Transcription:

Melanie Cole (Host): When I was pregnant, I was so excited to eat for two because that’s what they always said that you do, but being 4 foot 10, it was not going to be a good look if I really overdid it, but what vitamins? What nutrition do you actually need? What’s the truth about that? My guest today is Dr. Christopher Kraft. He’s an obstetrician/gynecologist at Baycare Health. Dr. Kraft, what’s the most important thing pregnant women can do as they prepare for pregnancy as far as nutrition and before they even get pregnant?

Dr. Christopher Kraft (Guest): No problem, so one of the most important things that a woman can do prior to pregnancy and also through pregnancy up to the point of delivery is take care of her own health.

Host: What does that mean?

Dr. Kraft: First and foremost, I like your story to lead into this conversation, pregnant women are not eating for two. Adequate nutrition is extremely important, so the actual recommendations according to the American College of Obstetrics and Gynecology is that during the first trimester, no additional caloric intake is required to support a healthy pregnancy. During the second trimester, it is recommended to up to 350 extra calories per day, and in the third trimester, up to 450 extra calories per day, and what that means is that could be a protein bar, that could be a protein shake, that could be additional vegetable supplements as well to really get adequate nutrients not only for the mother but also to the fetus and support adequate growth.

Host: So that eating for two is an old adage for sure, how much weight should we be gaining?

Dr. Kraft: That’s a very, very good question, and the actual weight is usually determined by body mass index. So a women who is considered to be underweight, who has a BMI less than 18 should approximately gain between 25 and 40 pounds throughout the entire course of pregnancy. Somebody who would be considered to have a normal weight would be a BMI between 19 to 25 and the recommendation is to put on approximately 25 to 35 pounds throughout the entire course of pregnancy, and a woman who would be defined as overweight would be a BMI defined as 25 to 29, and the recommendation is to put on approximately 15 to 25 pounds, and the medical definition of an obese woman would be a BMI greater than 30, the recommendation is to put on approximately 10 to 20 pounds throughout all of pregnancy.

Host: Wow that’s a lot easier said than done I guess, Dr. Kraft, because really as you get hungry and you get those cravings – I craved liver, which brings me around to the question of the vitamins that we need because my doctor said well maybe you’re a little iron deficient, let’s get you some iron. So how do we know what we’re supposed to take? And I want you to concentrate a little on folic acid as you know now that is the standard of care, something that we have to have because it’s been proven to help birth defects.

Dr. Kraft: That is correct. So the recommendation is for all women leading into pregnancy is that they should take a prenatal vitamin, which will also give you adequate support of folic acid as well, but it also provides you with a broad range of vitamin supplements that are the cornerstone of DNA synthesis and DNA synthesis is the most important aspect for the first trimester in pregnancy as we go through what’s called organogenesis, and the situation such as yourself where you were desiring an organ meat usually that are high in iron saturation, women who can be anemic are recommended to take iron supplementation and they could have cravings, which can be considered to be bizarre in pregnancy or outside of pregnancy, for iron meats such as liver. Folic acid is extremely important to pregnancy as well, and one of the most common birth defects that we see in folic acid deficient women is what’s called open neural tube defect, and that could be something as simple as a cleft palate or something as complex as spina bifida. Now we fortunately live in America where a lot of our food sources are supplemented with folic acid, so we don’t see that problem frequently; however, there are many countries outside the United States that do have a folic acid problem, and a lot of these women through over the course of pregnancy will end up delivering in the United States today. So the recommendation is at least 0.4 mg of folic acid supplementation on a daily basis, and then depending upon health complications or associated pregnancies like twins, you might need additional folic acid supplementation.

Host: There are a lot of myths out there, Dr. Kraft, like shellfish and fish and the mercury and you know we hear fish is good for us and the omega-3’s – do we not eat fish when we’re pregnant? And sushi is definitely a no go. Tell us about some of the do’s and don’ts and bust up a few myths for us.

Dr. Kraft: Sure, the apex predators of the sea are typically the fish that eat other fish, and when they have it they can have increased sources of mercury and mercury can sometimes be a heavy metal that can be toxic to fetal development. So it is recommendation that a woman can have up to 8 oz of apex predators, which would be something like salmon or a shark meat, in pregnancy on a weekly basis. Things like sushi are a no-no; however, it is a cultural bias as well. So we have a lot of Asian Americans who still consistently eat sushi throughout the course of pregnancy; however, we do recommend that there could be bacteria or viruses present within uncooked meat that could potentially have serious complications associated with the pregnancy.

Host: What about things like caffeine or we hear we’re not allowed to drink alcohol during pregnancy, but then you turn to other sources of things that can either help with energy or to relax and what about things like that?

Dr. Kraft: Yes, okay so that’s a two part question. The first part is in terms of caffeine, so one of the things that I tell women who are coffee drinkers is that they can have up to 250 mg of coffee per day, which is approximately an 8 oz cup of coffee. What we don’t want to do is go above and beyond that, and the reason being is that caffeine can sometimes cause vasoconstriction. Vasoconstriction leads to poor profusion of the placenta. When you have decreased perfusion of the placenta, it can possibly result in fetal growth restriction. Fetal growth restriction can be a potential harmful outcome in pregnancy leading to what’s called intrauterine fetal demise as you start to get into the third trimester and towards the estimated due date of delivery. Fetal alcohol syndrome is probably the greatest risk associated with alcohol consumption during pregnancy, and there is a significant amount of data that’s out there that suggests that there is no volume of alcohol that can be consumed that has a direct correlation to fetal alcohol syndrome. So some women who may consume less than an ounce of alcohol on a daily basis may not have any result in their child being negatively impacted; however, on the other hand, someone who may have maybe one or two drinks throughout the course of pregnancy could potentially put themselves at risk. So the recommendation for pregnancy is to avoid all alcohol.

Host: Which is a really good recommendation. So what about exercise. I’m an exercise physiologist, but I had to really kind of limit some of the things that I was doing as you start getting bigger, and your balance is shifted, and you can’t see your feet – what do you want people to know about exercise? If they were an exerciser before they got pregnant, what can they do or if they were not an exerciser, is that the time to start?

Dr. Kraft: Sure that’s another great question, and what I try and encourage all pregnant women to do regardless of their exercise tolerance is at least 30 minutes of cardiovascular exercise on a daily basis. That could consist of walking. That could consist of going to a stationary bike and pedaling for 30 minutes. Now if I have a patient who gets pregnant that has been highly active with their exercise routine prior to pregnancy, I inform them to continue their exercise routine during pregnancy. Now obviously I ask them to limit core strength exercises like squats because you increase intraabdominal pressure, which could place you at increased risk for complications like preterm labor or preterm delivery. However, if, I’ll use my wife as an example, she was a runner and ran approximately you know 5 miles on a daily basis and my wife ran up until 34 weeks of gestation. Now that’s not my recommendation for everybody. My wife unfortunately did not listen to me, but she had a great pregnancy and great delivery and I find that women who leading into pregnancy are engaged with their exercise routine, their pregnancy process is somewhat comfortable, more so than a women who has – who doesn’t exercise or doesn’t partake in 30 minutes of cardiovascular exercise, and I also note that they are able to tolerate their labor. It seems to be more tolerable for them. Their pain threshold seems to be a little bit higher, and they also don’t seem to be as winded throughout the labor phase.

Host: Wow, really all good reasons to keep up with that exercise program, and always consulting with your physician is a good idea to see how much you can do or if there are any red flags. Dr. Kraft, as you summarize this for us, and what a great segment, so informative – what would you like to add? What you like pregnant women or women thinking about getting pregnant to know about their nutritional needs and what they should do to take care of themselves just like you said at the beginning?

Dr. Kraft: Sure, the first thing that I would encourage all women to do is seek their doctor prior to getting pregnant and discuss their healthcare needs prior to getting pregnant, and then also start a prenatal vitamin at least 3 months in advance of their expected gestational start date. In addition to that, if you are currently not exercising, I would encourage you to start a healthy diet, but also start – it doesn’t have to be life changing, but it’s moderation and something that can be consisted of 30 minutes of walking on a daily basis, can improve your pregnancy outcomes, lead to increased fertility rates, and also improve pregnancy outcomes and also the labor phase.

Host: That’s great information, thank you so much Dr. Kraft. We always like to have our OB/GYN’s on because there’s so much information for women that we really need to hear from the experts and thank you again for joining us. You’re listening to Baycare Health Chat. For more information, please visit baycare.org, that’s baycare.org. I’m Melanie Cole, thanks for tuning in.