The setting is a medical office with a newly pregnant couple and their doctor. There is a lot of discussion and counseling planned at this visit. Some patients are anxious, some are not, but always they have questions. This scene plays itself out in my office multiple times a day.
The order will vary with the practitioner, but is likely to include a review of medical symptoms of the pregnancy, such as nausea and fatigue, or abnormal bleeding. Additionally, we will explore medical questions including family history, medical history, medications, and any hereditary genetic risk. The couples’ list of questions will sometimes be short, sometimes extensive, and inevitably includes several of the following: Can I color my hair? Can I use self-tanner or teeth whitener? Can I get a bikini wax? Can I get a massage? Can I travel? Some come in with a bag of varying herbal or vitamin supplements that they want to know are safe during pregnancy.
While these questions are important, they often supersede questions about nutrition, exercise, and pregnancy weight gain, and we do need to address those before the visit is over.
Recommendations
Dr. Gabriela Siegel
With that in mind, here are the key messages related to exercise and nutrition that I proactively weave into my patients’ early pregnancy visits.
Continuing exercise in pregnancy is important to maintain cardiovascular health, muscle tone, and well-being. Just as when we are not pregnant, a sedentary lifestyle affects our overall health in a negative manner, unless avoiding exercise is recommended for a medical indication. Neither overdoing nor under exercising are a good way to achieve the body’s goals. Exercising to a conversational pace is a good measurement to achieve. For those who do not have a regular exercise routine, a good-paced walk several times a week or a prenatal fitness class can be a reasonable option.
The old adage of “eating for two” is one that we need to dispense with early in the process. In actuality, eating for “1.2” should be adequate for most patients. When starting a singleton pregnancy with a normal body mass index, only about 300 more calories a day should meet the new nutritional demands. Patients who are overweight or underweight need those guidelines adjusted and sometimes, in those situations, a nutritionist’s input can be a helpful addition.
Although the nutritional demands during pregnancy increase only a little bit, what we choose to eat while pregnant is important. While cravings influence our appetite, it continues to be important to pay attention to the variety of foods on our plate.
There is no specific pregnancy diet. Simply following the normal recommendations for healthy eating is the correct idea. Making sure to get adequate folic acid – at least 800 mcg daily – beginning preconceptionally to prevent neural tube defects, and then enough calcium to encourage healthy bone development – 1,000 mg per day either through supplements or food sources – is a good place to start.
Focusing on nutrient-dense foods such as lean proteins, low-fat dairy products, fruits, vegetables, and whole grains and incorporating a variety of these foods into the diet is ideal. That looks like this: Two to three servings of vegetables of different colors, two servings of fruit, three servings of whole grains, and two to three servings of lean protein sources on a daily basis.
Protein-rich foods should be varied to include seafood, lean meats, eggs, beans, nuts, and seed sources. Ideally, all women – especially those who are pregnant or breastfeeding – should incorporate two to three servings of a variety of seafood a week into this rotation to optimize the natural benefits of omega-3 fatty acids. The data suggest that this has not been the case, and it is important to emphasize these benefits to fetal and maternal well-being both for the short and long term.
Quite frankly, avoiding seafood is likely to pose more harm than otherwise. And there are only four types of fish that should be avoided during pregnancy: shark, swordfish, tilefish, and king mackerel. That leaves us with a long list of choices to fit varying tastes and budgets; everything from salmon and canned tuna to tilapia or cod and more can be safely enjoyed during pregnancy.
Managing the visit
This new pregnancy visit does take a long time. Our office has put together a folder that includes information and handouts on recommended genetic testing; good health and nutrition in pregnancy; a schedule of visits; information on nausea and vomiting symptoms; and testing done in routine prenatal care. This serves to help the physician remember the points to discuss, streamlines the visit, and allows the patient to take material home to review without having to commit the entire visit to memory.