prenatal nutrition checklist - province of manitoba · prenatal nutrition information and...

November 2013 Welcome to the Prenatal Nutrition Manual for healthcare professionals working with pregnant women. This manual was designed by Public Health Dietitians from the Winnipeg Regional Health Authority and was created especially for use during Healthy Baby community drop-in programs. The purpose of the Prenatal Nutrition Checklist is to help guide client discussions. It is not intended to be used in the following manners:

- as a form for the client to fill out without follow up - as an assessment - as a form of charting to be kept on file

The client’s name or other identifying information should not be written down on the checklist. The goal of the Prenatal Nutrition Checklist is to provide evidence based prenatal nutrition information and corresponding handouts to equip healthcare professionals in their work with prenatal women. How to use this manual:

1. Following this page is the Prenatal Nutrition Checklist. This is a conversation guide for you, the healthcare professional, to use when initiating a discussion with a prenatal client. The checklist encompasses all the major discussion points for a conversation on optimizing pregnancy outcomes through healthy eating and nutrition.

2. Each tab thereafter corresponds to each of the questions asked on the Prenatal Nutrition Checklist in the order in which they appear on the checklist. Within each tab, there are summaries of background evidence for the topic.

3. The colourful folder on the left contain handouts pertaining to each of the topics in the checklist.

4. A memory stick has been included with the electronic copies of resources that can easily be printed by each user of this manual as needed. A document at the back of the binder has been included with information on resource reordering, for resources that cannot be easily printed.

The resources, background information and summaries that have been included are the most up to date information available at the time of printing.

Prenatal Nutrition Checklist

Are you taking prenatal vitamins?

Do you take any other vitamins/herbal products/herbal teas/medication? o If yes, please list: _________________________________________

Do you have anemia (low blood iron)?

Are you ever worried about food? Do you have…

Diabetes?

Nausea/vomiting?

Heartburn?

Constipation?

Diarrhea?

Lactose intolerance? Do you know which foods are important to eat during pregnancy? ________________________________________________________________________________________________________________________________________ ____________________________________________________________________ Do you know which foods to avoid during pregnancy? ________________________________________________________________________________________________________________________________________ ____________________________________________________________________ How is your appetite?

Always hungry

Often hungry

Rarely hungry

What beverages do you drink?

Coffee

Tea

Energy drinks

Pop

What do you know about breastfeeding? _____________________________________________________________

Did you know? If you have at least one of the following, it is recommended that you take 5mg Folic Acid per day until you are 12 weeks pregnant. Prenatal vitamins usually contain 0.4-1.0 mg Folic Acid so you would need to take extra Folic Acid in a

separate pill. Talk to your medical doctor or midwife.

Insulin dependant diabetes

BMI >35

Epilepsy/epileptic seizures

Family history or previous baby with Neural Tube Defect

Or belong to a high risk ethnic group (Celtic, Sikh, Northern Chinese)

Healthy Baby Prenatal Nutrition Checklist Resource Re-Ordering

Print from memory stick Order from other organizations

Safe Foods/Food Safety

1. Artificial Sweeteners

2. Eating Fish During Pregnancy

3. Food safety during pregnancy

Safe Foods/Food Safety

1. Safe Food Handling For Pregnant

Women (Health Canada:

http://www.hc-

sc.gc.ca/contact/pubs-eng.php)

Healthy Pregnancy

1. Healthy Eating Guidelines for

Pregnancy

2. Thinking about having a baby

Healthy Pregnancy

1. The Sensible Guide to a Healthy

Pregnancy (Health Canada:

http://www.hc-


2. Eating Well with Canada’s Food

Guide (Health Canada:

http://www.hc-


3. Dial-a-Dietitian pamphlet (1-877-

830-2892 or 204-788-8248 in

Winnipeg)

Constipation/Diarrhea

1. Constipation (EAL Nutrition Visual

Aids, page 5)


Increasing Your Fibre Intake

Lactose Intolerance

1. Lactose Intolerance (EAL Nutrition

Visual Aids, page 6)

Caffeine

1. Caffeine During Pregnancy and

Breastfeeding

2. Is caffeine safe in pregnancy

3. Are Herbs and Herbal Teas Safe to

use during Pregnancy and

Breastfeeding

Nausea/Vomiting

1. Nausea and Vomiting In Pregnancy

- WRHA

2. Nausea (EAL Nutrition Visual

Aids, page 4)

3. Nausea and Vomiting of Pregnancy

SOGC

Heartburn

1. Heartburn (EAL Nutrition Visual

Aids, page 7)

2. Safe medications for heartburn

(EAL Nutrition Visual Aids, page

8)

3. Unsafe medication for heartburn

(EAL Nutrition Visual Aids, page

9)

4. Managing Heartburn

Anemia

1. High Iron Foods (EAL Nutrition


Anemia

1. Iron, Are you getting enough?

(http://health.beefinfo.org/en/resour

ces/nut_education/default.aspx)

Diabetes


Women with Gestational Diabetes

2. Sample Meal Plan

Vitamins/Minerals

1. Prenatal vitamins (EAL Nutrition


2. Multivitamins (EAL Nutrition


3. Food sources of folate

4. High Calcium foods (EAL

Nutrition Visual Aids, page 17)

Vitamins/Minerals

1. Folic Acid it’s never too early

(Spina Bifida and Hydrocephalus

Assoc of Canada – Email

[email protected] or call 1-800-565-

9488 or 204-925-3650 in

Winnipeg)

REFERENCE SECTION:

The reference section has been included for health providers to have current and accurate

information to share with participants or others. Each tab corresponds to one of the

questions on the prenatal nutrition checklist in the order in which they appear on the

checklist. The background information and summaries that have been included are the

most up to date information available at the time of printing. Please check the original

source for updates.

mailto:[email protected]

Artificial Sweeteners:Are they safe during pregnancy & breastfeeding? Artificial sweeteners make food taste sweet without adding sugar

or calories. Artificial sweeteners that have

been added to packaged foods and drinks are safe during pregnancy and breastfeeding.

SAFE Artificial Sweeteners during pregnancy and breastfeeding:

Aspartame (Nutrasweet, Equal) Sucralose

(Splenda) Acesulfame

Potassium (Ace‐k, Sunnett, Sweet One)

Stevia

(Sweet Leaf)

• Health Canada has not approved stevia

leaves and

extracts as a sweetening agent. Further safety tests

are needed.

Sweetners

under review by Health Canada

Saccharin (Hermesetas) Cyclamate (Sweet `n Low, Sugar Twin)

UNSAFE Artificial Sweeteners during pregnancy and breastfeeding:

Artificial Sweeteners are a beneficial

sugar substitute for diabetics because

they do not raise blood sugar levels.

Courtesy of Health Start for Mom and Me. Updated October 2012. References: PEN (2012). Sweeteners Evidence Summary. Canadian Diabetes Association (2011). Sugar and Sweeteners. Can be

found at http://www.diabetes.ca/files/en_sweeteners_final.pdf. Health Canada (2010). Food and Nutrition: Sugar Substitutes. Can be found at www.hc‐sc.gc.ca.

http://www.diabetes.ca/files/en_sweeteners_final.pdf

http://www.diabetes.ca/files/en_sweeteners_final.pdf

http://www.hc-sc.gc.ca/

Eating Fish During Pregnancy and Breastfeeding Eat 2 or more servings of fish every week. (1 serving = ½ cup or 2.5

ounces) Choose a variety of SAFE

fish during pregnancy and breastfeeding

Light Tuna Shrimp Salmon Sole Sardines

Crab & Lobster Trout Mussels & Clams Scallops Oysters

Other safe fish include: pollock, anchovies, herring, carp, haddock, flounder, Atlantic mackerel, lake

whitefish, perch, capelin, char, hake, mullet, and smelt.

Limit

these types of fish because they contain high amounts of mercury

Avoid UNSAFE

fish during pregnancy and breastfeeding

Raw Fish Smoked fish, unless

heated,or canned

Imported fish from

Asia, especially dried

fish

• Fish oil Supplements are NOT

recommended for women with

intrauterine bleeding and bleeding

disorders or women taking blood thinners. • Do NOT take cod liver oil• Choose fish instead of supplements.

Courtesy of Health Start for Mom and Me. Developed October 2012.

References: Health Canada (2009).Prenatal Nutrition Guidelines for Health Professionals ‐

Fish and Omega‐3 Fatty

Acids. Available at hc‐sc.gc.ca. PEN (2012). Pregnancy: Key practice points. “Are there safety concerns for the ingestion of fish in women who

are pregnant, planning to

become pregnant or breastfeeding related to mercury contamination? PEN (2012). Pregnancy Evidence Summary.

Eat NO more than 1 cup

or 5 ounces (2 servings)

per month

Albacore & White tuna

– No more than 10 ounces (2 cups)

per week

Shark Swordfish

Escolar

& Marlin Fresh or frozen tuna Orange Roughy

Eat Safely,EatWellFood SafetyDuring Pregnancy

Foodborne illness

can make your baby

sick before and after

birth.

Why is food safetyimportant duringpregnancy?• Foodborne illness can be caused by eatingcontaminated food. It can affect everyone,but it can be more serious for you and yourbaby when you are pregnant.

• During pregnancy your body changes. Thisincludes how your immune system works.These changes may make you more likely tobecome sick, and certain diseases may causemore serious illness for you and your baby.

• Foodborne illness can make your baby sickbefore and after birth.

Eat Safely, Eat wellFood Safety During Pregnancy

Your pregnancy is an important time. Eating safe and healthyfoods is important to you and your baby. There are many thingsto consider when choosing and preparing food. This informationis designed to help you make the best choices for you and your baby.

Choose foods that

are not considered

high-risk.

Follow safe food

handling practices.

What should I eat duringmy pregnancy?• A well-balanced diet with healthy foodsand the nutrients that you need for ahealthy pregnancy for you and your baby.

• Foods which are properly washed, storedand cooked to prevent foodborne illness.

• Foods which are safe for pregnant women.

How can I keep myselfand my baby safe fromfoodborne illness?• Bacteria that can cause foodborne illnessinclude Listeria, Salmonella, Campylobacterand E. coli.

• Bacteria can be found in a variety of raw andcooked foods including, meat, poultry, eggs,fruits, vegetables and dairy.

• Bacteria that can cause foodborne illness donot change the smell, look or taste of your food.

• Symptoms of foodborne illness are stomachcramps, nausea, vomiting, fever and diarrhea.

• Most foodborne illness is unpleasant, but thesymptoms usually go away after a few days.During pregnancy there is a risk of moreserious complications for you and your baby.

• Proper food handling and taking steps toseparate, chill, clean and cook will help toprevent foodborne illness.

Listeriosis• Listeriosis is caused by Listeria, a bacteriathat can contaminate food and lead toserious illness.

• Listeria is unique because it can be foundon foods which you do not usually cook andit can grow at refrigerator temperatures.

• Foods that Listeria may be found on include:unpasteurized cheese and milk, soft andmould-ripened cheese, deli meats, packagedhot dogs, raw seafood and smoked salmon.

• Listeriosis in pregnant women can causemiscarriage or stillbirth, or your baby canbe born very sick.

• Symptoms of listeriosis include fever,headache, nausea and vomiting.

• Listeriosis can be prevented by avoidingcertain foods and handling food safely.

Listeriosis can

be prevented by

avoiding certain

foods and handling

food safely.

FOODS TO AVOID

All unpasteurized cheese and dairyproducts

All soft cheeses, even if they arepasteurized (e.g., Brie, Camembert,feta, mould-ripened cheese such asGorgonzola)

Deli meats (e.g., ham and turkeyslices, cured meats such as salamiand prosciutto

Uncooked hot dogs

Refrigerated pâtés and meat spreads

Refrigerated smoked fish andseafood products (e.g. smokedsalmon)

Raw and undercooked meat and fish(e.g., sushi, raw oysters, carpaccio,steak tartar)

Raw egg, egg dishes with runnywhites/yolk or any food itemscontaining raw or under-cookedeggs as an ingredient (e.g. eggnog,tiramisu)

Unpasteurized juice or cider

Raw sprouts (e.g. alfalfa, mung beansand clover)

SAFER ALTERNATIVES

Pasteurized hard cheese and dairyproducts

Pasteurized hard cheese(e.g. Cheddar, Swiss, Parmesanand Colby), or cooked pasteurizedsoft cheese

Deli meats that are cooked untilsteaming hot (to internal tempera-ture of 74° C or 165° F or warmer)

Hot dogs that are cooked untilsteaming hot (to internal tempera-ture of 74° C or 165° F or warmer)

Canned pâtés and meat spreads(they do not require refrigerationuntil after opening)

Canned smoked fish and seafoodproducts (they do not requirerefrigeration until after opening)

Cooked meats and fish (e.g.,cooked whole chicken breast,roast pork, beef or salmon)

Cooked eggs (until whites/yolk issolid) and dishes containing cookedegg or use pasteurized egg products

Pasteurized juice or cider

Cooked sprouts until steaming hot(to internal temperature of 74° C or165° F or warmer)

Raw meat, poultry, fish and seafood can becontaminated with bacteria. These raw foodsshould be kept separated from other foods toprevent the spread of bacteria.

• When shopping keep raw meat, poultry,fish and seafood separate from other foodsin your cart and grocery bags.

• Store raw meat, poultry, fish and seafood on thebottom shelf of the fridge in sealed containers.

• If you have used utensils, cutting boardsor serving trays for raw meat, poultry, fishand seafood don’t use them again until theyare washed in hot, soapy water or use cleanutensils and plates.

SEPARATE

Safe food handling Proper cooking, cleaning and storage of your food can remove orreduce the cause of foodborne illness.

There are four key steps in safe food handling:

CLEAN

COOK

CHILL

Bacteria grow rapidly at room temperatures, butmore slowly at cold and hot temperatures.

• Raw meat, poultry, fish, seafood, eggs or left-overs should not be left at room temperaturefor more than two hours. Refrigerate or freezeas soon as possible.

• Keep cold food refrigerated below 4º C (40º F).

• Thaw frozen food in the fridge or microwave,not at room temperature.

Washing and sanitizing removes bacteria fromfood, hands, containers and other surfaces.

• Wash hands with warm water and soap for atleast 20 seconds before and after handlingfood, changing diapers, touching pets orusing the washroom.

• Wash all fresh produce in clean, running water.

• Wash utensils, cutting boards, serving traysand countertops with hot soapy water.

• Sanitize after washing with hot soapy water.To make a sanitizing solution in a spray bottleto use on utensils and surfaces combine5 mL (1 teaspoon) of household bleachper litre (4 cups) of water. Squirt or wipe thesanitizing solution on countertops and othersurfaces. Wipe with a clean cloth or paper towel.

Bacteria that can cause foodborne illness arekilled by high temperatures.

• Cook all meat, poultry, fish, seafood and eggsthoroughly and to 74º C (165º F).

• Use a food thermometer to measure theinternal temperature of your food. Insert theprobe of the thermometer into the centre ofthe food to read the temperature.

• Keep hot food hot, above 60º C (140º F).

Nutrition duringpregnancy• Consult with the Canada’s Food Guide, yourhealth care provider, a dietician or otherresources such as Baby’s Best Chance toensure you are getting a well balanced dietwith the necessary vitamins and nutrients.

• Choose safer options while pregnant to avoidfoodborne illness.

Nutritional benefitsand risks of fishFish are an important source of protein andOmega 3 fatty acids which are important foryour baby’s brain development.

Some kinds of fish contain higher amountsof mercury, a metal that can be harmful to adeveloping brain.

It is recommended that consumption of:

• Ahi tuna (bigeye tuna), escolar, sea-bass,shark, marlin, swordfish and barracuda belimited to 2 servings per month (150 grams).

• Canned tuna (albacore), cod, bass, rockfishand trout be limited to 4 servings per week(300 grams).

• Other fish (salmon, trout, sole and BC orCanadian albacore tuna) can be eaten inany quantities and anytime.

Salmon, trout, sole

and BC or Canadian

albacore tuna can be

eaten in any quantities

and anytime.

Did you know?• Infant botulism is a rare disease that can occur when a child less thanone year old swallows spores of Clostridium botulinum bacteria, whichare found in dirt and dust and can contaminate honey. Honey should notbe fed to newborns.

• Avoid gardening and changing cat litter during pregnancy to reducerisk of toxoplasmosis.

• Consume refrigerated leftovers within three days or freeze them forlater use.

• Do not refreeze defrosted food.

• Follow all storage and cooking instructions and “best before” dates.

Additional referencesIf you have further questions talk to your healthcare provider or consult with these additionalresources.

BC Centre for Disease Control

www.bccdc.ca

http://www.bccdc.ca/dis-cond/a-z/_l/Listeria/overview/Listeriosis.htm

Canada’s Food Guide

http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

Best Chance Website

http://www.bestchance.gov.bc.ca

Baby’s Best Chance

http://www.health.gov.bc.ca/library/publications/year/2010/bbc.pdf

Canadian Partnership forConsumer Food Safety Education

http://www.canfightbac.org

Healthlink BC

http://www.healthlinkbc.ca

Do Bugs Need Drugs?

http://www.dobugsneeddrugs.org

Notes

Linda Coe Graphic Design Limited

655 West 12th AvenueVancouver, British ColumbiaCanada V5Z 4R4

www.bccdc.ca/foodsafetyinpregnancy

| PAGE 1Updated: 2013-07-23

© 2007 Province of British Columbia. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Healthy Eating Guidelines for Pregnancy Eating well during your pregnancy gives your baby healthy nutrients to grow and develop. Following Canada's Food Guide will provide the nutrition building blocks you need for a healthy pregnancy. Some nutrients, like folate (folic acid), iron, calcium and omega-3 fats, are particularly important during pregnancy.

To meet your energy (calorie) needs during pregnancy:

� Follow . Canada's Food Guide for your age group. � During the second and third trimesters, add two to three

additional Food Guide Servings each day. Enjoy them with meals, or try . an extra snack such as:

» an apple and cheese » yogurt and fresh fruit » hummus with vegetable sticks

� Get your energy from healthy foods rather than foods high in fat, salt or sugar like chips, salted pretzels, candy, sweetened beverages, cakes and cookies.

Visit . www.healthcanada.gc.ca/foodguide for serving size examples and meal and snack ideas. To meet your folate (folic acid) needs, especially in the 1st trimester:

� Take a daily multivitamin that has 0.4 mg (400 mcg) of folic acid. » Do not take more than 1 mg (1000 mcg) per day.

� Choose high folate foods every day such as: » lentils and dried beans like chickpeas, black, navy and pinto

beans » edamame

http://www.healthcanada.gc.ca/foodguide

http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php#snack

http://www.healthcanada.gc.ca/foodguide



» sunflower seeds and peanuts » vegetables like broccoli, asparagus, okra, spinach, Brussels

sprouts, collards and mustard greens » some fruits like papayas and avocados » enriched pasta

Folic acid is a B vitamin that helps your body make new cells. Folate is found naturally in some foods. Folic acid is a man-made form of folate. It can be hard to get enough from food alone, so you need to take a folic acid supplement before and during pregnancy, as well as afterward. Getting enough folate (folic acid) reduces the risk of a birth defect that affects the brain and spinal cord, called a neural tube defect. To meet your iron needs throughout pregnancy:

� Choose food sources of iron such as: » cooked mussels, clams and oysters » beef and lamb » cooked organ meats

� liver is very high in vitamin A. Do not eat more than one food guide serving (75g) of liver per week during the first three months of pregnancy.

» chicken and fish » pumpkin seeds and cashew, pine and hazel nuts* » dried beans, peas and lentils* » fortified whole grain cereals* » dark leafy greens like spinach and swiss chard*

*Eat these iron rich foods with foods that are sources of vitamin C, like kiwi fruit, citrus or tropical fruit, or bell peppers to help iron absorption.

� Take a daily multivitamin that has 16-20 mg of iron. » Some women may need more. Talk to you healthcare provider

about the amount of iron you need.



Iron helps build new red blood cells and helps them carry oxygen. During pregnancy, the amount of blood you have increases to meet the needs of both you and your baby. The iron you eat while pregnant will help your baby store enough for when she is born. To meet your calcium needs, include 2 servings of milk and alternatives every day:

� 250 mL (1 cup) of 1% or skim milk or fortified soy beverage. � 50 g of lower fat cheese (less than 20% M.F.) � 175 g (3/4 cup) of yogurt or kefir

Calcium helps teeth, bones, the heart, nerves and muscles develop. Without enough calcium from your diet, calcium is taken from your bones to help your baby develop. Having enough calcium throughout your pregnancy meets the needs of both you and your baby. To meet your omega-3 fat needs:

� Eat at least 2 servings (150 g) per week of fatty fish like salmon, mackerel or herring.

» See the Additional Resources for information about choosing fish that is lower in mercury.

� Choose walnuts, ground flax seeds, chia seeds, soy products and canola oil more often.

� Some foods may be fortified with omega-3 fats. Read the label on foods like margarine, eggs, yogurt, juice and soy beverage.

Omega-3 fats are used for your baby's brain and eye development. Omega-3 fats include alpha linolenic acid (ALA), EPA and DHA. ALA is an essential fat found in plant sources like nuts, seeds and soy. ALA is used to make EPA and DHA. EPA and DHA are found in only a few animal-based foods such as fish. To meet your omega-3 needs, choose a variety of these omega-3 sources.



Other considerations for a healthy pregnancy:

� Enjoy regular physical activity. Check with your doctor before beginning a new exercise program.

� Some foods, like meat, fish, poultry and seafood may have bacteria that, if the meat is not properly cooked, can harm you or your growing baby. See the Additional Resources for specific food safety information.

� Avoid alcohol during pregnancy. � You can have caffeine in moderation. Limit to 300 mg per day—

about 500 mL (2 cups) of coffee or 1000 mL (4 cups) or tea per day.

� Herbal supplements are not recommended during pregnancy. When limited to 3 cups per day, the following herbs taken as herbal tea are considered to be safe:

» bitter orange/orange peel » echinacea » peppermint » red raspberry leaf » rose hip » rosemary

� Sugar substitutes except cyclamate and saccharin are safe in moderation during pregnancy. Avoid consuming large amounts of foods that have sugar substitutes, as these foods could replace healthier foods.

� If you are overweight or underweight, your nutrition needs may be different. Discuss this with your doctor who may refer you to a registered dietitian.

� If you have nausea, vomiting, heartburn or constipation during pregnancy that is keeping you from eating, ask your family doctor or obstetrician for help.

� If you are having twins or triplets, the healthy eating information in this handout also applies to you. You may however, have higher nutrient needs. Talk with your healthcare provider to find out the amount that is right for you.



� Health Canada, The Sensible Guide to a Healthy Pregnancy .

http://www.phac-aspc.gc.ca/hp-gs/pdf/hpguide-eng.pdf or 1-800-622-6232.

� Health Canada, Mercury in Fish . www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php

These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.

Distributed by:

http://www.phac-aspc.gc.ca/hp-gs/pdf/hpguide-eng.pdf

http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php

http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php

Best Food Forward Plan Shop Cook Enjoy

Trusted advice from dietitians. www.dietitians.ca

Thinking about having a baby?

Healthy babies begin with healthy moms! The foods you eat before you become pregnant are important

to help you and your baby be as healthy as possible.

Eating Well with Canada’s Food Guide helps you choose the foods that will give you the nutrition you for pregnancy. Every day, eat a variety of foods from

each of the four food groups: • Vegetables and Fruit: 7-8 servings of a variety of

vegetables and fruit • Grain Products: 6-7 servings emphasizing on

whole grains more often

• Meat and Alternatives: 2 servings of poultry, fish, lean meat, dried peas, beans, lentils, eggs or

tofu. • Milk and Alternatives:

o Over 19 years of age: 2 servings of lower fat

milk, cheese, yogurt or enriched soy beverages

o Under 19 years of age: 3-4 servings

Pregnant women need just a little more food each day, but not until the second or third trimester. For

most women, this means an extra one or two Food Guide Servings from any of the food groups each day. One extra snack is usually enough,

for example, a small container of yogurt, half a sandwich, or a piece of fruit with a small handful of

nuts. Use Canada’s Food Guide to help you determine how much food is in “one serving”.

Important nutrients for you and your baby

In addition to a healthy diet, pregnant women should take one multivitamin supplement daily that

contains folic acid, iron and Vitamin B12. Make sure that your supplement has no more than 10,000 IU of Vitamin A because too much vitamin A can cause

birth defects.

Talk to your health care professional about taking a multivitamin supplement before you become pregnant.

Folic Acid Folic acid is a vitamin needed both before you conceive and during pregnancy. This vitamin helps

reduce the baby’s risk of developing a birth defect, called neural tube defect, which affects the brain and

spinal cord. If neural tube defects occur, they happen in the first month of pregnancy, likely before you even know you are pregnant! This is why it is so

important to make sure you’re getting enough folic acid every day before you get pregnant.

Since it is difficult to get enough folic acid from food alone, women of childbearing age should take a

daily multivitamin and mineral supplement that contains 0.4 mg (or 400 μg) of folic acid three

months before becoming pregnant and throughout pregnancy. Make sure the supplement contains no more than 1 mg (or 1000 μg) of folic acid unless

your physician recommends otherwise.

http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php�

http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php�

http://www.healthcanada.gc.ca/foodguide�

Trusted advice from dietitians. www.dietitians.ca

It is important that your supplement also has vitamin

B12 because high doses of folic acid can hide a vitamin B12 deficiency.

In addition to a folic acid supplement, choose a healthy diet that includes foods higher in folic acid.

Cooked asparagus, cooked spinach, romaine lettuce, kidney beans, chickpeas, lentils and sunflower seeds

are some excellent sources of folic acid.

Iron During pregnancy, your requirements for iron

increase. This extra iron is needed to make red blood cells that carry oxygen through your own body and to your growing baby. Make sure your prenatal

multivitamin contains 16 to 20mg of iron.

Also be sure to include foods that provide iron, such as whole grain and iron-enriched breakfast cereals, lean meats, dried peas and beans, dark green

vegetables, dried fruits and nuts. To help your body better absorb the iron from plant-based foods, eat

them with foods that are high in vitamin C such as berries, tomatoes, peppers, oranges, broccoli, cauliflower, kale and potatoes. Avoid tea and coffee

(during a meal and within one hour of eating a meal) as they decrease the amount of iron that your body

absorbs from plant-based foods.

Other things to think about when planning a healthy pregnancy

Weight – Being at a healthy weight before you get

pregnant is important for you and your baby. A

healthy lifestyle with regular physical activity and healthy eating will help you achieve a healthy body weight. Before you become pregnant, talk to your

health care provider about a healthy weight for you. How much weight you should gain during pregnancy

depends on your pre-pregnancy weight. For more on healthy weight gain during pregnancy

see the Pregnancy Weight Gain Calculator at http://www.hc-sc.gc.ca/fn-

an/nutrition/prenatal/bmi/index-eng.php.

Caffeine – Caffeine crosses into the baby’s blood

when you are pregnant. Take a look at your caffeine intake and keep it to less than 300 mg a day. That’s about the amount found in two. 240mL (8 ounce)

cups of coffee. Choose healthy beverages without caffeine such as water, sparkling water, milk or

fortified soy beverage and decaffeinated tea or coffee more often.

http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/bmi/index-eng.php�



UNTIL JULY 2016

© 2013 Dietitians of Canada; may be reproduced in its entirety. For non-commercial use only.

Approximate caffeine content of drinks (250 mL)*: • Brewed coffee – 80-180mg

• Instant coffee – 76-106mg

• Cappuccino or Latte – 45-75mg

• Black tea – 43-60mg

• Green tea – 25-45mg

• Decaffeinated coffee or tea – 0-5mg

• Cola soft drink (1 can/355 mL) – 36-50mg

Herbal teas –Most herbal teas should be avoided

during pregnancy or when you are trying to conceive

a baby. . Herbal teas that can be consumed in moderation

include ginger, bitter orange/orange peel, echinacea, peppermint, red raspberry leaf, rosemary and rose

hip. Have no more than 2-3 cups of these safe herbal teas per day.

Other considerations for you and your baby Mercury and fish – Pregnant women and women

who may become pregnant can benefit from the

nutrients in fish. However, because too much mercury can harm the fetus, it is important to know what amount and types amounts of fish are safe to

eat.

Pregnant women and women who may become pregnant are advised to limit eating frozen and fresh

tuna, shark, swordfish, marlin, orange roughy and escolar to 150 grams per month, which is equals

two servings in Canada’s Food Guide. Up to 300 gm of canned albacore (“white”) tuna per

week can be safely consumed. All other fish and shellfish not listed above can be eaten. Choose a

variety.

Alcohol – Alcohol can affect the unborn baby. Avoid

alcohol if you are planning a pregnancy and when

you know you are pregnant. For more information: Visit the Healthy Pregnancy

website or download a copy of A Sensible Guide to a Healthy Pregnancy.

http://www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Caffeine/Food-Sources-of-Caffeine.aspx�

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High Iron Foods (for baby over 6 months)

Chicken/Turkey Lamb Goat Beef

Pork

Shrimp

Egg Yolk

Fish Canned Light Tuna or Salmon

Tofu Sardines

Peanut Butter Beans Infant Cereal

Chickpeas Lentils

Healthy Start for Mom & Me Winnipeg, Canada. 2012

High Iron Foods (during pregnancy)

Beef Goat Lamb Chicken/Turkey

Canned Light Tuna Whole Egg or Salmon

Fish Shrimp Sardines

Pork

Tofu

Iron Supplement

Nuts Chickpeas Peanut Butter

Lentils

Beans

Multivitamins (If breastfeeding or planning to become pregnant)

Centrum $13.97

Equate Century Plus $9.47

Shoppers Drug Mart

Centrum

Centrum Exact Essentra $ 13.99 $ 11.99

Centrum $ 13.97

Exact Essentra

Superstore Extra Foods Wal-Mart

$ 10.99

Safeway

$ 18.99 Life

$ 7.99 Centrum Regular Formula $15.89 $7.59

Note: Breastfeeding women need extra folic acid and vitamin D.

Take a multivitamin each day if you are breastfeeding or planning to become pregnant.

Nausea

Ginger Tea

Lemon

Diclectin

Constipation

Beans Popcorn Lentils

Brown Rice Whole Wheat Bread Bran Cereal Chickpeas

Apple with skin Orange Carrots

Fruits and Vegetables

Prunes Water

Dried Fruit

Lactose Intolerance

Milk Soy Beverage

¼ cup

Lactaid Milk

Lactaid Pills Lactaid Drops

Heartburn

May want to avoid:

Acidic Food Spicy Foods Fried Foods Coffee

May want to try:

Milk

Safe Medications for Heartburn (during pregnancy)

Take occasionally in single recommended doses.

Note: Antacids interfere with iron absorption.

Unsafe Medications for Heartburn (during pregnancy)

Baking Soda Alka-Seltzer ENO Pepto-Bismol Avoid as a drink

Cleaning and baking are safe

Textures for Baby

Blended Chicken (6 months)

Mashed Chicken (7-8 months)

Chopped Chicken (9-12 months)

Cooked Meat

Cooked Beans Chopped Beans (9-12 months)

Mashed Beans (7-8 months)

Blended Beans (6 months)

Cooked Vegetables Mashed Carrots

(7-8 months) Chopped Carrots

(9-12 months)

Making Food for Your Baby

Boil chicken until no longer pink inside

Remove skin and bones from chicken

Meat

Soak beans in water and place in the refrigerator overnight

Beans Boil beans until tender

Peel carrots Vegetables Boil until vegetables are tender

Make Extra Food for Your Baby and Freeze for Later Freeze extra food in an ice cube tray Put frozen cubes in a plastic bag,

label and date, and return to freezer. Take cubes out as needed

Frozen cubes of food

To Thaw: OR

Put frozen cubes in the refrigerator overnight

Put frozen cubes in a pot and heat up

(can add a bit of water)

Storage:

In a fridge freezer for 2 months

In a refrigerator for up to 3 days

In a deep freezer for 6 months

OROR

Powdered Infant Formulas

Good Start Similac Enfamil A+

President’s Choice (Superstore)

Parent’s Choice (Wal-Mart)

Note: Be sure formula is “iron fortified” or says “with iron”.

Infant Formula

Concentrate (add water) Ready-To-Feed (do not add water)

Presidents Choice

Enfamil A+

Similac

Check Label

Good Start

Check Label

Vitamin D Supplements

Superstore Extra Foods

D-drops $16.49

D-Vi-Sol (Enfamil) $15.49 D-Vi-Sol (Teddy’s)

D-drops

$ 10.99

$17.99 D-Vi-Sol (Enfamil)

$15.49 D-Vi-Sol (Teddy’s)

$10.99

Wal-Mart

D-drops D-Vi-Sol (Enfamil) D-Vi-Sol (Equate) $14.97 $12.97 $8.77

Vitamin D Supplements (Cont’d)

Shoppers Drug Mart Safeway

D-drops $17.99 D-Vi-Sol (Life)

$11.99D-Vi-Sol (Enfamil)

$17.99 D-Vi-Sol (Enfamil)

$15.99

High Calcium Foods (for strong bones)

Note: Some Chinese brands of soy beverages are not fortified with calcium of vitamin D.

Firm tofu contains more calcium than softer tofu (1 cup firm tofu = 25% DV; 1 cup soft tofu = 14% DV). Tofu is set in calcium sulphate.

Calcium 30% Iron 6-8% Vitamin D 45%

1 cup fortified soy beverage (So Nice, So Good)

Yogurt Cheese Soy Beverages Soy Beverages

Calcium ~30% Vitamin D ~45%

Milk Cheese Cheese Smoothie

Tofu Broccoli Kale Bok Choy Canned salmon

with bones Sardines

Prenatal Vitamins (before baby is born) Superstore

Note: PregVit prices listed include 1mg folic acid. Also comes with 5mg folic acid for ~ $5.00 more.

Need a prescription from doctor for PregVit.

Wal-Mart

Materna $17.77

PregVit ~$35.00 (60 pack)

Need to take 2 per day

Shoppers Drug Mart

Materna $17.77

PregVit $38.30 (60 pack)


Extra Foods

Exact $13.99

Materna $19.79



Safeway

Materna $24.99

PregVit

$37.65 (60 pack) Need to take 2 per day


Need to take 2 per day Materna $19.99

Vita Health

Quest (180 capsules) Equate $10.97

$29.99 Need to take 3 per day

Superstore

Formula Preparation (Ready-To-Use)

Do not add water

1) Wash all utensils 2) Boil utensils in a 3) Clean top of can, shake well and open

4) Pour into sterilized in hot soapy water. deep pot for bottles.

2 minutes

8) After feeding, discard 5) Put nipple and ring 6) Test temperature. Let cool if too hot and feed or

7) Feed baby. unused formula on bottle, shake

well. remaining in bottle within 1 hour refrigerate. Note:

If you prepare more than one feeding, bottles must be refrigerated and used within 48 hours

Formula Preparation (Concentrate)

Liquid Concentrate Water Bottle Size

30 mL 30 mL 2oz 60 mL 60 mL 4oz 90 mL 90 mL 6oz 120 mL 120 mL 8oz

8) Feed baby7) Test temperature. Let cool if too hot.

6) Put nipple and ring on bottle, shake well.

5) Add 120 mL of previously boiled water into sterilized bottle

9) After feeding, discard unused formula remaining in bottle within 1 hour.

4) Pour 120 mL of concentrated liquid formula.

3) Boil more water for 2 minutes, then remove water from heat and let cool until lukewarm

2) Boil utensils in a deep pot for 2 minutes

1) Wash all utensils in hot soapy water.

Note: If you prepare more than one feeding, bottles must be refrigerated and used within 48 hours

Formula Preparation (Powder)

8) Test temperature. Let cool if too hot.

7) Put nipple and ring on bottle, shake well.

6) Pour mixture into sterilized bottle.

5) Add 3 level scoops of powder. Mix well. Standard Dilution: 1 level scoop per 60 mL of water.

10) After feeding, discard unused formula remaining in bottle within 1 hour.

9) Feed baby.

Pour 180 mL of water.

4) For a single bottle: 3) Boil more water for 2 minutes, then remove water from heat and let cool for 30 minutes

2) Boil utensils in a deep pot for 2 minutes

1) Wash all utensils in hot soapy water.

Powder Water Bottle Size 1 scoops 60 mL 2oz 2 scoops 120 mL 4oz 3 scoops 180 mL 6oz 4 scoops 240 mL 8oz

Note: If you prepare more than one feeding, bottles must be refrigerated and used within 24 hours.


© 2013 Dietitians of Canada. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Healthy Eating Guidelines for Increasing Your Fibre Intake Why This Diet is Important This fact sheet provides tips on how to add more fibre-rich foods in your diet. There are different kinds of fibre found in foods such as vegetables, fruit, legumes (peas, beans, lentils) and whole grains and cereals. Some fibre can help to lower blood cholesterol and control blood glucose (sugar) levels. This is called soluble fibre and is found in some vegetables and fruit and legumes. Other types of fibre, called insoluble fibre from some vegetables and fruit, whole grains and wheat bran, help keep your bowels regular and may protect against colon cancer. Constipation may be improved with a diet that is high in fibre. It is important to eat a variety of foods to get enough of both types of fibre. A healthy diet includes 25-38 grams of fibre a day. Talk to a dietitian if you want help on increasing the dietary fibre in your diet.

Use Canada's Food Guide to plan your meals and snacks. Refer to Additional Resources below to get a copy of the guide

� Grains » Eat at least six servings of whole grain products every day.

Examples include rolled oats, barley, brown rice, quinoa and whole wheat breads, breakfast cereals and pasta.

» Use whole grain bread, rolls, pita or bagels when making toast or sandwiches.



» Replace at least half of the white flour with whole wheat flour in your recipes.

» Add 15-30 mL (1-2 Tbsp) of bran, ground flax seed or a very high-fibre cereal to your cereal in the morning.

� Vegetables and Fruit » Eat at least seven servings of vegetables and fruit every day.

Aim for 1-2 servings of fruit and vegetables at every meal and snack.

» Eat the peels of your vegetables and fruits whenever possible. » Try having fruit as a snack or as a dessert. Pears, raspberries

and blackberries are top choices for fibre. Guava, persimmon and kumquat are exotic high fibre fruits worth trying.

» Eat vegetables and fruit instead of drinking juice. � Legumes

» Add barley, beans, peas or lentils to soups, stews and casseroles. For example, add black beans to spaghetti sauce or lentils to soup.

» Roast chickpeas or steam edemame (soybeans in a pod) for an easy snack.

» Use legume-based dips (ex: hummus, baba ghanoush) for veggies instead of sour cream based.

� Nuts and Seeds » Add toasted nuts, sesame seeds, sunflower or pumpkin seeds

to salads and cereals. » Sprinkle on pasta dishes and stir-fries. » Grab a handful of nuts (60 mL (1/4 cup) as a quick snack.

� Read Food Labels » Compare products and pick the one with the most fibre. Be

sure you are comparing the same serving sizes. » Check for grams of fibre. High-fibre foods have four or more

grams of fibre per serving.



» Look for ingredients such as bran, whole grain whole wheat, oatmeal or rye flour.

» Increase the fibre in your diet slowly to avoid gas, bloating and diarrhea.

� Divide fibre-containing foods throughout the day at both meals and snacks.

� Drink plenty of fluids. Here is an example of how to increase your fibre intake with only a few small changes:

Low Fibre Diet

Fibre (g)

Fibre (g)

High Fibre Diet

Breakfast

175 mL (3/4 cup) flaked corn cereal

0.8 5.0 125 mL (1/2 cup) flaked bran cereal

250 mL (1 cup) low fat milk 0.0 0.0 250 mL (1 cup) low fat milk

1 slice (35 g) white toast 0.9 3.2 1 slice (35 g) whole wheat toast

15 mL (1 Tbsp) jam 0.2 0.9 15 mL (1 Tbsp) peanut butter

125 mL (1/2 cup) orange juice

0.3 3.1 1 small orange

Lunch

2 slices (70 g) white bread 1.8 6.2 2 slices (70g) whole wheat bread

75 g light tuna 0.0 0.0 75 g light tuna

15 ml (1 Tbsp) light mayonnaise

0.0 0.0 15 mL (1 Tbsp) light mayonnaise

1 medium leaf lettuce 0.1 0.1 1 medium leaf lettuce

1/2 tomato, sliced 0.8 0.8 ½ tomato, sliced



Information on fibre content is from the Canadian Nutrient File 2012.

125 mL (1/2 cup) vanilla yogurt

0.0 0.0 125 mL (1/2 cup) vanilla yogurt

2.0 60 mL (1/4 cup) raspberries

Snack

1 medium apple 2.6 5.0 1 medium pear

Water Water

Supper

75 g baked chicken breast 1.0 1.0 75 g baked chicken breast

125 mL (1/2 cup) mashed potato

1.6 4.0 1 medium baked potato with skin

125 mL (1/2 cup) carrots 2.2 2.2 125 mL (1/2 cup) carrots

250 mL (1 cup) low fat milk 0.0 1.2 250 mL (1 cup) romaine lettuce salad

125 mL (1/2 cup) vanilla pudding

0.0 0.0 250 mL (1 cup) low fat milk

1.3 125 mL (1/2 cup) fruit cocktail

Snack

4 melba toast crackers

1.3 2.5 1/2 whole wheat pita

30 g (1 oz) cheddar cheese 0.0 2.5 60 mL (1/4 cup) hummus

125 mL (1/2 cup) grapes 1.0 1.0 125 mL (1/2 cup) grapes

Water Water

Total Fibre 15.8g 41.9g



Available from: . http://webprod3.hc-sc.gc.ca/cnf-fce/newNutrientSearch-nouvelleRechercheAliment.do?lang=eng

� Canada's Food Guide - http://www.hc-sc.gc.ca/fn-an/food-guide-

aliment/index-eng.php These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.

Distributed by:

http://webprod3.hc-sc.gc.ca/cnf-fce/newNutrientSearch-nouvelleRechercheAliment.do?lang=eng%c2%a0

http://webprod3.hc-sc.gc.ca/cnf-fce/newNutrientSearch-nouvelleRechercheAliment.do?lang=eng%c2%a0



Is caffeine safe in pregnancy?

Health Canada recommends that pregnant and breastfeeding women have less than 300 mg of caffeine per day.

Reference: Health Canada. 2006. Caffeine. Available from www.hc-sc.gc.ca. Kaiser Permanente Division of Research (2008, January 22). Caffeine Is Linked To Miscarriage Risk, New Study Shows. ScienceDaily. Johns Hopkins Medical Institutions (2008, September 25). Caffeine Experts Call For Warning Labels For Energy Drinks. Revised by Healthy Start for Mom & Me Winnipeg, MB. Production made possible through contribution from the Public Health Agency of Canada (CPNP) and Healthy Child Manitoba (Healthy Baby). Revised June, 2009. Originally developed by Nina Kudriakowsky, RD, Mount Carmel Clinic.

0

Ideas to Boost Your Energy without Caffeine:

Drink water Get a good night’s sleep Take a 10-minute walk Try not to skip meals Eat healthy

What is 300 mg of caffeine?

2 cups of coffee, brewed, drip method

3 cups of black tea

Note: 1 cup = 8 oz

New research says... having more than 200 mg of caffeine per may double the risk of miscarriage compared to not having caffeine.

OR Buyer Beware! Some energy drinks contain the same amount of caffeine as 14 cans of Coke!

=

Limit other foods that have caffeine and sugar:

Cola Drinks

Cola Slurpees Lattes

Energy Drinks

Hot Chocolate

Iced Cappuccinos

Chocolate Bars

Green Tea

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Caffeine During Pregnancy and Breastfeeding Limit caffeine intake to 300 mg per day

2 cups of coffeeWhat is 300 mg of caffeine?

3 cups of black tea

Limit other foods with caffeine:

Green Tea Chocolate

Soft Drinks Cola Slurpee Latte

Hot Chocolate Chocolate

milk Iced Cappuccinos & Coffees

Eating and drinking more than 200 mg per of caffeine per day during pregnancymay

double the risk of miscarriage compared to not having caffeine

Do NOT

drink energy drinks during

pregnancy or while breastfeeding

Courtesy of Health Start for Mom and Me. References: Health Canada (2010). Caffeine: It’s your health. Available at www.hc‐sc.gc.ca. PEN (2012). Key Practice Points. What is the impact of caffeine

intake in pregnancy and lactation? PEN (2012). Pregnancy Evidence Summary. PEN.(2010). Caffeine Practice

Guidance Summary. Revised October 2012. Kaiser Permanente Division of Research (2008, January 22). Caffeine linked to miscarriage risk new study shows. Science Daily.

1 cup = 250 ml

http://www.hc-sc.gc.ca/

Are Herbs or Herbal Teas Safe to use during Pregnancy & Breastfeeding?

Some herbs are safe to use in cooking or tea.

Limit these herbal teas to 2-3 cups a day:

Echinacea Orange peel/bitter orange

Peppermint Red raspberry leaf

Rose hip Rosemary

* Supplements (pills or extracts) of the above herbs are not safe.

Is Ginger safe?

Fresh ginger root is safe in cooking and tea.

Ginger supplements (pills) are safe in pregnancy (maximum amount: 1.5 grams per day split into 3 to 4 equal doses for the relief of nausea and vomiting).

* Ginger extract (liquid) is not safe

* Ginger supplements (pills) are not recommended for breastfeeding women

Other safe warm drinks:

Hot lemon water Hot apple juice Hot milk

References: PEN - Practiced-Based Evidence in Nutrition. What herbal beverages/supplements are safe to take during pregnancy and lactation? Retrieved from: http://www.pennutrition.com/KnowledgePathway.aspx?kpid=3043&pqcatid=144&pqid=3092 . Last updated September 14, 2012. PEN – Practice-Based Evidence in Nutrition. (February, 2010). Herbs to Use with Caution During Pregnancy and Lactation. Retrieved from:http://www.pennutrition.com/KnowledgePathway.aspx?kpid=755&trid=1174&trcatid=34. March 19, 2010. Developed by Healthy Start for Mom & Me, Winnipeg, MB. Production has been made possible through financial contribution from the Public Health Agency of Canada (Canada Prenatal Nutrition Program) and Healthy Child Manitoba (Healthy Baby Program). Updated January 28, 2013.

Pregnant and breastfeeding women should avoid these herbs and herbal teas because we do not have enough information:

BurdockHopsJapanese mintLemon balm

Aloe Black cohoshBlue cohoshBuckthornCalendula (Marigold)ChamomileChaste tree (Chasteberry)ColtsfootComfreyDong quaiEphedraEvening primrose (safe during lactation)Fennel (not enough information in pregnancy)FeverfewGinkgoGinseng (avoid in first trimester, caution in

later stages of pregnancy and breastfeeding)

JuniperKavaLabrador teaLobeliaLicorice (candy is unsafe if contains

glycyrrhizin acid/licorice extract)PassionflowerPennyroyalSageSassafrasSenna (small amount safe in short term)St. John’s wortTea tree oilThujaUva-ursi

• Pregnant women should avoid these herbs and herbal teas due to known harmful effects.

• Breastfeeding women should avoid these herbs and herbal teas due to known harmful effects or because we do not have enough information.

Herbs and Herbal Teas not safe during Pregnancy and Breastfeeding:

LindenRed bush tea (Rooibos tea)ValerianWild Yam

http://www.pennutrition.com/KnowledgePathway.aspx?kpid=3043&pqcatid=144&pqid=3092

http://www.pennutrition.com/KnowledgePathway.aspx?kpid=755&trid=1174&trcatid=34

Nausea and Vomiting in Pregnancy Always feeling sick? You’re not alone! Many women experience nausea and vomiting due to hormone changes. The good news is that it usually disappears after the first three months. Here are some tips to help you cope: Keep crackers, bread or dry cereal near your bed to eat before getting up. Get out of bed slowly and avoid sudden movements. Avoid having an empty stomach. Eat whatever appeals to you in five or six small meals throughout the day. Wait 30 minutes after eating before lying down or brushing your teeth. Drink fluids between meals, not with meals. Choose cold foods because they often do not have a strong smell. Eat lightly spiced foods. Avoid foods high in fat such as bacon, gravy, fried meat, French fries. Try smelling fresh cut lemons. If you have a bad taste in your mouth, suck on hard candy or ice cubes. Try ginger tea or ginger ale to settle your stomach. When cooking, open windows or use the fan. Avoid smoke, strong smells, alcohol and caffeine. Get plenty of fresh air. Being tired can make you feel worse. Try to get lots of rest.

To be used in conjunction with advice from a Registered Dietitian.

October 2012

Public Public Education Education PamphletPamphlet


Introduction Introduction

More than half of all pregnant women suffer from nausea and vomiting during their pregnancy. Since each woman is different and each pregnancy is different, the severity of nausea and vomiting of pregnancy (NVP) will vary from woman to woman.

What causes NVP?What causes NVP?

No one knows exactly what causes the nausea of pregnancy. Most researchers believe it’s a combination of the many physical changes taking place in your body such as the higher levels of hormones during early pregnancy.

How long will How long will morning sickness last?morning sickness last?

Nausea and vomiting usually begin around the 6th week of pregnancy. Although common in the morning, “morning sickness” can actually happen at any time of the day. For 80% of sufferers, this condition stops around the 12th week of pregnancy although queasiness can come and go throughout pregnancy. The other 20% will suffer from nausea and vomiting for a longer period of time. Some women may even have the condition until the end of their pregnancy.

Most women who suffer from NVP will see their condition interfere with usual daily activities. Many will have to change their daily schedule in some way in order to cope with their condition.

The health effects of nausea and The health effects of nausea and vomiting of pregnancy vomiting of pregnancy

Most cases of nausea and vomiting in early pregnancy aren’t harmful

to the mother and her unborn child. While short-term dietary defi ciencies do not appear to have any harmful effects on pregnancy outcome, severe and persistent NVP

symptoms can affect your health.

Nausea and Nausea and Vomiting of PregnancyVomiting of Pregnancy

For most women, the feelings of nausea and the episodes of vomiting decrease at some point during the day so that they feel hungry again and can keep food down. However, if you are so sick that you are missing meals day after day, your baby may not be getting all the daily nutrients to grow as healthy as he or she can.

What if I just What if I just can’t keep anything down?can’t keep anything down?

About 1% of pregnant women in Canada (some 4,000 women per year) will suffer from excessive vomiting in pregnancy called “hyperemesis gravidarum”. In such cases, the lack of food, fl uids and nutrients may be harmful to their health and the well-being of their baby. If left untreated, severe cases of NVP can lead to dehydration.

Dehydration happens when the body does not have as many fl uids as it should. This may be caused by losing too many fl uids or not drinking enough. Severe cases of dehydration may require intravenous fl uids and vitamin supplementation from the hospital. Seek medical attention if you suffer from signs of dehydration such as infrequent urination or dark yellow urine. NVP can be diffi cult to control; the sooner you are diagnosed and begin treatment, the more likely you will be able to avoid severe symptoms.

Helpful tips to Helpful tips to control nausea and vomiting:control nausea and vomiting:

DIET – Food

• When you fi rst wake up, eat a few crackers and then rest for 15 minutes before getting out of bed.

• Get up slowly and do not lie down right after eating. • Eat small meals or snacks often so your stomach

does not become empty (for example, every 2 hours). Try not to skip meals.

• Do not hesitate to eat whatever you feel like eating and eat whenever you want to. However, it is best to avoid cooking or eating spicy, fatty and fried foods.

• If cooking odours bother you, open the windows and turn on the stove fan. If possible, ask someone else to cook the meals.


Nausea and Nausea and Vomiting of Vomiting of PregnancyPregnancy

• Try eating cold food instead of hot (cold food may not smell as strong as hot food).

• Sniffi ng lemons or ginger can sometimes relieve an upset stomach.

• Eating salty potato chips can help settle the stomach enough to eat a meal.

DIET – Drinks

• Drink small amounts of fl uids frequently during the day.

• Avoid drinking fl uids during meals and immediately before or after a meal.

Food Ideas to Help Relieve Nausea

Salty: Chips, pretzels Tart/Sweet: Pickles, lemonade Earthy: Brown rice, mushroom soup, peanut butter Crunchy: Celery sticks, apple slices, nuts Bland: Mashed potatoes, gelatin, broth Soft: Bread, noodles Sweet: Cake, sugary cereals Fruity: Fruity popsicles, watermelon Liquid: Juice, seltzer, sparkling water, ginger ale Dry: Crackers

LIFESTYLE – Rest

• Get plenty of rest since nausea tends to worsen when a woman is tired. Try napping during the day. Typically, a pregnant woman needs more sleep in the fi rst three months of pregnancy.

• You may need to take some time off work or make other arrangements for household chores and childcare.

• Enlist the support of friends and family.

LIFESTYLE – Other

• Get plenty of fresh air and avoid warm places as feeling hot can add to nausea.

• Acupressure wrist bands or acupuncture can be benefi cial for some women. If you are considering acupuncture, consult your healthcare professional and look for an experienced and licensed acupuncturist.

• Try ginger, an alternative remedy thought to settle the stomach. Dosages of up to 250 mg four times a day appear to be safe.

• Try taking your prenatal vitamins (one with a lower amount of iron if that mineral makes your nausea worse) with food or just before bed. If multivitamins make your nausea worse, take folic acid alone on a daily basis.

Note: So called “natural products” are often used under the assumption that they are safe. However, the safety and effectiveness of these treatments have not yet been proven and it is important to note that very few of these products have been properly studied in pregnancy. Ask your healthcare provider before taking herbal remedies.

Medications Medications

Although it is generally wise to stay away from over-the-counter medications during pregnancy, there is a safe and effective prescription medication that can help women when nausea and vomiting affect their well-being and daily activities.

Doxylamine succinate/pyridoxine HCI (Diclectin®), a combination of vitamin B6 and an antihistamine called doxylamine, is the only medication approved in Canada for the treatment of nausea and vomiting in pregnancy. Its safety and effectiveness for the treatment of NVP is recognized by Health Canada. Its safety throughout pregnancy has been long established and studies have shown no evidence that harmful effects are experienced by babies.

If Diclectin® does not cure your symptoms, other medications may be prescribed by your health care provider.

Who can help you with your NVP?Who can help you with your NVP?

If you have NVP and are looking for support and counselling, you should talk to your healthcare provider.

You may also contact the Motherisk NVP Helpline toll free at 1-800-436-8477 for ways to deal with morning sickness. For information on the safety and risks of medications during pregnancy and breastfeeding, call the Motherisk Program at (416) 813-6780 or visit www.motherisk.org.

Final thoughtsFinal thoughts

There are many ways of lessening or eliminating nausea and there is no reason for women to feel guilty about treating these symptoms. Your healthcare provider can help you control the nausea and vomiting so that you can have a pleasant and healthy pregnancy.

© Copyright SOGC 2000-2004 - The Society of Obstetricians and Gynaecologists of Canada web site provides information on a wide range of health and medical topics. The information contained herein is not intended to substitute for the advice of a physician, and you are advised always to consult your doctor for specifi c information on personal health matters. Unless otherwise specifi cally indicated, the naming of any organization, product or therapy on this site does not imply SOGC endorsement.

English Literature Title

© 2010 Dietitians of Canada. All rights reserved. May be reproduced in its entirety provided source is acknowledged.

This information is not meant to replace advice from your medical doctor or individual counseling with a registered dietitian. It is intended for educational and informational purposes only.

Updated: May 10, 2010 I PAGE 5



Managing Heartburn Why This Diet Is Important

Heartburn is caused by a back-up of stomach acid into the esophagus. When stomach acid comes into contact with the walls of the esophagus it often causes a "burning" feeling. Certain foods and lifestyle choices can increase the back-up of stomach acid, making symptoms worse. If you have symptoms of heartburn, avoiding certain foods can help decrease the burning you feel. Making lifestyle changes can also help. Consult your Doctor immediately if diet and lifestyle changes do not help, or if you experience vomiting, anemia, unplanned weight loss, chest pain or shortness of breath.

● Achieve and maintain a healthy weight. ● Stop smoking. ● Limit or avoid beverages that contain alcohol. ● Limit or avoid drinks with caffeine such as coffee, tea or cola

drinks. ● Remain sitting upright during meals and for 45 to 60 minutes after

eating. ● Avoid eating two to three hours before bedtime. ● Avoid eating large amounts of food at one time. ● Raise the head of your bed six to eight inches when sleeping.

Try "bed blocks", special foam wedges or a hospital bed. Pillows may not be adequate as they raise only your head. Your esophagus should be higher than your stomach.

● Avoid clothing that is tight across your stomach. ● Limit or avoid foods that may trigger symptoms such as spices,

peppermint, chocolate, citrus juices, onions, garlic and tomato







products.

Foods That May Cause Discomfort:

The types of foods that bother people with heartburn can vary a lot. Eat a variety of foods and take note of which foods cause you discomfort. When your symptoms have settled, you may try re-introducing these foods into your diet in small amounts and as part of a meal.

You may find that eating high fat foods cause you discomfort. Some people with heartburn report an increase in symptoms following a high fat meal. Choosing lower fat food choices is also part of healthy eating and can help with weight reduction.

● Do not try to cut out all fat from your diet. Limit the fat you use at the table and in cooking to 30 to 45 mL (2 to 3 Tbsp) each day. For more information on different kinds of fats and how to include healthier fats in your diet.

● Choose lower fat dairy products like 1% and skim milk and yogurt, lower fat cheese (less than 20% milk fat) and low fat sour cream.

● Eat lean meats and poultry (remove skin). Choose lower fat alternatives like lentils, chickpeas and tofu often.

● Limit amounts of high fat desserts and snacks like cookies, commercial baked goods and chocolate.

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Sample Meal Plan For Women with Gestational Diabetes While you have gestational diabetes, it is important to eat three meals plusthree snacks a day. One snack should be at bedtime. It's also important to spread carbohydrate containing foods evenly throughout the day. (Refer to the fact sheet "Healthy Eating Guidelines for Gestational Diabetes" for more information.)

Use the sample meals and snacks below as a guide. Vary your meals and snacks based on your own food preferences.

Sample Breakfasts

Breakfast Number 1 Breakfast Number 2 Breakfast Number 3

175 mL (¾ cups) cooked oatmeal with 2 Tbsp nuts 250 ml (1 cup) skim or 1% milk 1 medium orange Glass of water

1 slice (35 g) whole wheat toast with 1/3 avocado, mashed 30 g (1 oz) cheese or 1 hard boiled egg or 30 mL (2 Tbsp) 100% natural peanut butter ½ medium mango 175 mL (¾ cup) plain low fat or 250 mL (1 cup) diet fruit yogurt

2 slices (70 g) whole wheat toast with 10 mL (2 tsp) non-hydrogenated margarine 1 scrambled egg with diced mushrooms, bell peppers and onion 250 mL (1 cup) skim or 1% milk



Sample Lunches

Lunch Number 1 Lunch Number 2 Lunch Number 3

375 mL (1 ½ cups) mushroom & barley soup Half tuna salad sandwich on 1 slice (35 g) of whole wheat bread Green salad - lettuce, tomato, cucumber, broccoli, bell pepper, 1/3 of a chopped avocado, 15 mL (1 Tbsp) oil and vinegar dressing 250 mL (1 cup) skim or 1% milk

Bean burrito - 125 mL (½ cup) refried beans, small whole wheat tortilla, 30 g (1 oz) grated cheese, salsa, lettuce and tomato Vegetable sticks with low fat dip 250 mL (1 cup) skim or 1% milk

Half roast beef sandwich - 45 g (1 ½ oz) roast beef, 1 slice (35 g) of whole grain bread, 10 mL (2 tsp) mayo, avocado slices, tomato slices and lettuce 175 mL (¾ cup) plain, low fat yogurt 250 mL (1 cup) blueberries Glass of water



Sample Dinners

Snack Ideas � 4 melba toast crackers and 50 g (1 ½ oz) cheese � 60 mL (¼ cup) walnuts and 1 apple � 15 mL (1 Tbsp) peanut butter (or other nut or seed butter) on 1

slice (35 g) of whole grain toast � 750 mL (3 cups) of popcorn (low fat) and 250 mL (1 cup) milk � 175 mL (¾ cup) plain, low fat yogurt and 1 small banana � 175 mL (¾ cup) hummous and ½ pita � 250 mL (1 cup) cottage cheese adn 125 mL (½ cup) pineapple

tidbits

Dinner Number 1 Dinner Number 2 Dinner Number 3

75 g (2 ½ oz) chicken breast with 15 mL (1 Tbsp) barbeque sauce ½ medium potato, with skin 60 mL (¼ cup) low fat sour cream and chives, for potato Asparagus spears, pan fried in 5 mL (1 tsp) canola oil 250 mL (1 cup) skim or 1% milk 2 medium kiwi

250 mL (1 cup) chilli con carne with beans 75 mL (2/3 cup) brown rice Green salad - lettuce, tomato, cucumber, broccoli, bell pepper, 15 mL (1 Tbsp) Italian dressing 175 mL (¾ cup) pineapple Glass of water

Salmon burger - 75 g (2 ½ oz) salmon patty, 1 whole wheat hamburger bun, 15 mL (1 Tbsp) reduced fat mayo, 125 mL (½ cup) red onion fried in 5 mL (1 tsp) canola oil, tomato slice and lettuce 250 mL (1 cup) coleslaw 175 mL (¾ cup) of plain low fat yogurt Glass of water



� Canadian Diabetes Association . www.diabetes.ca � Healthy Eating for Gestational Diabetes .

http://www.pennutrition.com/viewhandout.aspx?Portal=RbCR&id=JMfrUAA=&PreviewHandout=bA==

These resources are provided as sources of additional information believed to be reliable and accurate at the time of publication and should not be considered an endorsement of any information, service, product or company.

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Notes

http://www.diabetes.ca/

http://www.pennutrition.com/viewhandout.aspx?Portal=RbCR&id=JMfrUAA=&PreviewHandout=bA

http://www.pennutrition.com/viewhandout.aspx?Portal=RbCR&id=JMfrUAA=&PreviewHandout=bA







Food Sources of Folate Information about Folate

● Folate is a water-soluble B vitamin. It is found naturally in foods. This vitamin cannot be stored in your body. You should eat folate-rich foods every day.

● Folate is important for everyone. It helps make red blood cells. If you do not have enough folate, you can get a type of anemia. If you have anemia you may feel tired, weak and unable to concentrate.

● Folate is very important for infants, children and women who are pregnant. It helps to prevent some birth defects.

● Folic acid is a form of folate. This is the type of folate found in vitamin supplements.

● Folacin is the generic name for folic acid and folic acid-related substances. It may be used instead of the words folic acid and folate.

How Much Folate Should I Aim For? ● Women who could become pregnant, are pregnant or

breastfeeding need more folate. They should take a daily folic acid supplement of 400 micrograms (mcg) or 0.4 milligrams (mg).

*This includes sources of folate from food and supplements

Age in years Aim for an intake of* mcg/day

Stay below* mcg/day

Men and Women 19 and older

400 1000

Pregnant Women 19 and older

600 1000

Breastfeeding Women 19 and older

500 1000







Food Sources of Folate

Dark green vegetables like broccoli and spinach and dried legumes such as chickpeas, beans and lentils are naturally good sources of folate. In Canada, folic acid is added to all white flour, enriched pasta and cornmeal products. The following table will show you which foods are sources of folate.

Food Serving size Folate (mcg)

Vegetables and Fruit

Vegetables

Edamame/baby soybeans, cooked 125 mL (½ cup) 106-255

Okra, frozen, cooked 125 mL (½ cup) 142

Spinach, cooked 125 mL (½ cup) 121-139

Artichoke, cooked 125 mL (½ cup) 79-106

Turnips greens or collards, cooked 125 mL (½ cup) 68-93

Broccoli, cooked 125 mL (½ cup) 89

Asparagus, cooked 4 sprouts 80-88

Brussels sprouts, frozen, cooked 6 sprouts 83

Lettuce, romaine or mesclun 250 mL (1 cup) 65-80

Escarole or endive, raw 250 mL (1 cup) 75

Beets, cooked 125 mL (½ cup) 72

Potato, with skin, cooked 1 medium 48-66

Spinach, raw 250 mL (1 cup) 61







Fruit

Avocado ½ fruit 81

Papaya ½ fruit 58

Grain Products

Pasta, egg noodles, enriched, cooked

125 mL (½ cup) 138

Pasta, white, enriched, cooked 125 mL (½ cup) 83-113

Bagel, plain ½ bagel (44.5 g) 101

Bread, white 1 slice (35 g) 60

Bread, whole wheat 1 slice (35 g) 18

Milk and Alternatives This food group contains very little of this nutrient

Meat and Alternatives

Meat Alternatives

Beans, cranberry/roman, cooked 175 mL (¾ cup) 271

Lentils, cooked 175 mL (¾ cup) 265

Peas (chickpeas, black-eyed/cowpeas, adzuki), cooked

175 mL (¾ cup) 180-263

Beans (mung, adzuki), cooked 175 mL (¾ cup) 234-238

Beans (pink, pinto, navy, white, kidney, great northern), cooked

175 mL (¾ cup) 157-218

Sunflower seeds, without shell 60 mL (¼ cup) 77-81







Source: "Canadian Nutrient File 2010" . www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/index-eng.php [accessed March 13, 2012]

Meatless (fish sticks, meatball, chicken), cooked

75 g (2 ½ oz) 59-77

Soy burgers/vegetarian, meatloaf or patty, cooked

75 g (2 ½ oz) 59

Soy nuts 60 mL (¼ cup) 59

Organ Meat

Liver (turkey, chicken) cooked 75 g (2 ½ oz) 420-518

Liver (lamb, veal), cooked 75 g (2 ½ oz) 262-300

Liver (beef, pork) cooked 75 g (2 ½ oz) 122-195

Miscellaneous

Yeast extract spread (vegemite or marmite)

30 mL (2 Tbsp) 371

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Notes

http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/index-eng.php

http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/index-eng.php

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