Tag Archive for: pregnancy

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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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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