This is a featured guest post by Elizabeth Ward, MS., RD, author of Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy.Elizabeth regularly writes for publications such as Men’s Fitness and WebMD, and blogs about about family nutrition and weight control issues for USAToday.com. Check out her pregnancy blog, Expect the Best Pregnancy, where you will get the latest and most credible nutrition advice during pregnancy.

Is a baby in your plans for the near future? Perhaps you’d like another child, but you’re just not ready yet.  No matter. When you’re in the childbearing years, it pays for you (and your male partner!), to prime your body for pregnancy, especially when you consider the possibility that conception can occur when you least expect it.

Preparing for pregnancy doesn’t differ much from living a healthy lifestyle.  Here are three steps, culled from my book, Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy, to help you have the healthiest child possible.

1. Practice Girth Control.  Being underweight or overweight may thwart a woman’s chances to conceive; when a future dad is overweight, his excess body fat may make matters worse.  

In addition to affecting fertility, being overweight when you conceive increases the risk of certain birth defects, including heart defects, and neural tube defects (NTD) like spina bifida.  Overweight women are also more prone to type 2 diabetes which may prove problematic for mom and baby.  And, women who enter pregnancy overweight tend to stay that way until delivery, and well beyond.

Starting a pregnancy at a healthy weight gives your child a better chance of developing properly, and reduces health risks for mom during pregnancy, including high blood pressure.

Determine your body mass index (BMI) to know whether your weight falls into a healthy range.  For help achieving a healthy weight at any stage of life, consult a registered dietitian (RD) by using the American Dietetic Association’s free referral service.
 
2. Fill in Nutrient Gaps.  Eating a balanced diet based on MyPyramid will help you and your partner get the nutrients that contribute to your good health, and that of your child’s, but that often go missing from the typical American diet, including calcium, fiber, magnesium, vitamins C and E, potassium, and carotenoids (used by the body to make vitamin A). 

Women in their childbearing years should pay particular attention to their intake of folic acid and iron. You need 400 micrograms (ug) of folic acid every day if you are capable of conceiving a child. That’s because folic acid helps to prevent NTDs, during the first 30 days of pregnancy – often when a woman does not know she’s pregnant. 

Women who are not pregnant require 18 milligrams of iron daily, but many are not meeting that quota.  Iron-deficiency anemia affects an estimated 8 million American women. It’s harder to correct an iron deficiency during pregnancy, when iron requirements soar, so make sure you get enough iron each day before conception occurs. 

While dietary supplements are not suitable substitutes for a balanced diet, a daily multivitamin fills in small gaps in nutrients that can sap fertility, particularly in men who don’t get enough vitamin C, folic acid, and zinc. 

Women who may become pregnant should take a daily multivitamin with 100% of the Daily Value for iron and folic acid. Men don’t need the extra iron and should take a multivitamin with no iron, or very low iron. 

3. Re-Think Your Drinks.  If you’re trying to conceive, it may be time to evaluate your caffeine and alcohol consumption. 

Some studies suggest excessive amounts of caffeine may result in miscarriage and stillbirth, while others question caffeine’s effects.  While the jury is still out regarding the safety of caffeine during pregnancy, it’s probably wise to limit your intake. The March of Dimes recommends 200 milligrams or less of daily caffeine- about the amount found in 10 ounces of Starbucks coffee – after conception occurs. It’s not a bad idea to start cutting back beforehand, however. There is some evidence that caffeine may hamper fertility.

There’s no safe amount of alcoholic beverages to drink during pregnancy, but how about when you’re trying to conceive?  It makes sense to enjoy a cocktail or glass of wine when you’re sure that you’re not pregnant. However, health professionals recommend erring on the side of caution when trying to conceive.

The Centers for Disease Control and Prevention (CDC) and the March of Dimes contend that drinking and trying for a baby do not mix.  Even moderate drinking (one or fewer drinks daily for a woman; two or less for a man) may make it more difficult to conceive for some couples. In addition, it is possible, no matter how careful you are, to be pregnant and not know it, and alcohol is particularly detrimental to a developing baby during the first trimester. 

In men, heavy drinking produces sperm with defects that may hinder their ability to fertilize an egg. Although the link between moderate drinking and fertility is murky, it’s wise for men to play it safe by limiting alcoholic beverages to two or less a day.

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The process of raising healthy eaters actually starts before conception. The health of women entering –and during – pregnancy has a profound impact on the health of both mom and baby.

Part of my job is to inform you (my readers) of important changes in public health recommendations. The Institute of Medicine last tackled pregnancy and weight in 1990 – almost 20 years ago. Health experts have been talking about the need to re-examine these guidelines for the last several years. Yet the newly released guidelines from the Institute of Medicine don’t look much different from the 1990 ones. That said, a lot was learned in the process. Let’s take a look…

A Different Population of Women
Pregnant women today look drastically different than moms-to-be did just 20 years ago. First off, more women start pregnancy either overweight or obese and they gain more weight during pregnancy. Women are also having children later in life with a substantial increase in multiple births. All of these factors increase the likelihood of chronic disease and complications during and after the prenatal period.

Key Takeaways
The Institute of Medicine extensively reviewed studies to determine the optimal range of weight gain for pregnant women. Here are some highlights from the report:
–Weight at the start of pregnancy may be the most important factor for a healthy pregnancy. The science clearly shows that pre-pregnancy weight alone can predict undesirable prenatal health outcomes.
–Women who gain more than the recommended amount of weight during pregnancy are more likely to have c-sections, preeclampsia, gestational diabetes and they are likely to remain overweight long after birth.
–Women who start off pregnancy underweight and gain less than the recommended amount of weight tend to have small (for gestational age) babies. Women who gain more than the recommended amount of weight tend to have large (for gestational age) babies.
–Gaining too little or too much weight has also been associated with preterm birth.

The Guidelines
Below are the 2009 guidelines from the Institute of Medicine. The guidelines assume that women gain 1.1-4.4 pounds in the first trimester. The biggest change from 1990 is the smaller range of weight gain for obese women:

Underweight <18.5 (28-40 pounds)
Normal Weight 18.5-24.9 (25-35 pounds)
Overweight 25.0-29.9 (15-25 pounds)
Obese > 30 (11-20 pounds)

Provisional guidelines for twins: normal weight (37-54 pounds), overweight (31-50 pounds), obese (25-42 pounds).

Want to know your BMI. Check it out here.

To Sum Up
Beginning pregnancy at a healthy weight and gaining a sensible amount during the pregnancy provides a healthier start for both you and your baby. This is an incredible opportunity because it allows you to develop a healthier relationship with food before your child is even born.

For more information on nutrition and pregnancy see our pregnancy nutrition section.

Subscribe to Raise Healthy Eaters to learn more about nutrition during pregnancy.

References
Weight Gain During Pregnancy: Reexamining the Guidelines

It’s been 22 days since my second child was born. My nipples throb and I’m loopy from little sleep and bad TV – what better time to have a frank discussion about breastfeeding?

I wish someone would have told me what nursing was really like before I had my first child. Yes, I took the breastfeeding class but it did little to prepare me. My child had a weak suck, didn’t gain enough weight and ended up receiving most of my breast milk through a bottle. I was the poster child for an anxious new mother (my in-laws have told me multiple times how much better I am doing the second time around!).

Equipped with realistic information, I believe the act of getting breast milk to babies can be more successful – and rewarding – for many women. Here’s what I think moms-to-be need to know…

1. The first 6 weeks are grueling: When I was having difficulties breastfeeding my daughter, a friend told me that even when everything goes right, nursing is still hard. Now that I have a successful feeder the second time around I know what she means.

The tough first 6 weeks are the result of recovery from birth mixed with severe lack of sleep and hormonal changes. In order to establish a successful breastfeeding relationship, it’s up to mom to feed baby around the clock (every 1-3 hours). And the first couple nights home from the hospital babies tend to be awake most of the night and asleep all day. Being solely responsible for feeding a baby can weigh on a new, exhausted mother.

Instead of being taking off guard with this reality, a mom-to-be can prepare by letting her loved ones know that breastfeeding will be her main concern the first few weeks. Family and friends can help by bringing meals, watching the baby while she sleeps or babysitting older children. She can work to get everything done before birth so she can put all her energy into feeding, knowing that at about 6 weeks baby will sleep longer and feedings will become more predictable.

2. It hurts! Every nursing book says that breastfeeding shouldn’t hurt if you are doing it right. But most of the moms I know including me, say that sore nipples are a pain those first few weeks. This adds to the challenge of initiating a breastfeeding relationship because newborns like to nurse constantly.

Being proactive about nipple pain management can help a new, nursing mom. Make sure you have some nipple cream like Medela’s lanolin that you can put on your nipples after feeding. Let your nipples air dry when you can. The pain is often due to a bad latch so make sure you see a lactation consultant in the hospital, have one visit you at home or go to support groups for additional help.

3. Pick out a lactation consultant ahead of time: The night I brought my first child home from the hospital my breasts were engorged and she couldn’t latch on. I was up at 3am searching frantically for a lactation consultant hoping to find one available 24 hours a day.

When things go wrong at home you don’t have the luxury of time – you need someone to come right away. Before the baby comes get a list of lactation consultants from friends and pick one just in case you need her. You can even call her ahead of time to check availability. Hopefully you won’t need one but it’s good to have a name and number in your back pocket.

4. Have a pump just in case: Some moms-to-be figure they don’t need a pump right away because they won’t use it until later. Every new mom needs a pump! If your baby has difficulty breastfeeding or won’t latch you’ll need to pump to keep your milk supply up. And if the doctor recommends you supplement with formula you might as well supplement with your own breast milk.

Remember, milk production works on supply and demand and if you give formula your supply decreases. If this happens in the first few weeks, you may not be able to get your supply back up later. Additionally, pumping allows your husband or partner to take over one late night feeding to give you a much-needed break.

5. You’ll be convinced you don’t have enough milk: Newborns nurse frequently. I used to take this as a sign that I didn’t have enough milk. The books I read said newborns feed every 3 hours. Apparently my second child didn’t read these books because he likes to feed constantly – and I’m trusting he knows what he’s doing. Babies also go through growth spurts at 3 weeks and 6 weeks when all they want to do is nurse. Knowing this is normal can ease your mind and build confidence that you do indeed have enough milk.

As long as your baby is gaining weight and having enough pee and poo diapers, they are fine. Save the routine-building for after 6 weeks and just feed your baby when they seem hungry.

6. The payoff is huge: Okay, enough of the downsides to breastfeeding. Once you get past 6 weeks you begin to see the benefits. Pain subsides and feedings become predictable. You start to enjoy the time alone with your baby. When baby wakes in the middle of the night there’s no need to warm up milk you just feed them and put them back to sleep. Babies become more efficient and breastfeed quicker. Knowing how hard it once was makes your success even sweeter. When it’s time to wean it’s usually hardest on mom.

7. There’s a third feeding option: When my first child refused to breastfeed at 7 weeks I was devastated. But I remembered that my sister-in-law pumped milk for her daughter for 6 months. So I decided to pump as long as I could. Not only did I make enough milk for my daughter but I produced about 5 extra ounces a day that I stashed in the freezer. Yes, pumping was a pain but I was still able to get breast milk to my daughter and it got easier as time went by. I kept offering her the breast and at 4 months she started to breastfeed. We made it 11 months with a combination of breastfeeding and pumping. I was very grateful for that pump!

Don’t get me wrong. I have nothing against formula. I know that breastfeeding does not always work for every mom. But exclusive pumping is another option for moms to consider. Most healthcare providers don’t know about full-time pumping and may discourage you from it. Just know that many moms make it work – for more information see this book/website on exclusive pumping, check out www.gotbreastpump.com and visit the online support forum (pumping moms) at Baby Center.

My hope is that breastfeeding goes smoothly for new moms everywhere. But by being prepared for the potential pitfalls, moms are more likely to be successful in this venture.

For more on infant nutrition see our Infant Feeding Guide

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