Nutrition and Dietetic Department March 2012
If you require this information in this leaflet in a community language or alternative format e.g. Braille, easy read, audio please contact the Equality and Diversity Department at: [email protected] or phone 01383 565142
Nutrition & Dietetic Department
and Sexual Health Service
Now that you have decided to try to have a baby, it is a good time to think about making some healthy lifestyle changes to be in the best possible health for pregnancy. The easiest and first thing to do is to take a small extra amount of a vitamin called folic acid. You can get this from a pharmacy or you can get free Healthy Start vitamins (see page 7 for more information). For folic acid to work properly, it needs to be taken for at least 3 months before you become pregnant. Your chances of becoming pregnant can be affected by your general health so think about making changes one step at a time. Your partner’s health is also very important in a successful pregnancy so work at making changes together. Consider how you can:-
• Eat a healthy diet.
• Drink plenty of fluids.
• Work towards reaching a healthy weight.
• Limit salt.
• Be more active.
• Stop smoking.
• Avoid alcohol.
• Get help to stop drug misuse. This leaflet will help you to understand what changes you can make together and where you can get more help.
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How to eat a healthy diet Making healthy choices means eating more fruit and vegetables and cutting down on fatty and sugary foods. Look at the label when choosing which foods to buy. Use the 100g figure and choose 3g of fat or less, 1.5g of saturated fat or less and 5g of sugars of less.
You might find it useful to keep a food diary for a few days to let you see how you are doing and if there are more changes you may be able to make. Choosing foods in the proportions shown on the Eatwell Plate will help you eat a balanced diet and reach a healthy weight. (see page 4) It will help you to get all of the nourishment your body needs. Make sure you eat lots of variety to make food enjoyable. No food can give you all of the nourishment you need so eating lots of different foods will add up to provide a healthy balanced diet.
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Nutrient High per 100g
Medium per 100g
Low per 100g
Sugars Over 15g 5-15g 5g or less
Fat Over 20g 3-20g 3g or less
Saturates Over 5g 1.5-5g 1.5g or less
Salt Over 1.5g 0.3-1.5g 0.3g or less
Fruit and Vegetables
Choose a variety Try to eat at least 5 portions per day The Eatwell Plate
Bread, rice, potatoes, pasta
and other starchy foods (include at every
meal)
Meat, fish, eggs, beans and other
non-dairy sources of protein
e.g. Soya, Quorn, TVP
(include at 2 meals each day)
Foods and drinks high in fat and/or sugar Keep to a small amount and try not to have every
day
Milk and dairy foods
(include at 2-3 meals each
day but choose from low fat/fat-free types and limit cheese)
Reproduced with the kind permission of the Food Standards Agency © Crown copyright material is reproduced with the permission of the Controller of HMSO and Queen’s printer for Scotland.
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After your baby is born Breastfeeding is best for you and your baby. A breastfed baby has a reduced risk of infections in the ear, gut and chest, reduced risk of developing childhood leukaemia or diabetes and less risk of becoming obese in childhood and later life. You have a reduced risk of breast or ovarian cancer and osteoporosis in later life. Check in your discharge pack or ask your Midwife or Health Visitor for information on your local breastfeeding groups (or see page 12). These are drop-in groups where you can get help and support with breastfeeding and can meet other breastfeeding Mums.
Further sources of information Food & Nutrition British Dietetic Association - www.bda.uk.com Healthy Start –www.healthystart.nhs.uk Food Standards Agency –www.eatwell.gov.uk Breastfeeding UNICEF UK Baby Friendly Initiative –www.babyfriendly.org.uk Smoking Cessation Services Fife Helpline 0800 025 3000 National—Smokeline 0800 848484 9am—9pm 7 days. Addiction Services 01592 716446 (Drugs & Alcohol) Physical Activity www.activescotland.org.uk www.fifedirect.org.uk
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• Both prescribed and illegal drugs can affect you and your pregnancy. We know that heroin, cocaine, crack, speed and cannabis all affect a baby’s health. Crack and cocaine can cause sudden death in the womb and babies born to drug addicted mothers will themselves be addicted at birth and suffer withdrawal. Most maternity units will have a team with a special interest in helping mothers who use drugs. It is important for you to confide in your midwife if you have a habit so that they can ensure the best care and support for both you and your baby.
• Being overweight or obese during pregnancy will put both you and your baby at risk. It can also lead to complications in your labour and recovery afterwards. If you are overweight or obese, you should not try to lose weight while you are pregnant. Keep your weight the same for most of your pregnancy and try to keep any weight gain until the last few weeks. Ask your midwife for advice or any help available to help you control your weight and for referral to the Dietitian at the ante-natal clinics at Victoria and Queen Margaret Hospitals.
• It is never too late to stop smoking during pregnancy. There is a lot of help available—just ask your midwife or doctor—or you could call ‘Smokeline 0800 848484’ for confidential and free advice.
• Go along and visit your local breastfeeding group while you are pregnant. You will be able to see where it is and to ask any questions you might have about breastfeeding. To find your nearest group, visit www.dwfchp.scot.nhs.uk.
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Weight Being either over or underweight can reduce your chances of conceiving. It is never advisable to follow any crash or fad diets, but follow a sensible, balanced diet as shown in the Eatwell Plate. The mechanism for how weight affects fertility is not really understood. We do know that being overweight and where on the body fat is stored, will make a difference to the hormones you produce which then affects ovulation and how regular your periods are. It is also important to note, however, that if you do become pregnant, controlling your weight now and during the pregnancy will make a big difference to the success of the pregnancy and to the health of you and your baby. If you feel you need help or support to manage your weight, there are Winning by Losing programmes running across Fife or you may be able to ask your GP or consultant to refer you to a Dietitian for individual support and advice.
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Fluid Fluid is very important for good health. Make sure you drink at least 8 cups or glasses of fluid every day. Water is the best drink; it is free, easy to reach and contains no calories. Whatever you choose to drink, remember to watch the sugar and the caffeine!
Salt Too much salt is linked to high blood pressure, heart disease and strokes. Keep your salt intake low by:-
• Cooking without salt or add a little in cooking but none at the table.
• Add black pepper, herbs and spices or lemon
juice for flavour instead. • Use home cooked foods rather than processed
foods, savoury snacks or sausages which are high in salt.
Alcohol While you are trying to become pregnant, current guidance is to try to avoid alcohol completely.
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Pregnant?
As soon as you know you are pregnant see your midwife/GP for antenatal care
• Continue to follow the healthy lifestyle advice already contained in this leaflet. You will be given more detailed information about many subjects when you attend for your antenatal appointments. Look out for your copy of “Ready, Steady, Baby!”
• Check in Ready, Steady, Baby! For information on safe handling of foods. Make sure that you wash all fruit, vegetables and salads to remove all traces of soil. Avoid sheep and their newborns in lambing season and use gloves if emptying the cat litter tray.
• If you are prescribed any medicines or are buying medicines from a pharmacy, you should always advise the doctor or pharmacist that you are pregnant and check that the medicine is still safe to take.
• Continue to take your folic acid until the end of your 12th week of pregnancy. Healthy Start vitamins can be taken through your whole pregnancy.
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Becoming Pregnant If you are on the contraceptive pill it is usually advised that you stop it and have one normal period before trying for a pregnancy. However, don't worry if you get pregnant sooner - it won’t harm the baby. Once you decide to start trying for a baby, it’s natural to wonder how long it will take to fall pregnant. Although the average time to conceive is around six months, there is a lot of variation. Some couples will get pregnant the first month, but others will take a lot longer than this. By the end of one year of trying, 90% of couples will be pregnant and a further 5% will get pregnant in the next year. Only a small number of couples will not be pregnant after two years of trying. It is important not to get too “obsessed” about getting pregnant and start having sex on demand. The fertile time of your cycle is when ovulation occurs and will be around 2 weeks before the start of your period. There is usually no need to buy ovulation kits. The egg is only viable for about 24 hours but sperm survives for up to 7 days. If you have sex 2 or 3 times a week, you cannot miss the fertile period. Don’t despair if you are not pregnant straight away -remember that it takes an average of six months for a couple to become pregnant. By following the advice in this leaflet, you will get your body in tip-top condition, ready for pregnancy and will reduce the chance of problems once you do become pregnant. Your partner’s fertility and sperm count is affected by his general health. Both heavy drinking and smoking can affect the numbers and quality of sperm so you should encourage him to cut down or better still, stop! If you are not pregnant after 12-18 months, visit your GP.
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Folic Acid There are some vitamins which are especially important for you at this time. In addition to eating a good healthy diet, you should be taking a supplement of 400 micrograms (mcg) of Folic acid everyday while you are trying for a baby until you are at least 12 weeks pregnant. This helps to prevent neural tube defects (NTD) in the growing baby (the neural tube is what will develop into the brain and spinal cord). If you have been told that you have a body mass index (BMI) of 30 or more, have diabetes, have had a previous baby affected by NTD or are taking some types of anti-epileptic medicines, you may be advised to take a supplement of 5 milligrams (mg) each day. If you have been advised to take 5mg of folic acid, you will need to get this on prescription from your own doctor.
Healthy Start Vitamins
Any woman who could become pregnant or has had a baby in the last year is recommended to take a daily Healthy Start vitamin tablet as they contain the right amounts of Folic acid and vitamins C and D. In Fife, Healthy Start Vitamins are given out, free of charge to all women from NHS Fife clinics and Health Centres and from the reception desks at Glenrothes, Randolph Wemyss and St Andrews Hospitals. For more information on
where your nearest clinic or health centre may be go to: www.nhsfife.org.
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Even if you are taking a 5mg dose of Folic acid, it is recommended that you take a Healthy Start vitamin to get your daily dose of vitamin D. Vitamin D is very important to your body. It is found in very few foods so we mostly get our vitamin D from the action of the sun’s rays on our skin. In Scotland we don’t get enough sun from September to April to make enough vitamin D. This is even more important if you have dark coloured skin or wear clothing which covers up your skin.
Foods to Avoid There are some foods which can be dangerous to a baby during pregnancy. Since you will not be able to predict when you will conceive, there are some foods which need to be avoided while trying to become pregnant.
• Soft cheeses with rind such as Camembert, Cambozola, Brie, Chevre etc.
• Unpasteurised milks including sheep and goat milks. (Normal cow’s milk is always pasteurised in the UK).
• Liver and liver products and all types of pâté, including vegetarian types.
• Limit tuna to no more than 4 cans (140g per can) or 2 fresh steaks per week.
• Avoid swordfish, marlin, shark and raw shellfish such as oysters.
• Eggs need to be cooked until both the yolk and the white are solid.
• Meat should be cooked until there are no pink bits. Current guidance is that you do not need to avoid peanuts unless you are allergic to them.
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Even if you are taking a 5mg dose of Folic acid, it is Physical Health To benefit health, adults should achieve 30 minutes of moderate activity on most days of the week. Moderate activity is equivalent to brisk walking. If you have never been active you should begin with 5 minutes of gentle exercise each day (like walking). If you are well, build up to 15 minutes of continuous activity 3 times each week, then move on to 30 minutes most days of the week. You should be able to keep up a conversation while you are exercising - if not, slow down. Try adding changes to your normal routine too such as
• Using the stairs not the lift.
• Park at the far side of the car park.
• Get off the bus early and walk part of the way.
• Put on the radio and dance while doing your housework.
Smoking Smoking can affect your fertility and therefore your chances of conceiving. Stopping smoking will improve your general health, your chance of conception and the outcome of any future pregnancy. We all know that smoking increases our chances of serious illnesses like lung cancer, but it will also affect the health of your baby. If you smoke during pregnancy, you are more likely to have a miscarriage or to give birth prematurely. Sadly babies of smokers are also more likely to be born underweight or to be stillborn. Your unborn baby is at risk from passive smoking, so you should tell your partner, family and friends not to smoke near you.
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