Exercise and Nutrition in Pregnancy

1. Exercise and Nutrition in Pregnancy Gowri Reddy Rocco, MD Family Medicine &Women’s Health

2. Exercise recommendations during Pregnancy- Introduction • In the past, women were told to significantly increase their caloric intake and decrease their physical activity during pregnancy. • Thus, pregnancy became a large contributor to the present obesity epidemic. • Currently, experts recommend that pregnant women continue and maintain an active lifestyle during their pregnancy. • Exercise does not increase the risk of miscarriage.

3. Exercise Regimens for Pregnant Females • A thorough medical exam/evaluation should be conducted prior to recommending an exercise program. • This is done at routine prenatal visits and an exercise prescription is usually recommended at this time.

4. Pre-exercise medical screening • Overall health, obstetrical history and medical risks are reviewed. • Considered factors include: • Age • General physical condition • Exercise history • Risk factors for coronary heart disease • Orthopedic history and musculoskeletal risks • Medication use • History of pulmonary disease • Anticipated type of exercise • Handicaps or disabilities • Current and past obstetric history

5. Pre-exercise medical screening • Women in good health should be encouraged to engage in regular, moderate intensity physical activity during a normal, uncomplicated pregnancy. • Pregnant women with diabetes, morbid obesity, or hypertension should be counseled on an individual basis. • Contraindications to exercise: • Preexisting or developing medical conditions • These women should be closely monitored.

6. Exercise Prescription • Exercise intensity should start light to moderate and should gradually increase. • There is no data to support health benefits from prescribing strenuous exercise to pregnant women. • A meta-analysis of exercise and pregnancy reported an exercise program for an average of 43 minutes 3 times a week at a heart rate= 144 bpm was not associated with adverse effects on maternal weight gain, birth wt., length of gestation, length of labor, or APGAR scores in normal pregnancies.

7. Benefits of Exercise • Pregnancy usually leaves women feeling tired, exercise gives you more energy to make through the day. • Exercise allows you to sleep better. • Improves your mood, lessens mood swings, improves your self image, and gives you some sense of control. • Prepares you for childbirth. Studies show shorter labor, fewer medical interventions, and less exhaustion during labor. • Easier to lose the weight after the baby is born.

8. Recommendations • Both ACOG ( American College of Obstetrics and Gynecologists) and ACSM (American College of Sports Medicine) recommends at least 30 minutes of physical exertion for most days of the week. • As your pregnancy progresses, your center of balance shifts, making falls more likely. Participating in activities such as swimming, walking or low impact aerobics do not put you at additional risk to slip or fall. • Keep your heart rate under 140 bpm and avoid overheating, especially in your first trimester and stay well hydrated.

9. Recommended exercises: Kegel: women have easier births, minimize bladder leaks and hemorrhoids. Please refer to handout. Walking: Start slowly, stretch before you begin. Wear good shoes to decrease risk of falling. Swimming: safest exercise for pregnant women, because doesn’t add extra weight or stress to your joints. Running and Jogging: usually if your in a habit of running before pregnancy, you can continue running. Make sure you’re well hydrated and avoid over-heating and wear good shoes. Bicycling and Stair climbing machines: Safe in the beginning, but as your center of gravity is shifting, you have a greater risk of falling. Yoga: Relieves stress and pressure on your body. Avoid laying on your back for extended periods of time and try not to overstretch. Aerobics/ Dance: Avoid spinning, leaping and jumping.

10. Exercises to Avoid: • Activities with high risk of falling or those with a high risk of abdominal trauma are not recommended: Skiing Water skiing Horseback riding Scuba diving Contact sports- ice hockey, soccer, basketball

11. When you exercise: • Don’t wear tight clothes • Wear a good sports bra • Wear comfortable shoes that give strong ankle and arch support • Breathe deeply • Drink lots of water • Keep your heart rate under 140 bpm • Avoid jerking motions • Avoid laying on your back for extended periods of time • Avoid exercise in extremely hot weather • Stop exercising if you have any vaginal bleeding, faintness, shortness of breath, contractions or nauseous feelings.

12. Benefits of Exercise during Pregnancy • Retrospective data suggest that exercise may: • prevent gestational diabetes • reduce the risk of developing preeclampsia • prevent excessive weight gain during pregnancy • Gaining weight at a steady rate can lower your chances of having • Hemorrhoids • Varicose veins • Stretch marks • Backache • Fatigue • Indigestion • And shortness of breath during pregnancy

13. Exercise in Postpartum • May start as early as 2 weeks or at 6 weeks after delivery. • Modest weight reduction while nursing is safe and does not compromise neonatal weight gain. • Nursing women should consider feeding their infants before exercising to avoid the discomfort of engorged breasts and also avoid the problems associated with increased acidity of milk secondary to any build-up of lactic acid. • Exercise postpartum is also associated with a decreased frequency of postpartum depression.

14. Nutrition in Pregnancy- Intro • Pregnancy is the one time in your life when your eating habits directly affect another person. • A nutritious, well-balanced eating plan will give your baby a strong start in life.

15. Nutrition in Pregnancy • The key components of a health lifestyle during pregnancy include: • Appropriate weight gain • Appropriate physical activity • Consuming appropriate amounts of food to allow adequate, but not excessive, maternal weight gain • Appropriate vitamin and mineral supplementation • Avoidance of alcohol • Avoidance of tobacco, drug use and other harmful substances

16. Avoidance of food borne illnesses • Food borne illness have adverse effects to mother and fetus, especially Toxoplasma and Listeria. • To avoid the risk of food borne illnesses, it is important to: • Frequently wash hands • Consume only meats, fish, poultry that are fully cooked • Avoid unpasteurized dairy products • Thoroughly rinse fresh fruits and vegetables under running water before eating • Hands, food prep surfaces, cutting boards, utensils that come in contact with raw meat, eggs, poultry, fish should be washed well with hot, soapy water

17. Pregnancy weight gain • How much weight a woman should gain all depends on her prepregnancy weight. • Underweight women with low weight gain during pregnancy appear to be at higher risk for having a low birth wt. Infant, preterm birth and recurrent preterm birth. • Obese women are at increased risk of having a large for gestational age infant, post term birth, and other birthing complications.

18. How much total weight should I gain? • This all depends on your prepregnancy wt: • 25-37 pounds for normal weight women • BMI<19.8 • 28-40 pounds for underweight women • BMI 19.2-26 • 15-25 pounds for overweight women • BMI 26-29 • 15 pounds for obese women • BMI>29

19. Where does the extra weight go? • Baby: 7-8 pds • Placenta: 1-2 pds • Amniotic Fluid: 2 pds • Uterus: 2 pds • Maternal breast tissue: 2 pds • Maternal blood: 4 pds • Your blood volume will have increased as much as 60% • Fluids in maternal tissue: 4 pds • Maternal fat and nutrient stores: 7 pds • Nutrients stored for breastfeeding the baby after delivery

20. Rate of weight gain • Also depends on prepregnancy weight and goal should be to keep weight gain as steady as possible • Healthy weight before pregnancy • 3-5 pds during the first trimester • 1-2 pds/ week second and third trimester • Underweight before pregnancy • 5-6 pds or more first trimester, depending on medical eval • 1-2 pds/week second and third trimester • Overweight before pregnancy • 1-2 pds first trimester • 1 pd/week during last six months

21. Risks of gaining too much weight • These are potential medical problems with gaining too much weight: • Gestational diabetes- high blood sugar • Backaches • Preeclempsia- high blood pressure • Leg pain • Increased fatigue • Varicose veins • Increased risk of cesarean delivery

22. Recommended Daily Allowances (RDAs) • 3-4 servings of fruits and vegetables • 9 servings of whole-grain or enriched bread, cereal, rice or pasta for energy • 3 servings of milk, yogurt and cheese for calcium • 3 servings of meat, poultry, fish, eggs, nuts, dried beans and peas for protein

23. RDAs • Calories- recommended intake is increase in daily caloric intake: • 340 kcal/day in the second trimester • 452 kcal/day in the third trimester • Protein- recommended intake is 75-100 grams/day. • This means 2-3 servings of meat (3 ounces-deck of cards) • Animal foods are considered complete or high-quality proteins b/c they contain all the 9 essential amino acids. • Plant based foods are incomplete, and can be fortified with soy products and increase of dairy products. • Carbohydrate- recommended intake is 175 g/day, up from 130 g/day in nonpreg women • Usually 8-9 servings of whole grain, enriched breads and pastas • Iron- recommended intake is 30 g/day, almost double. • This means 2-3 servings of green leafy vegetables, 3 servings of whole grains, and 2-3 servings of lean protein. • Necessary for fetal/placental development and to expand the maternal blood volume. • Calcium- recommended intake is 1000 mg/day. • For fetal skeletal development, especially in third trimester. • This means 3-4 servings of dairy products. • Folic acid- recommended 600-800 mcg daily. • Preconception recommendation to all fertile females of 400mcg, because the neural tube closes between 18-26 days after conception so folic acid supplementation after the diagnosis of pregnancy is usually too late to reduce the effects of neural tube defects.

24. Additional benefits • Omega –3 Fish Oils, consisting of DHA (Docosahexaenoic acid), appear to be essential for early brain development during gestation and infancy. • Recommended dose is between 200-400mg/day • Offspring of mothers who took Omega-3 Fish Oils during pregnancy and lactation scored higher on cognitive tests. • These supplements also have been to show to: • Improve visual acuity • Decrease the risk of allergic disorders • Improve neurological, immunological and physical development

25. Dietary Restrictions • Fish: • 2 or more servings/week associated with improvement with fetal brain development, however, it is very important not to eat fish containing mercury, which causes delayed development and brain damage to the child and mother. • Avoid eating any shark, king mackerel, tilefish, tuna • Low in mercury fish are shrimp, canned light tuna, wild Alaskan tuna, catfish. Canned albacore white tuna has more mercury than canned light tuna.

26. Dietary Restrictions • Caffeine: • A stimulant and a diuretic, this leads to increased BP, HR and reduction in body fluids leading to dehydration. • Caffeine also crosses the placenta to your baby, you are able to metabolize it, however, your baby is not. • Found in coffee, tea, chocolate, soda, some OTC meds that relieve headaches. • Studies have reported an association between high levels of caffeine consumption and risk of miscarriages, decreased birth weight, and late fetal death. • Restriction of caffeine consumption to 1-2 cups or less than 300mg/day seems prudent. • The less caffeine you consume the better. • Artificial sweeteners: • No evidence of use during pregnancy increases birth defects, however, advised to avoid if possible.

27. Breastfeeding Nutrition • Women breastfeeding should increase their caloric intake by 300-500kcal above prepregnancy levels • Should also consume 1000mg/day of Calcium • Caloric demand of breastfeeding is estimated at 640kcal/day, however, this depends on maternal weight.

28. THANK YOU!!! ANY QUESTIONS?