and vegetables to your day?

Work through the tracker thinking of a usual day, or what you ate yesterday, to see how you measure up.

For example, you might have a banana on your cereal (one serve of fruit), some blueberries for dessert (another serve of fruit) and a cheese and salad sandwich for lunch (one to two serves of vegetables depending on how much salad you add). This totals two serves of fruit and one to two serves of vegetables that day.

The tracker will help you see where there are opportunities to add more fruit and vegetables during the day. For example, including them at meals where you haven’t filled in a box or by dishing out larger serves at your meals.

No matter how close (or far!) you are from the recommendations, pregnancy is the perfect time to optimise your eating habits for the health of you and your growing bub.

Need more help?

We offer individual consultations and self-paced online courses as we know you all have different learning styles and budgets. Attending an individual session OR online course with a Lifestyle Maternity dietitian will allow you to assess your diet against recommended guidelines and identify changes that can be tailored to your lifestyle and dietary preferences.

In our self-paced online course you will be encouraged and guided to assess your own health habits against pregnancy recommendations, participate in activities around setting health goals for optimal nutrition and learn how to adapt your routines with confidence to achieve these goals to make them stick. More information here.

An individual consult involves a more thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. If you would like further information book an appointment  now.

 

 

 

 

 

 

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IMAGE DESCRIPTION: Photo being taken of a colourful salad in a bowl with image viewed through phone screen. Two hands holding phone and watch on left wrist turned up to face the camera.

 

REFERENCES:

Blumfield M, Hure A, Macdonald-Wicks L, Patterson A, Smith R, Collins C. Disparities exist between national food group recommendations and the dietary intakes of women.BMC Womens Health 2011;11:37.

Blumfield M, Hure A, Macdonald-Wicks L, Smith R, Simpson S, Raubenheimer D, et al. The association between the macronutrient content of maternal diet and the adequacy of micronutrients during pregnancy in the women and their children’s health (watch) study.Nutrients. 2012;4:1958–76.

McKenna E, Hure A, Perkins A, Gresham E. Dietary Supplement Use during Preconception: The Australian Longitudinal Study on Women’s Health.Nutrients. 2017;9:1119.

Mishra G, Schoenaker D, Mihrshahi S, Dobson A. How do women’s diets compare with the new Australian dietary guidelines?Public Health Nutrition. 2015;18(2):218-25.

Slater K, Rollo M, Szewczyk Z, Ashton L, Schumacher T, Collins C. Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations? Nutrients. 2020;12(8):2438.

Wilkinson SA, Schoenaker DAJM, de Jersey S, Collins CE; Gallo L et al. Exploring the diets of mothers and their partners during pregnancy: Findings from the Queensland Family Cohort pilot study. Nutrition & Dietetics. 2022; 79 (5): 602-615.

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Going against the grain – What are you missing out on if you go grain-free in pregnancy?

Grain foods have received a lot of unfavourable attention recently.  Many popular diets label them ‘high carb’ or ‘unhealthy’ and promote removing them from our diet. However, there is very little evidence that going grain-free will be anything but troublesome. In fact, it may even be detrimental to our health. Read on to find out why grains are important, particularly when we are pregnant.

 

What are grain foods?

Food originating from grains include wheat, oats, rice, barley, millet and corn. Grain foods are one of the five main food groups. Foods are grouped together based on the types of nutrients they provide. Eliminating an entire food group can make it very difficult to get all the nutrients we need. For example, two-thirds of our intake of vitamin B1 (Thiamin) comes from this food group!

 

What nutrients do grains provide?

Grain foods are a good source of carbohydrate – the main energy source for our body and particularly our brain. Without sufficient energy we may experience fatigue, difficulty concentrating, mood swings and dizziness (not ideal when we are growing a baby!)  Also, without carbohydrate our body burns fat for energy. This might sound like a good thing but it can result in weight loss and high levels of ketones in the blood. It is unclear whether ketones can affect a growing baby, but some studies seem to suggest they can be harmful.

Grain foods provide fibre. Many pregnant women experience constipation brought on by hormone changes. Eating high fibre carbohydrates can help alleviate this side effect. Wholegrains are the best sources of fibre. Wholegrain foods include multigrain or wholegrain breads and crackers, oats, muesli, quinoa, buckwheat and popcorn (hold the butter). Diets high in wholegrains also tend to have a lower GI which means they get digested more slowly. This helps to keep us feeling full for longer and can sustain our energy levels. It is wise to limit refined or highly processed grains like white bread, sugary breakfast cereals, biscuits and cakes as these contain little fibre and often have lots of added sugar (these are also called ‘ultra-processed foods’).

Grain foods provide lots of different nutrients including vitamins and minerals. Two key nutrients for pregnancy are folate andiodine, of which grain foods are good sources.

Folate or folic acid is a B-vitamin. Sufficient folic acid intake is important to reduce the risk of neural tube defects in a developing baby. For women planning a pregnancy and during the first three months of pregnancy, it is recommended to take a daily folic acid supplement that contains at least 400 micrograms (μg) of folic acid, in addition to eating foods that are rich in folic acid. Foods high in folate or folic acid include cereals, bread, fruits and vegetables.

Pregnant and breastfeeding women have increased iodine requirements. Iodine is important for growth and development, especially of the baby’s brain. As most bread in Australia is made with iodised salt, this is a good reason to keep it in your diet while pregnant. Other food sources of iodine include fish, eggs and dairy foods. Women should still take a supplement containing 150μg of iodine when planning a pregnancy, throughout pregnancy and while breastfeeding.

What are the health benefits of grains?

As well as providing important nutrients, grains are necessary for proper digestion and satisfying hunger and taste.  Wholegrains can also help stabilise blood glucose levels and lower cholesterol. Many studies have shown that adequate wholegrain intake can reduce our risk of obesity, diabetes, heart disease and some cancers.

How much do I need to eat each day?

The Australian Dietary Guidelines recommend women who are pregnant eat 8 ½ serves of grains each day.

One serve is equal to:

  • one slice of bread,
  • ½ cup cooked porridge, pasta, rice, quinoa, polenta or barley,
  • 2/3 cup cereal flakes,
  • ¼ cup muesli or
  • 3-4 crispbreads.

Adequate grain intake might look like:

Breakfast                      1 cup porridge (2 serves)

Morning tea                  yoghurt with ¼ cup muesli (1 serve)

Lunch                           wholegrain sandwich or wrap (2 serves)

Afternoon tea               3-4 wholegrain crackers with cheese (1 serve)

Dinner                          1-1.5 cups rice/pasta/quinoa (2-3 serves)

 

Eating moderate amounts of nutritious carbohydrates, rather than eliminating them altogether, will help make sure you and your baby are as healthy as possible.

If you would like help to make sure you are getting all the vitamins and minerals you need during pregnancy, here at Lifestyle Maternity, specialist women’s health dietitians are available to support you. If you would like further information book an appointment with a Lifestyle Maternity Dietitian now.

 

 

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IMAGE DESCRIPTION: Spiral pasta in a tomato sauce in a white bowl, with a fork resting on the pasta. Cherry tomatoes and garlic bread pieces are around the bowl.

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What to eat before and after the gestational diabetes test

What is gestational diabetes?

Gestational Diabetes Mellitus or GDM is a type of diabetes that occurs during pregnancy. It is diagnosed using a 2-hour Oral Glucose Tolerance Test (OGTT) at around 26 to 28 weeks of pregnancy*.

The OGTT is a blood test ordered by your GP, obstetrician, or antenatal clinic. This is a ‘universal test’, which means all pregnant women should have this test.

How do I prepare for my OGTT?

Discuss any medication, both prescription and non-prescription, with your doctor or midwife. You may need to stop medications before the test. The OGTT is a fasting test, so have nothing to eat from 9pm the night before the test. Water is permitted in small amounts. You will need to avoid strenuous exercise and smoking for 8 hours before the test. During the test you will need to sit for the two hours. Even walking around the shops can interfere with the test results.

Does my diet affect the outcome of the test?

Some written information provided to women can be a little misleading or hard to understand.

Some examples of (confusing) advice we have seen include…

“Continue to eat your normal balanced diet making sure you include at least 150 grams per day of carbohydrate for at least 3 days prior to the test. You diet should include cereals, grains, rice,  pasta, fruits, crackers and starchy vegetables such as potatoes, beans and corn”

and

 “..consume at least 10 serves of carbohydrate each day”

We get lots of questions from concerned women that “this seems to recommend a lot of carbohydrate!”. Many ask,

“Is this ON TOP of what I usually eat?”

and

“What happens if I don’t eat this?”

To make sense of this it helps to know how much carbohydrate is in food and how much most Australians eat.

First of all, the ‘minimum of 150g per day’ is easily consumed by most people. Serves of carbohydrate can be quantified in 15g serves and usually equates to a ‘serve’ of food. For example, a slice of bread, half a cup of pasta, a glass of milk, a tub of yoghurt, a medium potato, or an apple, orange or banana each contain about 15g of carbohydrate.

So, by having cereal and milk or toast for breakfast, a sandwich, bread roll or wrap at lunch, and meat with vegies (including a potato, sweet potato, or corn) or a stir fry with some noodles or rice at dinner, plus snacks through the day of fruit and yoghurt, or even plain biscuits, you will easily consume the minimum 150g of carbohydrate per day required.

Some studies have shown that not eating ENOUGH carbohydrate before your test might give a ‘false positive’ result – it might look like you have GDM when you do not (eek!).

To ensure you get the correct result following your OGTT we advise women to continue to eat a healthy balanced diet that includes foods from all the food groups in the days leading up to their test. Use the above examples as a guide to what you might eat throughout the day.

What happens after an OGTT?

If your results are normal you can continue with your usual antenatal care. If your blood glucose levels are raised you have GDM.  It is best practice for you to see an range of specialists including an endocrinologist, diabetes educator and a maternal health specialist dietitian to assist you in the management of GDM.

What changes do I need to make?

A healthy lifestyle incorporating diet and exercise is the starting point to best manage GDM.  Regular meals incorporating slow acting carbohydrates, reducing saturated fats and added sugars/ultra-processed foods and including regular walks and other physical activity will help manage GDM.

A dietitian is the best person to help you build your knowledge, skills and confidence to make these and many more changes to optimise your health with GDM.

Current research shows us that women with GDM who attend regular appointments with a dietitian during their pregnancy have a greater chance of managing their GDM and weight gain. This in turn helps baby to have good outcomes and reduces your risk of developing diabetes in the future.

So, how often should I see the dietitian?

All studies point to the benefits of ongoing contact and support from an expert maternal health dietitian when managing your GDM. Studies testing the effectiveness of GDM nutrition guidelines have shown improved pregnancy outcomes (less need for insulin and better control of blood glucose levels) when women saw a specialist maternal health/GDM dietitian a minimum of three times during their pregnancy + a postnatal review.

Our Director and Principal Dietitian, Dr Shelley Wilkinson, has applied these findings in health services she has worked in and collaborated with and now brings them to Lifestyle Maternity.

Our specialist maternal health-GDM dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals. At these appointments a dietitian can assist you to adjust your individual meal plan timing and the content of your diet to optimise your BGLs.

Practical suggestions to help you balance your dietary goals for GDM, manage your weight gain to your individual needs, and develop the healthiest baby possible will be negotiated and matched to your needs.

What does the Lifestyle Maternity GDM service offer?

We would love you to learn to manage your blood glucose levels while still meeting your pregnancy nutrition needs through participating in our innovative gestational diabetes mellitus (GDM) model of care.

 Once you book your GDM package with Lifestyle Maternity you will be sent:

  1. a one-page sheet that summarises your NEED-TO-KNOW dietary modifications. This will help you get your head around and changes you may need to make,
  2. an introductory video to support your first week after diagnosis. It’s a GDM explainer plus more in depth dietary information,
  3. a diary to start keeping a WEEK LONG food and blood glucose record. This will allow your Lifestyle Maternity dietitian to review your progress BEFORE your SECOND appointment with us.

Your individual consult will involve a thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. This will involve tailoring best practice nutrition guidelines to your personal circumstances and preferences to optimise your health once bub arrives.

The cost of the GDM package (your individual assessment and plan PLUS being sent the starter information sheet, PLUS video link and food and blood glucose diary paperwork, PLUS the review and assessment of this diary by an expert maternity dietitian) is $185. Current Lifestyle Maternity clients will received reduced rates for this appointment ($140).

Each subsequent “review” appointment costs $105. This includes out-of-appointment review of your BGLs and diary prior to each appointment. At your third appointment (your second ‘review’) you will receive a PeNut + Lifestyle Maternity GDM Cookbook (RRP $49). This will help give you extra meal time inspo and includes 30 dietitian-designed, low GI recipes (10 breakfasts, 10 lunch/dinners, and 10 snacks).

 

Don’t have GDM but still need general nutrition help?

We offer individual consultations and self-paced online courses as we know you all have different learning styles and budgets. Attending an individual session OR online course with a Lifestyle Maternity dietitian will allow you to assess your diet against recommended guidelines and identify changes that can be tailored to your lifestyle and dietary preferences.

In our self-paced online course you will be encouraged and guided to assess your own health habits against pregnancy recommendations, participate in activities around setting health goals for optimal nutrition and learn how to adapt your routines with confidence to achieve these goals to make them stick. More information here.

An individual consult involves a more thorough assessment of your dietary and lifestyle patterns with a personalised action plan being developed in collaboration with the dietitian. If you would like further information book an appointment  now.

* People from the groups below are those who would be considered at higher risk of GDM and should be tested for GDM in EARLY PREGNANCY.

  • Previous hyperglycaemia in pregnancy
  • Previously elevated blood glucose level
  • Maternal age ≥40 years
  • Ethnicity: Asian, Indian subcontinent, Aboriginal and Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African
  • Family history of diabetes mellitus (first degree relative with diabetes or a sister with gestational diabetes mellitus)
  • Pre-pregnancy body mass index >30 kg/m2
  • Previous macrosomia (baby with birth weight >4500 g or >90th centile)
  • Polycystic ovary syndrome
  • Medications: corticosteroids, antipsychotics

IMAGE CREDIT: Richard Jaimes/Unsplash

IMAGE DESCRIPTION: Pregnancy woman with young boy kissing her pregnant belly and looking at the camera

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Why am I told to avoid so many foods in pregnancy? Understanding food safety in pregnancy.

Sometimes it can feel like the list of foods to avoid in pregnancy is longer that what you are allowed to eat. Due to changes in a woman’s immune system during pregnancy, you are more susceptible to food poisoning. This is from the usual culprits – Salmonella, E.coli and Campylobacter – but also one you hear a lot about in pregnancy, Listeria. 

What is Listeria? 

During pregnancy women are more susceptible to getting Listeriosis by eating foods containing the bacteria Listeria which can cross the placenta. Symptoms may include fever, headache, tiredness, aches, pains, diarrhoea and/or nausea. It’s important to note that while symptoms may be mild in pregnant women, it can result in miscarriage, premature birth or, in rare cases, stillbirth.  

What does this mean for me now that I’m pregnant? 

This means extra care is needed for food storage, preparation and, of course, selection. To help reduce the risk of getting Listeriosis, here are the key things to remember: 

  • Practice good food hygiene by washing fresh fruit and vegetables before you eat them 
  • Refrigerate leftovers and consume within 24hours, reheating to a visibly steaming temperature 
  • Avoid buffet meals or ready-to-eat sandwich and salad bars
  • Avoid raw or cold seafood 
  • Consume only dairy products that have been pasteurised 
  • Avoid soft serve ice-cream or milkshakes/thick shakes with soft-serve as an ingredient 
  • Ask for all meats to be well-cooked 
  • Deli meats, including pre-packaged or freshly sliced off the bone, soft cheeses and pate should be avoided 
  • Ensure eggs are cooked through, no runny yolks! 
  • All sushi varieties should be avoided 
  • Actively discuss menu options with restaurants and cafes to make sure your meals are freshly prepared 

However, if you avoid all foods that carry a risk for harbouring listeria, it is likely that you will consume fewer nutrients. This is not ideal as you ARE growing a baby. 

 

You don’t have to go without! For every item on the “no” list, there are a number of alternative and this table will help to make those choices (source). 

Foods to avoid 

Safe alternatives to enjoy 
  • Deli meats  
  • Pre-sliced and pre-packaged meats 
  • Cold ready to eat chicken 
  • Meats cooked at home  
  • Tinned fish (two to three times per week) 
  • BBQ chickens, if eaten immediately when hot 
  • Chilled or raw seafood  
  • Sashimi or sushi 
  • Smoked salmon (or other smoked fish varieties) 
  • Oysters 
  • Pre-cooked shellfish including prawns and crabs 
  • Tinned fish including salmon and tuna (two to three times per week) 
  • Freshly cooked seafood, including shellfish, eaten hot 
  • Pre-packaged or pre-cut fruit, vegetables and salads 
  • Salad and sandwich bars 
  • Buffets  
  • Homemade salads with freshly washed ingredients 
  • Freshly cut and washed fruit 
  • Canned or frozen fruit and vegetables 
  • Soft cheese including brie, camembert, ricotta, feta and blue cheese 
  • Pate or meat spreads 
  • Hard cheeses such as cheddar 
  • Processed cheese 
  • Cream cheese spreads 
  • Plain cottage cheese 
  • Soft cheeses that are cooked and eaten when hot 

 

Pregnancy is the perfect time to optimise your eating habits for the health of you and your growing bub.  

For advice on how to tailor the recommendations to your lifestyle, make an appointment with Lifestyle Maternity to simplify your pregnancy journey by tailoring nutrition advice to your preferences and lifestyle. 

 

IMAGE CREDIT: Klara Avsenik Unsplash 

IMAGE DESCRIPTION: Sushi rolls on a platter with chopsticks resting to the left hand side 

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Making sense of gestational diabetes – diagnosis and diet

What is gestational diabetes? 

Gestational Diabetes Mellitus (GDM) or gestational diabetes (GD) is a type of diabetes that occurs during pregnancy. It is diagnosed following a 2-hour Oral Glucose Tolerance Test (OGTT) at around 24 to 28 weeks of pregnancy.  

Some women whose health, pregnancy or family history put them at a higher risk will also have this test early in their pregnancy.  

The OGTT is a blood test ordered by your GP, obstetrician, or antenatal clinic. This is considered a ‘universal test’, which means all pregnant women should have this test. 

Why do some women get GDM? 

GDM occurs as a result of changes in hormone levels as pregnancy progresses. These changes  can interfere with how some women’s insulin works. Insulin usually helps process glucose from the blood into the muscles (for energy) and liver (for storage and energy).  

What happens if my blood glucose levels stay too high in late pregnancy? 

If high blood glucose levels (BGLs) are not treated, a number of problems can be seen in a pregnant woman or her baby.   

Women with poorly-controlled BGLs are at much higher risk of developing type 2 diabetes mellitus after pregnancy. This risk increases when women are not supported to follow a healthy lifestyle or to healthily lose their pregnancy weight.  

A woman with GDM can have a baby that has an unhealthy growth pattern before it is born.  A baby’s insulin still works well so, even in utero (in the womb), it is able to store extra glucose and will grow faster and fatter. This means the growing baby can be at risk of: 

  • being a very large baby,  
  • having early delivery, 
  • being distressed during birth, and/or
  • having low blood glucose levels at birth.  

Babies born to mums whose BGLs have been higher than ideal, without good support for BGL management, are also more likely to be overweight or obese into their adult lives and have diabetes themselves.   

So, do I have to cut all sugar out of my diet to control my blood glucose levels? 

No. Although some foods we eat (carbohydrates) put glucose into our blood stream, cutting these foods out completely means we cut out all the nutritious goodness we need for a healthy pregnancy and a growing and developing baby. We also need carbohydrates to run our body – without them it is like a car running out of fuel. 

GDM is primarily managed by following a healthy well-balanced eating plan, taking into consideration carbohydrate intake and physical activity. If women’s BGLs are unable to be managed with diet and activity alone, medication such as insulin (injections) or metformin (tablets) are sometimes needed.   

Ongoing, regular contact with Diabetes Educators, Dietitians, and medical specialists during pregnancy is important for good BGLs and best outcomes for mother and baby.  

How many visits should I have with a dietitian? 

All studies point to the benefits of ongoing contact and support from an expert maternal health dietitian when managing your GDM. Studies testing the effectiveness of GDM nutrition guidelines have shown improved pregnancy outcomes (less need for insulin and better control of blood glucose levels) when women saw a specialist maternal health/GDM dietitian a minimum of three times during their pregnancy and a postnatal review.  

Our Director and Principal Dietitian, Dr Shelley Wilkinson, has applied these findings in health services she has worked in and collaborated with and now brings them to Lifestyle Maternity. Our specialist maternal health-GDM dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. If you need support, please make an appointment to help you achieve your goals. 

 

IMAGE CREDIT: Unsplash, Paul Lin 

IMAGE DESCRIPTION: Pregnant woman standing outside, side on, looking down at an orange gerbera  

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Why “2 & 5”? – understanding the science that supports our dietary guideline goals for fruit and vegetables

The Australian Dietary Guidelines recommend we ‘Go for 2&5’ … in other words, to enjoy two serves of fruit and five serves of vegetables every day.

Where does the recommendation for ‘2&5’ come from?

The benefits of eating fruit and vegetables have long been reported (by doctors, scientists and of course, our mothers!). Not only do they make for a colourful and tasty meal experience, but they also provide lots of nutrients that can help to keep us healthy and protect us from disease.

Scientists are beginning to discover more about how certain foods can protect us from disease. Vegetables and fruit contain phytochemicals, or plant chemicals, as well as a variety of vitamins and minerals. These ‘biologically-active’ substances have been linked to a reduced risk of cardiovascular disease, stroke and some cancers.

How much extra do I have to eat for health benefits?

Did you know that each additional serve of vegetables you eat each day reduces your risk of coronary heart disease?1 And that consumption of at least one and a half serves of fruit each day is associated with a reduced risk of stroke?1 Additionally, researchers have found that overall risk of mortality (dying) decreased by 5% for each additional serving of fruit and vegetables consumed per day (up to five serves per day, beyond which no further reduction in risk was seen).2

Different fruits and vegetables contain different nutrients and can therefore help protect our bodies in different ways. For this reason, it is a good idea to include a variety of fruits and vegetables in your diet – colour your meals and snacks with fruit and vegetables.

Fruit and vegetables may also help prevent excessive weight gain. They are low in energy (kilojoules) and high in fibre relative to other foods and help to ‘fill us up’.1 This reduces the risk of overeating which can cause weight gain.

After some practical (and yummy) tips to help? Read on…

If you’re finding it hard to get enough vegetables, you could try:

  • Aiming to fill half your plate (or meal) with salad or cooked vegetables at lunch and dinner,
  • Having grilled tomatoes, mushrooms, spinach or baked beans at breakfast (yes, legumes count as a vegetable too!), or
  • Including vegetable based dips like hummus or salsa with vegie sticks or crackers as a snack.

If your fruit intake is low, you could try:

  • Adding tinned fruit or sultanas to your breakfast cereal,
  • Making a fruit smoothie, or
  • Including fruit in your salads (such as peaches in a green, leafy salad or apple in potato salad or sultanas in a grated carrot salad).

Remember that each additional serve of fruit and vegies you eat each day can have a valuable effect on your health.

For more ideas on how to add extra fruit and vegies to your day make an appointment to see a Lifestyle Maternity dietitian. We can help tailor these recommendations to your individual needs and preferences.

[1] National Health and Medical Research Council. Australian Dietary Guidelines – providing the scientific evidence for healthier Australian diets. Canberra: National Health and Medical Research Council; 2013 Feb.

[2] Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu F. Fruit and  vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014; 349: g4490.

 

IMAGE DESCRIPTION: Close up of tomatoes, cucumbers, lettuce and carrots

IMAGE CREDIT:  Scen Scheuermeier/Unsplash

CO-AUTHOR: Elin Donaldson, APD

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Pregnancy weight gain – why just setting a number is the wrong conversation

Weight gain in pregnancy – it’s a hotly debated topic. Whether we post about it or discuss it with our antenatal colleagues we get some strong opinions and concerns.

“Yet another thing to feel guilty about while pregnant!”

 

“Is there any evidence that it makes a difference?”

 

“Setting a number for weight gain is just simply the wrong conversation!”

We agree!

Only focusing on a number, a simple target out of context, is not helpful and potentially even harmful.

Read on to see the history of weighing in pregnancy. We outline why it is important and how we are approaching best-practice care around healthy pregnancy weight gain for women at Lifestyle Maternity.

The history of weighing in pregnancy

Pregnancy weight gain advice has changed considerably over the years. This is because evidence has emerged about its links to the health of both a mother and her baby. The demographics of childbearing women has also changed (1).

  • In the 1930s, all women were advised to gain 14 pounds (in metric that’s 6.3kg) to decrease the risk of pregnancy complications.
  • In the 1970s, it was observed that increased pregnancy weight gain was associated with increased birth weight. It was surmised that pregnancy weight gain should not be restricted as it would likely be harmful with respect to birth weight.
  • From the 1970s to 1990s, there was a move away from the ‘one size fits all approach’. And in 1990 the US Institute of Medicine released their pregnancy weight gain guidelines. These were developed primarily in response to concerns about low birth weight infants and, at the time, there was very limited data for women with high body mass indices (BMIs).
  • Since then, overweight and obesity levels in childbearing women have increased dramatically. So too have complications associated with excess pregnancy weight gain. These include gestational diabetes, ‘large for gestational age’ babies and caesarean sections. Additionally, overweight levels amongst pre-schoolers have risen dramatically. These changes suggest excess weight gains are associated with negative maternal and infant outcomes. As a result the Institute of Medicine guidelines were revised to reflect optimal pregnancy weight gain for best outcomes for mothers AND infants.

 

Why do we focus on healthy weight gain in pregnancy?

Studies tell us that weight gain outside of the guidelines is linked with negative health consequences for both a mother and her baby. Pregnant women who gain weight in accordance with the US Institute of Medicine guidelines (adopted for use in Australia) have the lowest risk of pregnancy and birth-related complications.

These include both health and delivery complications. Women who gain weight above recommendations are more likely to have longer hospital stays, caesarean sections, high blood pressure and diabetes in pregnancy. They are also more likely to have trouble losing this weight after their baby is born and have difficulty breastfeeding. Women who do not gain enough weight are more likely to deliver their baby early.

What are the current pregnancy weight gain guidelines?

The amount of weight to gain in pregnancy differs based on a woman’s pre-pregnancy BMI. To work out your BMI divide your weight (in kilograms) by your height (in metres), squared. If you are using your calculator on your phone divide your weight by your height, and then divide it by your height again. Look in the table below to see the weight gain range for your BMI.

 

BMI (kg/m2)

 Singleton (one baby) pregnancy total weight gain range (kg) Rates of weight gain in 2nd and 3rd trimester (kg/week)

<18.5

 12 ½ – 18

0.51 (0.44-0.58)

18.5-24.9

 11 ½ – 16 0.42 (0.35-0.50)
25-29.9 7 – 11 ½

0.28 (0.23-0.33)
≥30 5 – 9

0.22 (0.17-0.27)

We take a holistic approach to supporting healthy pregnancy weight gain at Lifestyle Maternity.

Weight is more than just a number …

Having a focus on the numbers on a scale (or in a table!) can be unhelpful. It doesn’t tell us the quality of what a mum is eating and nourishing her growing baby with. It doesn’t tell us how full or hungry she is. And it doesn’t tell us how active she is.

An obsessive focus on weight out of context can be stressful and cause anxiety – so that’s why we believe that monitoring weight is just one part of the puzzle with healthy pregnancy weight gain. As dietitians we also want to make sure that women are making healthy food choices, eating to appetite, and being physically active, and that baby is growing appropriately on scans.  We also believe that we have a duty of care to support women in achieving these healthy lifestyle goals.

However, it is still important to track how a woman’s weight gain is progressing – to be able to make clinical decisions and to provide more support, when required. Just as action is taken when a blood pressure is shown to be high rather than just expecting it to change once it’s identified, we need to link the monitoring of weight gain to helpful ways to address it through dietary and lifestyle changes to ensure women have the healthiest pregnancies possible.

How do Lifestyle Maternity Dietitians talk about weight?

Societal stigma associated with obesity has relevance for all health professionals striving to maintain good patient relationships, whilst providing evidence-based care. Lifestyle Maternity Dietitians have undertaken a lot of work in this area to make sure they are supporting the women they see in the most caring and respectful way (2, 3, 4).

We have also been involved in training for our maternity colleagues who have told us that providing best-practice care is important to them, but they are scared of offending women and causing anxiety or blowing things out of proportion.

The research we have been looking into reminds us all that “words matter” and that terminology acceptable to women may differ from that routinely used by health professionals  (5). We are learning from research that words such as ‘weight’ and ‘BMI’ are more likely to be positively received than references to ‘fat’ and/or (morbidly) ‘obese’ (6,7)(No surprises there!).

We support the approach that when we have conversations with pregnant women about healthy weight gain goals we avoid direct reference to BMI categories (e.g. ‘underweight’, ‘overweight’, ‘obese’ etc.).  Simply stating “Based on your weight at the beginning of pregnancy, this weight gain is recommended for the healthiest pregnancy possible” is both respectfully and clinically appropriate.

Further to this, we also like to raise the important topic that food is neither good nor bad – it is morally neutral. Eating healthy food does not make someone good, just as eating less healthy food does not make someone bad. Rather than referring to food as good or bad, terms like every day and sometimes food are more appropriate.

What resources do Lifestyle Maternity Dietitians use to support healthy pregnancy weight gain?

We use a resource our Director and Principal Dietitian, Dr Shelley Wilkinson, developed during her PhD studies. This resource is called the Lifestyle Maternity Personalised Pregnancy Weight Tracker©. This evidence-based resource was developed to support healthy lifestyles during pregnancy. This easy-to-use tool takes the guess-work out of weight gain during pregnancy by allowing women to track their weight gain each week against international and Australian guidelines. All women who see the dietitians at Lifestyle Maternity will gain access to their BMI specific tracker in the Members’ section of our website.

Studies show that when a woman knows how much weight to gain during her pregnancy AND is provided with continual feedback about how she is progressing, she is more likely to gain an appropriate amount of weight.

Rather than a one-size-fits-all approach, this approach tailors a weight gain goal to each and every woman during her pregnancy.

 

Instructions provided with the Pregnancy Weight Tracker show how to start using the tracker. Watch our instructional video that accompanies the Tracker to help you complete it. Discuss it at each visit with us or any of your other health care providers.

References:

  1. Institute of Medicine. Weight gain during pregnancy: Reexamining the guidelines. 2009, Washington, D.C.: The National Academies Press.
  1. Wilkinson SA, Stapleton H. (2012). Overweight and obesity in pregnancy: the evidence-practice gap in staff knowledge, attitudes and practices. Aust N Z J Obstet Gynaecol. 52:588-592.
  1. Wilkinson, SA. Wilkinson, Shelley A., Poad, Di and Stapleton, Helen (2013) Maternal overweight and obesity: a survey of clinicians’ characteristics and attitudes, and their responses to their pregnant clients. BMC Pregnancy and Childbirth, 13 117: 1-8. doi:10.1186/1471-2393-13-117
  1. Wilkinson, Shelley A., Donaldson, Elin, Beckmann, Michael and Stapleton, Helen (2016) Service-wide management of healthy gestational weight gain following an implementation science approach. Maternal and Child Nutrition, 13 2: . doi:10.1111/mcn.12266
  1. Gray C, Hunt K, Lorimer K, Anderson A, Benzeval M, Wyke S. (2011). Words matter: a qualitative investigation of which weight status terms are acceptable and motivate weight loss when used by health professionals. BMC Public Health, 11(531). 29 June.
  1. Thomas S, Hyde J, Karunaratne A, Herbert D, Komesaroff P (2008). Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expect, 11:321–330.
  1. Wadden T, Didie E (2003). What’s in a name? Patients’ preferred terms for describing obesity. Obes Res, 11(9):1140–1145.

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What happens in the first 9 months can last a lifetime – understanding fetal programming.

Have you heard about ‘fetal programming’? No, this isn’t about how children are very good at using iPads! Fetal programming is also known as the ‘developmental origins of health and disease’. It explains how (very) early-life nutrition plays a role in the development of many adult chronic diseases. This means things like heart disease, type 2 diabetes, lung conditions, and even some forms of cancer.

The once popular idea of the ‘parasitising’ fetus – that is, that a growing baby does not miss out on nutrients – is now known NOT to be true. From history and times of famine we know that women are LESS affected than their infants and that conditions in the womb can influence bub’s health later in life.

We all know that smoking, alcohol and taking certain medications are not safe during pregnancy due to their effects on the developing fetus. We now know that variations in the quality or quantity of nutrients consumed by mothers during pregnancy can have permanent effects upon developing body parts.

 

Fetal programming – what are the basics?

  • The environment in your womb can alter the development of your fetus, with a permanent effect on your child.
  • Several subtle changes are known to alter fetal programming, such as altered nutrition/diet quality or quantity, or maternal stress (and outcomes can be positive or negative, depending on the changes made).
  • The effects of these changes do not always become obvious at once, but sometimes only show up later on in a child’s life (sometimes their adult life, such as type 2 diabetes or obesity).
  • In the first few weeks the physical structures of the baby in the womb are being formed. But the brain is being formed all through pregnancy and its development can be affected even at later stages of pregnancy.
  • Growing more slowly doesn’t just affect early life. It can impact health throughout life, even in old age. This is because some of the organs such as the kidney and the pancreas which have also grown differently at the beginning are less able to function properly in old age.

 

I understand a little bit of science – how would you explain fetal programming in more technical terms to me?

The area of biological science that looks into fetal programming is “epigenetics”. “Epi” means “above”, so this is looking “above genetics”. Epigenetics is the study of how your behaviours (like what and how you eat, as well as exercise and move) and environment can cause changes that affect the way your genes work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence. Examples of mechanisms that produce such changes are DNA methylation and histone modification, each of which alters how genes are expressed without altering the underlying DNA sequence.

In simpler terms epigenetics is not saying that there are changes to the basic building blocks of life (DNA) – you might look at DNA like lego blocks that have to be put together in a certain way – like following the instructions completely. When we do not eat a good quality diet (following the pregnancy dietary guidelines) this can change the way our basic building blocks are put together (like when you do not follow the lego instructions and make it up as you go along – it might still look like a house, but not the one in the diagram!).

 

So, what should I be eating during pregnancy?

The Australia dietary guidelines are informed by scientific studies that tell us the best amounts and combinations of foods to eat for good health and limiting long term disease. They combine the best food and nutrition science into simple and easy to understand household measures and serves. Check out the ‘Eat for health’ website for more information about how to personalise the guidelines to your pregnancy, plus for some shopping, budgeting and meal preparation tips. We also have free resources on our Lifestyle Maternity page as well as extra, in-depth and practical handouts, planning and tracking sheets in our Members’ Section.

Lifestyle Maternity runs a Nutrition program specially tailored for pregnant women. Our Nutrition Essentials for Pregnancy workshop is a small online group. It is a great way to share your own stories while also learning from others’ experiences. We keep things engaging, using interactive activities and discussion points while learning the essentials of nutrition for pregnancy. It is best attended in early pregnancy (before 20 weeks), but will be of benefit at any time during pregnancy.

Further reading:

World War II/The Dutch Famine and DOHaD/Fetal programming

Image credit:

Photo by Jelleke Vanooteghem on Unsplash

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