Eating Well during Pregnancy and Breastfeeding Before you get pregnant, make sure that you are eating well by consuming a balanced diet of a variety of food and food rich in folic acid and iodine. During pregnancy and breastfeeding, your body needs additional folic acid, iron, iodine, and calcium for your baby to grow and develop. More calories are required from the second trimester onwards, and a bit more during breastfeeding. However, you do not need to eat too much to meet the extra needs. A balanced diet consisting of a variety of foods and choosing foods that are rich in folic acid, iron, iodine and calcium are basis for good nutrition for you and your baby. In this way, you could reduce the risk of overweight or high blood pressure in future. Table 1: Extra needs of nutrients during pregnancy and lactation Pregnancy First trimester Second and third trimesters Formation of baby’s Babies grow in size and weight. major organs requires More calories, folic acid, iron, iodine Key points folic acid. Weight gain is and calcium are needed for normal relatively small at this body functions and development of stage. the baby. Folic acid Increase Increase Iron Increase Increase Increase Iodine Calcium Increase Breastfeeding Extra calories, folic acid, iron, iodine and calcium are needed to provide nutrients to the baby. Increase Increase Increase Increase Table 2: Extra needs in energy during pregnancy and lactation More calories are required during pregnancy and lactation, but you do not need to take much food, especially in the first 3 months of pregnancy. The followings are examples of food that provide the extra calories required. Choose food rich in folic acid, iron, iodine and calcium. First trimester of 1 glass* skimmed milk / low fat milk / pregnancy 1 slice whole wheat bread OR (approximately 100 calcium fortified low sugar soy milk kilocalories) OR 1 slice whole wheat bread + Second and third 1/2 bowl** rice + 1 slice low fat cheese / ham + trimesters pregnancy 1/2 bowl** green leafy vegetables + 1 glass* skimmed milk / low fat milk / (approximately 300 – 1 tael# fish / lean meat + calcium fortified low sugar soy milk + 1/2 to 1 large orange / apple / pear 400 kilocalories) 1/2 to 1 large orange / apple / pear 1 tomato cheese sandwich OR (=2 slices whole wheat bread + 2 slices 1/2 bowl** rice + Breastfeeding tomato + 1 slice low fat cheese) + 1/2 bowl** green leafy vegetables + (approximately 500 1 glass* skimmed milk / low fat milk / 1½ tael# fish / lean meat + kilocalories) calcium fortified low sugar soy milk + 1½ large orange / apple / pear 1 large orange / apple / pear # 1 tael = roughly equals to the size of a table tennis ball; **size of bowl = 300 ml; size of glass* = 240ml The leaflet ‘Nutrition for Pregnant Women &Breastfeeding Mothers’ http://www.fhs.gov.hk/english/health_info/class_topic/ct_woman_health/wh_antenatal.html provides more information on food choices. 1 2011June28 Foods that are rich in Folic Acid Women who are pregnant or planning to be pregnant need to eat plenty food rich in folic acid. This prevents anemia and development of spinal bifida in babies (a birth defect in spinal cord and backbone). Green leafy vegetables, e.g. spinach, bok choy, choy sum, broccoli etc Beans and pulses Fruit, e.g. papaya, banana, melon, grapefruit, strawberry, orange Fortified breakfast cereal Foods that are rich in Iron Iron is important for making red blood cells. Inadequate iron will cause anemia and affect the growth and development of brain of the baby. 1. Animal sources of iron are easily absorbed Red meat such as pork and beef contain more iron Chicken and other poultry Seafood such as fish and shrimp Fish is also an important source of long chain polyunsaturated fatty acids( e.g. DHA), which is essential for the development of brain in babies Fish which contains higher DHA and relatively lower mercury level includes farmed salmon, sardines, thread-fin fish, big-eyed, Pacific Saury, seabass Liver is a good source of iron Limit to no more than 100gm (5 tablespoon) a week, as liver is also high in vitamin A. Too much vitamin A may harm you and your baby 2. Plant sources of iron Green leafy vegetables and pulses also contain iron. Include food rich in vitamin C, e.g. oranges, kiwi, in your meals to help iron absorption 3. Fortified breakfast cereal * Zinc is essential for the growth and immune system of your baby and healing of wound. Most iron rich foods are also rich in zinc, e.g. meat, seafood, fish. Stop Smoking & Drinking Alcohol!!! Alcohol affects the development of your baby, leading to low birth weight and intellectual impairment Avoid Food or Drinks containing Caffeine. E.g. coffee, tea Vegetarians, mother of multiple pregnancies or having medical problem (e.g. gestational diabetes) may need to follow other special advice from dietitian and their doctors. 2 2011June28 Foods that provide Iodine You should take adequate iodine to ensure the normal development of your baby’s brain and growth. Seaweeds (including kelp and seaweed) are of the highest iodine content Include seaweeds in part of balanced diet. Do not eat too much seaweeds In addition to a normal diet, non pregnant woman gets adequate iodine if she consumes : 1 bowl of mung beans and kelp sweet dessert soup or miso soup containing 1 1.6-2.5g (about /16 tael) dried kelp per bowl every 2 months, or 2 small packets (each packet weighs 1.1g) of seaweed snack a day During pregnancy and breastfeeding, 5 small packets (each packet weighs 1.1g) or 2 medium packets (each weighs 2.5-3g) of seaweed snack provide the iodine you and your baby need in a day. Also use the nutrition label on the package to help you choose one with lower fat and sodium content Avoid eating hijiki which contain high level of arsenic Use iodized salt to replace ordinary salt. Add iodized salt when served Limit the total salt intake to 5 grams or 1 tablespoon a day, including salt from sauces, seasoning and salt from other foods Seafood (including marine fish, prawns, mussels, oyster, etc.), egg yolk, milk and milk products These food items contain lower level of iodine. The usual daily serving size may not provide sufficient amount of extra iodine required for pregnancy / lactation During pregnancy and lactation, women with previous or active thyroid diseases also need to increase the iodine intake. As additional iodine intake may affect the thyroid function, women should notify their attending specialists or doctors and have the thyroid function closely monitored. They should also follow the doctor's advice to consume appropriate amount of iodine rich food or take iodine supplements. If you have problem eating adequate foods rich in folic acid, iron, iodine or calcium, seek advice from your doctor, registered pharmacist or registered dietitian for any need for supplement. Foods that are rich in Calcium Calcium forms bones and teeth in baby and reduces the risk of preterm labour. Green leafy vegetable, e.g. choy sum, Chinese mustard, bok choy, broccoli, kale Tofu, fortified soymilk Sesame , nuts Seafood such as shrimp, dried oyster or shrimp, sardines with bones Milk and milk products (e.g. cheese, yogurt) - choose low fat products 3 Spend some time for outdoor activity in the sun everyday. Sunlight exposure helps body to produce vitamin D which is needed for calcium absorption and forming strong bones. 2011June28 Food Safety 1. Choose safe food Buy food from hygienic and reliable shops Prevent bacterial contamination Listeria can cause miscarriage, prematurity and cause infection in your baby When choosing fish Don’t eat high risk food that may be contaminated by listeria or other bacteria, such as: Don’t eat large predator fish, e.g. sword fish, shark, marlin, alfonsino, some types of tuna (e.g. bluefin tuna), mackerel etc. These contain high levels of mercury. Excessive exposure to mercury will affect the development of nervous system of your baby ； Do choose fish with lower level of mercury, e.g. grass carp, dace, rabbit fish, grey mullet, Mandarin fish/ perch, farmed salmon, sardines, thread-fin fish, big eyed, Pacific saury ； Unpasteurized milk and milk products, e.g. mould-ripened soft cheese; Raw food such as oyster, sashimi or sushi Smoked ( chilled or refrigerated) seafood or cold dishes, e.g. smoked salmon Pâté Raw and uncooked foods such as raw eggs or food containing raw or partially cooked eggs in salad dressing, mayonnaise, eggnog Pre-prepared salad (such as in salad bars). Do consume a variety of fish and maintain balanced diet. 2. Keep Clean 3. Wash your hands and utensils properly before and during food preparation; Toxoplasmosis is an infection caused by a parasite found in some animal (e.g. cat) faeces and soil. Toxoplasmosis can be harmful to the growth and development of unborn babies. Avoid pet getting into the kitchen; Avoid contacting their faeces; Always wear gloves when you are gardening or changing cat/ pet litter and wash your hands afterwards. Separately store and handle raw food and cooked food Use separate knives and cutting boards to handle raw and cooked food. 4. Cook food thoroughly 5. Keep food at safe temperature Refrigerate at or below 4 oC or keep cooked food above 60 oC before serving; Refrigerate cooked and perishable food (including leftover food) within 2 hour; Refrigerate uneaten proportion promptly at or below 4 oC and keep for no more than 3 days. Cook or reheat food until it is steaming hot throughout. For more information on food safety, you can visit http: www.cfs.gov.hk 4