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You’ve undoubtedly heard that childhood obesity is fast becoming a national epidemic. Today, more than one-third of American children are overweight, and about one-fifth are obese. Childhood obesity increases risk of heart disease, diabetes, cancer, chronic pain, and social & psychological problems, as well as decreasing life span. As a mom, you will have a powerful impact on your children’s health as they grow by modeling and cheerleading for healthy habits and healthy body image. Below is a list of four steps you can take from the very beginning to lower your baby’s future risk of childhood obesity.

1. Prevent or treat gestational diabetes. Having untreated gestational diabetes during your pregnancy doubles your baby’s risk of childhood obesity. Luckily, research indicates that early detection and treatment of gestational diabetes to return blood sugars to the normal range (less than 96 mg/dL before a meal or less than 120 mg/dL after a meal) normalizes baby’s risk of childhood obesity as well. Make sure you’ve talked to your midwife or doctor about testing for gestational diabetes during your pregnancy and that you follow all treatment recommendations if you are diagnosed. To lower your risk of developing gestational diabetes in the first place, limit sweets and sweetened beverages, increase your intake of non-starchy vegetables, and get regular exercise.

2. Aim for a healthy pre-pregnancy weight. If you’re thinking of starting a family soon, reaching a healthy weight before you become pregnant can lower your future children’s risk of childhood obesity. Research estimates babies born to individuals with a pre-pregnancy BMI between 25-29.9 have a 50% increase risk of childhood obesity, while those born to women with a pre-pregnancy BMI above 30 have a two-fold increased risk compared to babies born to moms with a pre-pregnancy BMI between 18.5-24.9. (Find out your BMI here.) Being overweight before pregnancy also increases your risk for developing gestational diabetes, so it’s worth implementing healthy eating and exercise habits to reach a healthy weight before pregnancy whenever possible.

3. Know the right amount of weight to gain during your pregnancy. If your BMI is between 19.8 and 26.0, the Institute of Medicine recommends you gain 25-35 pounds during your pregnancy, or about a pound a week during your second and third trimesters. For women with a pre-pregnancy BMI of 26.1-29.0, aim for 15-25 pounds, or about 2 pounds every 3 weeks during trimester 2 and 3. If your pre-pregnancy BMI was 29.1 or higher, total pregnancy weight gain should be 15 pounds or less. Gaining more weight during your pregnancy than these limits is linked to a 23% increase in childhood obesity for your baby.

4. Breastfeed your baby for at least six months. Exclusive breastfeeding of your baby for the first six months of life lowers his or her risk of childhood obesity by 24%. This is true for all babies, regardless of a mother’s pre-pregnancy weight, gestational diabetes or amount of weight gain during pregnancy.

By Nutritionalist Lindsay Pasdera

1. Introduce Highly Allergenic Foods to Your Baby around month 6

Surprised? We used to think delaying introduction of highly allergenic foods including dairy, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish, was the best approach to lower the risk of food allergies in babies and children. But there’s a growing body of evidence linking early introduction with lower risk of developing a food allergy. The American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends starting with a lower allergy risk solid food (like a single vegetable puree or chicken or turkey puree). If your baby has tolerated a solid food, the recommendation is to then introduce yogurt or cheese, egg, soy, wheat, peanut butter, tree nut butters, fish and shellfish. Introduce new foods at home, and always wait 3 to 5 days between new introductions so you can identify which food caused any reactions. It’s a good idea to check with your pediatrician before following these recommendations of the AAAAI, especially if you have any questions or concerns. Always get guidance from your pediatrician before introducing highly allergenic foods if your baby already has a known food allergy, you suspect your baby has a food allergy, your baby’s sibling has a food allergy, or your baby has had a positive blood test to a food.

2. Breastfeed your Baby

Breast milk is best, for so many reasons. When it comes to allergies, breast milk is the least likely to trigger an allergic reaction. Exclusive breastfeeding for the first 6 months is linked to lower risk for your child of atopic dermatitis, development of a dairy allergy, and early onset wheezing. Avoiding highly allergenic foods while you’re breastfeeding is NOT recommended, unless you or your baby has an existing food allergy. Check with your pediatrician if you have any questions or concerns about your diet while breastfeeding.

3. Eat a variety of nutritious foods during pregnancy

You may have heard you should avoid highly allergenic foods during pregnancy, but according to the AAAAI, “there is no significant allergy prevention benefits to your baby if you avoid highly allergenic foods” during pregnancy. Discuss with your ObGyn or Midwife if you have questions or concerns about your diet while pregnant.

“Words are, of course, the most powerful drug used by mankind.” (Rudyard Kipling) They have an effect beyond their use in verbal communication and last for years within the mind and heart of the receiver. Pregnant women, women in labor, and children are very psychologically open. They receive messages beyond words and often do not have the ability to filter. As a result, things that are said during these formative times can stick in one’s memory for a very long time. I have worked with a woman who remembered negative comments made during her labor when her “baby” was now 68 years old!

We all must pay close attention to what we say and how we say it. If you are in a position of authority or the person you are talking to or about thinks you are, you must be even more careful.

On the positive side, affirmations are used all over the world to empower, motivate and encourage. The opposite is also true. Words can be used to control, deflate, disempower and contain behavior, restrict thought, and interject doubt. I believe one can actually program people to fail by interjecting fears, your own or others, into your conversion with them.

What is a woman hearing at her prenatal visits?

Is she hearing this: “Yes you can!”, “I believe you know how to”, “I trust your body knows”, “you know your body best”, “you should consider all of your options”, “I support your right to make decisions about your body, your birth and your baby”.

Or is she hearing this: “We are worried about you”, “you have these risk factors”, “you are so (short, small, big, narrow, old, young)”, “you have (gained too much, gained too little, have a bad diet, are anemic, have diabetes, have high blood pressure, had a surgical birth last time) and your baby is (too big, too small, laying sideways) and your placenta is (too big, too small, too close to the cervix).”

Imagine how different it would be to have someone who said “Let’s look at all of your options and come to a decision that you feel and think best suits you and your baby. While I may not agree with your decision, I do agree to your right to make that decision.”

What do women hear in labor?

Are they hearing that things are “going slow”, “Not looking normal”, “Borderline”?

Or do they hear “this is part of the process”, “all is well”, “the baby knows the way out”,  “we need to be patient”, “Let’s try this”, “Let me help you”, “you will birth your baby”, “There will be help available when you decide you need help”.

What do women hear about breastfeeding?

“Your breasts are (too big, too small, different), your nipples are (too big, too small, inverted), your milk is (not enough, too slow, not rich enough, too rich, gassy), your baby is (too sleepy, confused, too hungry, unhappy, prefers a rubber nipple).”

Or do they hear “your breasts are designed to make the perfect food for your baby in the right amount, when the baby needs it. Your baby is born with instincts telling her/him how to eat and when. You and your baby will succeed!”

What do our children hear? What do other people say to our children or within ear shot of our children? Do they tell your daughter she is cute but your son that he is smart? Or do they say that your son is a “tough little man” but your daughter is “sweet”?

Our children need to hear that we believe in them. “I know you will figure out this problem”, “What do we need to do to solve this problem?” It’s also important for us to listen, children know more than you think!

Sometimes I hear parents passing on their “abilities” to their children in a negative way: “Oh, she is clumsy just like me”, “He will never be very good at sports”, or “I could never do math either”. What would happen if they said “The biggest determinant of what you can do is what you choose to do and how frequently you try to do it”. Your limits are not your children’s. You may consider them to be yours but they may have simply been adopted by you as a result of something you were told in your childhood! 

Patterns in parenting and communication tend to be repeated unless the cycle is broken. Practice makes perfect, never quit trying to improve. We can empower others through our words and actions. Everyday, one day at a time, YOU CAN make a difference!

Rosanne Gephart, MSN, NP, CNM

Better Beginnings was featured in the Press Democrat this Mother’s Day in an article highlighting the many services for new moms in Sonoma County. Our new, weekly, free to all, Breastfeeding Cafe was featured prominently.

Check out the article here:

PD Article: Help for Mom

The healthiest beverage during pregnancy is water. If you don’t like the flavor of plain water, try floating slices of lemon, lime or orange, or mint and cucumber in your water. Other great options include hot or iced herbal tea (without added sweeteners), sparkling water with fruit essence (for example, lemon Perrier).

You can have 1-2 glasses of milk or kefir per day as part of your 3 servings of dairy daily (yogurt or cheese can make up the rest). One to two servings of low-sodium 100% vegetable juice can fit as well.

Use the above beverages to reach the minimum of 80 ounces of non-caffeinated beverages needed daily during pregnancy.

If you do drink caffeinated beverages, limit caffeine during pregnancy to a maximum of 200 milligrams per day (equivalent to about 12 ounces of coffee). Don’t add sweeteners.

Beverages to Avoid

There is NO safe amount of alcohol during pregnancy. Period. Avoid beverages containing added sugars and artificial sweeteners. Liquid sugar calories, even those from 100% fruit juice, can cause excess weight gain and elevated blood sugars, increasing the risk of gestational diabetes.

Avoid:
Alcohol of any kind
Soda & Diet Soda
Fruit Juice, including fruit & vegetable juice blends
Sports Drinks
Energy Drinks
Lemonade
Fruit Punch, Kool-Aid, Tang, etc
Sweetened Tea (Iced, Hot, Herbal, etc)
Sweetened Coffee Drinks of any kind
Hot Chocolate
Flavored Milk (chocolate, strawberry, etc)

5. Iron-deficiency anemia during pregnancy is more common than you’d think. In fact, an estimated 1/3 to 1/2 of pregnant women have some level of iron deficiency. The best way to prevent iron-deficiency during pregnancy is to take a prenatal vitamin containing iron every day. Your midwife or OB-GYN will recommend blood tests to check your blood iron levels and may recommend additional iron supplements if your iron levels are low.

4. Iron-deficiency anemia has serious consequences during pregnancy. Individuals with iron-deficiency often experience feeling weak, chronically tired, lightheaded or dizzy, and can even have heart palpitations and shortness of breath. The impacts on the baby include elevated risk for pre-term birth, low birth weight, inadequate infant iron stores and may impact fetal brain development.

3. In addition to your prenatal vitamin, you can choose foods that contain highly-absorbable “heme” iron to your daily diet: lean beef, chicken, pork, fish, shellfish, and whole eggs. “Non-heme” iron is found in plant foods like nuts, beans, vegetables and fortified grains. Non-heme iron is harder to absorb than heme iron, but you can increase its absorption by adding some high-in-vitamin-C foods to the meal. For instance, have some homemade salsa made with tomatoes & lime juice along with chiles, onions and cilantro with your black beans. Vitamin C also helps absorption of supplemental iron, so a great plan would be to add a squeeze of fresh lemon juice to the water you take your prenatal vitamin with.

2. Do not take supplemental iron (i.e. your prenatal vitamin) with anything containing calcium. Calcium and iron bind together in the digestive track, preventing absorption of both. Make sure you wait at least two hours between any calcium supplements you take and your prenatal vitamin or other iron supplement. Also, avoid eating or drinking calcium-containing foods (like milk, yogurt, cheese or calcium-fortified foods) for two hours before and after taking supplemental iron. For example, if you take your prenatal vitamin at 6pm with dinner, you could have a glass of milk or a calcium chewy after 8pm. Caffeine and antacids also decrease iron absorption, so use the two hour separation rule here too.

1. The form of iron matters! Read your prenatal vitamin label and choose one that contains iron from ferrous bisglycinate, ferrous fumarate or ferrous gluconate. These are much better absorbed and tolerated than ferrous sulfate, which has the highest constipation risk.

Registered Dietitian Nutritionist Lindsay Pasdera

Adults in the United States spend more than $26 billion on dietary supplements each year. The number of families adding “supplements” to their diets is even higher in California. There are supplements for children, pregnant and breastfeeding women, and even our pets! The internet is full of web pages, informational YouTube lectures, and people in white coats with stethoscopes around their necks all declaring their product to be safe and effective. If you consult a typical medical doctor you will get recommendations for the FDA approved medications, but often little else unless they have had specific training in diet therapy and the use of supplements.

What is the next step?

First, realize there are benefits and risks for all medications, herbal remedies, and supplements. The combination of all of these, including items in you diet, can be harmful even when they have worked well for your friends and family. Your body is unique. Knowing how you have responded to medications or supplements in the past is paramount, as is knowing what current medications you are on and how they may interact with each other.

Second, your body is designed to work with a variety of foods and liquids. Massive doses of any one food or supplement can overwhelm the usual mechanisms for the elimination of toxins and wastes. You kidneys and your liver work hard to achieve balance in your body. If you overwhelm these organs, the back up of the toxins in your system can cause non-repairable damage.

Third, if you want to try a specific remedy, research it first. Look at dose (strength and frequency), side effects (both short and long term). Ask yourself these questions:

**Has this been studied? By whom? Recently? Do I know of any professional health care provider who recommends this treatment?

**Do I have any health care conditions that might make this more dangerous to use?

**Can this remedy be purchased from a reputable source?

**What are the benefits and risks?

Lastly, let your physician, family and friends know when you start a complementary or alternative medication or remedy. They can help you monitor for side effects that you may have not been aware of.

By: Rosanne Gephart MSN, NP, CNM

Resources:

Consumer Lab (www.consumerlab.com) Provides independent test results and information to help consumers and health professionals identify the highest quality health and nutrition products.

Medline Plus: Herbals and Supplements (www.nlm.nih.gov/medlineplus/druginfo/herbal_all.html) Allows physicians and consumers to research dietary supplements and herbal remedies for effectiveness, dosage and interactions with medications.

National Center for Complementary and Alternative Medicine (http://nccam.nih.gov) Provides information on common alternative therapies, training and research resources.

National Institute of Health, Office of Dietary Supplements (http:dietary-supplements.info.nih.gov) Provides information about Health conditions and alternative therapies, including herbs and dietary supplements.

It’s happening! Better Beginnings is opening a free Community Breastfeeding Cafe this Monday, March 21st. Think of the Community Breastfeeding Cafe as part mom’s group and part lactation clinic, with tea and cookies! A lactation specialist will be available to provide professional support and answer questions. Make new friends and find a community to join in on your breastfeeding adventures.

This event is sponsored by Better Beginnings and generously hosted by the Knox Presbyterian Church.

When: Mondays from 9:30am-11:00am
Where: Knox Presbyterian Church at 3rd Street and Stony Point Road (across the street from Olivers Market)

1) A little bit of healthy fat

The two healthiest fats include omega 3s and monounsaturated fats. Read about the omega-3 benefits, dietary sources and needs during pregnancy here (please link to last month’s blog). Food sources of healthy monounsaturated fats include olives and olive oil, avocados, nuts, nut oils and nut butters, and canola oil. Add a small portion a few times a day to keep you satisfied in between meals and snacks, help absorption of fat-soluble vitamins, and keep your skin soft and hair shiny.

2) Calcium-rich roods

The daily recommended intake of calcium during pregnancy is 1200 mg, so most women benefit from a calcium supplement during pregnancy (take this at least 2 hours apart from your prenatal vitamin, as iron and calcium compete for absorption). However, research shows that calcium from dairy impacts bone density more favorably than supplemental calcium, so including three servings of dairy each day is a good idea for non-vegans. In addition to yogurt, milk, and cheese, some non-dairy foods are natural sources of calcium, including legumes and greens like kale and collards.

3) Whole grains or starchy vegetables

Pregnancy is not the time to avoid carbs, but there is no benefit to increasing your intake of refined grains, highly-processed high-carb snacks, or sweets. Instead, get a serving of whole grains or starchy vegetables with each meal. Both are packed with minerals, vitamins, and fiber. In addition to whole grain bread, whole wheat pasta, steel cut oats and brown rice, try quinoa, barley, bulgur, amaranth, sweet potatoes and winter squash.

4) Colorful vegetables and whole fruit

A prenatal vitamin is very important, but there are so many phytonutrients that aren’t available in any pill! Three to four servings of non-starchy vegetables and one to two servings of whole fruit each day delivers phytonutrient antioxidant power for cancer prevention, anti-inflammatory properties to reduce pain and cardiovascular disease risk, and lower risk of gestational diabetes by improving insulin sensitivity. Aim to eat vegetables and fruits from all the different color groups, because each color group has its own set of phytonutrients. Whole fruits and vegetables also provide abundant fiber to prevent constipation. For best health, eat more non-starchy veggie servings than fruit servings, and limit intake of fruit juice and dried fruit, which can be high in sugar.

5) At least 75 grams dietary protein

Most pregnant women get plenty of protein in a day, but it’s worth tracking for a few days to get a sense of your typical consumption. You can find the amount of protein in a food by searching online. Make sure you are measuring the portion of food you eat to get an accurate protein count.

Good sources of protein include eggs, seafood*, poultry*, lean meats*, yogurt (particularly Greek), cheese, milk, beans*, nuts & seeds*, some whole grains like quinoa, soy products* including tofu and tempeh, and seitan*. (Foods marked with an asterisk are good sources of iron as well as protein.)

Your increased protein needs start in the first trimester of pregnancy. If you are having trouble getting enough protein in due to morning sickness, consider a protein supplement (powder or ready-to-drink shake) that is low in sugar and made from whey, soy or egg protein.

Those are the top five things to eat daily during pregnancy. Remember to also drink plenty of water (aim for a minimum of 80 oz per day) and take your prenatal vitamin.

Here’s to your health!

Registered Dietitian Nutritionist Lindsay

This month another in a long line of research studies linking omega-3 consumption of expectant mothers to baby’s brain health was published. The study found that pregnant mice fed a diet similar to the American diet, which is typically low in Omega-3 fatty acids, birthed babies with smaller brains and abnormal emotional development compared to pregnant mice with adequate omega-3 intake.


The two types of omega-3 that are important for baby’s brain development are DHA and EPA. The minimum recommended intake of DHA+EPA for pregnant women is 1400 mg per week. To get there, aim to add two 6-ounce servings of omega-3 rich seafood per week (remember don’t eat RAW fish during pregnancy). Because some seafood is contaminated with mercury, which is harmful to developing fetuses, it is important to limit intake to 12 ounces per week. You might also consider adding a DHA/EPA supplement daily, and replacing corn oil, soybean oil, safflower oil and sunflower oil (and processed foods made from them, i.e. mayonnaise) with olive oil, nut oils, or canola oil instead (because the former compete with DHA/EPA). It’s useful to note that while flaxseeds and walnuts are very healthful and provide omega-3s, they do not contain DHA & EPA. If you are a vegetarian or vegan, consider a DHA supplement made from algae during pregnancy.


Here is a great list of high DHA & EPA seafood with low mercury contamination.  Wild Salmon is a favorite, but personally, I think sardines are hidden gem when it comes to pregnancy nutrition. Six ounces of sardines contain a whopping 2200 mg of omega-3s (compared to 620 mg for a similar portion of salmon); have extremely low risk of mercury contamination since they are so small; and are very affordable! Try canned or fresh sardines in any spicy tomato sauce (think veracruzna, puttanesca, or diablo) or make a grown-up tuna fish sandwich replacement by mashing in a large bowl two 3.75 ounce cans of sardines (drained), 1/4 cup plain non-fat greek yogurt, 1 tablespoon fresh flat-leaf parsley, 2 teaspoons drained chopped capers, 1 teaspoon lemon zest, 2 teaspoons fresh lemon juice, and salt & pepper to taste. Or try this lovely recipe for Linguine with Sardines & Lemon from Bon Appetit (I recommend using whole wheat linguine for best nutrition).  You’ll be doing something great for your health and making sure your baby has the best possible beginning.


Registered Dietitian Nutritionist Lindsay Pasdera

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