Articles
Pregnancy
- What is Folate?
- Stress Incontinence
- Getting fit and losing weight after pregnancy
- Nutrition During Pregnancy By Ruth Logan July 1999
- Foods to avoid
Folate – what is it?
Folate is a water-soluble B-group vitamin, which means it is not stored in the body like the fat-soluble vitamins so we need a daily intake. It is commonly added to vitamin and /or mineral supplements in its manufactured form, folic acid. Folate is used as the generic term. Folacin is a non-approved term but means the same thing as folate.
Folate – why is it important?
Over the last decade research has shown a strong connection between increased folate intake and the prevention of neural tube defects (NTDs). The term NTDs applies to any abnormality of the embryonic brain and/or the spinal chord. NTDs include spina bifida, where the spinal column has failed to form properly, anencephaly, where the brain and skull have not developed correctly and encephalocoele, where the brain comes through a skull defect. In Australia, NTDs affect between 400-500 births each year. Research indicates that increased folate intake can prevent 7 out of 10 of NTD births. Folate also reduces the prevalence of anaemia in the last part of pregnancy.
Folate – who needs extra?
All women of reproductive age need extra folate, including younger teenage girls who have no intention of becoming pregnant, but are sexually active. Extra folate is needed at least one month before getting pregnant and is especially important during the first 3 months of pregnancy. This is a time when many women may not be aware they are pregnant, especially when considering that about half of all pregnancies are unplanned.
Folate – how much is needed?
The current recommendation for women (16-44 years) is to aim to consume 400-500 micrograms (mcg) of folate per day. Women should not take more than the recommended doses unless they have a family history of NTDs and have consulted with their doctor. Breast-feeding women are advised to consume 350mcg/day.
Meeting the recommended daily intake for folate can be achieved by:
- Taking a folate supplement – some multivitamins only contain 200mcg (0.2mg) of folate.
It is important that women choose those containing 400mg-500mcg (0.4-0.5mg) if they are unsure about their dietary intake of folate. Folate tablets are available from supermarkets and pharmacies. - Choose foods with added folate. Many cereals now have folate added to them so check the nutrition panels on packets of cereal to make sure you are choosing one with added folate.
- Choosing foods rich in folate. Good food sources include:
- green leafy vegetables (spinach, broccoli, asparagus and brussel sprouts)
- legumes (which includes beans and peas)
- fruit (strawberries, bananas, oranges, orange juice)
- nuts and eggs.
Most women would find it difficult to get the folate they need from food alone. Furthermore, it is hard to measure the amount of folate eaten in food as folate levels can be affected by cooking at high temperatures and food processing. Green vegetables should be cooked for a short time, using little water – the best cooking methods include stir-frying, steaming and cooking in a microwave.
The easiest way to make sure you get enough folate is to take a supplement and eat a diet rich in folate. Diets that contain rich sources of other B group vitamins and vitamin C are also generally rich in folate.
What about folate in foods?
Foods containing at least 40mcg folate per serve Food
| Foods | mcg folate |
|
|
Stress Incontinence By Rosie Salzman
The pelvic floor muscles are frequently overlooked, even though they are one of the most important muscle groups in the body, contributing significantly to the role of sexual response, child birth and support of the bladder, womb and bowel. Weakness in the pelvic floor muscles can lead to the development of stress incontinence, a particularly devastating condition, that occurs in more than one in three women between the ages of thirty and sixty years.
Pelvic floor muscles
The pelvic floor is a layer of muscle that stretches from the pubic bone at the front to the base of the spine. The pelvic floor muscles are classified as postural muscles, which means that they need to be active when the body is in the upright position. Without the support of a healthy pelvic floor, the ligaments that hold the bladder, bowel and womb in place can become damaged. The pelvic floor muscles need to be slow to fatigue, enabling them to cope with everyday occurrences like a sneeze, cough or jump, which create a rise in pressure, squeezing the bladder. The muscles must be strong enough to respond efficiently to this rise in pressure with short bursts of power, in order to prevent urine from leaking from the bladder. If the muscles are unable to respond efficiently a condition called stress incontinence will occur.
Many women are unaware how weakness of the pelvic floor muscles originates, but it is commonly associated with pregnancy, childbirth, menopause (when changes in hormonal production affect the pelvic support) and strenuous or vigorous activity (such as weight lifting). Although these muscles do weaken with age, teenage girls can also display the symptoms of pelvic floor weakness.
Locating the pelvic floor muscles
Many people find the pelvic floor muscles difficult to locate and do not exercise them as part of their daily physical activity. Test the location of the pelvic floor muscles by contracting them while urinating, which will stop the flow (note this is not an exercise and should not be performed on a regular basis). Another way of finding the location is through touch. Place a finger just behind the vagina and try to tighten the muscles around the water passage. You will be able to feel this if you are doing the procedure correctly.
Strength
The frequency that the exercises should be performed is dependent on the level of weakness discovered, but as with any exercise routine, workouts should be a gradual build up of duration and strength contractions. If you find the exercises demanding, aim to achieve ten contractions. However, if you suffer from stress incontinence and find these exercises do not improve your condition, you may wish to seek professional advice.
Exercising the pelvic floor muscles
Many women wrongly believe that they are strengthening the pelvic floor muscles through everyday workouts. However, this is not the case so it is of paramount importance to incorporate exercise (see below) for the muscles into daily activity. Frequently exercising the pelvic floor muscles will also raise the awareness of this part of the body, enabling you to detect any weaknesses or change in condition.
Basic
Sit or lie comfortably with the knees slightly apart. Concentrate on the pelvic floor muscles. Attempt to lift and squeeze the muscles. Imagine you are trying to stop a flow of urine. Breathe naturally throughout, without squeezing your buttocks or tensing your abdomen.
Repeat the same exercise again, this time making the contractions faster and stronger.
Correct Exercises
Endurance
Use the same protocol as explained in the basic exercise. Contract the muscles for at least two seconds, but as long as possible would be preferable. Rest an equal amount of time, then repeat.
Getting fit and losing weight after pregnancy
You’re back home again. You’re happy, but maybe not physically fit. That’s perfectly normal, since your body has gone through significant changes during pregnancy and has worked very hard during the birth of your baby. When you give birth, you lose around six kilos (13 pounds) immediately.
When you return home again, you continue to lose water and, once your uterus returns to its original size, you will lose another two to three kilos (four to seven pounds). If you are breastfeeding, you will get back to your normal weight more quickly because producing milk uses fat stores in your body and burns up lots of energy.
It is important to allow your weight to come off slowly. This process should happen naturally as long as excess kilojoules are not consumed. Aim to give yourself around six months to get your figure back naturally before resorting to a restricted eating plan. The early days of motherhood are not a good time to restrict your diet. Your body needs some additional energy and nutrients to meet the extra requirements of feeding and generally looking after your baby.
As a guide:
- Eat a wide variety of foods (including breads, cereals, rice, pasta, vegetables, legumes, fruits, milk, cheese, yoghurt, lean meat, poultry, fish, eggs, nuts and seeds)
- Drink plenty of water
- Avoid skipping meals, especially breakfast
- Take the time to have a nutritious lunch and dinner
- Have your meals at regular intervals
- Have balanced meals and snacks, without too much fat or sugar
Getting a flat stomach again
Your stomach muscles and skin need toning up as they become distended and stretched during your pregnancy. A few gentle toning exercises will help you get your stomach firm again.
Before giving your stomach muscles a workout, you must first ensure that any physical damage as a result of giving birth has healed and is back to normal again. Speak with your doctor to find out what is best for you and when you can start.
Strengthening your pelvic floor muscles
During pregnancy and during the act of giving birth, significant demands are made on the muscles that make up your “pelvic floor”. Relaxation of these muscles is responsible for poor bladder control, which some women suffer from after giving birth.
Pelvic floor exercises after childbirth can help the muscles to recover more quickly. Speak to your doctor or physiotherapist for information on pelvic floor muscle exercises that are suitable for you.
Keeping regular
Some women experience poor bowel habits after childbirth. This inconvenience can be resolved by eating a fibre-rich diet, drinking plenty of fluids and including some gentle exercise like walking.
To help improve your bowel movements, eat a variety of fibre-rich foods like:
- Wholemeal bread
- Fibre-rich breakfast cereals
- Fruits (fresh, canned and dried)
- Vegetables
- Legumes (lentils, split peas, chick peas, red kidney beans, baked beans, four bean mix)
If you would like more specific information on how to lose weight safely and effectively, consult your doctor or an accredited practising dietitian, who will provide tailored dietary advice based on your lifestyle and your physical condition.
Nutrition During Pregnancy By Ruth Logan July 1999
Are regular exercisers less prone to constipation?
Yes this is true; however, if difficulties arise follow these guidelines:
· Increase your fluid intake, as fibre can only be effective if sufficient moisture is present.
· Increase your consumption of fibre rich foods – include extra wholemeal/grain bread, cereals and fruit/vegetables. Baked beans on toast is a great bowel softening snack!
· Check with your doctor or pharmacist that it is not your iron supplements (if you are taking them) that are altering your bowel habits.
When it comes to nutrition during pregnancy, physically active females often have specific questions and concerns that cannot always be answered by the standard pregnancy literature. In the following article, Sports Dietitian, Ruth Logan, provides answers to 14 commonly asked questions.
How do I avoid excess weight gain during pregnancy?
It is important for women to gain an adequate amount of weight during pregnancy, as poor weight gain may result in a low birth weight infant. However, there is no need to ‘eat for two’. Your energy needs during pregnancy only increase by a small amount – approximately 600 kJ to 1000kJ – and this figure will be influenced by exercise frequency, intensity and duration. If you decrease your exercise level due to morning sickness or tiredness in early pregnancy, you may need to reduce your total energy intake to avoid excess weight gain.
The best way of working out your individual energy requirements is to monitor your weight change. A good guide is 1 to 2 kilograms in the first three months. In the following months, a gain of 0.4 kg per week is usual, resulting in a total weight gain during pregnancy of 10 to 13 kg. An especially lean athlete may gain the full 13 kg, while a woman carrying excess body fat prior to conception may be safe gaining 6 kg or less, as there is no need for the maternal fat store deposits to be laid down. The bottom line is that you need to ‘eat to appetite’, with an emphasis on healthy foods.
These are the components of weight gain in pregnancy:
Breast tissue – 0.5 kg
Foetus – 3.4 kg
Placenta – 0.6 kg
Uterus weight – 1.0 kg
Amniotic fluid – 0.9 kg
Increased blood volume – 1.5 kg
Maternal fat stores – 3 to 4 kg
Extracellular fluid – 1.0 kg
Total Gain: 12.0 kg
Sports that demand low body weight (e.g., jockeying, light-weight rowing), or low body fat (e.g., gymnastics, ballet, body building) are not desirable during pregnancy. Attempting to arrest weight gain can prove dangerous, with an increased risk of medical complications for mother and baby. Pregnancy is not a time for strict dieting! Athletes should expect to see a marginal increase in skinfold thickness.
How much of different types of food should I be eating?
The following list gives a good guide to the serve sizes recommended for different types of food.
Food group: Bread, cereal, rice, pasta, crackers, noodles
Serve size: 1 slice bread, 1/2 cup cereal, 2 crackers, 1/2 cup rice/pasta
No. serves daily: 8 to 12
Food group: Vegetables
Serve size: 1 potato, 1/2 cup vegetables, 1 cup salad
No. serves daily: 5 to 6
Food group:Fruit
Serve size: 1 piece
No. serves daily: 3 to 4
Food group: Meat, fish, chicken, legumes, nuts
Serve size: 65 to 100 g cooked meats, 80 to 120 g fish, 1/2 cup legumes, 2 eggs, 1/3 cup nuts, 1/4 cup seeds
No. serves daily: 1 1/2
Food group: Extra foods
Serve size: 600 kJ snack (e.g., four biscuits), 1 tbsp margarine, 1 can soft drink
No. serves daily:0 to 2
NB: Small amounts of added fats and oils are expected to be used in cooking and on bread.
Source: The Australian Guide to Healthy Eating, 1998.
How do I avoid heat stress when I exercise regularly?
It is essential to avoid heat stress and dehydration, because severe and repeated episodes of hyperthermia (high body temperature) can adversely affect fetal development. Pregnant exercisers should follow these guidelines (note: a mild rise in maternal body temperature of 1 to 2° C is not a cause for concern):
· Avoid exercise in hot weather
· Decrease exercise intensity to reduce body temperature increase
· Wear appropriate clothing
· Drink plenty of fluids before exercise (500 ml minimum in the last 30 minutes), during exercise (1 cup every 15 minutes), and after exercise (minimum 1 to 2 litres). Cooled fluids may be more palatable in hot weather.
· Special sports drinks may be useful if you are exercising longer than an hour, or if you are struggling to gain enough weight. The extra energy is unnecessary is you are only participating in short periods of low intensity activity.
Do I need to increase my iron intake?
During pregnancy, iron needs are almost double that of non-pregnant women. A healthy diet generally provides only 1.0 mg iron/1000 kJ, hence iron supplements are often required to reach an intake of 22 mg/day. Endurance female athletes are especially at risk of iron deficiency as they may have started their pregnancy with depleted iron stores. It is advisable for all pregnant athletes to have iron checks either before conception, or early in pregnancy. The levels should then be checked at regular intervals throughout pregnancy.
Here’s how to meet your daily iron needs:
1. Eat iron-rich foods:
Eat 1 to 2 serves per day of haem iron foods, like lean red meat, and to a lesser extent pork, chicken and fish.
2. Maximise your iron absorption
Meat and vitamin C rich foods increase the absorption of non-haem iron by up to four times. Non-haem iron foods include bread, cereals, vegetables, eggs and legumes.
3. Watch what you drink
Tea and coffee can inhibit the absorption of non-haem iron. Enjoy these drinks in moderation between meals.
Why do I need folate?
Folate is a member of the Vitamin B Group and is required for healthy growth and development of body cells. Women are now encouraged to increase folate intake for at least one month before pregnancy and for the first three months (1st trimester) of pregnancy to reduce the risk of birth abnormalities, such as spina bifida. Pregnant athletes are advised to follow the same precautions.
The average requirement for folate during pregnancy is 400 micrograms per day, which is double the need of the non-pregnant female. To achieve this without a supplement, you need to eat a large range of foods rich in folate. Folic acid supplements are often combined with iron and are often recommended by doctors.
The following foods contain at least 40 micrograms/serve (1/10 of the daily requirement in pregnancy):
Orange – 1 whole
Broccoli/cauliflower (cooked) – 3/4 cup
Spinach/brussel sprouts – 1/2 cup
Baked beans – 1/2 cup
Lentils (cooked) – 3/4 cup
Peanuts – 1/4 cup
Bread (fortified with folate) – 1 slice
Breakfast cereal (+ folate) – 3/4 cup
Source: ANZFA 1999
Should I reduce my calcium intake to keep my weight down?
No, calcium requirements actually increase in the final three months (last trimester) of pregnancy. This increased need is easily met using fat-reduced dairy products or calcium fortified soy products. If you choose to breast feed, you need to further increase your calcium intake during this time.
These are the recommended dietary intakes for calcium at different stages of a woman’s life:
19 to 54 years – 800 mg
Pregnancy (3rd trimester) – 1,100 mg
Breastfeeding – 1,300 mg
Post-menopausal – 1,000 mg
Three serves daily of the following foods will ensure an adequate intake of calcium.
1 cup (full cream/fat reduced/skim) = 300 mg calcium
1 cup low fat soy milk (fortified) = 300 mg calcium
1 cup yoghurt (flavoured) = 280 mg calcium
1 cup (Physical Skim/Shape) milk = 450 mg calcium.
Are supplements necessary?
It is impossible to make a blanket statement on supplement use, as each individual will have their own special needs. You are well advised to avoid large doses of vitamin and mineral supplements without medical supervision, and specific supplement like folate, iron and calcium should be taken with your doctor’s supervision. If you have been in the habit of using other supplements before your pregnancy, seek your doctor’s opinion about whether it is safe to take them during pregnancy.
Is it safe to be a vegetarian during pregnancy?
For the pregnant female athlete, vegetarianism can lead to difficulty achieving adequate protein, energy, iron, and zinc intakes. A vegan vegetarian diet (where all animal products are eliminated) is likely to be deficient in iron, calcium, zinc and Vitamin B12. Soy products, nuts, seeds and legumes become essential sources of protein and energy. The diet tends to be very bulky, and this limits energy intake in later pregnancy when stomach capacity is reduced. Vitamin B12 supplementation and medical advice are essential for pregnant vegans.
Lacto-ovo vegetarians (those who eat dairy foods and eggs), need to eat legumes, nuts and seeds to ensure adequate protein intake. This diet can be eaten safely during pregnancy if well planned, and iron and zinc levels are monitored. Vegetarians who eat chicken, eggs, dairy foods and fish, should not have a problem with their iron and zinc.
Is it true that I will have food cravings?
Some pregnant women really do crave specific foods, although there seems to be little scientific evidence to suggest why. If chocolate or fatty foods become a fancy, beware of excess weight gain. A craving for sweet foods can sometimes be blamed on insufficient carbohydrates in the diet, so re-check your intake of satisfying foods, like grain bread, high fibre cereals and fruit.
If the craving is for yoghurt, banana sandwiches or fruit smoothies, be relieved as these foods are important components of your diet.
What can I do about indigestion?
Indigestion causes discomfort in many pregnant women in later stages, as the growth of the fetus decreases stomach capacity. The problem is often exacerbated by physical activity, particularly bending and stretching. Here are some quick tips to alleviate indigestion:
· Avoid exercise that aggravates indigestion
· Avoid excess caffeine
· Eat small meals more frequently and avoid eating within two hours of exercise
· Have a snack ready to eat after you finish exercising
· Avoid fatty spicy foods, or anything that causes problems
· Be careful not to overly restrict food choices
· If the problem becomes severe, seek medical advice.
What foods cause listeriosis?
You can minimise the risk of infection from this bacteria by avoiding certain high risk foods, and paying special care to food handling and preparation at home. High-risk foods include pate, smoked seafood, soft cheeses, cooked diced chicken, cold meat products, pre-prepared salads, and raw seafood.
Safe foods include all freshly cooked foods, hard cheese, fresh milk products, UHT milk, yoghurt, fresh washed fruit and vegetables and all canned foods.
How do I avoid feeling tired?
Chronic tiredness is very common in early pregnancy (and is more noticeable in second and subsequent pregnancies), but a renewed feeling of well-being generally returns at about 15 weeks gestation. Take a diet check for carbohydrates once again, as insufficient energy intake could add to the situation. It is important to have small frequent snacks for energy boosts, and if chronic fatigue continues, have your doctor check your iron status.
Should I exercise if I suffer from morning sickness?
If your morning sickness is severe, it will become extremely difficult and quite unsafe to exercise. However, morning sickness differs from one person to the other, and can range from a decreased feeling of well-being, to vigorous vomiting. Some women find their worst time is in the evening, which contradicts the title of morning sickness. Exercising during morning sickness can cause complications like heat stress/dehydration, early fatigue and electrolyte disturbances. If you are suffering extreme morning sickness, concentrate on your fluid intake and eating small, dry bland meals/snacks.
Contemplating Pregnancy?
Here are 10 some simple steps to follow if you are planning a pregnancy.
1. Stop smoking.
2. Avoid alcohol – preferably for three months before, and the first three months of pregnancy.
3. Reduce caffeine to less than 300 mg per day, i.e., a maximum of four moderate strength cups of coffee/tea daily.
4. Get into the habit of drinking water.
5. Reduce your intake of artificial sweeteners. Learn to enjoy the natural flavours of food.
6. Talk with your doctor about taking a daily folic acid supplement (500 micrograms is recommended).
7. Have your iron status checked, especially if you are an endurance athlete or have been in heavy training.
8. Broaden your eating pattern and food choices.
9. Reduce body weight prior to conception if overweight.
10. Find out what forms of exercise you’ll feel comfortable with during pregnancy.
Foods to avoid
Red = Don’t eat
Purple = Eat with caution
Blue = Ok to eat
foods-to-avoid.pdf | Food | Examples | What to do |
| MEAT, POULTRY & SEAFOOD | ||
| Processed meats | Ham, salami, luncheon, chicken meat etc. | DON’T EAT |
| Raw meat | Any raw meat, raw chicken, or other poultry, beef, pork, etc. | DON’T EAT |
| Poultry | Cold chicken or turkey e.g., used in sandwich bars | DON’T EAT |
| Hot take-away chicken | Purchase freshly cooked, use immediately, store leftovers in fridge and use within a day of cooking. | |
| Home cooked | Ensure chicken is cooked thoroughly, use immediately – store any leftovers in fridge and use within a day of cooking. | |
| Paté | Refrigerated paté or meat spreads | DON’T EAT |
| Seafood | Raw seafood | DON’T EAT |
| Ready-to-eat chilled peeled prawns | DON’T EAT | |
| Smoked fish and seafood | DON’T EAT | |
| Cooked fish and seafood | Cook until steaming hot, eat while hot, store leftovers in the fridge and use within a day of cooking. | |
| Sushi | Store-bought | DON’T EAT |
| Home-made | Don’t use raw meat or seafood, eat immediately | |
| Cooked meats | Beef, pork, chicken, mince | Cook thoroughly, eat while hot. |
| DAIRY & EGGS | ||
| Cheese | Soft and semi-soft cheese e.g. brie, camembert, ricotta, fetta, blue etc. | DON’T EAT unless in a fully cooked dish eg. spinach and ricotta canneloni. |
| Processed cheese, cheese spreads, cottage cheese, cream cheese etc. | Store in the fridge, eat within two days of opening pack | |
| Hard cheese e.g., cheddar, tasty cheese | Store in the fridge | |
| Ice cream | Soft serve | DON’T EAT |
| Packaged frozen ice cream | Keep and eat fronzen | |
| Milk | Unpasteurised(raw) | DON’T DRINK OR USE |
| Pasteurised | Keep refrigerated, drink within use-by-date. | |
| Other dairy | Cream, yoghurt | Check use-by-date, keep refrigerated. |
| Custard | Don’t eat unless heated until steaming hot. | |
| Eggs | Cook thoroughly | |
| VEGETABLES & FRUIT | ||
| Salads | Pre-prepared or pre-packaged salads e.g from salad bars, smorgasbords | DON’T EAT |
| Home-made | Wash and dry salad ingredients well just before making and eating salads, store any leftover salads in fridge and use within a day of preparation | |
| Fruit | All fresh fruits | Wash and dry well before eating |
| Vegetables | All fresh vegetables | Wash and dry well just before eating raw or wash before cooking |
| Frozen vegetables | Cook; Don’t eat uncooked | |
| Parsley | Home-grown and store fruit | Don’t eat raw; can use in cooked dishes. |
| Bean spouts | Alfalfa sprouts, brocolli sprouts, onion sprouts, sunflower sprouts, clover sprouts, radish sprouts, snowpea sprouts, mung beans and soy beans. | DON’T EAT either raw or cooked |
| OTHER FOODS | ||
| Leftovers | Cooked foods | Store leftovers covered in the fridge, eat within a day and always, reheat until steaming hot |
| Canned foods | Tinned fruit, vegetables, fish, etc. | Store unused portions in the fridge in a clean, sealed containers and use within a day. |
| Stuffing | Stuffing from chicken or poultry | Don’t eat unless cooked separately and eat hot |
| Hummus | Store-brought or home-made | Store in fridge, eat witin 2 days of opening/making |