Importance of Diet and Lifestyle During Pregnancy for Mother and Baby's Health

1. 2018 Journal Tasks 1 & 2 Ruth Charles Registered Dietitian October 2016

2. Diet and lifestyle during pregnancy is very important for both the mother and the developing baby’s future health. Women need to have the nutrients needed for good health during and after pregnancy. So do fathers! Infants have the best possible environment in which to grow and develop. Ruth Charles RD Oct 2016

3. Ruth Charles RD Oct 2016

4. Ireland 2016- we know… prevalence of maternal obesity is high and rising 1 in 6 at 1st antenatal appointment are obese diet quality before and during pregnancy shown to influence pregnancy outcomes poor quality diets can have long term implications for the health of women and their children. Heart disease and diabetes, may have their root in this period of early development. Ruth Charles RD Oct 2016

5. First trimester (0-12 weeks) maternal diet has a larger role in the development and differentiation of organs and can have a substantial effect on the outcome of that pregnancy. • Foetal growth may be most vulnerable to maternal dietary inadequacies in early pregnancy as nutrients are required to be present in the correct balance for successful implantation and organogenesis. • > 12 weeks primary role shifts to overall fetal growth and brain development Ruth Charles RD Oct 2016

6. a nutrient-dense dietary patternhigh intakes of low fat dairy, fruit and vegetables has a positive effect on birth weight. Ruth Charles RD Oct 2016

7. Nutrition and Lifestyle before Pregnancy Sexually active women of childbearing age daily supplement 400μg folic acid up to 12 weeks of pregnancy. Aim to be within ideal weight for height range. BMI 20-25. Ruth Charles RD Oct 2016

8. Key nutrients • Energy sources and total calories • Folic acid, iron, calcium, vitamin D, Vitamin A, omega-3 fats • Multicoloured fruit and vegetables Ruth Charles RD Oct 2016

9. Energy balance Ruth Charles RD Oct 2016

10. Ruth Charles RD Oct 2016

11. Ruth Charles RD Oct 2016

12. Ruth Charles RD Oct 2016

13. Ruth Charles RD Oct 2016

14. Folic acid • prevent neural tube defects (NTDs) in babies, e.g. Spina Bifida. Ruth Charles RD Oct 2016

15. 400 micrograms from supplement + 500 micrograms from diet= Cup peas/beans/lentils 2 portions of veg Ruth Charles RD Oct 2016

16. Iron • transport of oxygen to the developing foetus • protects health of a pregnant woman. • A pregnant woman’s body adapts to absorb more iron from the diet. It is still essential that there is sufficient iron in the diet to support both the mother and the developing foetus. Ruth Charles RD Oct 2016

17. Foods rich in iron are important during pregnancy 15mg per day is required = Lean protein twice a day 4 slices of wholemeal bread Beans/lentils Spinach & broccoli Supplement only if not achievable from diet. Haemachromatosis is the exception Ruth Charles RD Oct 2016

18. Calcium • pregnancy induces adaptations to maternal calcium homeostasis but most women do not reach the recommended daily intake • protect the bone health of the mother • to provide for healthy development of the foetal skeleton. Ruth Charles RD Oct 2016

19. Calcium 1,000mg - 1,300mg calcium a day = 3-5 portions of dairy each day + spinach, sweet potatoes, rhubarb, beans, bread, seeds and nuts. Dairy free: soy-based products fortified with calcium. Supplement only if not achievable fro diet Ruth Charles RD Oct 2016

20. Vitamin D • stores of a mother determine her developing foetus’s stores of vitamin D at birth. • Chronic low Vitamin D levels in Ireland • needed to help absorb calcium in the body and a whole range of other functions. Ruth Charles RD Oct 2016

21. 10μg (400 IU) vitamin D every day = . 500ml of fortified milk a day Ruth Charles RD Oct 2016

22. Mother: less blood clot formation, protective against heart disease. • Foetus: essential component of the brain, nervous system and retinas. Ruth Charles RD Oct 2016

23. 700-1,400mg DHA per week for pregnancy + 1,750mg combined EPA and DHA per week = 1-2 portions of oily fish per week . one serving of fresh tuna (150g) per week, or two 240g cans of tinned tuna per week. Ruth Charles RD Oct 2016

24. a supplement may be needed for women who do not like oily fish, who are vegan, or who find it difficult to consume enough omega-3 rich foods in their daily diet. • take an omega-3 and omega-6 supplement or a pregnancy-specific supplement in order to avoid excessive intakes of other vitamins, such as vitamin A Ruth Charles RD Oct 2016

25. Vitamin A • strengthens immunity • maintenance of healthy skin and mucus linings, e.g. in the nose, • improves vision in dim light. • important for the development of the foetus. Ruth Charles RD Oct 2016

26. 700μg a day = 3-5 portions of dairy Amounts of vitamin A (greater than 7,000μg/ day, may harm the developing foetus. Some foods such as liver and liver products naturally contain very high amounts of vitamin A and pregnant women need to avoid these foods. Ruth Charles RD Oct 2016

27. Fluids Without enough water, people become dehydrated, feel more tired and can’t concentrate Ruth Charles RD Oct 2016

28. Caution! • Alcohol • Caffeine • Food safety unpasteurised milks and cheeses, uncooked cured or smoked meats or smoked fish as well as ready-to-eat foods. • Smoking Ruth Charles RD Oct 2016

29. Alcohol and cigarette smoke Alcohol – none is safe harms the developing foetus increases the risk of miscarriage and pre-term delivery. Smoking - stop & avoid second-hand smoke. harms the developing foetus adversely affect foetal growth. Increased risk of low birth weight Increased risk of asthma Avoid second-hand smoke. Ruth Charles RD Oct 2016

30. Caffeine consumption in excess of 200mg per day has been shown to have negative effects on birth weight Ruth Charles RD Oct 2016

31. Food safety • Listeria,Salmonella and Toxoplasma gondii can be extremely harmful to the developing foetus. • Avoid • Unpasteurised milk and dairy products made with unpasteurised milk. Foods include all soft cheese and mould-ripened cheese (even those made with pasteurised milk), e.g. Brie, Camembert, goats’ cheese, and blue cheese, e.g. Danish Blue, Stilton, Roquefort • Pâté made from meat, vegetables or fish • Smoked salmon and gravid lax fish Ruth Charles RD Oct 2016

32. People who want to lose weight should include at least 60-75 minutes of moderate activity every day. Ruth Charles RD Oct 2016

33. Key pregnancy foods • Fortified milk • Oily fish • Lean meat • Pulses, nuts, seeds and wholegrains • Colour: Fruit, veg. and salad Ruth Charles RD Oct 2016

34. A new WHO guideline recommends adults and children to reduce their daily intake of free sugars to less than 10% of their total energy intake. (World Health Organisation, 2015) With a further reduction to 5% of total energy for extended health benefits Ruth Charles RD Oct 2016

35. Why? http://www.who.int/mediacentre/news/releases/2016/curtail-sugary-drinks/en/ “Reduced consumption of sugary drinks means lower intake of “free sugars” and calories overall, improved nutrition and fewer people suffering from overweight, obesity, diabetes and tooth decay. Free sugars refer to monosaccharides (such as glucose or fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook, or consumer, and sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates”. Ruth Charles RD Oct 2016

36. What is the Metabolic syndrome? • Your body becomes resistant to its own Insulin • Your own Insulin becomes ineffective Ruth Charles RD Oct 2016

37. Waist circumference >37”M, >32”F Ruth Charles RD Oct 2016

38. Ruth Charles RD Oct 2016

39. Ruth Charles RD Oct 2016

40. Ruth Charles RD Oct 2016

41. Is all sugar the same? No!Naturally occuring Antioxidants, phytochemicals, fibre Protein, calcium, probiotics Protects dental health Ruth Charles RD Oct 2016

42. Health issues associated with these sugars Added to food Modified from a natural sugar ! hidden sugar! Alcohol, high salt, high fat, dental health, weight gain, metabolic syndrome Ruth Charles RD Oct 2016

43. How much sugar do we eat? Irish adults are eating over 7 servings a day from top shelf of the food pyramid IHF 2015 Ruth Charles RD Oct 2016

44. 10% of total energy Ruth Charles RD Oct 2016

45. Average teenage girl • 1800 calories • 10% = 180 calories • 1g of carbohydrate (sugar) = 4 calories • 180 calories ÷ 4 = 45g • 45g of sugar = 9 teaspoons maximum Ruth Charles RD Oct 2016

46. Ruth Charles RD Oct 2016

47. 0g added sugar Ruth Charles RD Oct 2016

48. Hidden sugar Ruth Charles RD Oct 2016

49. Ruth Charles RD Oct 2016

50. Ruth Charles RD Oct 2016