Nutrition

During pregnancy you are likely experiencing a lot of unexpected (and many times uncomfortable) changes to your body. You may be going through heartburn, extreme food aversions, constipation or simply feeling puffy and bloated all over the place. (But not to worry, as these symptoms are very common and natural during pregnancy!)

However, on top of all of this, the anxiety over weight gain may be looming over your head, especially when society holds a certain unrealistic body ideal for women and there is constant pressure to quickly “snap” back in shape postpartum. Afterall, stress is the last thing we want during pregnancy, but there is an unbelievable amount of expectation that goes into carrying another human being, when all we want is to have a healthy baby.  

Thus, in today’s article, Wellspring Nutrition is going to help clear up some of the confusion surrounding gestational weight gain to hopefully make your pregnancy journey the healthiest and the most fulfilling. 

What is going on in our body? 

Gestational weight gain is a natural and healthy aspect of pregnancy as your body is supporting fetal growth and development. Some of you may be wondering why you are gaining weight rather quickly during the early phases of pregnancy when the baby is not even that big. This is due to the fact that during the first 30 weeks, maternal fat stores are increased as the body is actively storing nutrients to meet the demands of growing the placenta, a brand new organ that forms just during pregnancy to sustain the growth of the baby, and the energy needs for later in the pregnancy and lactation. During the later stages of gestation, your body will divert a lot of its nutrients to the developing fetus.  

Although total weight gain is variable for each individual, there are certain patterns that are commonly observed. In many cases, the first trimester accounts for 5 percent of the total weight gain and the remaining 95 percent is slowly gained during the last two trimesters. 

Overall, aside from the extra fat deposits, the added weight comes from the placenta, the amniotic fluid (the liquid that surrounds the fetus for protection), increase in body water, expanded blood volume, tissue development in the breasts, and uterus and mammary glands amplification. These changes to your body are driven by hormonal shifts to prepare nourishment and a home for your baby!

Why is it important to be conscious? 

We acknowledge that any topic surrounding weight, and especially discussing numbers can be extremely triggering for some. There is definitely no merit to obsessing solely over a number on a scale, when you already have a lot going on. Nevertheless, having a general idea of what a healthy pregnancy weight gain should look like is important in preventing certain pregnancy complications as well as for the long term health of you and your baby.

Insufficient gestational weight gain is linked to low birth weight and small-for-gestational-age (SGA) newborns. Babies who were born at a low birth weight are predisposed to cardiovascular and metabolic complications later in life. On the contrary, excessive gestational weight gain leads to a higher likelihood of macrosomia (infants being much larger than average) and large-for-gestational-age (LGA) newborns. These birth outcomes are associated with future obesity, diabetes and cardiovascular disease for the child. Unfortunately, for the mother, excessive weight gain is also considered to be a significant determinant for gestational diabetes and hypertension, labor complications, difficulty with breastfeeding, and even pregnancy loss. 

It has been shown that mothers with an accurate knowledge of gestational weight gain recommendation were more likely to meet those targets, indicating that having some level of awareness will lower the likelihood of the mother and the baby to have adverse long-term health outcomes.  

How much weight should I be gaining?

As mentioned earlier, there is variability in the total amount of weight gained in pregnancies among different women, and thus there is no uniform approach that is deemed appropriate for everyone. However, there are certain national standards that have been created.  

The Institute of Medicine (IOM)’s clinical recommendation range for total weight gain is categorized based on the person’s prepregnancy BMI:

Underweight (BMI of under 18.5): 28 to 40 pounds/ 12.7 to 18.1 kg

Normal Weight (BMI between 18.5 to 24.9): 25 to 35 pounds/ 11.3 to 15.8 kg

Overweight (BMI between 25 to 29.9): 15 to 25 pounds/ 6.8 to 11.3 kg 

Obese (BMI over 30): 11-20 pounds/ 4.9 to 9 kg

The BMI scale is undoubtedly not the most reliable way of determining someone’s weight category and its associated health implications, as it fails to discriminate between muscles and fatty tissues. However, it serves as a convenient ballpark estimate to figure out what you should be aiming for.    

Moreover, the recommended weight gain is higher if you are carrying twins. The recommendation is 37 to 54 pounds (16.8 kg to 24.5 kg) if you are normal weight, 31 to 50 pounds (14.1 to 22.7 kg) if you are overweight, and 25 to 42 pounds (11.3 to 19.1 kg) if you are  considered to be obese in the BMI classification. 

It is important to keep in mind that these are standards in the U.S as the IOM (now called the National Academy of Medicine) is an American non-governmental organization. Interestingly, there has not been an international consensus among what is considered to be the “appropriate” range of gestational weight gain. For instance in Japan, where low gestational weight gain is rather common, the recommendation has an upper limit of 12 kg (26.4 pounds) for underweight and normal weight women, and an individualized plan for anyone above those weight classifications. Countries like Ghana, Italy, Canada, Bulgaria, Nicaragua, and Denmark have recommendations that are similar to the U.S IOM specification. Switzerland and Brazil also have identical recommendations to those of the IOM for the underweight, normal weight and overweight category, but have an upper limit of 7 kg (15.4 pounds) for anyone in the obese classification.  Furthermore not all countries go by the pre pregnancy BMI category. Some countries in Latin America have recommendations to attain a goal BMI on the basis of gestational age.  Other countries have general guidelines that are not based on the mother’s body size or gestational age. Examples include India which has a recommendation of 10 to 12 kg (22 to 26.4 pounds) total weight gain, France which recommends an average total gain of about 12 kg (26.4 pounds) , and Myanmar which recommends an increase of 1 kg (2.2 pounds) a month from the fifth month of gestation to the end of pregnancy.   

Thus, you should keep in mind that the IOM recommendation is just one point of reference, and using your best judgment based on your health status or consulting your healthcare provider for your specific circumstance may be beneficial.     

It is important to note that for mothers in the overweight or obese category, research indicates that it may actually be beneficial to gain minimal weight or even no weight at all. For overweight and obese mothers, gaining less than the IOM’s recommendation of 15 pounds significantly reduced the risk for preeclampsia, cesarean delivery, and large for gestational age (LGA) infants.   

A key takeaway from this article should be to have a general idea of what a healthy weight gain looks like for you individually, but without dwelling too much on the number on the scale and focusing on creating a lifestyle that is healthful to you both physically and mentally. For instance, in terms of food, focusing on the nutrient density in order to nourish your baby instead of overly obsessing on calories intake would go a long way. Please feel free to check out our articles on prenatal nutrition, as they discuss crucial nutrients that are needed during pregnancy! 

Additionally, exercise during pregnancy will not only help prevent excessive weight gain but also assist with the alleviation of other pregnancy complications such as gestational diabetes and hypertension, high blood pressure, and edema. It will have a positive impact on your mental wellbeing as exercise can contribute to better sleep as well. There are certain types of exercise that pregnant women are discouraged from taking part in, so make sure to consult with your healthcare provider first.      

Looking for more support? 

Our fertility dietician Anabelle is available for one-on-one consultation and can help you address any of your concerns regarding fertility, pregnancy or hormonal imbalances like PCOS! 

References: 

1. Aoyama T, Li D, Bay JL. “Weight Gain and Nutrition during Pregnancy: An Analysis of Clinical Practice Guidelines in the Asia-Pacific Region.” Nutrients. 2022 Mar 18;14(6):1288. doi: 10.3390/nu14061288. PMID: 35334946 PMCID: PMC8949332 https://pubmed.ncbi.nlm.nih.gov/35334946/  

2. Donangelo CM, Bezerra FF. “Pregnancy: Metabolic Adaptations and Nutritional Requirements.” Encyclopedia of Food and Health, (2016): 484-490. https://doi.org/10.1016/B978-0-12-384947-2.00565-1

3. Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL. “Gestational weight gain and pregnancy outcomes in obese women: how much is enough?” Obstet Gynecol. 2007 Oct;110(4):752-8. doi: 10.1097/01.AOG.0000278819.17190.87. PMID: 17906005 https://pubmed.ncbi.nlm.nih.gov/17906005/

4. Lain KY, Catalano PM. “Metabolic changes in pregnancy.”Clin Obstet Gynecol. 2007 Dec;50(4):938-48. doi: 10.1097/GRF.0b013e31815a5494. PMID: 17982337 https://pubmed.ncbi.nlm.nih.gov/17982337/

5. Langley-Evans SC, Pearce J, Ellis S. “Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review.” J Hum Nutr Diet. 2022 Apr;35(2):250-264. doi: 10.1111/jhn.12999. Epub 2022 Mar 20. PMID: 35239212 PMCID: PMC9311414 https://pubmed.ncbi.nlm.nih.gov/35239212/

6. Scott C, Andersen CT, Valdez N, Mardones F, Nohr EA, Poston L, Loetscher KC, Abrams B. “No global consensus: a cross-sectional survey of maternal weight policies.” BMC Pregnancy Childbirth. 2014; 14: 167.Published online 2014 May 15. doi:10.1186/1471-2393-14-167 PMCID: PMC4031379 PMID: 24884985 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031379/ 

7. Shulman R, Kottke M. “Impact of maternal knowledge of recommended weight gain in pregnancy on gestational weight gain.”Am J Obstet Gynecol. 2016 Jun;214(6):754.e1-7. doi: 10.1016/j.ajog.2016.03.021. Epub 2016 Mar 21. PMID: 27012961 https://pubmed.ncbi.nlm.nih.gov/27012961/ 

8. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 

9. “Weight gain during pregnancy.” https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/01/weight-gain-during-pregnancy#:~:text=For%20twin%20pregnancy%2C%20the%20IOM,42%20lb)%20for%20obese%20women. 

10. Zhou, M., Peng, X., Yi, H, Tang S, You H. “Determinants of excessive gestational weight gain: a systematic review and meta-analysis.” Arch Public Health. 2022 May 3;80(1):129. doi: 10.1186/s13690-022-00864-9.PMID: 35505415 PMCID: PMC9066815 https://pubmed.ncbi.nlm.nih.gov/35505415/

As a pregnant woman, you might be reading up on certain foods to consume during pregnancy to ensure that you are obtaining all the nutrients that are necessary for the healthy development of your baby. At the same time, you might also be feeling terrible about not accomplishing this goal of nourishing your baby due to the food aversion, loss of appetite, and nausea that occurs during pregnancy.  

These nausea and vomiting are commonly known as “morning sickness” even though it typically happens any time of the day. You are definitely not alone if you are going through this. It is a common pregnancy experience that approximately 70 to 80 percent of women encounter. Most women experience nausea just during their first trimester although in some cases, it could last longer. By the end of the first trimester, about 60 percent of cases are resolved. 

What causes nausea during pregnancy? 

Researchers are still not entirely sure what the exact driving force behind this physiological phenomenon is but there are a few compelling theories. One theory points to hormonal factors, specifically that of the placenta, an temporary organ that forms during pregnancy that sustains the growth of the baby. There has been a positive association between the elevated production of human chorionic gonadotropin (hCG), a hormone produced by the placenta and the severity of nausea and vomiting. This hCG may prompt the ovaries to produce more estrogen, and increased estrogen levels are linked to morning sickness symptoms. Additionally, vitamin B deficiency is another potential contributor. 

Even though there is no such thing as a fool-proof hack or an absolute preventive action, we have compiled five nutritional tips that may help alleviate your nausea during the first trimester (or really anytime of your pregnancy).

Tip #1: Vitamin B6 consumption

As being deficient in Vitamin B is considered to be one of the risk factors, consuming adequate amounts of vitamin B6 is said to be effective against the incidence of pregnancy nausea and vomiting. Data from randomized trials found an association between vitamin B6 and alleviation of morning sickness. One multivitamin trial found that women who took multivitamins containing vitamin B6 were far less likely to experience nausea and vomiting compared to the placebo group. Furthermore, the American College of Obstetricians and Gynecologists (ACOG) recommends taking a combination of vitamin B6 and doxylamine, as this has been linked to a 70 percent decrease in morning sickness. 

Although taking supplements is one way to ensure adequate vitamin B6 intake, there are foods that you can consume that are rich in this nutrient. These include fish (especially tuna and salmon), organ meats like beef liver, chickpeas, potatoes, poultry, bananas and dark leafy greens such as spinach.   

Tip #2: Magnesium consumption

Since symptoms of magnesium deficiency include nausea, vomiting, loss of appetite, and fatigue, sufficient magnesium intake may ease your morning sickness symptoms. Magnesium deficiency is common in the United States as the National Health and Nutrition Examination Survey (NHANES) of 2013–2016 found that 48 percent of Americans do not consume adequate amounts of magnesium. Magnesium plays an important role in protein synthesis, functioning of muscles and nerves, and the regulation of blood sugar and blood pressure. Other than potentially alleviating nausea, it is a crucial nutrient during pregnancy as it is shown to reduce pregnancy complications like leg cramps, preeclampsia, gestational diabetes, and hypertension.   

Some magnesium rich foods include pumpkin seeds, chia seeds, almonds, green leafy vegetables, cashews, peanuts, and avocados.  

Tip #3: Ginger consumption

There has not been much concrete scientific evidence on the viability or the potential harms of many herbal remedies for pregnancy complications. However, ginger has shown clinical significance in terms of management of nausea and vomiting, without much notable side effects and adverse outcomes for the fetus. In a study(randomized trial) that compared a group that took ginger supplements to the placebo group, the ginger group experienced fewer morning sickness symptoms. 

Ginger could be in the form of capsules (supplements), ginger tea from freshly grated ginger, or crystalized ginger. For best results you should stick to products that have enough actual ginger.      

Tip #4: Probiotics consumption

The “good bacteria” in our body is referred to as probiotics. Pregnancy leads to different types of hormonal changes including the increase in estrogen and progesterone levels. These hormonal changes have an impact on the gut microbiome which can contribute to digestive system-related discomfort like nausea, vomiting, upset-stomach, and constipation. Researchers have found that probiotic supplementation during pregnancy has led to an improved gastrointestinal functioning and significantly reduced nausea and vomiting. 

Common foods that probiotics are found in include yogurt, kimchi, miso, kefir, sauerkraut, natto and tempeh. Taking supplements is another option as well- the supplement that was used in the above research mainly consisted of a strain of a beneficial bacteria called Lactobacillus, and had 10 billion live cultures.  

Tip #5: Small meals throughout the day

Instead of having 2 to 3 big meals in a day, eating small frequent meals or snacks throughout the day is recommended, along with drinking fluids in between these meals.  

Morning sickness can actually get exacerbated when you have an empty stomach, so having some food in your system can ease the symptoms. Thus, neither being too hungry nor being overly full is the key.   

Having a low blood sugar level from not eating, or vomiting may lead to a vicious cycle of nauseousness, so maintaining a stable blood sugar throughout the day by having these small regular meals may mitigate the nausea triggers.  

Make sure that the foods that you are consuming are protein-rich. Protein stabilizes your blood sugar levels and a study has found that eating a protein-dominated meal led to a reduction in nauseousness compared to a meal with a different macronutrient distribution. Going with bland foods and steering away from spicy and fatty foods can make eating easier as well.   

Extra Tip: Don’t be too hard on yourself! 

Stress can make your morning sickness worse. We understand how frustrating it is to feel nauseous when all you want to do is to consume nutrient-dense food for your growing baby. It is okay if you are not able to follow the “perfect” prenatal meal plan during this time. When you are going through this state in pregnancy, if you are able to eat something…anythingーeven if it is just a piece of cracker, or a small bite of toast, you should think of it as a win! Your body is doing miracles right now and you should feel comfortable to trust the process. It is not only a temporary occurrence (91 percent of cases of nausea and vomiting are resolved by 20 weeks of gestation), but also, your baby has the ability to delve deep into your reserves to draw nutrition from you in the meantime. Hang in there!     

If you feel that the nausea and vomiting is too severe, you may have a condition called hyperemesis gravidarum. It is a separate entity from the standard nausea and vomiting that gets experienced during pregnancy, and you should speak with your healthcare provider immediately if you believe that you might have this.  

Looking for more support?

Our fertility dietician Anabelle is available for one-on-one consultation and can help you address any of your concerns regarding fertility, pregnancy or hormonal imbalances like PCOS! 

Schedule your appointment today here: https://p.bttr.to/3FdLY5q 

Reference: 

1. “Ginger for morning sickness.” https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.ginger-for-morning-sickness.tn9125

2. “How can I tell if I have low magnesium?” https://www.medicalnewstoday.com/articles/322191

3. Lee NM, Saha S. “Nausea and Vomiting of Pregnancy.”Gastroenterol Clin North Am. 2011 Jun; 40(2): 309–vii. doi: 10.1016/j.gtc.2011.03.009 PMID: 21601782 PMCID: PMC3676933 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676933/

4. “Magnesium.” https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ 

5. “Morning Sickness.” https://www.brighamandwomens.org/obgyn/brigham-obgyn-group/patient-education/morning-sickness#:~:text=Being%20pregnant%20causes%20changes%20in,start%2C%20or%20make%20it%20worse.

6. Niebyl JR. “Nausea and Vomiting in Pregnancy.” N Engl J Med 2010; 363:1544-1550 DOI: 10.1056/NEJMcp1003896 https://www.nejm.org/doi/full/10.1056/nejmcp1003896

7. “Probiotics improve nausea and vomiting in pregnancy, according to new study.” https://health.ucdavis.edu/news/headlines/probiotics-improve-nausea-and-vomiting-in-pregnancy-according-to-new-study/2021/12

8. “Vitamin B6.” https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/#:~:text=The%20richest%20sources%20of%20vitamin,fruit%20(other%20than%20citrus).

9. Zarean E, Tarjan A. “Effect of Magnesium Supplement on Pregnancy Outcomes: A Randomized Control Trial.”Adv Biomed Res. 2017 Aug 31:6:109. doi: 10.4103/2277-9175.213879. PMID: 28904937 PMCID: PMC5590399 https://pubmed.ncbi.nlm.nih.gov/28904937/

As an expecting mother, despite all the excitement and the anticipation, there are indeed many things to worry about and proper nutrition during pregnancy might be one of them. Aspiring to give your baby a strong healthy start to life and to ensure their flourishing growth, you might be wondering what types of food or nutrients to actively incorporate in your diet throughout the duration of your pregnancy.  

If this is your situation, you have come to the right blog post! Wellspring Nutrition is here to clear up any confusion and steer you to the right path of healthy eating for you and your baby.     

While doing your research, you have likely come across recommendations regarding the different B vitamins, vitamin D &C , calcium, omega 3 fatty acids, iodine, iron, folate, choline and so on…  

Some of these may sound familiar while for the others not so much. This might become a bit overwhelming. 

Thus, in today’s blog post, we will specifically breakdown the importance and the purpose of choline, a potentially overlooked but critical nutrient that pregnant women are highly encouraged to consume adequate amounts of and how you can add them to your prenatal nutrition repertoire.   

What is choline?

Choline is a nutrient that plays an essential role in the physiological process of living organisms, as it supports metabolic functions, maintains the structural integrity of cells, and aids the activities of the brain and nervous system. They are present in many of the foods that we are already familiar with (more on this later in this article!), although they are also naturally produced in the human liver. Despite this, many people, including pregnant women, do not reach the recommended intake of choline set by the Institute of Medicine (IOM). As a matter of fact, the National Institute of Health (NIH) reports that 90-95 percent of pregnant women do not consume the adequate intake (AI) of choline. For pregnant women, this AI is set to be 450 milligrams per day, while for lactating women, it is 550 milligrams per day. This is because lactation further increases the bodily demand of choline due to the rich source of choline in human breast milk, making choline a crucial nutrient postpartum as well.   

Why is choline intake during pregnancy so important?

Choline assists the anatomical development of the fetus, and consuming the sufficient intake level is associated with decreasing the likelihood of certain birth defects. Several studies also link adequate choline consumption to an improved cognitive function and development for the fetus. Let’s look at these one by one.

Development

Choline plays a crucial role in the overall physical growth of the fetus, particularly for the establishment of the spinal cord as well as the proper brain and neural pathways development especially in the hippocampal region, where its core features involve attention, learning and memory. Choline also supports cellular growth, transportation of macronutrients from the mother to the baby and provides anti-inflammatory benefits during pregnancy. Because certain  neurodevelopmental processes of the baby are completed within the duration of the pregnancy, it is important to be conscious of not being deficient in such key nutrients.

Healthy Birth

Research suggests that choline deficiency during pregnancy is linked to the increased risk of Neural Tube Defects (NTD) while the risk decreases with higher choline consumption. NTD is a serious condition where the neural tube, which is responsible for the initial development of the brain and the spine, does not go through proper closure. The Center for Disease Control and Prevention (CDC) reports that a spinal cord defect and a brain defect are the two most common forms of NTD.  

Additionally, choline supplementation may help prevent premature birth. This is because docosapentaenoic acid (DHA), a type of omega 3 fatty acid, has recently been found to be associated with decreasing the likelihood of a preterm birth, and studies have shown that choline supplementation could be a effective approach to increase the availability of DHA in our body. 

Cognitive Function 

Maternal choline intake during pregnancy is also potentially associated with the improved long-term cognitive function of the child although further research is needed to support this claim for humans (Many of the previous studies are done on rats and mice…). 

There are however several human studies that indicate a strong connection between improved cognitive outcomes such as for information processing speed, memory and learning ability of the child and higher prenatal intake of choline. This may be unsurprising considering how as discussed earlier, adequate choline intake provides the foundation for the healthy neurodevelopment of the fetus.  

What food should I eat for choline? 

So, how can we achieve this 450~550 milligram-a-day goal? 

Here are some foods that are excellent sources of choline:

• chicken
• salmon
• eggs
• beef
• milk
• legumes
• quinoa
• pork
• wheat germ
• tree nuts such as almonds and pecans
• cruciferous vegetables

For more information, we suggest checking out the USDA Database for the Choline Content of Common Foods to make more informed food consumption decisions!

Should I take supplements? 

Animal food products such as whole eggs, meat and seafood contain the most concentrated amount of choline.  If you are on a vegan or a vegetarian diet and are concerned about not hitting the daily choline intake goal, the Dietary Guidelines for Americans 2020-2025 (chapter 5 covers all of the basics of nutrition during pregnancy) recommend consulting a healthcare specialist for guidance of whether or not taking choline supplements would be suitable for you. It is important to note that many prenatal supplements contain an insufficient amount of choline if any at all. Thus, it is recommended to seek out dietary supplements that consist only of choline, or a combination of choline and B-complex vitamins. These usually contain somewhere between 10 milligrams to 250 milligrams of choline per dose.   

The Dietary Guidelines for Americans 2020-2025 reports that many Americans including pregnant women are failing to meet the recommendations for the consumption of different food groups and subgroups such as vegetables, fruits, grains, and proteins. These are food groups/sub groups that contain choline and other essential nutrients that aids a healthy pregnancy.    

We will be releasing more articles to spread increased awareness of the importance of prenatal nutrition so please stay tuned and we look forward to seeing you again! 

References 

1. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. “Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study.” FASEB J. 2018;Apr;32(4):2172-2180. doi: 10.1096/fj.201700692RR. Epub 2018 Jan 5. PMID: 29217669 PMCID: PMC6988845
2. “Choline.” https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/
3. “Dietary Guidelines for Americans.” 2020-2025, https://www.dietaryguidelines.gov/food-sources-calcium
4. “Facts About Neural Tube Defects.” https://www.cdc.gov/ncbddd/birthdefects/facts-about-neural-tube-defects.html#:~:text=NTDs%20occur%20when%20the%20neural,anencephaly%20(a%20brain%20defect).
5. Irvine N, England-Mason G, Field CJ, Dewey D, Aghajafari F. “Prenatal Folate and Choline Levels and Brain and Cognitive Development in Children: A Critical Narrative Review.”  Nutrients. 2022 Jan; 14(2): 364. doi: 10.3390/nu14020364 PMCID: PMC8778665 PMID: 35057545
6. Korsmo HW, Jiang X, Caudill MA. “Choline: Exploring the Growing Science on Its Benefits for Moms and Babies.” Nutrients. 2019 Aug; 11(8): 1823. doi: 10.3390/nu11081823 PMCID: PMC6722688 PMID: 31394787
7. “Science Update: High-dose DHA influences immune responses during pregnancy, may reduce risk of preterm birth.”

https://www.nichd.nih.gov/newsroom/news/012122-DHA#:~:text=longer%20being%20updated.-,Science%20Update%3A%20High%2Ddose%20DHA%20influences%20immune%20responses%20during%20pregnancy,reduce%20risk%20of%20preterm%20birth&text=Taking%20supplemental%20docosahexaenoic%20acid%20(DHA,the%20risk%20of%20preterm%20birth.

8. Zeisel SH, da Costa KA. “Choline: An Essential Nutrient for Public Health.” Nutr Rev.  2009 Nov;67(11):615-23. doi: 10.1111/j.1753-4887.2009.00246.x. PMID: 19906248 PMCID: PMC2782876

If you are currently pregnant you are most likely encountering quite a lot of surprising changes to your body. It is normal for your body to experience certain levels of discomfort, as the mother’s organs, especially the lungs, kidneys and heart get strained due to the fetus’ need for oxygen and nutrients, and the elimination of waste products.   

Thinking about the health of you and your baby during pregnancy can be overwhelming. There are numerous health complications that may occur and thus maintaining your well being can be a challenging endeavor. 

Today, we will specifically discuss gestational diabetes, a health condition during pregnancy that has been on the rise, and tips on how to manage it.  

What is Gestational Diabetes? 

Gestational diabetes is diabetes (excessively high blood glucose/sugar levels) that may occur during pregnancy. 

An organ called placenta that supports the growth and development of the baby forms in the mother’s uterus during pregnancy. The placenta synthesizes hormones that reduce the effectiveness of insulin, a type of hormone that is secreted by the pancreas. 

When food is consumed, insulin controls the storage and the usage of the blood sugar. Therefore, because insulin is less effective during pregnancy, a modest increase in blood sugar levels is common and a normal part of pregnancy. However gestational diabetes is detected when this increase in blood sugar becomes excessive. 

This type of diabetes usually goes away once the pregnancy is over but it has potential long term consequences for both the mother and the baby. Having gestational diabetes increases the likelihood of the mother developing type 2 diabetes later in life. It is also linked to the development of obesity and type 2 diabetes for the child.  

Wellspring Nutrition has compiled a list of five tips that can help you get through your pregnancy in the most healthful way possible, especially if you are struggling with gestational diabetes or have risk factors.   

Tip #1: Exercise

Research suggests that consistent physical activity during pregnancy reduces the risk of gestational diabetes by 50 percent.  

The recommended amount and level of physical activity depends on how active you were prior to pregnancy, but the general recommendation is 150 minutes of low to moderate intensity physical activity per week. Here are some examples of activities that are generally safe to do: 

• Walking
• Swimming 
• Light aerobics 
• Cycling
• Yoga
• Pilates
• Light jogging 

If you were very active before pregnancy, you should be able to maintain the same level of activeness but it is best to consult with a health care specialist first.  

Other than lowering the risk for gestational diabetes, there are many benefits to staying active during pregnancy for both you and the baby. For the mother, physical activity can also lower the risk for gestational hypertension, high blood pressure during pregnancy. Staying active also boosts cardiovascular function, decreases back pain, contributes to better sleep, minimizes the loss of bone density due to pregnancy, and reduces edema (swelling caused by pregnancy) of legs and feet. For the baby, an appropriate amount of exercise leads to longer gestation (prevention of preterm birth), potential improvement for their brain development, and an increased likelihood of them having a healthy BMI during childhood.  

Please keep in mind, however, that there are certain types of physical activities that pregnant women should avoid. Activities that could lead to abdominal trauma must be avoided. These are few examples of physical activities that you should avoid: 

• Contact sports (soccer, wrestling, basketball, football etc.)
• Downhill skiing 
• Scuba diving 
• Horseback riding
• Heavy weightlifting 
• Hot yoga

Regardless of your background or your specific condition, if you are looking to stay active during your pregnancy, you should speak with your health care provider to ensure the safety of you and the baby.  

Tip #2: Being aware of optimal weight gain during pregnancy

Gaining weight during pregnancy is a natural and normal process. This is absolutely not the time to be attempting any kind of weight loss. It is also important to be mindful of what a healthy weight gain should look like during this critical period. 

During the first trimester, mothers should be consuming around the same amount of calories as prior to pregnancy and should be expecting around 2 to 4 pounds of weight gain. After the first trimester, gaining around 0.8 to 1 pound per week is considered to be ideal. During the second and third trimester, mothers should be consuming about 350 to 450 additional calories compared to their pre-pregnancy days. 

The optimal total weight gain is around 25 to 35 pounds for someone with a BMI in the normal range. If you are carrying twins, however, the optimal range is between 37 to 54 pounds.  

Tip #3: Eating quality carbohydrates

Controlling your blood sugar levels is essential for managing gestational diabetes. Choosing the right type and amount of carbohydrates to consume is a great place to start. 

Although skipping carbohydrates might sound tempting if you are worried about your blood sugar levels, this is never recommended. Carbohydrates supply energy for the placenta and it supports the healthy growth of your baby. There is no evidence for the effectiveness of a low carbohydrate diet for managing gestational diabetes and the general recommendation is a minimum of 175 grams a day, although it may depend on the individual.   

When consuming carbohydrates, choosing the type with a low glycemic index is highly recommended. The glycemic index of a food indicates how rapidly it causes the blood sugar level to rise.  Low glycemic index foods raise the blood sugar level much more slowly compared to high glycemic index foods, due to its slower rate of absorption.    

Mothers with gestational diabetes should avoid refined grains such as white rice, white bread, white pasta, and white flour as well as foods containing a lot of added sugars since they usually have higher glycemic index. 

The recommended carbohydrates on the other hand are starchy foods with high dietary fiber content such as whole/unprocessed grains, beans/legumes, vegetables, and fruits. 

Additionally, carbohydrate consumption should be spread out throughout the day- instead of eating a few big meals a day, having smaller meals distributed within a day helps control major blood sugar fluctuations.  

Tip #4: Watching your diet

Although pregnant women should consume more calories during their second and third trimester, the quality of your food should be prioritized over quantity. 

Other than carbohydrates, there are several macro and micro nutrients that you should be actively incorporating in your diet during your pregnancy especially if you are dealing with gestational diabetes.

Research suggests that consuming protein from lean meat (unprocessed), fish, and plants are favorable for the treatment of gestational diabetes. In fact, women with gestational diabetes are recommended to consume 350 grams of fish per week. Check out our blog about high protein foods here as well, as we talk about safe types of fish to consume during pregnancy. 

The overall fat intake for women with gestational diabetes should be around 20 to 35 percent of total energy intake and the consumption of saturated fat should be restricted.  

There are several vitamins and minerals that play an important role during pregnancy. Iron, calcium, folic acid (Vitamin B9), and 25-Hydroxyvitamin D are a few examples. 

Here are the Institute of Medicine (IOM) recommendations for these micronutrients:

• Iron: 27 milligram/day
• Calcium: 1000 milligram/day
• Folic acid: 600 microgram/day
• 25-Hydroxyvitamin D: 5 microgram/day

These dietary advice are not just specific to women with gestational diabetes but apply to all pregnant women to ensure a healthy pregnancy with the best possible outcomes.

Tip #5: Screening 

This is especially important if diabetes runs in your family or you are considered to be overweight prior to pregnancy. 

Although lifestyle modification is key for gestational diabetes management, visiting your healthcare provider and receiving nutritional guidance or possible clinical treatment tailored to your individual needs should be a priority as well.

It is recommended that all women regardless of a history of type 2 diabetes be screened between 24 and 28 weeks of pregnancy. If you have risk factors for type 2 diabetes, getting screened at your first prenatal visit is advised. Regardless of your health history, receiving prenatal care, especially during the first trimester is crucial as that is the most critical time for the baby’s development.

Looking for more support? 

Whether it is guidance regarding hormonal imbalances like PCOS, or any fertility or pregnancy concerns, Wellspring Nutrition has your back! Our fertility dietician is available for consultation. 

References: 

1. “Exercise During Pregnancy: Safe And Beneficial.” https://newsnetwork.mayoclinic.org/discussion/exercise-during-pregnancy-safe-and-beneficial-too/
2. “Insulin Basics”, https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics
3. Rasmussen L, Poulsen CW, Kampmann U, Smedegaard SB, Ovesen PG, Fuglsang J. “Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus.” Nutrients 2020 Oct 6;12(10):3050. doi: 10.3390/nu12103050. PMID: 33036170

 PMCID: PMC7599681

4. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 

1. “What Is Glycemic Index.” https://www.eatright.org/health/wellness/diet-trends/what-is-glycemic-index

If you are currently pregnant, the journey of sustaining a whole other life in your body probably feels like an extraordinary experience but at the same time, a great deal of responsibility ( in a positive way of course! ) 

Although there are many aspects relating to the healthy growth and development of the fetus that are beyond our control, one of the main factors that we do have control over is our lifestyle choices- namely our diet. 

There are a handful of nutrients that you do not want to be missing out on during your pregnancy to ensure the best possible health outcome for your baby. These include choline, iron, calcium, Vitamin D, iodine, and folate to name a few. 

If you recently found out that you are pregnant or are planning on conceiving, you are in luck! Today, Wellspring Nutrition is specifically going to highlight the importance of folate, and how this nutrient can be a powerful ally for preventing a common type of birth defect- the neural tube defect.     

What is a Neural Tube Defect?

Neural tube defect is a birth defect that affects the central nervous system of the baby. In a developing embryo, the neural tube is the precursor to their brain and the spinal cord. Neural tube defect occurs when the neural tube does not properly go through the closure process to complete its formation. The two common types of neural tube defect include: 

• Spina bifida (swelling or protrusion of spinal cord or fluid in the back) 
• Anencephaly (exclusion of a major segment of the brain) 

What is folate?

Folate, otherwise known as vitamin B-9, is found in various foods. As they play an important role in the nucleic acid (DNA and RNA) production and amino acid (the building blocks of protein) metabolism, they are crucial to the functioning of cells.    

Folic acid is its synthetic form- meaning folate that is found in dietary supplements and fortified foods. 

Why folate is important

The need for folate significantly increases during pregnancy especially because the event of a neural tube defect is closely linked to maternal folate deficiency. Inadequate folate intake can lead to a high homocysteine level in the blood, which is considered to be a risk factor for neural tube defect. Homocysteine is an amino acid and as it is broken down by the vitamin B-complexes, having a high level of this usually indicates deficiency in vitamins. 

According to a recent study, another risk factor for neural tube development is the lack of DNA repair function. Since folate is crucial to DNA synthesis, folate deficiency can lead to a loss in the integrity of DNA. Thus, the mechanism for DNA repair is going to be negatively impacted. Genome stability is an important aspect of neural development for the embryo, and adequate folate intake is necessary for a properly functioning DNA repair mechanism. 

The timing of sufficient folate intake is important to consider. Neural tube formation of an embryo is completed around three to four weeks after conception. This means that anyone trying to conceive should ideally start incorporating folate in their diet as soon as possible, even if pregnancy is yet to be confirmed. 

Even if you are reading this much further into your pregnancy, there are still reasons to consume an adequate amount of folate.  

Other than lowering the risks of neural tube defects, research shows that sufficient folate intake during pregnancy is beneficial for the neurodevelopment of the child. There is a study that links prenatal folic acid supplementation to a lowering of the risk of Autism Spectrum Disorder (ASD), and advancements to the cognitive, motor and intellectual functions of the child.     

What food should I eat for folate?

Although the general recommendation is about 400 micrograms a day, pregnant women are advised to consume about 600 micrograms of folate every day.   

Here are some food items that are good sources of folate to help meet this target:

• Beef Liver 
• Spinach
• Black-eyed peas
• Chickpeas 
• Asparagus
• Brussel sprouts
• Romaine Lettuce
• Broccoli
• Eggs

As you can see, leafy greens, legumes, and liver are the best sources.  

Moreover, it is important to note that folate tends to be sensitive to heat and oxygen.  Especially for the leafy greens, it is advised to eat them fresh or have them lightly cooked. In a study that compared the folate retention for different food products, for spinach, boiling led to only 49 percent retention of folate. On the other hand, steaming proved to be the best way to preserve folate in vegetables. Another good news is that the same study found that grilling beef for an extended period of time did not result in much loss of folate as well. 

Other than foods naturally present with folate, consuming grain products may be helpful as well. This is because starting in 1998, the U.S Food and Drug Administration (FDA) mandated a folate fortification of grain products such as bread, rice, cereal, flour, and pasta.

However, consumption of refined grain products should be limited during pregnancy to prevent significant spikes in your blood sugar levels.  

Looking for more support? 

Our fertility dietician Anabelle is available for one-on-one consultation and can help you address any of your concerns regarding fertility, pregnancy or hormonal imbalances like PCOS! 

References

1. “Chickpeas (garbanzo beans, bengal gram), mature seeds, cooked, boiled, without salt.” https://fdc.nal.usda.gov/fdc-app.html#/food-details/173757/nutrients

2. “Embryology, Neural Tube.”  https://www.ncbi.nlm.nih.gov/books/NBK542285/

3. “Folate.” https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

4. “Folate and Folic Acid on the Nutrition and Supplement Facts Labels.”https://www.fda.gov/food/new-nutrition-facts-label/folate-and-folic-acid-nutrition-and-supplement-facts-labels#:~:text=For%20folate%2C%20the%20DV%20is,consume%20500%20mcg%20DFE%20daily.

5. Gao Y, Sheng C, Xie RH, Sun W, Asztalos E, Moddemann D, Zwaigenbaum L, Walker M, Wen SW. “New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children – A Systematic Review”PLoS One. 2016 Nov 22;11(11):e0165626. doi: 10.1371/journal.pone.0165626. eCollection 2016.PMID: 27875541 PMCID: PMC5119728 https://pubmed.ncbi.nlm.nih.gov/27875541/

6. “Homocysteine” https://my.clevelandclinic.org/health/articles/21527-homocysteine

7. McKillop DJ, Pentieva K, Daly D, McPartlin JM, Hughes J, Strain JJ, Scott JM, McNulty H.“The effect of different cooking methods on folate retention in various foods that are amongst the major contributors to folate intake in the UK diet.” Br J Nutr. 2002 Dec;88(6):681-8. doi: 10.1079/BJN2002733. PMID: 12493090 https://pubmed.ncbi.nlm.nih.gov/12493090/

8. “Pregnancy diet: Focus on these essential nutrients.”https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082

9. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 

10. Wang X, Yu J, Wang J.“Neural Tube Defects and Folate Deficiency: Is DNA Repair Defective?” Int J Mol Sci. 2023 Jan 22;24(3):2220. doi:10.3390/ijms24032220. PMID: 36768542 PMCID: PMC9916799 https://pubmed.ncbi.nlm.nih.gov/36768542/

Apple cider vinegarー the name surely gives it a cozy fall vibe doesn’t it? 

Vinegar in general has demonstrated numerous health benefits but apple cider vinegar (ACV) , which is made from fermented apples, in particular has been gaining attention from many health experts in recent years (And no, ACV is not seasonalー thankfully it is around all year).

If you were curious as to what makes ACV beneficial to our health, you have come to the right place! 

Blood sugar control:

Hyperglycemia, more commonly known as high blood sugar, affects countless people worldwide. This phenomenon is usually attributed to the lack of insulin in the body and is associated with both type 1 and type 2 diabetes. Insulin is a hormone that is secreted by the pancreas that controls what the body does with the energy obtained from food; it determines if it wants to use or store the blood sugar. 

Research suggests that ACV may assist with glycemic control- that is our blood sugar levels. 

Studies have shown that ACV consumption is associated with the overall reduction of blood glucose (sugar) levels. 

Therefore, the consumption of ACV may serve as an ally for diabetes management as well as prevention.     

Preventing cardiovascular diseases:

Now let’s talk cholesterol ー

Cholesterol travels throughout the bloodstream carried by “lipoprotein”, a type of protein. 

There are two types of these lipoproteins: 1) LDL (low-density lipoprotein) cholesterol 2) HDL (high-density lipoprotein).

LDL is commonly referred to as the “bad” cholesterol while HDL is referred to as the “good” cholesterol. Since HDL, along with the liver, helps get rid of the cholesterol in the blood, higher HDL level can contribute to lowering the risk of cardiovascular diseases such as stroke, heart attack and peripheral artery disease. 

ACV consumption was associated with higher levels of HDL for people who do not have diabetes. 

Furthermore, studies have found that for those with type 2 diabetes, ACV consumption was linked to an improved lipid panel- a blood test that serves as a screening for cardiovascular diseases. 

This blood test is based on cholesterol and triglycerides (a type of fat in our blood) levels. The buildup of these fats in the blood will lead to a hardening of the arteries and increase the risks of cardiovascular diseases. A decrease in both triglyceride and cholesterol levels in patients with type 2 diabetes was seen with the consumption of ACV.   

Overall, this suggests a positive association between our heart health and ACV.  

Antioxidative properties and other disease prevention: 

ACV is said to have antioxidative and anti-inflammatory properties. There have been several studies that have linked such properties to the potential prevention and the remedy of kidney/urinary stones.  

The kidney filters our blood, removes wastes from it and produces urine. It plays an important role in the body’s maintenance of the balance of fluid and minerals which is crucial for our physiological functioning.  

Kidney stones are relatively common and may unfortunately lead to chronic kidney diseases. Although ACV should not be relied on as a sole treatment, its therapeutic effect says a lot about its defensive nature against oxidative stress and inflammation in our body.  

Relatedly, ACV contains a phytochemical (compounds found in plants that can yield positive health effects) called flavonoid. Flavonoid have been found to have favorable effects on the following health complications: 

• angina pectoris
• cervical lesions 
• chronic venous insufficiency 
• dermatopathy
• gastrointestinal diseases 
• lymphocytic leukemia 
• menopausal symptoms 
• rhinitis 
• traumatic cerebral infarction      

Looking for more support? 

If you would like to get more inspiration- whether it is about how to specifically incorporate ACV into your meals or anything related to concerns regarding PCOS and/or fertility struggles   please feel free to check out our meal plans or any other services with our fertility dietician. We would love to provide guidance to your wellness journey!

References: 

1. “Familial Hyperlipidemia.” https://www.upmc.com/services/heart-vascular/conditions-treatments/hyperlipidemia#:~:text=Hyperlipidemia%20defines%20an%20elevated%20level,stroke%2C%20and%20peripheral%20artery%20disease.

2. Gambaro G,  Croppi E, Bushinsky D f,  Jaeger P g,  Cupisti Ad, Ticinesi A e,  Mazzaferro S c,  D’Addessi A b,  Ferraro PM.  “The Risk of Chronic Kidney Disease Associated with Urolithiasis and its Urological Treatments: A Review.” J Urol. 2017 Aug;198(2):268-273. doi: 10.1016/j.juro.2016.12.135. Epub 2017 Mar 10. PMID: 28286070
3. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A. “The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials.” BMC Complement Med Ther 2021 Jun 29;21(1):179. doi: 10.1186/s12906-021-03351-w. PMID: 34187442 PMCID: PMC8243436

4. “Hyperglycemia (High Blood Glucose)” https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia#:~:text=Hyperglycemia%20is%20the%20technical%20term,can’t%20use%20insulin%20properly. 

5. Kumar A, Nirmal P, Kumar M, Jose A, Tomer V, Oz E, Proestos C, Zeng M, Elobeid T, K S, Oz F. “Major Phytochemicals: Recent Advances in Health Benefits and Extraction Method.” Molecules. 2023 Jan; 28(2): 887. Published online 2023 Jan 16. Doi: 10.3390/molecules28020887 PMCID: PMC9862941 PMID: 36677944

6. “LDL and HDL Cholesterol and Triglycerides.” https://www.cdc.gov/cholesterol/ldl_hdl.htm

7. “Lipid Panel” https://my.clevelandclinic.org/health/diagnostics/17176-lipid-panel#:~:text=A%20lipid%20panel%20is%20a,a%20measurement%20of%20your%20triglycerides.

8. “Phytochemicals.” https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals

9. Singh AS, Singh A, Vellapandian C, Ramaswamy R, Thirumal M. “GC–MS based metabolite profiling, antioxidant and antiurolithiatic properties of apple cider vinegar.” Future Sci OA. 2023 Apr; 9(4): FSO855. doi: 10.2144/fsoa-2023-0035 PMCID: PMC10116371 PMID: 37090488

10. “Your Kidneys & How They Work”https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work