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Toronto Notes 2019 Counselling of the Pregnant Woman Counselling of the Pregnant Woman
Nutrition
• Canada’sFoodGuidetoHealthyEatingsuggests
■ 3-4 servings of milk products daily (greater if multiple gestation)
■ a daily caloric increase of ~100 cal/d in the 1st trimester, ~300 cal/d in the second and third
trimesters and ~450 cal/d during lactation (less If BMI >25)
■ daily multivitamin should be continued in the 2nd trimester for women who do not consume an
adequate diet; otherwise, routine vitamin supplementation is not necessary (avoid excess vitamin A)
• nutrientsimportantduringpregnancy
■ folate: 0.4 mg/d for first 12 wk (5 mg/d if high risk)
• supportsincreaseinbloodvolume,growthofmaternalandfetaltissue,decreasesincidenceofNTD
• foodsrichinfolicacidinclude:spinach,lentils,chickpeas,asparagus,broccoli,peas,brusselssprouts,
corn, and oranges
■ calcium: 1200-1500 mg/d
• maintainsintegrityofmaternalbones,skeletaldevelopmentoffetus,breastmilkproduction ■ vitamin D: 1,000 IU
• promotescalciumabsorption
■ iron: 0.8 mg/d in T1, 4-5 mg/d in T2, and >6 mg/d in T3
• supportsmaternalincreaseinbloodcellmass,supportsfetalandplacentaltissue
• requiredamountsexceednormalbodystoresandtypicalintake,andthereforeneedsupplementaliron
• ironistheonlyknownnutrientforwhichrequirementsduringpregnancycannotbemetbydietalone
(see Iron and Folate Deficiency Anemia, OB26)
■ essential fatty acids – supports fetal neural and visual development
• containedinvegetableoils,margarines,peanuts,fattyfish
Caffeine
• diureticandstimulantthatreadilycrossesplacenta
• lessthan300mg/disconsideredsafe
• relationshipbetweencaffeineandIUGRisunknown(ACOG) • SOGCstates1-2cups/daresafeduringpregnancy
Herbal Teas and Preparations
• notenoughscientificinformationaboutsafetyofvariousherbsandherbalproductstorecommend their use during pregnancy
• someherbalteascanhavetoxicorpharmacologicaleffectsonthemotherorfetus
• raspberryleafteaoftenusedattermtopromotelabour
• HerbalTeasConsideredSafeinModeration(2-3cups/d):Citruspeel,Ginger,Lemonbalm,Linden
flower – (unless cardiac condition), Orange peel, Rose hip
Foodborne Illnesses
• microbiologicalcontaminationoffoodmayoccurthroughcross-contaminationand/orimproperfood handling
■ listeriosis (Listeria monocytogenes) and toxoplasmosis (Toxoplasma gondii) are of concern during pregnancy
■ avoid consumption of raw meats, fish, shellfish, poultry, hotdogs, raw eggs, and unpasteurized dairy products
■ avoid unpasteurized soft cheeses, deli meats, smoked salmon, and patés as they may be sources of
Listeria
• chemicalcontaminationoffood
■ current guideline for mercury of 0.5 ppm in fish is not considered harmful for the general
population, including pregnant women
■ Health Canada advises pregnant women to limit consumption of top predator fish such as shark,
swordfish, king mackerel, tilefish
Lifestyle
• exerciseunderphysicianguidance;“talktest”=shouldbeabletospeakwhileexercising;avoidsupine position after 20 weeks GA
■ absolute contraindications
• rupturedmembranes,pretermlabour,hypertensivedisordersofpregnancy,incompetentcervix,
IUGR, multiple gestations (>3), placenta previa after 28th wk, persistent 2nd or 3rd trimester bleeding, uncontrolled type I DM, uncontrolled thyroid disease, or other serious cardiovascular, respiratory, or systemic disorder
■ relative contraindications
• previouspretermbirth,mild/moderatecardiovascularorrespiratorydisorder,anemia(Hb≤100g/L),
malnutrition or eating disorder, twin pregnancy after 28th wk, other significant medical conditions
• weightgain:optimalgaindependsonpre-pregnancyBMI(variesfrom6.8-18.2kg)
• work:strenuouswork,extendedhoursandshiftworkduringpregnancymaybeassociatedwithgreater
Obstetrics OB11
Sources of Caffeine
• 5 oz cup coffee: 40-180 mg • 5 oz brewed tea: 20-90 mg • 12 oz cola: 46 mg
• Red Bull®: 67 mg
• Dark chocolate bar: 10 mg • 8 oz hot chocolate: 5 mg
risk of low birth weight, prematurity, and spontaneous abortion