Pregnancy is a nine-month continuum that begins with conception and ends with the birth of your new baby. It is a time of tremendous change in your life, often accompanied by feelings of anticipation and fear. It is also a time when maintaining good health is vitally important. From the moment of conception and even before, the choices that you make about diet, exercise and medical care will have a profound effect on the growth and development of your baby. There is no greater gift you can give your child than to live a healthy lifestyle every single day of your pregnancy.
Before you delve into this chapter, I want to let you know that it is not formatted in my usual style. You will not see my recommendations categorized by diet, vitamins/minerals and herbal remedies. Nor do I conclude this chapter with my Bottom Line. Due to the heftiness of this topic, and the fact that nutrition needs and concerns change with each trimester, I have provided nutrition strategies throughout the text. In the latter part of this chapter I sum up by presenting your nutrient and food requirements during all stages of your pregnancy. Therefore, anyone concerned with this topic should read this chapter in its entirety. Enjoy the journey to motherhood!
Confirming Your Pregnancy
The first sign of pregnancy is usually a missed menstrual period. If you’re sexually active and your menstrual cycles are quite regular, there’s a good chance that you are pregnant if your period is more than a week late. Menstrual cycles usually stop during pregnancy, although some women have been known to have light periods during the entire nine months.
To confirm your pregnancy, you can take a urine test that will detect the presence of pregnancy hormones—HCG (human chorionic gonadotropin)—in your system. You can choose to have the urine test done at your doctor’s office or you can do it yourself, using one of the many home pregnancy test kits available in most drugstores. By the second week after conception, home pregnancy tests are 90 percent accurate. As an alternative to the urine test, you can have a blood sample taken at your doctor’s office and tested at a laboratory. A blood test can detect pregnancy hormones as early as eight days after conception.
If you wait to confirm your diagnosis until you are four weeks past conception, your doctor will perform an internal examination and physically check for signs of pregnancy. He or she will look for a slight enlargement of your uterus and color changes in your vagina and cervix caused by increased blood flow. This examination is very accurate in determining pregnancy.
A typical pregnancy lasts 39 weeks or nine months from conception. Your expected date of delivery is usually 280 days from the first day of your last menstrual period. However, less than 5 percent of all babies arrive on their due date, so you should anticipate that your baby might arrive earlier or later than expected. Traditionally, pregnancies are divided into three stages or trimesters, each lasting roughly three months. Your body undergoes many changes during these stages and each trimester represents important growth and development milestones. By following a healthy lifestyle and arranging for good prenatal care throughout all the stages of your pregnancy, you can give your baby the very best start in life.
The First Trimester
Every pregnancy is unique and the symptoms that you experience may be different from those of other women. By understanding what these symptoms mean and how they affect your body and your baby, you will be better prepared for the many physical and emotional adjustments that lie ahead.
During the early stages of pregnancy, there are profound changes taking place in your body. Your baby, or fetus, is growing rapidly in your uterus and requires many nutrients to build essential structures and systems. Your body produces up to 50 percent more blood to carry these nutrients to the fetus. To handle the increased blood flow, your heart rate speeds up and you breathe faster, which sends more oxygen to the fetus. Your metabolic rate increases and all of your bodily functions are accelerated.
In addition to these physical changes, it’s quite natural to feel some emotional stress at this time, even if you’re very happy to be pregnant. You may have fears about your baby’s health or your ability to be a good mother, or you may worry about work, finances or lifestyle changes. As you adapt to these physical and emotional symptoms, you may find that your energy level drops and you feel much more tired than usual.
Fatigue is a common symptom in the first trimester. This is a time in your pregnancy when you may need to slow down a little, because your body is working hard. Rest as often as you can, take a nap when time allows and go to bed early. Incorporating moderate exercise, such as a 30-minute walk, into your daily routine will increase your energy level and help you combat your feelings of fatigue. Making sure you eat a healthy diet that includes three meals and a mid-day snack will also help you feel more energetic.
It’s quite likely that you’ll suffer from an increasing need to urinate during these early days of pregnancy. Laughing, sneezing or coughing may cause embarrassing leaking of urine, and you may have to get up more often at night to use the bathroom. Because of the demands of pregnancy, your kidneys are working overtime to filter the larger volume of blood in your system, and this stimulates your body to produce more urine. At the same time, your uterus is growing and putting extra pressure on your bladder. The result is a reduced bladder capacity that keeps you from straying far from a bathroom.
Although you should not be restricting your fluid intake during pregnancy, you may find that avoiding beverages for a few hours before bedtime helps to minimize nighttime interruptions. Wearing panty liners during the day will also help protect you against unexpected leaking.
Many women are troubled by nausea and vomiting during the first 14 to 16 weeks of their pregnancies. This is one of the most uncomfortable symptoms of the first trimester and affects nearly 70 percent of all pregnant women. Although it is commonly referred to as morning sickness, nausea is not limited to the morning hours—it can and does occur at any time of the day. Normally, these symptoms will come to an end after the first three to four months but, in some cases, morning sickness will last beyond the first trimester and may even persist throughout the entire pregnancy. Rarely, the vomiting may be so severe that hospitalization is necessary to maintain adequate nutrition and fluid intake.
Nausea and vomiting may be caused by the hormone changes produced by the placenta and the uterus. Increases in the hormone progesterone tend to slow down the gastrointestinal system, allowing food to remain in your stomach for a longer time. This extra digestion time is good for your baby because it helps your body extract additional nutrients from the food you eat. Unfortunately, it may also upset your stomach and add to your feelings of nausea.
Strategies to Reduce Morning Sickness
These tips have helped many of my clients.
• Eat small, frequent meals every two to three hours, rather than two or three large meals.
• Avoid hunger; eat a few crackers before getting out of bed in the morning and don’t skip meals.
• Choose low-fat protein foods (lean meat, canned tuna, chicken breast, eggs, legumes) and easily digestible carbohydrates (fruit, rice, pasta, potatoes, toast, dry cereals).
• Drink fluids between meals rather than with meals.
• Avoid fried foods or other foods that cause stomach upset, such as gassy vegetables and spicy foods.
• If the smell of hot meals makes you queasy, try eating cold food. Try for a sandwich instead of a hot entree.
• To abate nausea, try to take small sips of fruit juice or a decaffeinated soft drink every 30 minutes. Some women report that a sports drink like Gatorade or PowerAde provides relief.
• Have a snack before bed.
• Evaluate your surroundings to find out what could be triggering your nausea. It could be the smell of coffee brewing, the sight of raw food, your perfume, patterned carpets, camera angles on television programs, and so on. It might not always be obvious.
• Cook with ginger for relief from nausea and vomiting. Ginger has been scientifically shown to help reduce morning sickness. Research demonstrates that ginger root improves appetite, reduces the stomach’s secretion of acid and increases the release of bile, a digestive aid. The active ingredients in the ginger root are known as gingerols and shogaols.
Buy fresh ginger root and add it to stir-fries and marinades. If you have a juicer, add a thick slice of ginger root to your concoction. You can also prepare ginger tea: steep 0.5 to 1 gram of the dried root in 150 milliliters of boiling water for up to ten minutes and strain; drink one cup three times a day. You can take 250 milligrams of fresh ginger up to four times daily. Ginger extract supplements are available from health food stores or pharmacies. If you take ginger supplements, use them for only a short period of time and do not exceed 1 gram (1000 milligrams) per day. The effects of long-term high doses of ginger on the growing fetus are not known. Adding fresh ginger root to your meals is safe throughout your pregnancy.
Your breasts will rapidly increase in size and weight, new milk ducts will grow and breast veins will become more noticeable. You may find that your breasts are tender and sore because of the increased production of estrogen and progesterone hormones. These hormonal changes, as well as the increased blood flow in early pregnancy, may also trigger headaches and dizziness. Stress, fatigue and hunger can make the headaches worse. Warm compresses and relaxation exercises should help ease these mild aches and pains. Painkillers and other medications should be avoided, unless recommended by your doctor.
If you are a healthy weight when you become pregnant you should expect to gain between 11 to 16 kilograms (25 to 35 pounds) in total. Here’s a look at the recommended weight gain over the course of your pregnancy (see page 45 in chapter 2 to calculate your BMI).
Underweight women (BMI < 20) 28-40 lbs (12.5-18 kg) Healthy weight women (BMI 20-27) 25-35 lbs (11.5-16 kg) Overweight women (BMI > 27) 15-25 lbs (7-11.5 kg)
Obese women (BMI > 29) At least 15 lbs (7 kg)
Twin pregnancy 35-45 lbs (16-20 kg)
Triplets pregnancy 50 lbs (23 kg)
Throughout the first trimester, you should expect to gain only a small amount of extra weight, normally not more than 1.4 to 2.3 kilograms (3 to 5 pounds). Even though your body requires extra nutrients, during the first trimester you need to add only 100 calories to your daily diet to maintain good fetal development.
If you gain too much weight during your pregnancy, you can endanger your own health and that of your baby. Diabetes, high blood pressure and fluid retention are more likely to develop in overweight women. If you gain too much weight, you may also find it difficult to lose the excess pounds after the birth of your baby. You’ll find recommended servings and portion sizes from all the food groups later in the chapter.
However, if you are overweight when you become pregnant, you must be careful not to restrict your calorie intake too severely. To nourish your growing baby properly, you must always maintain a balanced diet that provides all the essential nutrients. A low calorie intake during pregnancy can result in the release of ketones into your blood and urine. Chronic ketone production is known to cause mental retardation in infants. If you are underweight when you conceive, or gain too little weight during your pregnancy (less than 9 kilograms, or 20 pounds), you may also be at risk of delivering a baby with low birth weight. Research indicates that the risks of restricting weight gain during pregnancy are potentially more harmful to the fetus than unrestricted weight gain.
The first trimester is a very crucial time in your baby’s development. During these few weeks, all the essential organs, structures and systems necessary to sustain life are formed. The heart begins beating and the digestive system is developing. The brain, backbone and spinal cord are all growing. Limbs are taking shape and facial features can be seen. Reproductive organs are in place, although they are still too small to indicate the baby’s gender. The circulatory and respiratory systems are functioning and so are the liver and kidneys. By the end of the first trimester, the fetus is usually about 7 centimeters (3 inches) long and weighs about 28 grams (1 ounce).