Pregnant Women Need New Buzz
Monday, January 21, 2008
Tara Gidus, MS, RD, CSSD, LD/N
A new study released today in the American Journal of Obstetrics and Gynecology came down pretty hard on pregnant women and the amount of caffeine they drink. The study found that women who rarely drank any caffeine had a relative low risk of miscarriage while women who drank less than 200 mg per day had a slightly higher risk. But women who drank more than 200 mg of caffeine daily had almost double the risk of miscarriage at almost 25% of the pregnancies.
Before you panic, please understand that miscarriage is more common than we like to believe. It is such a private issue that you don't hear many people talking about it, but about 20% of known pregnancies can end in miscarriage. Most miscarriages are a result of a genetic defect and is beyond the mother's control. However, it does appear that even when researchers controlled for other risk factors such as smoking, age, alcohol use, and previous miscarriage, caffeine use was linked to increased risk.
It is well known that caffeine crosses the placenta, but it is not known really what happens to the fetus once that happens. The speculation is that it may affect cell development and decrease blood flow to the placenta.
Most miscarriages happen early in pregnancy, so if you are planning on becoming pregnant, cutting back on caffeine now is a good idea. Don't wait until you know you are already pregnant.
How much
caffeine do you drink?
It depends on how long you steep your tea and how strongly your coffee is brewed, but here is a guide. Researchers are recommending that pregnant women not drink more than 2 cups, but remember that your "mug" may be more than a "cup." A "cup" is 8 fluid ounces.
8 oz coffee: 107 mg (most people drink out of larger mugs than 8 oz)
12 oz Starbucks "tall" coffee: 270 mg
8 oz Starbucks "short" coffee: 180 mg
12 oz latte: 75 mg
1 oz espresso: 77 mg
12 oz most soft drinks: 25-45 mg
8.3 oz Red Bull: 80 mg
8 oz black tea: 47 mg
8 oz green tea: 25 mg
8 oz hot chocolate: 5 mg
Photo courtesy of once and future.Labels: caffeine, pregnancy, Tara Gidus
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Fertility Diet
Tuesday, December 18, 2007
Tara Gidus, MS, RD, CSSD, LD/N
You may have seen the cover of Newsweek recently with an
article on diet and fertility. While that article fully supported a new book called
The Fertility Diet by Harvard Medical School researchers, others are
skeptical of the research presented in the book. One interesting recommendation they have is to eat more high fat dairy foods, such as ice cream. I remember
reading a study about this, and it happened to be authored by these same Harvard researchers. Diet studies are difficult to do because people eat so many different foods and it is hard to know what they ate that really had an impact on what you are studying. I find it hard to believe that ice cream will increase fertility and low fat dairy foods will decrease fertility. Surely there were other factors that may have had an influence.
We (medical community) do not really know what causes infertility and what can really boost fertility, especially in the diet. Limited research exists on this topic, but I think there are some factors that are pretty well accepted.
- Smoking decreases fertility in men (decreased sperm count) and women
- Maintain a healthy weight. Being underweight can be just as detrimental on hormone levels and suppressing ovulation as being overweight.
- Lose weight if you are overweight. Being overweight can make it much harder for women to get pregnant. Even losing 5-10% of your body weight may help increases your chances of conceiving. You will also have a much healthier pregnancy if you are not overweight or obese.
- Stress can affect hormones in both men and women, suppressing ovulation or decreasing viable sperm.
- Pesticides can affect sperm count and quality and may affect a woman's eggs. Choose organic and wash all produce well.
- Sleep can cause leptin levels to fall which has been linked to infertility in women
- High mercury levels in the blood from eating too much high mercury fish can cause infertility in men and women
- A healthy diet is vital. We know that folic acid is necessary for prevention of neural tube defects once you are pregnant, but it may also help increase fertility in men and women.
- Antioxidants such as Vitamin C, E, and selenium can help fertility in men and women. Eat your fruits, vegetables, nuts and seeds, and whole grains.
- Other nutrients like iron, zinc, B-6, B-12, and magnesium are also important for conception. Men and women who are trying to get pregnant should take a multivitamin with minerals every day in addition to eating a well-balanced diet including fruits, vegetables, whole grains, lean protein, and dairy.
Photo of my son, Basil, when he was about 5 minutes old.Labels: fertility, pregnancy, Tara Gidus
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Sudden Changes Ground Rounds
Tuesday, August 14, 2007
Tara Gidus, MS, RD, CSSD, LD/N
Thank you to Christian Bachmann of
Med Journal Watch for publishing my
Pregnancy Do's and Don'ts in
Grand Rounds 3:47 on Sudden Changes. Grand Rounds is a compilation of the best of medical-oriented blogs and this time the theme is change. There are 41 different blog entrys highlighted.
Check it out and enjoy some new blogs!
Labels: Grand Rounds, pregnancy, Tara Gidus
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Nursing No No's
Monday, July 23, 2007
Tara Gidus, MS, RD, CSSD, LD/N
If you are interesting in information on Breast Feeding, please read my previous
post on Nursing Nutrition.
In this post, I am going to talk about things to avoid when nursing.
Food related dangers:
Mercury and PCBs (polychlorinated biphenyls) are chemical pollutants in some fish and can be harmful because they are passed through breast milk and can damage the nervous system. Mercury is found in high levels in shark, swordfish, king mackerel, and tilefish. Limit tuna to 12 ounces per week or less.
Alcohol does pass into breast milk. An occasional drink may be fine, but it may also cause your baby to be less alert and in excess alcohol can affect brain development. One way women get around this is to nurse, then have a drink, then “pump and dump.” This means you pump after drinking and throw the milk away. If you do not choose to pump and dump, at least wait two hours after drinking one drink to nurse. Never have more than one drink.
Caffeine does also pass into breastmilk. You can have a cup of coffee or caffeinated soda, but just remember that it may contribute to colic or just plain fussiness in your baby. Some babies are even sensitive to the amount you may be getting in chocolate!
The same food safety precautions that you took while pregnant should also be taken while nursing. Cook food to proper temperatures, avoid raw or undercooked meat, unpasteurized milk and cheese, and chill food promptly to store.
Non food related dangers:
Smoking should also be avoided when nursing because nicotine passes into breast milk. Nicotine can affect your ‘letdown’ reflex, decrease milk supply, and increase chances of colic, sinus infection, or fussiness. Smoking near a child (a spouse who smokes) is also dangerous because you are exposing the baby to secondhand smoke, increasing risk of asthma and allergies and possibly getting burned.
Certain medications can pass into breast milk, too. Most pass in concentrations that are too low to harm your baby, but to be sure check with your doctor.
Recreational drugs also pass into breast milk and should never be used--bad for you and for baby!
Did you know?
Eating strongly flavored foods like onions, garlic, broccoli, cauliflower, cabbage, beans, or spicy food can flavor breast milk. These flavors make some babies fussy and other babies do not even notice. If you do think certain foods are upsetting your baby, avoid them! Babies are fussy enough without us eating things that may cause them to be even more fussy!
I had quite a bit of garlic yesterday and Basil was not a happy boy last night and didn’t want to get to bed. It makes me wonder if is was coincidence or if it was the garlic!
Tune in for the next post on how to increase your milk supply!
Labels: breast feeding, lactation, nursing, pregnancy, Tara Gidus
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Nursing Nutrition
Sunday, July 22, 2007
Tara Gidus, MS, RD, CSSD, LD/N
I will spare you the logistical details of nursing Basil, but I thought I would devote a few posts nursing and what I have learned since I started a month ago.
The first few days after having the baby are tough for many reasons, but I think one reason the baby is so fussy is because they are living off of colostrum, and it is such a small amount! They teach you in breastfeeding class that their stomach is only the size of a marble when they are born, but I still think they are not getting enough to eat from the colostrum. Once my milk "came in" Basil was a much happier baby!
The first week to 10 days was tough because of pain, cracking, and bleeding. Again, I will spare you the details, but let’s just say it takes some adjusting and you are going to have some discomfort and pain at first. I had to find the right position and use the lanolin ointment to help with all of those things.
Enough about me, let’s talk about what is going on with nutritional needs during lactation.
Did you know?
- Humans produce very little colostrum, but cows produce 9 gallons!
- It takes more calories to produce breastmilk than it did to make the baby!
- Breastfeeding helps you lose body fat. Your body uses 100-150 calories a day from the fat you stored during pregnancy.
- The other extra energy to produce the milk come from extra energy from food choices.
- Most women need about 350-400 extra calories for the first six months and 400-500 extra calories for the second six months (baby is eating more)
- Strict dieting may reduce your milk supply
- Your calcium needs actually do not increase during lactation, but it is important to get that 1,000 mg per day you were always supposed to be getting. Take a supplement if you do not get 3 servings of dairy per day.
- You do need more of a lot of the vitamins and minerals, so it is a good idea to take a prenatal vitamin or at least a general multivitamin daily.
- You need about 15 cups of fluid daily, and more if you are thirsty. Keep water next to you while you are nursing. I keep a 33 oz cup next to the rocking chair at night and during the middle of the night feedings I am drinking and usually have it gone by morning.
For more information on breast feeding:
La Lache League
National Breastfeeding Awareness Campaign
International Lactation Consultant Association
www.kellymom.com
www.breastfeeding.com
Stay tuned for future posts on Nursing No No’s and also Myths and Facts About Increasing Your Milk Supply
Photo on the right is of Basil last week. He looks ready to eat!
Photo of statue (in the Louvre) courtesy of celeste
Labels: breast feeding, lactation, nursing, pregnancy, Tara Gidus
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Any Day Now
Wednesday, June 20, 2007
Tara Gidus, MS, RD, CSSD, LD/N
Well....here it is June 20. My due date is officially here! Here is a recent picture of me in all my pregnant glory! I feel great but I don't think I am going to have the baby today. I guess he just isn't ready to meet the world yet.
Funny story: I was on the treadmill at the gym yesterday. I was talking with one of the trainers and she asked me when I was due. I said, "Tomorrow." The girl working at the front desk a few feet away turned around and could not believe that I was on the treadmill on the day before my baby was due. She said, "What are you doing on the treadmill if you are due tomorrow? I would be at home with a pint of ice cream!" I laughed it off but later was thinking about her comment.
As I have gone through this pregnancy everyone is amazed that I have been able to continue to exercise. I don't know if I am lucky or just determined, but I have consistently gone to the gym 5 days a week. As a runner pre-pregnancy I wanted to see how long I could keep running, but I stopped about a month ago. I only ran once a week, and quite honestly it was just to say I was still running! It wasn't comfortable, and I much preferred the elliptical trainer or walking with incline on the treadmill at the gym.
I take pride when people tell me I look great or that I seem to have a lot of energy (I do!). I have worked very hard in this pregnancy to eat well and keep myself in shape. Believe, me, there were many mornings when I didn’t want to get out of bed to exercise, but I did because I knew I would feel better later in the day. Exercise helped me a lot with circulation and kept the
swelling down in my feet, too!
Back to the ice cream comment: I have had ice cream during my pregnancy, but I did not gain excessive weight because I was careful about portion and frequency of my food choices and I was very active. I think too many women use pregnancy as a time to let loose with their diet and to stop exercising. Every woman is different. Some are not able to exercise for medical reasons. In addition, there are many women who do take care of themselves while pregnant, but I am amazed at how many women use pregnancy as a time to let healthy habits slide.
Next time you see a pregnant woman exercising,
congratulate her! It is possible and encouraged to be active while pregnant! We know that it significantly improves outcomes for the mother and baby.
Click here to read a good overview of benefits and potential risks of exercise during pregnancy from the American Academy of Family Physicians.
I will keep you posted on my progress!
Labels: exercise, pregnancy, Tara Gidus
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Weight LOSS During Pregnancy?
Thursday, June 14, 2007
Tara Gidus, MS, RD, CSSD, LD/N
The guidelines for weight gain during pregnancy are pretty straightforward:
Underweight (BMI less than 18.5) 28-40 pounds
Normal weight (BMI 18.5-24.9): 25-35 pounds
Overweight (BMI 25-29.9): 15-25 pounds
Obese (BMI over 30): no more than 15 pounds
A
new study found that obese pregnant women who had gestational diabetes had better pregnancy outcomes if they exercised moderately and
did not gain weight, or even lost a few pounds, during their pregnancy. This news is quite different than what we have heard in the past. We often hear that pregnancy is not a time to start an exercise program and that pregnant women should “take it easy.” Many women “eat for two” which promotes a significant weight gain above the recommended amounts listed above. The women in this study who exercised and did not gain weight had normal weight babies compared to other women who did not exercise, gained more weight, had larger babies, and also increased their odds of having a C-section.
The author of this study suggests that women who are obese pre-pregnancy can indeed exercise and can actually start exercising when becoming pregnant. He recommends 30 minutes of aerobic exercise 5-6 days per week at a moderate (comfortable) pace.
The long term benefits of not gaining too much weight, especially for someone who starts pregnancy already obese, include reduced risk of hypertension, diabetes, asthma, and other potential health risks to the baby. A healthy diet, along with the exercise, is key to preventing significant weight gain. Visit a
Registered Dietitian to learn how to eat during pregnancy, especially if you have diabetes.
Bottom lineIt is always best to lose weight and start exercising well before considering pregnancy. However, if you do find yourself pregnant, obese, and not a regular exerciser, talk to your doctor about starting an exercise program. Make sure that you visit your doctor regularly when pregnant so he or she can monitor your progress. The health of the mother and the health of the baby are obviously very important. Moderate exercise appears to be beneficial to both mom and baby, but always check with your physician before starting an exercise program.
To view the entire article in the
Journal of Applied Physiology, Nutrition, and Metabolism, click
here.
Labels: pregnancy, Tara Gidus
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Pregnancy "Do's and Don'ts," Part Three
Monday, May 14, 2007
Tara Gidus, MS, RD, CSSD, LD/N
Now that you know not to eat double portions of everything and you have learned to love your body, let’s finish this series with some other helpful hints for what to eat and not eat when you are pregnant.
Do
Cook food to proper temperatureI know this might seem like obvious advice, but food safety is of utmost importance when you are pregnant. Your body has had years to build up it’s immunity to those little bugs like
listeria, e. coli, salmonella, etc. But your baby’s body has essentially very little immunity. The bacteria can pass over to the fetus and cause infections, premature delivery, and miscarriage. When heating leftovers, microwave until steaming hot.
Don’t
Eat raw or unpasteurized meat, cheese, milk, yogurt, or raw eggsComing from a sushi lover, this is easier said than done. Veggie sushi, California rolls made of crabstick, and sushi with shrimp or other cooked fish is fine. Stay away from raw or undercooked tuna and salmon. You may see lists of cheeses like brie, feta, blue, camembert, and queso blanco fresco also on the list of no-no’s. In the US, most cheese is going to be pasteurized. Feta is fine as long as the ingredient label says it is pasteurized. I would stay away from the moldy cheeses like blue (roquefort) and gorgonzola.
Eggs also need to be cooked well—no more sunny side up or over easy. Order them scrambled well or over hard. Be aware of raw eggs in things like mousse or cookie dough. Now I am really getting mean—no raw cookie dough!
DoRefrigerate promptly and make sure your fridge is at 40 degrees or less.Buy a thermometer for your fridge to make sure it is at the proper temperature. Take food out off the fridge and eat it as soon after as possible. If you have
leftovers from a restaurant, get them home and refrigerated within 2 hours of the meal or just throw them away.
Don’t
Let perishable food sit out on the counter for more than 2 hours.
When you make the lasagna, serve and eat. Get the leftovers in the fridge as soon as possible. Don’t eat pizza that has been sitting out for several hours. Anytime
perishable food sits out at room temperature it is breeding tons of little bacteria just waiting to attack your stomach.
Do
Eat fishes high in omega three fatty acids
Your baby’s brain will thank you for the DHA and EPA in fishes. They are essential to brain growth and development. Stick to fishes like salmon, trout, and herring. Tuna is also a good choice, but read the next statement for the limits. If you don’t like fish, you can eat ground flax seeds or take a fish oil supplement (make sure it is from low mercury fishes). Another option is to eat certain brands of
eggs high in omega-3's.
Don’t
Eat shark, swordfish, king mackerel, or tilefishAll four of these fishes are highest in
mercury. Mercury can stay and build up in your bloodstream for many months, so even watching mercury content of fish pre-pregnancy is smart. If you like tuna, you can safely consume 6 oz of “white,” or albacore, tuna per week or 12 oz of “light” tuna per week while you are pregnant.
I have so many other tips for pregnancy, but I think these three posts will do it for now. Let me know if you have any other questions and I will be happy to answer or create a whole new post on your topic.
Labels: fish, food safety, mercury, pregnancy, Tara Gidus
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Pregnancy "Do's and Don'ts," Part Two
Friday, May 11, 2007
Tara Gidus, MS, RD, CSSD, LD/N
Yesterday I talked about how much to eat, what to eat, and the importance of supplements in
Pregnancy Do's and Don’ts Part One. Today I will go in a different direction with what I have learned during pregnancy. This may be the most important lesson I have learned.
Do
Love Your BodyI have worked hard throughout my life to stay in shape. I eat a balanced diet (with room for chocolate). I have run 7 marathons in less than 4 years. Pregnancy was very new and foreign to me and I was worried about what would happen to my body when I got pregnant. Would I get “fat?” Would people be looking at me because I am a dietitian to see if I gained the right amount of weight and not an ounce too much? Would I feel sluggish and “big?” Would my face get puffy? Would I look the same from behind as I used to? As women, we tend to obsess a little bit too much over these sorts of thoughts. Here is the truth: my body has changed. A lot. But I love it! I have unsightly varicose and spider veins, swelling ankles, and a little bit more padding in quite a few different areas. However, instead of feeling embarrassed or defeated, I look at my body as an incredible vehicle to bring a new life into this world. The most important thing to me is not fitting into a certain size jeans. I feel blessed in my new role as expectant mother, but more importantly I feel a responsibility to treat my body with utmost care to house and grow this child for 9 months. If my body has to change to create a new life, that is a small price to pay.
Don’t Obsess over every stretch mark
Keep yourself active through moderate exercise most days of the week. Eat a variety of healthy foods and satisfy your appetite. Your body is going to change and hopefully your attitude toward your body will change along with it! Your body needs to stretch to fit a new life inside and your mind needs to stretch to embrace that new life. Even if those stretch marks and varicose veins stay with you long after pregnancy, look at them with pride at what your body was able to accomplish. It is a true miracle every time a child is born. Your body was made to bend, stretch, and even waddle while carrying a child. Embrace it!
Since I went on so long in this blog, I will need to add another
Part 3 to my advice for expectant mothers. For Mother’s Day this weekend, give yourself the gift of body love. Ladies, embrace the changes. Guys, tell your gorgeous expectant lady how incredible she looks and how every day of her pregnancy she has gotten more beautiful.
Labels: pregnancy, Tara Gidus
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Pregnancy "Do's and Don'ts" Part One
Wednesday, May 09, 2007
Tara Gidus, MS, RD, CSSD, LD/N
Today is the start of my 34th week of pregnancy! I am starting to get ready, nesting a little bit, and also dealing with some anxiety! I have learned a thing or two about
nutrition for pregnancy that I didn’t know before, so here are some tips broken down in a simple “do's and don’ts” format.
DO
Eat for 1.15You only need 300 more calories per day. It comes out to about 1.15 times more than your normal diet, depending on how much you were eating before. This is like having a few more
bites at each meal. It doesn’t take much! That being said, I know that I was extremely hungry during my second trimester but now that I am winding down and much bigger, I am not as hungry and get full very quickly. Follow your appetite. Some days you will eat less than normal and some days it will be much more. You may eat the same as pre-pregnancy your first trimester, a lot more your second, and a varied amount during your third.
DON’T
Eat for 2People will try to force food on you and affectionately say, “You can have it…you are eating for two!” Your friends and family mean well, and they are probably even jealous of the fact that you can eat more than you used to! Just remember, don’t use pregnancy as an excuse to gorge or to “get fat.” Any excess weight you gain while you are pregnant will have to come off or be accepted once that little one enters the world. Studies show that women who gain 30 pounds vs 80 pounds during pregnancy do not have significantly different birth weights of their babies.
DO
Make calories countYour baby does not need extra sugar but rather vitamins, minerals, proteins, complex carbs, healthy fats, etc. Aim for 25 grams of protein more than pre-pregnancy and the rest of the calories can come from carbs and healthy fats.
DON’T
“Junk out”
Even if you don’t eat too many calories, what you choose could be low in nutritional value and is not contributing to the health of the baby. Think, "Does my baby need this chocolate candy bar or would a chocolate pudding made with real milk be a better choice?"
DO
Take your prenatal vitaminIf you suspect your prenatal vitamin is making you sick, at least take a regular multivitamin and an extra 400 mcg. of folic acid. If you have trouble remembering to take it, place it out somewhere obvious. Have it in sight next to something you do routinely every day like your toothbrush, keys, or purse. Also, I learned to take my prenatal vitamin with food in the evening and I didn't feel sick from it.
DON’TTake other supplements or herbals without your doctor's blessingYou may think what you are taking is perfectly harmless, but you may not know of a little known side effect on your baby. Check with your doctor before taking even an extra iron pill!
I will have more tips on how to eat when pregnant tomorrow!
Photo of Tara at 31 weeks pregnant
Labels: pregnancy, Tara Gidus
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