Staying Healthy in Pregnancy

Staying healthy during your pregnancy

Mental health during pregnancy

What about mental health concerns in pregnancy?

Pregnancy is often seen as a happy time for the parents to be. It is normal for you and your partner to feel many different emotions as you prepare to become parents. You may find your mood changes quickly from excited or happy to sad or anxious.

If feelings of sadness or anxiety don't get better it could be a sign of something more serious. Did you know that mental health concerns like depression and anxiety can start or get worse during pregnancy? In fact about 20% of women suffer from prenatal depression and/or anxiety. Prenatal depression can happen at any time in the pregnancy. It is more common in the second and third trimesters.

What are the symptoms of depression?

  • You and your partner may not always know that what you are feeling is more than the emotional ups and downs of pregnancy.  Learning about the signs of postpartum depression and be alert for them. Mothers don't always know that what they are feeling is more than the "baby blues". Talk to your health care provider, if your symptoms last for more than two weeks. You are not alone.
  • Fathers to be can also experience depression. It can start during pregnancy and/or after the baby is born. Symptoms of depression are the same for men and women. But they may present differently in men. Best Start's Prenatal Education Key Messages tell us that some common symptoms of depression in men are:
    • Mood swings
    • Anger and irritability
    • Physical symptoms like headaches or fatigue
    • Hyperactive behaviour

What are the possible effects?

Mental health disorders in pregnancy can have many effects. They can affect you, your partner, your baby and your pregnancy.

Some of the possible effects are:

  • Baby being born too early
  • Low birth weight
  • Miscarriage
  • Not getting enough prenatal care
  • Postpartum depression
  • Difficulty building a positive relationship with your baby during pregnancy
  • Problems forming a secure attachment after the baby is born

What can you and your partner do?

  • Remind yourself this is not your fault. It is normal and you are not alone.
  • Talk to each other and your family about how you are feeling.
  • Be ready to listen.
  • Don't try to do everything. Ask for help.
  • Take care of yourself. Try to get as much sleep as possible. Eat healthy foods and be active.
  • Talk to your doctor about medications.
  • Call Ottawa Public Health Information 613-PARENTS / Toll free 1-866-426-8885.
  • Call the Crisis Line at 613-238-3311. Open 24 hours a day to provide immediate support.
Nutrition tips for pregnant women

When you are pregnant you need extra calories and nutrients to: 

  • Help your baby grow.
  • Build fat stores to get ready for breastfeeding.
  • Increase fluids (blood, amniotic fluid, maternal fluids).

Canada's Food Guide can help you make healthy choices to get those extra servings needed.

Extra calories are not usually needed in the first 3 months of pregnancy. During the last 6 months of pregnancy you will need 2 to 3 extra Food Guide servings a day to meet the need for extra calories and nutrients.

Supplements

Prenatal supplements help you and your baby get all the nutrients you need during pregnancy. You still need to eat a balanced diet. Ask your health care provider to recommend a multivitamin.

Note: More is not better. Don't take higher doses of any supplement unless instructed by your health care provider.

Folic Acid

Folic acid is a B vitamin, important for the development of baby's brain and spinal cord. These develop in the first 4 weeks of pregnancy. Not getting enough folic acid can put your baby at higher risk of having a neural tube defect (NTD). Neural tube defects are when the brain or spinal cord does not develop normally.

How can I make sure I am getting enough folic acid?

  • Eat good sources of folic acid such as:

    • dark green vegetables (broccoli, spinach, peas and brussel sprouts)
    • corn
    • dried peas
    • beans
    • lentils
    • oranges and orange juice
    • breads and pasta made with enriched flour
  • Take a multivitamin with 0.4mg of folic acid every day starting at least 3 months before you get pregnant. Continue taking it during pregnancy and breastfeeding.

Some women need more folic acid than others. Talk to your health care provider about the amount of folic acid that is right for you.

Iron

During pregnancy women need more iron for many reasons. Iron is needed to support the increased amount of blood the mother makes in pregnancy. It helps your baby to grow properly and helps with their brain development. Babies also save up some of the iron they get from their mother to use after they are born.

Most multivitamins have iron. Health Canada recommends that pregnant women make sure that their multivitamin has 16-20mg of iron. Some women need more iron than others. Talk to your health care provider about the right amount of iron for you.

What foods are sources of iron?

Examples of animal food sources are:

  • meat (beef, chicken, pork)
  • fish (sardines, salmon, haddock)
  • shrimp

Iron from animal foods is better absorbed in your body than from plant sources.

Plant sources of iron are:

  • dried fruits such as dried figs, raisins, dried peaches, prunes and dried apricots
  • prune juice
  • vegetables such as artichokes, avocados, peas, broccoli, spinach, pumpkin and squash
  • cereals such as cream of wheat, wheat germ, cooked oatmeal and fortified breakfast cereals
  • nuts
  • pumpkin seeds, sunflower seeds and sesame seeds

To help your body use the iron in plant sources eat them with a food or drink that has vitamin C. Some sources of vitamin C include:

  • orange juice
  • kiwis
  • cantaloupe
  • strawberries
  • green peppers
  • cabbage and broccoli
Calcium and Vitamin D

Calcium helps to build healthy bones and teeth for both you and your baby. Vitamin D helps your body to absorb and use the calcium we eat.

What foods and drinks have calcium?

  • milk, yogurt and cheese
  • kefir
  • tofu
  • sesame seeds
  • broccoli, bok choy and kale
  • sardines
  • fortified soy beverage

What are some sources of vitamin D?

  • milk
  • fortified soy beverage
  • margarine
  • fatty fish (salmon)
  • egg yolk
  • mushrooms

Your body can make vitamin D when you are in the sunlight, but it is important to get enough from food sources all year.

More is not better. Taking more than the recommended amount of vitamin D can hurt you and your baby. Talk to your health care provider about your need for a supplement with calcium and vitamin D.

Caffeine while pregnant

Pregnant women should limit their amount of caffeine to no more than 300 mg a day. This means no more than 2 cups of coffee per day (1 cup = 250 ml). Caffeine is in other drinks and foods as well.

Caffeine

  • Increases blood pressure & heart rate
  • Passes to your baby through the placenta
  • The Public Health Agency of Canada states that too much caffeine isn't good for you or your baby. It can increase the risk of possible negative effects on the pregnancy and baby's development.

What are sources of caffeine?

Food and Drink Sources of Caffeine 

Food or Drink

Amount of Caffeine (mg)

Coffee (6 oz/200 mL)

Percolated

72-144

Filter drip

108-180

Instant

60-90

Tea (6 oz/200 mL)

Weak

18-24

Strong

78-108

Some varieties of pop (one 12 oz can /355ml)

28-64

Chocolate bar (2 oz/60 g)

Milk Chocolate

3-20

Dark

40-50

Some medications contain caffeine. Always check the ingredient list on product labels or ask a pharmacist.

Instead of drinks containing caffeine, choose water or milk. Pregnant women need to drink at least 2 litres of fluids every day. That's about 10 cups per day. It is best to try to get this from water and milk. Eating vegetables and fruit adds to the amount of fluids you get and is better than drinking juice.

Herbal Tea vs. Regular Tea

Little is known about the safety of herbal products during pregnancy.

  • Not all herbal teas are caffeine-free, so check the label.
  • Not all herbal teas are safe to drink during pregnancy.
  • The preferred type: single-herb types in filtered tea bags; avoid mixtures.
  • Avoid teas with known allergens.
  • Choose plain water, hot lemon water, warm milk, or regular Ovaltine instead.
Omega 6 and Omega 3

Omega 6 and Omega 3 are essential fatty acids needed for the development of your baby's brain, nerves and eyesight.

Sources of Omega 6:

  • vegetable oils (canola, soybean) - non hydrogenated
  • margarines/salad dressings made from non hydrogenated oils
  • corn, sunflower & peanut oils, some nuts & peanuts
  • moderate amounts in beef, pork, chicken, eggs

Sources of Omega 3:

  • Salmon and other fatty fish. Choose fish low in mercury (PDF)
  • Walnuts
  • Ground flaxseed
  • Check labels for foods with added omega 3 for other sources
Physical activity

Having an active pregnancy is important for your health and the health of your baby. If you exercised regularly before you were pregnant, you still can during your pregnancy. Exercising regularly means that you do 30 minutes of exercise at least 3 times a week.

If you were not active before pregnancy, it’s best to wait until after your 12th week (first trimester) to start. It’s always a good idea to talk to your health care provider before starting or changing your physical activity habits. 

What are some of the benefits of being active during pregnancy?

  • Lowers the risk of diabetes in pregnancy
  • Lowers the risk of high blood pressure in pregnancy
  • Gives you more energy
  • Helps pregnant women to gain the right amount of weight
  • Helps to lower stress
  • Helps you sleep better
  • Provides social contact and support

Choose activities you enjoy. Keep it fun by doing activities with your family and friends. Try doing an exercise class with other pregnant women. Walking, swimming and stationary bike are some great activities you can do in pregnancy.

How can I exercise safely?

If you aren’t active, start exercising slowly. Try aerobic activity 3 times per week for 15 minutes. Then you can increase to 30 minutes of aerobic activity no more than 4 times per week. 

Always:

  • Do a warm-up and cool-down with every workout.
  • Breathe normally when you exercise - don't hold your breath.
  • Drink water before, during and after exercise.  
  • Eat a light snack about 30-60 minutes before exercise.
  • Use the talk test. If you can’t talk without getting out of breath then you need to slow down.

Avoid:

  • Activities with sudden starts, stops, jumping, and twisting.
  • Activities that have a danger of falling.
  • Exercising on an empty stomach.
  • Getting too hot. Your body temperature should not go higher than 38°C.
  • Outdoor exercise when it is warm and humid outside.
  • Exercise when you are sick or have a fever.
  • Hot tubs, saunas, whirlpools and hot yoga. Check temperature of heated pools before using.

After your 16th week of pregnancy, don't do exercises that need you to lie on your back. Try them when you are sitting, standing or lying on your side instead.

Pregnant women should stop exercising and call their health care provider for these reasons:

  • Bleeding from the vagina
  • Any 'gush' of fluid from the vagina
  • Extreme fatigue or shortness of breath
  • Chest pain
  • Painful contractions of the uterus
  • Headaches, dizziness or faintness

Call your local community centre or check the City of Ottawa's Recreation Guide to find exercise programs in your area.

For more information on exercise during pregnancy, visit: http://www.ontarioprenataleducation.ca/active-living/

Stress

Stress is our bodies' reaction to a real or imagined threat or challenge. Stress is a part of everyday life. Everyday stress helps you to focus, problem solve and get a task done.  The body reacts to this stress in many ways, such as your heart rate goes up and your muscles become tense, making you ready to take action. Once the stress is gone, the body returns to normal. Sadly, stress can also last a long time and be overwhelming for some people. The body and brain are constantly reacting to this type of stress. Overtime it can affect your mental and physical health, including during pregnancy.

Learning ways to deal with stress before pregnancy can help improve your mental and physical health during pregnancy, the health of your baby and the well-being of your family, such as:

  • Increasing your chances of becoming pregnant. Stress can change some women's periods and timing of the egg leaving the ovary. Also, men can have a low sperm count because of stress.
  • Increasing the chance of your baby being born at term
  • Helping your baby's brain and body to grow and develop.

Helping you adapt to the emotional changes and challenges of pregnancy and becoming new parents.  

What are some signs of stress?

  • Feeling tired all the time.
  • Feeling tense or anxious.
  • Feeling sad or irritable.
  • Frequent minor health complaints.
  • Change in appetite or sleep patterns.
  • Change in relationships.
  • Using alcohol, medications or other drugs to relax.
  • Trouble concentrating and making decisions.

What can you do to lower your stress level? You can try to:

  • Get to know yourself, how you think and feel under stress.
  • Think about what helped you cope with stress in the past.
  • Take care of your body - eat well, be active, enjoy nature and get enough sleep.
  • Learn to take time each day to breathe deeply, relax and still your mind.
  • Connect with family, friends, co-workers, neighborhood resources or faith groups to build a community to support you and your family.
  • Reach out to family, friends or a health professional to talk about your mental health and to ask for the help you need. Enjoy life, listen to music or laugh with a friend
  • Keep things simple and learn to say "no".  Don't take on more than you can handle.
  • Learn to problem solve - be realistic as to what you can and cannot do 
Healthy Weight Gain

How much weight should I gain?

It is important to gain a healthy amount of weight during pregnancy. A healthy weight gain will help your baby grow and have a healthy start. . How much weight you need to gain in pregnancy depends on your Body Mass Index (BMI) before pregnancy. It also depends on if you are having more than one baby. BMI is a number based on a comparison of your weight and height. You may not gain much weight in the first three months, about 0.5 - 2 kg or 1.1 - 4.4 lbs. Your weight gain will be gradual for the rest of your pregnancy, about 1lb (0.42kg) per week.

Suggested weight gain for pregnant women

BMI

before pregnancy

Recommended

Total Weight Gain

Suggested Total Weight Gain

for Twin Pregnancy

BMI < 18.5

Underweight

12.5 - 18 kg

(28 - 40 lbs)

No guideline currently available

BMI 18.5 - 24.9

Normal weight

11.5 - 16 kg

(25 - 35 lbs)

17 -25 kg

(37 - 54 lbs)

BMI 25 - 29.9

Overweight

7.0 - 11.5 kg

(15 - 25 lbs)

14 -23 kg

(31 - 50lbs)

BMI 30 or greater

Obese

5 - 9 kg

(11 - 20 lbs)

11 -19 kg

(25 - 42lbs)

Talk to your health care provider about pregnancy weight gain, especially if you have any sudden weight gain or loss.

Resource: Pregnancy Weight Gain Calculator

Where does it all go?

Your baby makes up only a part of the weight that you gain in your pregnancy. Your body must add blood, muscle, and other tissues to build a healthy baby and this is why the right weight gain is important when you're pregnant.

Want to speak with a Registered Dietitian?

  • Call Telehealth Ontario and ask to speak with a Registered Dietitian. Available Monday-Friday 9am-5pm at 1-866-797-0000 (TTY: 1-866-797-0007)

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